“What is their immune system? Rare complication seen in some children with COVID-19

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High school junior Jameela Barber called her teacher in Dallas County, Texas last Friday to apologize for neglecting to do her schoolwork.

Her school principal Eleanor Webb said Barber had told her teacher that she was not feeling well.

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“She said,” As soon as I feel better, because I feel really, really sick, I’m going to make my assignments missed, “said Webb at NBC affiliate KXAS.

Jameela Barber.Lancaster Independent School District

The next day, Webb said, Barber died from complications from COVID-19. She was 17 years old.

Barber’s case is rare; only a handful of pediatric coronavirus deaths have been reported in the United States. However, the exact numbers for children are difficult to determine: the Centers for Disease Control and Prevention told NBC News that it does not track deaths from COVID-19 in children under 18 as it does for the flu.

The first data on pediatric cases of COVID-19 suggest that, for the vast majority of children, the disease is relatively mild.

Recently, however, reports of potential serious complications specific to children have begun to emerge in the United States and Europe: a handful of children have developed dangerous inflammation around the heart and other organs. It is similar to a rare condition called Kawasaki disease, which causes swelling of the coronary arteries, mainly in children.

Efforts to collect data on how the virus affects children are in their infancy. The Pediatric Infectious Disease Transplant Network, in coordination with the St. Jude Children’s Research Hospital and other major children’s hospitals across the country, has just started to collect data on children diagnosed with COVID-19.

It is not known why most children seem to be spared. Children may not have the same chronic health conditions, such as high blood pressure or type 2 diabetes, that are found in the most severe cases of COVID-19 in adults.

Children’s immune systems may also not respond to this coronavirus infection with the same hyperinflammatory response as that documented in adults.

“It’s very perplexing,” said Dr. Adrienne Randolph, senior intensive care doctor at Boston Children Hospital. “What about their immune system and their immune response to this virus so they don’t really get sick?” “

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Randolph is leading a national research project to understand why the virus works differently in children, and why some, like Barber, have more serious and even fatal consequences. The objective is to enroll 800 children and young people up to 25 years of age.

A large body of data on the risks associated with COVID-19 in young people is important, said Randolph, “because when a vaccine is available, it will likely not be available to everyone right away. “

In other words, a vaccine would probably be a priority for those most exposed to complications from the coronavirus.

“A new syndrome”

The handful of children who have developed the Kawasaki complication reflect “a new syndrome,” said Dr. Jane Burns, director of the Kawasaki Disease Research Center at the University of California at San Diego.

“The way it affects the heart is completely different from what we usually see in Kawasaki disease,” said Burns. “This is new because it is mainly the heart muscle that fails,” adding that it appears that the immune system attacks the heart, as opposed to the coronary arteries.

It is not known how many children can have this condition. Doctors at Columbia University Medical Center in New York City reported treating three of these cases in children 6 months to 8 years of age.

“What we saw [is] there are children who can have inflammation of the blood vessels and develop a toxic shock-like syndrome, “New York health commissioner Dr. Howard Zucker said on Thursday.

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But it may be too early to link this new type of inflammatory reaction to COVID-19, as only some of the patients have tested positive for coronavirus infection. Some have tested negative, although they have been exposed to infected family members.

This development has left doctors perplexed, who have scheduled a call with experts from around the world this weekend to share information about the cases.

“We are working to develop a unified case definition,” said Burns.

The World Health Organization is also “urgently” studying the potential link between this new problem and COVID-19.

Lighter symptoms

In the end, COVID-19 remains rare in children; only 2% of children tested for coronavirus in the United States are positive. By far, most cases of COVID-19 – especially the most severe cases – have occurred in adults.

Pediatric infectious disease experts note that complications from the coronavirus are rare in children, a trend that has also been seen in other countries.

“We have data from China, we have data from Italy and other parts of Europe, as well as now preliminary data from the United States” that most pediatric cases seem to range from asymptomatic symptoms to mild symptoms, said Randolph.

People over 65 tend to have significantly higher rates of complications and mortality.

Dr Buddy Creech, director of the Vanderbilt Vaccine Research Program at Vanderbilt University Medical Center in Nashville, noted the same thing.

Symptoms in children “always seem much milder than adults,” said Creech. And there is a growing theory that fewer symptoms for a shorter period of time could indicate that children are not very good at spreading the virus.

“It is tempting to speculate,” said Creech, noting that the theory has not been proven.

But, he added, “it would be interesting to at least consider the possibility that children with milder symptoms and shorter illnesses may actually have fewer days of positive virus than they lose from their noses or from their throat. “

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