Covid-19: alert on severe forms affecting children

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In England, Italy and also in France, an unusual influx of children admitted to intensive care units for severe inflammation of the heart tissue and coronary arteries led paediatricians to issue an alert. Doctors were surprised by this abnormal influx of young patients, some of whom tested positive for Covid-19. Health Minister Olivier Véran said he was worried but vigilant about the situation, as schools are expected to reopen in a few days.

The first urgent alert was launched on April 27th by British doctors worried about a "crisis of confidence". a rare but dangerous reaction in children that may be related to coronavirus infection ». The Medical Director of the NHS, the English health system, Stephen Powis, said he had heard reports of rare and serious diseases in children. « It's only in the last few days that we've seen these reports. We have asked our experts to examine the situation as a matter of urgency. "he said. said at the BBC.

At the same time, an unusual influx of young patients has led the heads of French paediatric intensive care units to wonder. Then to exchange. Three major Parisian departments have identified at least fifteen cases of myocarditis, i.e. inflammation of the heart's muscle tissue, which leads to heart failure, in young patients. « At Trousseau Hospital, we found three in ten days, compared to the usual two or three per year. ' John Hultquist, director of intelligence analysis for the cybersecurity company FireEye, details at BFM, Professor Pierre-Louis Léger, head of the pediatric intensive care unit at Trousseau Hospital (AP-HP). « In Necker, it's more than a dozen and at the Robert Debré Hospital, three or four "he continues. « In other words, a totally abnormal balance sheet in this period... ".

In addition to the British and French doctors, their Italian counterparts also observed similar syndromes in Bergamo, the centre of the epidemic on the peninsula. These findings were echoed by Spanish and Swiss paediatricians.

Health Alert

This situation led the five paediatric intensive care units in Ile-de-France to issue an alert to the health authorities on Monday 27 April. Then learned societies, including the French Paediatric Society, the French Society of Rheumatology and Paediatric Internal Medicine, sent an alert to health professionals on Wednesday 29 April.

Centre rare diseases of congenital cardiac malformations counts at least 25 cases in three weeks in the Paris resuscitations,''. including nine in Necker alone in the last two days. " The Centre mentions "a growing number of children of all ages (...) hospitalised in a context of multi-systemic inflammation, frequently associating circulatory failure with factors favouring myocarditis... ".

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According to Professor Léger interviewed by BFM journalists, the first eight patients are between 8 and 15 years old. Those of Professor Dauger, less than 10 years old. Most of them have no comorbidity, i.e. pre-existing disease. Often, the young patients have shown digestive signs, fever, and then respiratory shock. « It looks like viral myocarditis or Kawasaki's disease, an inflammatory disease, but it is not a disease because it is common in younger children (usually under 5 years old) and the picture is not typical; that is, not all symptoms fit. ", analyses Professor Léger.

According to this doctor, the majority of the children tested positive for Covid-19, either by diagnostic or serological tests. That is, they have antibodies showing that they have been previously infected, often without symptoms.

Incomprehensible influx

Doctors do not understand this influx of young patients to Paris, even though the coronavirus epidemic in this region is on the wane. They suspect a delayed effect of the contamination. The children would have been contaminated and would have developed low noise inflammatory syndromes, unnoticed, which would have worsened afterwards. The surprise is all the greater since, so far, the epidemic seems to have spared the children. Indeed, according to the latest epidemiological bulletin of Public Health France, the under-14s represent less than 1% of hospitalizations for Covid-19. As of April 21, of the 5405 patients admitted to intensive care, 26 were under 14 years old.

Children admitted to emergency departments in recent days suffer from abdominal pain, diarrhoea and vomiting, followed by fever; doctors then discover heart inflammation and severe respiratory syndrome. In addition, not all children recently admitted to hospitals are positive for Covid-19 on PCR tests. In Trousseau, doctors treated a child who was not PCR positive but who had all the signs of Covid-19 on CT.

Scientists, such as Professor Dauger, head of the paediatric intensive care unit at the Robert-Debré Hospital, believe there must be a correlation with Covid-19 but the direct relationship and physiological mechanism is not yet known. He confides his doubts to the journal The World : " We're sticking with question marks. Is it a direct attack of the virus? Or post-infectious reactions, immune response abnormalities? It's not documented at this time. "

While the Prime Minister announced on April 28 that schools will open for children as early as May 11, the Minister of Health wants to reassuring in the face of this news. « I take this very, very seriously. We have absolutely no medical explanation at this point. "The fact remains that he remains on the idea that children are little affected by Covid-19 and does not, to date, intend to question the reopening of the schools.

It's true that doctors want to be reassuring. Professor Léger states that " The evolution of the treated patients is rather favourable, even if it requires a stay in intensive care, and medication to support the heart. ». He adds a positive note: " For the three patients on my ward in Trousseau, all of them recovered ". " Parents must be reassured that these are rare cases that do not call into question the fact that children are less prone to serious forms of the disease and are probably less likely to be carriers or vectors than adults. ", says Professor Dauger of the Robert Debré Hospital.

 

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