The New York Times
New discoveries about the two ways in which children become seriously ill with the coronavirus
A large national study found important differences in the two main ways in which children became seriously ill with the coronavirus, findings that can help doctors and parents better recognize conditions and understand more about children at risk for each. The study, published Wednesday in the journal JAMA, analyzed 1,116 cases of young people who were treated at 66 hospitals in 31 states. A little more than half of the patients had acute COVID-19, the predominantly pulmonary disease that afflicts most adults who fall ill with the virus, while 539 patients had the inflammatory syndrome that broke out in some children weeks after they had a typically mild infection. initial. The researchers found some similarities, but also significant differences in the symptoms and characteristics of the patients, which ranged from babies to 20-year-olds and were hospitalized last year between March 15 and October 31. Subscribe to the newsletter The Morning in New York Times Young People with the syndrome, called Multisystemic 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 COVID -19 acute were under 6 or over 12 years old. More than two-thirds of patients with either condition were black or Hispanic, which experts say probably reflects socioeconomic and other factors that disproportionately exposed some communities to the virus. “It is still shocking that the overwhelming majority of patients are not 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 Children’s Hospital & Medical Center in Omaha, Nebraska, which was not involved in the study. “There is clearly racial disparity there.” For reasons that are not clear, although young Hispanics also appeared to be at risk for both conditions, black children appeared to be at greater risk of developing inflammatory syndrome than acute disease, said Dr. Adrienne Randolph, senior author of the study. and a specialist in pediatric intensive care at Boston Children’s Hospital. A potential clue mentioned by the authors is that with Kawasaki disease, a rare childhood inflammatory syndrome that has similarities to some aspects of MIS-C, black children appear to have a higher frequency of cardiac abnormalities and are less responsive to one of the standard treatments, 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. Even so, more than a third of patients with acute COVID did not have a previous medical condition. “It’s not like previously healthy kids are completely free of impurities here,” said Randolph. The study assessed obesity separately from other underlying health conditions and only in patients aged 2 years or older, finding that a slightly higher percentage of young people 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 establish that healthy children are at greater risk for MIS-C. It could be “mainly a numbers game, with the proportion of infected children and the proportion of healthy children, rather than saying that there is something immune in healthy children that puts them at a disproportionately greater risk,” he said. Overall, he said, the study documentation of the differences between the two conditions was useful, especially because it reflected “a reasonably representative set of hospitals in the United States”. Young people with inflammatory syndrome are more likely to need treatment in intensive care units. Its symptoms were much more likely to include gastrointestinal problems, inflammation and involve the skin and mucous membranes. They were also much more likely to have heart-related problems, although many of the acute COVID patients did not receive detailed cardiac assessments, the study noted. Approximately the same proportion of patients with each condition – more than half – required respiratory support, with just under 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 general COVID-19 infections across the country during the winter. Some hospitals reported that there were a greater number of critically ill patients with MIS-C in the current wave compared to previous waves. “I will be fascinated to see the comparison from November 1st onwards with this group, because I think we all feel that children with MIS-C have become even more ill recently,” said Ballweg. An optimistic sign of the study was that most serious heart problems in young people with inflammatory syndrome returned to normal within 30 days. Still, Randolph said that any residual effects remain unknown, which is why one of his co-authors, Dr. Jane Newburger, associate chief for academic affairs in the cardiology department at Boston Children’s Hospital, is conducting a national study to monitor children with inflammatory syndrome for up to five years. “We cannot say 100% with certainty that everything will be normal in the long run,” said Randolph. This article was originally published in The New York Times. © 2021 The New York Times Company