Editor’s note: NJ Spotlight News celebrates the second anniversary of the arrival of COVID-19 in New Jersey, focusing on how the disease has changed our lives and what life looks like now. This story has long focused on COVID among young patients, what experts know about its impact and how much more they need to find out. You will find all our stories related to the pandemic here.

This was at the very beginning of the pandemic, when Dr. Lawrence Kleinman, deputy chairman of the Department of Pediatrics at Rutgers University, began to draw attention to the unexpected consequences of COVID-19 infection in children.

Studies from Europe have shown that some young patients have children developing multisystemic inflammatory syndrome (MIS-S), a condition that can cause severe inflammation of some organs. By the end of May 2020, there were more than two dozen cases in New Jersey where children infected with coronavirus became infected with MIS-C.

“Being in New Jersey and New York – one of the first areas where COVID-19 landed in the United States – we were part of one of the first studies we looked at [MIS-C]Said Kleinman. “So we’ve been thinking about things like that since these observations were seen in Europe.”

At St. Barnabas Hospital, the head of the Department of Pediatric Infectious Diseases, Dr. Uzma Hassan, also soon noticed strange symptoms in young people infected with COVID-19.

“We started looking at things when adults started reporting prolonged symptoms more than a month after hospitalization,” Hassan said. “And, according to our usual protocol for any of our children who are hospitalized with COVID, we followed them very closely on an outpatient basis and began to notice some of what we saw in adults.”

More questions than answers

After two years of pandemic and after several iterations of coronavirus variants, about 12.6 million American children have tested positive for COVID-19, with 4.8 million cases reported since early 2022 alone. according to to the American Academy of Pediatrics. New Jersey reported nearly 331,500 cases of COVID-19 in children and 198 diagnoses of MIS-C. As children appear to be increasingly susceptible to infection, states across the country are easing pandemic restrictions such as mandates on masks, doctors and researchers in New Jersey, the U.S. and around the world are seeking to better understand COVID-19 in adolescents.

“We started with the myth that children were spared, not.”

Last year, Hassan coordinated the creation of a pediatric care program after COVID-19 in St. Barnabas and the New Jersey Children’s Hospital at Newark Beth Medical Center Israel. Kleinman is now the lead researcher for a new study on the long-term effects of COVID-19 on children, which will soon begin recruiting. They, like pediatricians everywhere, have more questions than answers.

“We started with the myth that children were spared – not true,” Kleinman said. “If we hadn’t compared [COVID-19 infection in kids] for adults it would, regardless, be a public health crisis in children ”.

Active healthy children are at high risk

Shortly after Hassan and her team began noticing that long-term symptoms in children were similar to those in adults, “we began receiving a bunch of recommendations from the community with children who had mild or asymptomatic COVID-19 but who had long-term symptoms of fatigue. , problems with smell and taste or problems with balance in about a month ”.

“… the most difficult times have been achieved among our truckers, athletes and accomplices.”

These symptoms, along with others such as brain fog, shortness of breath, palpitations and decreased cognitive abilities, are consistent with what doctors across the country have found among young patients with COVID. At first, Hassan said, this common ailment in children and adolescents was similar to that caused by Epstein-Barr virus, childhood mononucleosis (mono) and mycoplasma infections. This especially reminded her of chronic fatigue syndrome, a condition that has amazed doctors for decades and from which there is no known cause or treatment.

As more and more young people turned to Hassan, she noticed another strange picture: children who were least expecting a serious victim seemed to suffer the most.

“I would say that among our population of truckers, athletes and those who have achieved great success, it was the hardest,” Hassan said. “We had kids who were normal students on the honor list who struggled with elementary math. But for us the athletes were the ones who fought the longest; these kids, who played, for example, three sports and went to four workouts a day, could barely get out of bed, and when they played one game, they were separated for the next two weeks or so. ”

In Rutgers Kleinman discovered the same thing. “Some of the children who were athletes were cured of adolescence COVID and then they lacked tolerance for exercise,” Kleinman said. “You look at them in the room and they look good, but they’re trying to walk around the neighborhood, and suddenly they don’t.”

“Most of all, for some reason, the child who strives the hardest is affected,” Hassan said.

The role of external triggers

As with complex illnesses such as chronic fatigue syndrome, there is now no understanding of how external triggers are depression from isolation; anxiety from fear of getting sick; grief from the loss of a loved one due to the virus – can worsen the symptoms of prolonged COVID in both adults and children.

“I would say that probably about 80% of these children come with COVID-19 [exhibit] depression and new anxiety, ”Hassan said. “Just like chronic fatigue, there are many environmental factors that contribute to the continuation or worsening of symptoms.”

The pandemic has led to unprecedented levels of anxiety and depression in people of all ages, according to public opinion polls and clinical data. Mental health providers in New Jersey said the need for their services is growing and that children are particularly affected after the closure of full-time school, forcing them to face months of online learning and social exclusion.

Both Kleinman and Hassan agree that the rapid increase in infection rates among children since the beginning of the year seems to suggest that they are much more susceptible to the omicron variant than to previous iterations of the virus. Indeed, in the United States in December and January, hospitalization of children due to COVID-19 infection increased significantly.

“Omicron beats kids much harder than previous options.”

Because so little is known about the effects of omicron on children, they are alarmed by the massive abolition of pandemic restrictions, especially masks. Of the 15 children who died from problems related to COVID-19 in New Jersey, nearly half died since Christmas.

Dr Stanley Weiss, a Rutgers professor of medicine who specializes in surveying and reading medical literature, said the current policy regarding the abolition of masks and other social restrictions is based on research conducted before Amicron.

“Omicron beats kids much harder than previous options,” Weiss said. “I think it’s almost certain that basing a policy on omicron data probably underestimates the risk among children, plus we still understand MIS-C in children early on.”

While it seems clear that omicron affects children more seriously, Weiss reiterated that because we still know little about the risk of prolonged COVID in adolescents, we cannot be entirely sure of the full impact of previous options. He pointed to Fr. preliminary reportpublished in late February, which analyzes the hospitalizations of children in the United States aged 5 to 11 years between January and March 2021.

“Their data suggest that for every species hospitalized because of COVID-19, there is another child who had MIS-C who was not hospitalized,” Weiss said. “Thus, their conclusion was that MIS-C was not as rare as the complication of the effects of COVID-19 (long-term COVID) as previously thought.”

“We all have fatigue from COVID, but I think there’s a rush to normalcy,” Kleinman added. “I know it’s an imperfect analogy, but I’d say there are times when I just don’t want to pin, but I do. So, in my opinion, it is important to wear a mask around children, around everyone who is not vaccinated – it is to be a good citizen, it is sensitivity to the environment. “

Improving well-being after vaccination

As we saw the need for boosters and perhaps another cycle of vaccines, there is no cure left for COVID-19, let alone long-term COVID-19. But previous studies have shown that vaccination has helped alleviate symptoms in some truckers.

Weiss noted a study by Michael Edelstein, an epidemiologist at the University of Bar Ilan in Israel, who found in early research that some long-term symptoms of COVID – fatigue, headache, weakness and constant muscle pain – are weakened after being relieved. . vaccinated.

“Our results suggest that, in addition to reducing the risk of acute disease, vaccination against COVID-19 may have a protective effect against long-term COVID,” – Edelstein et al. wrote.

Returning to St. Barnabas, Hassan finds similar results.

“Anecdotally, I can say that there is probably a significant improvement in symptoms across the country and for our group after vaccination,” Hassan said. “We don’t really know why this happens, but many children who have had long-term symptoms of fatigue or problems with smell and taste, after vaccination they begin to feel better.”

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