Its link with the coronavirus is not established, but the appearance of inflammatory disease in young children questions and worries the world scientific community.
Does the new coronavirus cause a serious new inflammatory disease in a small number of children and adolescents? This is the question that concerns several countries, including France, after the recent appearance of unusual cases, in the midst of the Covid-19 epidemic. In hospitals in Paris, around twenty similar cases have been observed.
Work in progress to study if there is “a link with the Covid-19”
“All of the paediatricians and resuscitators are working together to see whether or not there is a need to make a link with the Covid-19, which I do not yet know when I speak to you,” said the minister. de la Santé, Olivier Véran, at the National Assembly. “This is something that concerns us,” had assured the day before his British counterpart, Matt Hancock.
This concern is all the more acute since all studies have so far shown that the severe forms of Covid-19 are extremely rare in the youngest. The alert left this weekend in England, with a report from the public health service, NHS England. A small number of similar cases have been mentioned in France, the United States, Spain or Belgium.
“It accelerated” in Paris hospitals
On all Parisian hospitals, this represents “about twenty children,” said AFP Damien Bonnet, head of pediatric cardiology at Necker Hospital for sick children.
“According to my French colleagues, there are others elsewhere,” he adds, stressing that their number in absolute terms “remains limited”. The first case was admitted to his hospital “three weeks ago” and “it has been accelerating for about 8 days”.
A shared finding in the United States. “I saw such patients yesterday and today, and my colleagues have seen them for three weeks,” said Sunil Sood, an infectious disease specialist at Cohen’s children hospital in New York. According to Professor Bonnet, these young patients are “from 2 to 18 years old”. Dr Sood mentions “adolescents, the youngest is 13 years old”.
“The children all evolve favourably”
How does it manifest? “These children come with digestive, respiratory or infectious symptoms” accompanied by “a heart attack”, answers Professor Bonnet, according to whom “most need to be helped with drugs to support the functioning of the heart”. The teacher remains positive:
“Children almost all evolve favourably, even if they are in an intensive care situation initially.”
Likewise, all of the young patients that Dr Sood was aware of have seen their condition improve, even if they have not all been discharged from hospital yet, and none have died.
Some symptoms suggest toxic shock syndrome or Kawasaki disease. This disease which affects children leads to inflammation of the blood vessels (skin rashes, lymph nodes, conjunctivitis, heart problems in severe forms, etc.). “Every blood vessel in the body is on fire,” says Dr. Sood.
But even if there are “overlaps of symptoms” with the cases currently observed, there are also differences, notes Professor Bonnet. The first of these is the age of the patients: “Kawasaki disease is primarily a disease of the small child, rather less than 2 years old, even if there are up to 4 or 5 years. There we see all ages. ”
All this “will become clearer over time, to find out if it is a particular disease”, adds the French doctor.
All children tested, not all positive
In all the countries where these cases have been reported, some young patients have tested positive for Covid-19 and others negative. The causal link between the coronavirus and these inflammatory symptoms is therefore not established with certainty.
However, the conjunction of the two challenges. “We are in the time of the Covid-19 epidemic, we see an infrequent disease becoming more frequent. That questions us, ”explains Professor Bonnet.
Another clue: even if the causes of Kawasaki disease are unknown, it has long been suspected that it could be “a disproportionate inflammatory reaction to a common viral infection”, according to Professor Bonnet.
Fear when reopening schools
“The new coronavirus may have the same inflammatory response as that caused by other viruses in Kawasaki disease,” adds Dr Sood. In adults, it is believed that severe forms of Covid-19 may be linked to the triggering of an overly strong immune response caused by the disease.
In all the countries concerned, specialists call for increased vigilance to better identify the causes of children hospitalised for an atypical inflammatory disease, and to determine whether or not the link with Covid-19 is proven. Whether related or not, the appearance of these cases risks raising concerns at a time when several countries are considering reopening schools after confinement.
“I think there is a benefit to children going to school, which must be weighed against the health risk,” said Professor Bonnet. According to him, “the risks of not sending children to school for many more weeks, especially in certain sections of the population, are perhaps much greater”.