welcome to the optimist daily report on
the chrono virus pandemic
I'm dr. Aegis I'm a chief medical
officer here osmosis most of pediatric
infectious disease physician and I used
to work at the CDC in the division of
viral diseases doing virus outbreak
research today we're gonna talk about
children in covent 19 to start us out I
want to take a look at this MMWR from
the CDC on Crona virus disease and
children and what I wanted to show you
is that among the 150,000 or so to
slightly shy of that reported cases that
they looked at in this MMWR roughly 1.7
percent were among children aged less
than 18 years of age and if there's one
silver lining if you could find one good
thing about this covered 19 outbreak
this pandemic it said it hasn't affected
children the way that it has affected
the elderly in fact I think we'd all be
responding to Cova 19 quite differently
if we knew that it was causing the same
levels of disease and death that it does
among the elderly there's a nice review
from The Lancet where they actually
reviewed 36 cases of children with over
19 and of those cases they found that 17
of those children had mild clinical
symptoms they actually grouped together
ten that had no symptoms as well as
seven that had acute respiratory
symptoms like a runny nose or a bit of
kind of nasal congestion and so the
general understanding has been that
basically and this is a viewpoint
article when children get it they
develop generally mild symptoms and the
real concern should be that if children
are infected but asymptomatic they could
still serve as a source of transmission
to adults that that kids can get it when
they're out and about with other kids or
other families bring it home and then
get adults or even elderly folks in the
home infected with the disease and in
fact we know that this is where the bulk
of the concern is now there are some
subgroups of kids to be thoughtful about
so there is this paper that came out in
late March look at neonatal early onset
of infection this is basically babies
that are just born to moms neonates and
they
33 of them these are all moms with Kobe
19 to see how many of the neonates would
develop Cova 19 as well and what they
found was that 3 out of 33 of these
infants these young babies within days
of being born developed Cova 19 their
key finding here is that in this cohort
it looks like the development of Cova 19
was maternal in origin meaning and the
thought process and you can look through
the paper in detail was that there may
have been entry uterine transmission
meaning while the baby was in the uterus
the virus may have gone from mom to
fetus and so in that situation what you
worry about is that the baby is is gonna
develop disease and these three babies
did develop disease you can see actually
on the right the chest x-rays in the
chest CT show that there's evidence of
pulmonary disease in these neonates all
three of them fortunately did quite well
and actually recovered and were
discharged from the hospital once all
this got better and now the other
subgroup you know we talked about
neonates is one side group the other one
is young children with underlying
diseases and conditions and so going
back to this MMWR paper that i talked
about you can see that they talked about
the fact that a number of them this is a
total of 80 out of 345 so about 23% of
these children had at least one
underlying condition and they say the
most common one was chronic lung disease
like asthma so we often don't think of
young children of being as being
high-risk but there are of course some
groups of children that are at high risk
the other thing that means is that 77%
of these children did not have at least
one underlying condition meaning there
were healthy children that developed
Cova 19 and again I want to underscore
that because I think people sometimes
have the misperception that really no
kids can get sick and that's not the
case they also do mention that there are
three deaths that were reported that
were thought to be due to Kobe 19
they're investigating those deaths there
have been deaths that have been well
reported to be related to Kobe 19 among
children so I also want to make sure
that that is not a misperception out
there either specifically children can
and have died of Kobe 19 but the
question remains why is it that children
in general aren't getting as sick and
aren't dying at the same rates as the
elderly and this paper tries to get at
some of these reasons in the context of
a RDS so you can see that this was
published before Kobe 19 but some of the
lessons I think apply to Coba 19 and
that's why I wanted to share with you
here just to set this up properly what
they did was they enrolled individuals
that had a RDS acute respiratory
distress syndrome and they put them in
two different age groups so for
different age groups less than 28 days
young children between 1 months and 18
years adults and then finally the
elderly people over age 65 and they had
all of them undergo a BA l and a BA L is
a bronchoalveolar lavage and you can
think of it as essentially a lung
washing they put fluid in the lungs and
then they pulled the fluid back out and
they test that fluid so that lung
washing gives you a sense of the
chemicals and the cytokines that are in
that fluid being representative of
what's happening deep down in the lungs
they then compared all that fluid to
each other to see if there were
differences in the chemicals are seeing
in young infants versus the elderly now
what they found was that levels did
differ between age groups they said
levels of myeloperoxidase aisle 6 aisle
10 and P selectin were higher as you got
older in aisle six in particular is one
that we know seems to correlate quite
strongly with bad outcomes with a RDS
related to Coppa 19 so it looks like
with younger individuals the chemicals
in their lungs are actually a different
profile from what you're seeing in the
adults and there's this phrase cytokine
storm and so what it means is that the
kids the younger individuals are not
having the same sort of cytokine storm
that you see in older individuals and
maybe that's why they're not having the
same bad outcomes with Cova 19 this is
the key figure from that and you can see
the key at the bottom white light gray
dark gray and then kind of darkest gray
or black represents the different age
groups and just showing you very quickly
the
my love peroxidase in aisle six I'm just
gonna focus on aisle six for a moment
because that's the one I flagged earlier
you can see that generally speaking
there is a trend towards having higher
levels and this is a logarithmic scale
you're on though on the y-axis having
higher levels of aisle six as you get
older and older so this is at the moment
the leading theory as to why kids are
not getting as sick with covenanting is
that their cytokine profile is just
different and they're not having these
storms that these elderly folks are
having when they get the virus all right
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Thanks
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