New Findings on 2 Ways Children Become Seriously Ill from the Coronavirus

A large nationwide study found important differences in the two main ways in which children become seriously ill from the coronavirus. These results can help doctors and parents better identify the conditions and understand more about the children at risk.
The study, published Wednesday in JAMA magazine, analyzed 1,116 cases of young people being treated in 66 hospitals in 31 states. A little more than half of the patients had acute COVID-19, the predominantly lung-related disease that affects most adults with the virus, while 539 patients had the inflammatory syndrome, which in some children occurs weeks after a typical mild one Disease broke out first infection.
The researchers found some similarities, but also significant differences in the symptoms and characteristics of the patients, which ranged from infants to 20-year-olds who were hospitalized between March 15 and October 31 last year.
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Young people with the syndrome known as Multisystem Inflammatory Syndrome in Children (MIS-C) were more likely to be between 6 and 12 years old, while more than 80% of patients with acute COVID-19 were either younger than 6 years or younger than older 12th
More than two-thirds of patients with both conditions were Black or Hispanic, which experts say most likely reflects socio-economic and other factors that some communities have disproportionately exposed to the virus.
"It's still shocking that the vast majority of patients are not white, and that goes 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, who was not involved in the study. "There are clearly racial differences there."
For unclear reasons, while Hispanic adolescents appeared to be equally at risk for both conditions, black children appeared to be at greater risk for developing the inflammatory syndrome than the acute disease, said Dr. Adrienne Randolph, lead study author and a specialist in pediatric intensive care at Boston Children's Hospital.
One possible clue that the authors mention is that in Kawasaki disease, a rare childhood inflammatory syndrome that shares similarities with some aspects of MIS-C, black children are more likely to have cardiac abnormalities and are less responsive to any of the standard treatments. intravenous immunoglobulin.
The researchers found that young people with the inflammatory syndrome were significantly more likely to have no underlying illnesses than those with acute COVID-19. Still, more than a third of patients with acute COVID had no previous health status. "It's not that previously healthy children are completely unscathed here," said Randolph.
In the study, obesity was assessed separately from other underlying health conditions and only in patients 2 years and older. It found that a slightly higher percentage of young people with acute COVID-19 were obese.
Dr. Srinivas Murthy, an adjunct professor of pediatrics at the University of British Columbia who was not involved in the study, said he was not convinced the results show that healthy children are at higher risk for MIS-C. It could be "mostly a numbers game that has the proportion of infected children and the proportion of healthy children out there, instead of saying that healthy children have something immune that puts them at disproportionately higher risk," he said.
Overall, the study's documentation of the differences between the two conditions was useful, particularly because it reflected "a reasonably representative group of hospitals in the United States."
Young people with the inflammatory syndrome were more likely to have had to be treated in intensive care units. Her symptoms were much more likely to have gastrointestinal problems, inflammation, and involvement of the skin and mucous membranes. They were also much more likely to have heart problems, although many of the acute COVID patients didn't get detailed heart exams, the study said.
Roughly the same proportion of patients with each disease - more than half - required respiratory support, with slightly less than a third of patients 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 does not reflect a recent surge in inflammatory syndrome cases that followed a surge in total COVID-19 infections across the country during the winter vacation season. Some hospitals have reported that there were higher numbers of critically ill MIS-C patients in the current wave compared to previous waves.
"I'll be intrigued to see a comparison with this group from November 1st because I think we all felt that the kids with MIS-C have been even sicker lately," Ballweg said.
An optimistic sign from the study was that most severe heart problems in young people with inflammatory syndrome improved to normal within 30 days. However, Randolph said any remaining effects remain unknown, which is why one of her co-authors, Dr. Jane Newburger, assistant director of academic affairs in the cardiology department at Boston Children's Hospital, is conducting a statewide study to track children with inflammatory syndrome for up to five years.
"We can't say 100% for sure that everything will be normal in the long run," said Randolph.
This article originally appeared in the New York Times.
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