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Children with Covid: why are there more cases and deaths in some countries? | Coronavirus

meDr. Fatima Marinho, Brazil’s leading emergency physician and epidemiologist, is observing symptoms of Covid-19 in children that are in stark contrast to the message that has been transmitted globally throughout the pandemic that children do not appear to be suffering seriously. the virus.

Severe muscle aches, diarrhea, cough, abdominal pain and hospitalization – all of this is happening to children with Covid-19 in Brazil, Marinho says.

The latest available data extracted by Marinho on April 15 showed that 2,216 children between the ages of zero and nine had died from Covid-19. This includes 1,397 babies under one year of age. Meanwhile, more than 67,000 children in the zero to nine age group have been hospitalized in Brazil.

Marinho, Senior Advisor to the global public health organization Vital Strategies, tells Guardian Australia: The epidemic in Brazil is changing the profile of serious cases ”.

“We see more young people hospitalized and dying from Covid compared to 2020,” he says. “Soon Brazil must begin to vaccinate young people due to the risk of new variants. But there are not enough vaccines. “

On Saturday, the World Health Organization (WHO) urged wealthier countries that had completed vaccinating their most vulnerable to delay vaccinating children and instead donate those doses to their Covax facilities so that can be distributed to the countries most in need. Vaccination of children has already begun in some countries, with Canada and the United States among those vaccinating children between the ages of 12 and 15.

“In low- and lower-middle-income countries, the supply of the Covid-19 vaccine has not been enough to even immunize healthcare workers, and hospitals are flooded with people in need of urgent life-saving care,” said WHO Director General Dr. Tedros Adhanom Ghebreyesus. .

“I understand why some countries want to vaccinate their children and adolescents, but right now I urge you to reconsider and donate vaccines to Covax instead.”

Children in India Covid
In India, not only have children been orphaned due to the high death rate from Covid-19, but the devastating second wave is seeing more children infected. Photograph: Soumyabrata Roy / Pacific Press / REX / Shutterstock

But among those in need of life-saving care in countries still ravaged by the virus, such as India, Brazil and Indonesia, are children. So why is Covid-19 infecting and affecting children so badly in some countries but not others, to the point that some countries may forego vaccinating children for the time being?

While more research is needed, Marinho says there are several influencing factors. One is that the diagnosis of Covid-19 in children comes too late, when children are already seriously ill and treatment is more difficult.

“There’s a ‘no risk to children’ culture, so doctors don’t think in terms of Covid-19,” he says.

“In addition to low access to timely medical care, there is also poverty and inequalities, and people who live in areas and houses with difficult social distancing. In poor houses there are more than four people per room ”.

Social distancing outside the home is also difficult, he says. “Family members have to go out every day to work or look for work,” says Marinho. “The newer Sars-CoV-2 variants also have a higher viral load compared to other variants.” This means that people are also more infectious.

“Brazil needs more tests for Covid-19, without tests and follow-up of cases and controls, the virus cannot be controlled and will continue to spread throughout the country,” he says. “The risk is new mutations.”

In Indonesia, the Indonesian Pediatricians Association (IDAI) said that official figures suggesting that 28 children have died from Covid are an underestimate, with the number approaching 160. ADAI President Dr. Aman B Pulungan, told ABC in June, “It shows that it is not true that the group of those under 18 years of age is not susceptible to Covid-19”.

In India, not only have children been orphaned due to the high death rate from Covid-19, but the devastating second wave is seeing more children infected. While infant mortality remains low overall, they are being hit the hardest.

A pediatric pulmonologist working in Bangalore, Dr. Srikanta JT, says that during the previous wave of Covid there could be one child a week with Covid.

“But according to the data of the majority [health] centers in India and our own data collected [the] In recent months, the second wave seems to be affecting children quite significantly and the numbers are gradually increasing, with almost 12 to 15 positive cases a day, ”he tells Guardian Australia. These include young children and adolescents.

While most children appear to have mild or asymptomatic infections that could be treated at home, there are a growing number of severe cases in children.

“We are also witnessing a significant number of serious cases such as severe pneumonia that requires ventilatory support in children with type 1 diabetes mellitus and complications thereof such as diabetic ketoacidosis, multisystem inflammatory syndrome, with significant morbidity and mortality. Although it is quantified to approximately 5% of our cohort, the figures are quite significant. “

In addition to the role of underlying conditions that are more common in children living in difficult conditions, Srikanta says that once the lockdowns and other restrictions were lifted after the first wave, there was a feeling in the general public that the pandemic was behind them.

“And most began to fully or partially refrain from Covid-appropriate behaviors,” he says. “This inappropriate behavior has led to a significant mix and therefore a second wave.”

One theory why children generally seem less susceptible to the virus than adults is that they have less of a type of receptor known as ACE2 in the respiratory tract. These receptors are a key pathway for the virus that causes Covid-19 to enter cells. Fewer ACE2 receptors are theorized to mean fewer opportunities for the virus to take hold.

“During the first wave of the pandemic, it was generally thought that both the absence and the reduction in the number of these receptors in children were generally protective,” says Srikanta. “But the second wave came with a more virulent strain, which appears to bypass the apparatus required for entry and better evade the immune system, thus an increase in both the number of children and the severity of infection.”

The latest epidemiological report of the WHO Covid-19 says that the highest number of new cases reported in the week to May 11 was in India[2738957newcases;anincreaseof5%)followedbyBrazil(423438newcases;similartothepreviousweek)Indonesiahadthethirdhighestnumberofnewcasesinthepreviousweekto11May;2738957Newcasesintheeasternregionofthepreviousyearwiththeprevious2682%ofnewcasesintheeasternregionfromthepreviousyearwiththepreviousyear2682%ofthenewEastAsiancaseofthepreviousyearintheeasternregionandtheprevioustwoweeksfromitsneweasternregiona5%increase)followedbyBrazil(423438newcases;similartothepreviousweek)Indonesiahadthethirdhighestnumberofnewcasesinthesouth-eastAsiaregionbehindIndiaandNepalwith36882newcasesa2%increaseontheweekprior[2738957casosnuevos;unaumentodel5%)seguidodeBrasil(423438casosnuevos;similaralasemanaanterior)IndonesiatuvoeltercernúmeromásaltodecasosnuevosenlaregióndelsudesteasiáticodetrásdeIndiayNepalcon36882casosnuevosunaumentodel2%conrespectoalasemanaanterior[2738957newcases;a5%increase)followedbyBrazil(423438newcases;similartothepreviousweek)Indonesiahadthethirdhighestnumberofnewcasesinthesouth-eastAsiaregionbehindIndiaandNepalwith36882newcasesa2%increaseontheweekprior

A professor of pediatrics and child health at the University of Sydney, Robert Booy, says that the population size of those countries is also likely behind the highest cases in children there. If variants or other mechanisms like the one involving ACE2 described by Srikanta are driving rates in children, more study is needed, he says.

“As this virus continues to mutate, it runs the risk of becoming much more transmissible, which is the main thing we have noticed in the last six months, but it can actually become more severe for children,” he says. “We just don’t know everything there is to know yet.”

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