The New York Times
New findings on 2 ways in which children become seriously ill with the Coronavirus
A large nationwide study found significant differences in the two main ways children became seriously ill with the coronavirus, findings that could help doctors and parents better recognize the conditions and understand more about the children at risk for each. The study, published Wednesday in the journal JAMA, analyzed 1116 cases of young people treated in 66 hospitals in 31 countries. Just over half of the patients had acute COVID-19, the predominantly lung-related disease that afflicts most adults who become ill with the virus, while 539 patients had the inflammatory syndrome that broke out in some children weeks after they usually ‘ a mild initial infection. The researchers found some similarities, but also significant differences in the symptoms and characteristics of the patients, ranging from infants to 20-year-olds and were admitted to hospital between March 15 and October 31 last year. Subscribe to The Morning Newsletter from the New York Times Young people with the syndrome, called Multisystem Inflammatory Syndrome in Children, or MIS-C, were more likely to be between 6 and 12 years old, while more than 80% of patients with acute COVID-19 was younger than 6 or older than 12. More than two-thirds of the patients with one of the two conditions were black or Hispanic, which experts say probably reflects the socio-economic and other factors that some communities disproportionate to the exposed to virus. “It is still shocking that the vast majority of patients are non-white, and this is true for MIS-C and for acute COVID,” said Dr. Jean Ballweg, medical director of pediatric heart transplantation and advanced heart failure at the Children’s Hospital and Medical Center, said. in Omaha, Nebraska, who were not involved in the study. “There is clearly racial diversity there.” For reasons that are unclear, while Spanish young people are equally likely to be at risk for both conditions, it seems that black children are at greater risk of developing the inflammatory syndrome than the acute illness, says Dr. Adrienne Randolph, senior author of the study. and a specialist in pediatric critical care at Boston Children’s Hospital. One potential clue cited by the authors is that black children appear to have a greater frequency of heart disorders and respond less to one of the standard treatments, with Kawasaki disease, a rare inflammatory syndrome in children. intravenous immunoglobulin. The researchers found that young people with the inflammatory syndrome were significantly more likely to have no underlying medical conditions than those with acute COVID-19. Yet, more than a third of patients with acute COVID had no medical condition. “It’s not like healthy kids here have been completely free before,” Randolph said. The study evaluated obesity separately from other underlying health conditions and only in patients 2 years of age or older, and found that a slightly higher percentage of adolescents with acute COVID-19 were obese. Dr Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia who was not involved in the study, said he was not convinced that the findings confirmed that healthy children were at higher risk for MIS-C. It could ‘mostly be a numbers game, with the proportion of children being infected and the proportion of healthy children out there, rather than saying that there is something immune in healthy children that puts them at an excessively higher risk,’ he said. In general, the study’s documentation on the differences between the two conditions was useful, especially as it reflects a ‘fairly representative set of hospitals in the US’. Young people with an inflammatory syndrome are more likely to be treated in intensive care. units. Their symptoms were much more likely to involve gastrointestinal problems, inflammation and the skin and mucous membranes. It was also much more likely to have heart-related problems, although many of the acute COVID patients did not receive detailed heart assessments, the study noted. About the same percentage of patients with each condition – more than half – need respiratory support, with slightly less than a third of those requiring mechanical ventilation. Approximately the same number of patients in each group died: 10 with MIS-C and eight with acute COVID-19. The data do not reflect a recent increase in cases of inflammatory syndrome that followed an increase in overall COVID-19 infections during the winter holiday period. Some hospitals reported that there were a greater number of seriously ill MIS-C patients in the current wave compared to previous waves. “I would be fascinated to see a comparison from November 1 against this group because I think we all felt that the kids with MIS-C were even more ill recently,” Ballweg said. An optimistic sign from the study was that most severe heart problems in young people with the inflammatory syndrome improved to normal within thirty days. Randolph said the rest of the effects are still unknown, which is why one of her co-authors, dr. Jane Newburger, co-principal of academic affairs in the cardiology department of Boston Children’s Hospital, conducted a nationwide study to follow children with the inflammatory syndrome. up to five years. “We can not say 100% sure that everything will be normal in the long run,” Randolph said. This article originally appeared in The New York Times. © 2021 The New York Times Company