When Jack’s parents noticed that his eyes were bright, they attributed it to late nights of video games and television.
When he developed a stomach ache and didn’t want to eat dinner, “they thought it was because I had eaten too many cookies or whatever,” said Jack, a ninth grad student in Queens Borough of New York who loves Marvel Comics and has ambitions to teach. himself “Stairway to Heaven” on guitar.
But over the next 10 days, Jack felt worse and worse. His parents consulted his pediatricians during video meetings and took him to an emergency care clinic over the weekend. Then one morning he woke up unable to move.
He had a tennis ball-sized lymph node, a raging fever, an accelerated heart rate, and dangerously low blood pressure. The pain overwhelmed his body in “a throbbing and prickling flare,” he said.
“You could feel it going through your veins and it was almost like someone had injected you with a right light,” he said.
Jack, who was previously healthy, was hospitalized for heart failure that day, in a vivid example of the recently discovered severe inflammatory syndrome linked to the coronavirus which has been identified in approximately 200 children in the United States and Europe and in has killed many.
The disease, which the Centers for Disease Control and Prevention calls multisystem inflammatory disease in children, has shaken widespread confidence that children have been largely spared the pandemic.
Instead of targeting the lungs like the main coronavirus infection, it causes inflammation throughout the body and can paralyze the heart.
It has been compared to a rare childhood inflammatory disease called Kawasaki disease, but doctors have learned that the new syndrome affects the heart differently and breaks out mainly in school-aged children, rather than infants and toddlers. The syndrome often appears weeks after infection in children who have not had symptoms of first-stage coronavirus.
In a Senate hearing last week, Dr. Anthony Fauci, a leader in the US government’s response to coronaviruses, warned that because of the syndrome, “We have to be careful not to be riders and to think that children are completely immune to the harmful effects. “
“He could have died”
Jack’s recovery and the experience of other survivors are Rosetta stones for doctors, health officials and parents eager to understand the mysterious condition.
“He certainly could have died,” said Dr. Gheorghe Ganea, who, along with his wife, Dr. Camelia Ganea, has been Jack’s primary physician for years. “When there is cardiovascular failure, other things can follow. Other organs can fail one after another and survival becomes very difficult. “
New York State reported three deaths and, last Sunday, 137 cases were under investigation in the city alone. Last week, an alert to the CDC urged doctors across the country to report suspected cases.
“Everyone is doing everything they can to help look at the issue from all angles, just to get the answers parents want, we want,” said Dr. Thomas Connors, a pediatric intensive care doctor who treated Jack at New York-Presbyterian Morgan Stanley Children’s. Hospital.
Neither Jack nor his parents, John McMorrow and Doris Stroman, know how he got infected with the coronavirus.
After cleaning his locker at Monsignor McClancy High School on March 18 to continue his online studies at home, he left the apartment only once, they said, to help his mother wash clothes in the laundry room of his building. Her parents and 22-year-old sister also avoided going out, and their tests were negative.
Last week, in their apartment, decorated with welcome balloons, the family – Jack wearing a blue bandana as a mask, his mother in a mask with the Rolling Stones language logo on it – told their story. His father, a truck driver recently laid off for the film industry, briefly choked and Jack jumped up to hug him.
The week after the rash on his hands and his stomach ache, about a month after he set foot in school, Jack developed a fever of 39 degrees and a sore throat. Worried, her mother organized a video visit with their pediatricians, who gave her an antibiotic for a possible bacterial infection. For several days, he felt the same, but other symptoms quickly appeared: swelling of the neck, nausea, dry cough, metallic taste.
On Saturday April 25, his fever reached 40.3 ° C, his chest was tense, and when he took deep breaths, “it hurt deep down,” he said.
Camelia Ganea did a video conference with the family that morning while she was still in pajamas, discovering that Jack could barely open his mouth. She prescribed steroids and suggested that they go to an emergency care clinic. There, Jack was tested for coronavirus, but it would take two days before the results arrived.
The pain on Monday was “flashing through me,” Jack said, and a pink rash covered his feet.
“I was very, very moved,” said Jack. He stopped himself. “I use the word emotional to hide the fact that I cried like a baby. “
Lying on the couch, he couldn’t move on his own and was looking for words to describe what was going on.
“On the roof,” he implored his parents, looking for an abbreviated way to ask them to bend his leg like a pointed roof.
“I didn’t know what I was trying to say, but I knew what I wanted to say,” he said later.
