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The New York Times

Why is COVID killing so many young children in Brazil? Doctors are baffled

RIO DE JANEIRO – Worried about a fever in her child that would not break, the mother took the young girl, Letícia, to the hospital. Doctors had disturbing news: it was COVID-19. But they were reassuring, noting that children hardly ever develop severe symptoms, said mother, Ariani Roque Marinheiro. Less than two weeks later, on February 27, Letícia died in the intensive care unit of the hospital in Maringá, southern Brazil, after days of labored breathing. Sign up for The Morning New York Times newsletter “It happened so quickly, and she was gone,” said Marinheiro, 33. “She was everything to me.” COVID-19 is ravaging Brazil, and in a disturbing new wrinkle that experts are working to understand, it appears to be killing babies and young children at an unusually high rate. Since the start of the pandemic, 832 children aged 5 and under have died from the virus, according to the Brazilian Ministry of Health. Comparable data is scarce as countries track the impact of the virus differently, but in the United States, which has a much larger population than Brazil, and a higher overall death toll from COVID-19, 139 children aged 4 years and under have died. And the official number of child deaths in Brazil is likely a substantial undercount, as a lack of widespread testing means many cases go undiagnosed, said Dr Fátima Marinho, epidemiologist at the University of São Paulo. . Marinho, who leads a study assessing the number of deaths among children based on suspected and confirmed cases, estimates that more than 2,200 children under the age of 5 have died since the start of the pandemic, including more than 1,600 babies under one year. “We are seeing a huge impact on children,” Marinho said. “That’s an absurdly high number. We haven’t seen this anywhere else in the world. Experts in Brazil, Europe and the United States agree that the number of child deaths from COVID-19 in Brazil appears to be particularly high. “These figures are surprising. It’s much higher than what we’re seeing in the United States, ”said Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics’ infectious disease committee and pediatric infectious disease specialist at the University of Pediatrics. ‘University of Colorado Anschutz. Medical campus. “According to one of the metrics we’re tracking here in the United States, those numbers are a bit higher.” There is no evidence available on the impact of variants of the virus – which scientists say lead to more severe cases of COVID in healthy young adults and increase the death toll in Brazil – on babies and children. But experts say the variant appears to lead to higher death rates in pregnant women. Some women with COVID give birth to stillborn or premature babies already infected with the virus, said Dr André Ricardo Ribas Freitas, epidemiologist at São Leopoldo Mandic College in Campinas, who conducted a recent study on the impact of the variant. “We can already state that the P.1 variant is much more severe in pregnant women,” said Ribas Freitas. “And, often, if the pregnant woman is infected with the virus, the baby may not survive or both may die.” Lack of timely and adequate access to health care for children once they fall ill is likely a factor in the death toll, experts said. In the United States and Europe, experts said, early treatment has been key to the recovery of children infected with the virus. In Brazil, overworked doctors have often been late to confirm infections in children, Marinho said. “Children are not tested,” she said. “They are sent back, and it is only when these children come back in a very bad condition that COVID-19 is suspected.” Dr. Lara Shekerdemian, head of intensive care at Texas Children’s Hospital, said the death rate of children who contract COVID-19 remains very low, but children living in countries with uneven medical care are at higher risk. great risk. “A child who might just need a little oxygen today may end up on a ventilator next week if he or she does not have access to the oxygen and steroids we give early in the process. disease, ”Shekerdemian said. “So what could end up being a simple hospitalization in my world can cause a child to need medical care that they just can’t get if there is a delay in accessing care. A study published in the Pediatric Infectious Disease Journal in January found that children in Brazil and four other Latin American countries have developed more severe forms of COVID-19 and more cases of multisystem inflammatory syndrome, a rare immune response and extreme to the virus, compared with data from China, Europe and North America. Even before the start of the pandemic, millions of Brazilians living in poor areas had limited access to basic health care. In recent months, the system has been overwhelmed as large numbers of patients have flocked to intensive care units, resulting in a chronic shortage of beds. “There is a barrier to access for many,” said Dr Ana Luisa Pacheco, pediatric infectious disease specialist at the Heitor Vieira Dourado Tropical Medicine Foundation in Manaus. “For some children, it takes three or four hours by boat to get to the hospital.” Childhood cases have increased amid the larger explosion of infections in Brazil, which experts attribute to President Jair Bolsonaro’s cavalier response to the pandemic and his government’s refusal to take vigorous action to promote the disease. social distancing. A lagging economy has also left millions of people without sufficient income and food, forcing many to risk infection as they seek work. Some of the children who died from the virus already had health problems that made them more vulnerable. Still, Marinho estimates they account for just over a quarter of deaths in children under 10. This suggests that healthy children also appear to be at increased risk for the virus in Brazil. Letícia Marinheiro was one of those children, his mother said. A healthy baby who had just started walking, she had never been sick before, Marinheiro said. Marinheiro, who fell ill with her husband Diego, 39, believes Letícia could have lived if her illness had been treated more urgently. “I think they didn’t believe she could be so sick, they didn’t believe it could happen to a child,” Marinheiro said. She remembers pleading for more tests to be done. Four days after the child’s hospitalization began, she said, doctors still had not fully examined Letícia’s lungs. Marinheiro still does not know how his family got sick. She had kept Letícia – a much-needed first child for years – at home and away from everyone else. Her husband, a supplier of barber shop products, had been careful to avoid contact with customers, even as he continued to work to keep the family afloat. For Marinheiro, the sudden death of his daughter left a gaping hole in his life. As the pandemic rages on, she says, she wants other parents to stop underestimating the dangers of the virus that has kept Letícia away from her. In her city, she watches families organize birthdays for children and the authorities push to reopen schools. “This virus is so inexplicable,” she said. “It’s like playing the lottery. And we never believe that will happen to us. It’s only when it takes someone from your family. This article originally appeared in The New York Times. © 2021 The New York Times Company


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