With a home monitor, they discovered that his blood pressure was very low. Mr. McMorrow lifted him, placing Jack’s feet above his, and dragged him to the car. At NewYork-Presbyterian / Weill Cornell Hospital, doctors gave Jack IV fluids and tried to diagnose his condition. He did not have obvious respiratory distress from COVID-19. And then they got the results of his Saturday coronavirus test: negative.
Suspecting he might have a disease like mononucleosis, they prepared to discharge him, thinking he could be safely monitored at home with instructions to return if his blood pressure dropped again, said his parents. .
His mother urged them to keep Jack longer when his eyes turned red with a “raging pinkeye case” and rolled back in his head, she said. After a conversation with Jack’s pediatrician, the hospital performed its own coronavirus test. It was positive.
The doctor decided that Jack should be transferred to the NewYork-Presbyterian pediatric branch, the Morgan Stanley Children Hospital, which treats many cases of coronavirus. Jack begged to go home. The doctor responded bluntly, saying that she knew that teens often thought they were invincible.
“She told me that if I go home now, by tomorrow, I will be dead,” said Jack. “I would say it scared me to death, but it scared me the most. It scared me to fight as hard as I could. “
Jack arrived at the children’s hospital so feverish that his father “washed me with ice water and it only looked like a tingling sensation,” he said.
Her resting heart rate was 165 beats per minute, about twice as high as normal, while her heart struggled to compensate for her alarming blood pressure, which hampered her ability to circulate blood and supply her vital organs. oxygen and nutrients.
“Her heart was not working very well”
This condition is a form of heart failure called cardiogenic shock, and Jack was “pretty serious,” said Dr. Steven Kernie, chief of pediatric intensive care medicine at the hospital and Columbia University. “Overall, his heart was not working very well,” he said. “He was not pumping as hard as normal. “
Doctors could not explain why Jack’s heart function was suddenly impaired. Its structure and rhythm were normal. But the blood vessels throughout his body were inflamed, a condition called vasculitis, so the muscles of the vessels “did not control blood flow as well as they should,” said Dr. Kernie.
Doctors also suspected that the heart was inflamed, known as myocarditis, which, in severe untreated cases, can cause lasting damage. Jack’s condition was not only painful, it reflected a frightening new pattern. “I remember that morning admitting several children with a similar syndrome,” said Dr. Connors, “and it was a bit like” What’s going on here? “”
The inflammation appeared to be caused by an overactive immune response, and Jack was given medication for a bacterial infection until tests excluded it. “Whenever children are in shock, you have to deal with everything,” said Dr. Kernie.
Jack’s positive coronavirus test was a clue, but others with similar symptoms had negative diagnostic test results, said Dr. Connors. The doctors then decided to check the other children for evidence of the coronavirus with a different test, one for antibodies, which reports that they had an older, more active infection. Most children ended up having a positive diagnosis or an antibody test result.
On April 29, Jack’s third day of intensive care, the blood pressure medication didn’t help enough, and doctors started planning to insert a center line in the groin to administer additional medication. They also prepared to put Jack, who was receiving nasal oxygen, under a ventilator, which doctors deem necessary when “your heart is not doing its job,” said Dr. Connors. “We didn’t know which direction it was going. “
But then the doctors started giving Jack steroids, which can have anti-inflammatory and immunosuppressive effects. Finally, something seemed to be working. Within hours, Jack needed less hypertension medication. As the family pediatrician, who trained on infectious diseases and spoke to the hospital team, said, “Jack has become a normal Jack.”
Doctors are not sure if steroids made the difference, but since then they have been given them much earlier to children with the syndrome, with encouraging results, said Dr. Kernie.
But Jack hadn’t come out of the woods even after moving to a regular hospital room. His heart rate was in the 1930s, about half of what he should be. The low heart rate could be due to the steroids, the doctors said, but they couldn’t be sure, so they transferred Jack to a unit with continuous cardiac monitoring.
“There are no conditions on me!
On May 7, 10 days after his hospitalization, Jack went home and walked around the apartment, channeling Pinocchio: “I’m a boy! There are no conditions on me! ”
He will need a cardiology follow-up appointment and will take steroids and blood thinners for a while. He may have heart valve tears and residual heart inflammation, but doctors expect them to heal on their own. Jack and his family have undergone genetic testing for research into the syndrome, and he and other survivors will be followed as doctors try to learn to recognize and treat it.
Stopping near a model of Darth Vader’s castle on his desk, Jack said he plans to become an actor. He was even an extra on the TV show “Gotham”, playing a kidnapped orphan. But before he got sick, he thought about studying medicine. “I was really in the heart,” he said. Now he’s even more interested.
“I just want to do more with my life now that I got it back,” he said, pointing to his Captain America shield.
By Pam Belluck © 2020 The New York Times
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