YOUNGEST COVID-19 PATIENTS MOST LIKELY TO AVOID SEVERE ILLNESS, RECOVER WITH CARE
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In a comprehensive review of research studies looking at infections from SARS-CoV-2 -- the virus that causes COVID-19 -- in infants less than 3 months old, Johns Hopkins Medicine researchers found that the majority of these tiny patients experience mild to moderate cases of the disease and usually recover with supportive care.
According to the U.S. Centers for Disease Control and Prevention (CDC), children ages 0 to 4 years were the population least impacted by COVID-19 between Jan. 21 and Oct. 15, 2020, both in number of cases (98,216 or 1.7%) and deaths (34 or less than 0.1%). The counts and percentages were calculated from CDC's totals for that time span of nearly 6 million cases and greater than 155,000 deaths in the United States for which age-specific data were available.
Nonetheless, the youngest members of that group -- infants less than 3 months old -- have still-developing immune systems and frequently come in close contact with their caretakers. This makes them disproportionally vulnerable to infection with the SARS-CoV-2 virus compared with older infants and other young children.
To more accurately assess the virus' impact on very young infants, the Johns Hopkins Medicine team conducted a systemic review of reports and studies published between Nov. 1, 2019, and June 15, 2020, on laboratory-confirmed community-onset (where symptoms are first seen outside of the hospital) SARS-CoV-2 infections in children less than 3 months of age. Thirty-eight publications describing 63 infants met the criteria for being included in the study.
The researchers used data from the documents to define several variables about the youngest group infected by SARS-CoV-2, including age, exposure to COVID-19, past medical history, clinical symptoms, SARS-CoV-2 testing, laboratory findings, clinical course, and resulting outcome after hospital discharge or end of care (disposition).
Most of the infants evaluated in the study -- 58 out of 63, or 92% -- were hospitalized upon confirmation of SARS-CoV-2 infection. Along with the most common characteristic, fever (46, or 73%), the patients presented with various degrees of respiratory, gastrointestinal, cardiac and neurological symptoms. Eventually, most of the cases proved mild to moderate and improved with supportive care. Three infants were asymptomatic. Of the 63 patients, only 13 (21%) were admitted to an intensive care unit and two (3%) required invasive mechanical ventilation. No deaths were reported.
"Our results demonstrate a need for physicians to suspect SARS-CoV-2 infection in young infants presenting with generalized symptoms, such as fever or decreased desire to feed, even in the absence of respiratory problems," says Johns Hopkins Children's Center pediatrician Julia Johnson, M.D., Ph.D., associate director of clinical research in the Division of Neonatology and assistant professor of pediatrics at the Johns Hopkins University School of Medicine. "Further studies of SARS-CoV-2 infection in this special population are needed to address unanswered questions about how infants acquire the virus and what impacts it may have on their future health."
AUTOPSIED HEARTS SHOW MYOCARDITIS LINK TO COVID-19 RARER THAN PREVIOUSLY BELIEVED
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The suspected link between the SARS-CoV-2 virus -- the cause of the COVID-19 pandemic -- and myocarditis, an inflammation of the heart muscle (myocardium), made news this past August when a German research study claimed that 60 out of 100 patients who had recovered from the coronavirus showed signs of the dangerous heart condition via MRI. Shortly after that announcement, stories arose about several athletes with possible COVID-19-related myocarditis -- including major league pitcher Eduardo Rodriguez, who was sidelined for the entire 2020 season -- that appeared to support the connection.
However, following a recent review of clinical findings from 277 hearts autopsied from people in nine countries who died from COVID-19, researchers at Johns Hopkins Medicine and the Louisiana State University Health Sciences Center, New Orleans suggest otherwise, saying their evaluation provides evidence that myocarditis related to the viral disease may actually be a rare occurrence.
The data from the autopsied hearts were published in 22 papers. After careful review, the researchers determined that the rate of myocarditis found in these patients is between 1.4% and 7.2%. Earlier studies, using imaging of hearts rather than a physical examination of the organs following death, reported rates ranging between 14% and 60%.
"What we have learned is that myocarditis is not nearly as frequent in COVID-19 as has been thought," says Marc Halushka, M.D., Ph.D., professor of pathology at the Johns Hopkins University School of Medicine and one of two study authors. "This finding should be useful for our clinical colleagues when considering how to best interpret blood tests and heart radiology studies."
"By bringing the data together from this large number of autopsy cases, we have better defined the spectrum of histologic findings that can be seen in the hearts of people with COVID-19," adds co-author Richard Vander Heide, M.D., Ph.D., M.B.A., professor of pathology at the LSU Health New Orleans School of Medicine.
The researchers say that even a low myocarditis rate of 1.4% would predict hundreds of thousands of worldwide cases of myocarditis following severe COVID-19. Low rates of myocarditis, they add, do not indicate that individuals infected with SARS-CoV-2 are not having cardiovascular problems, but rather those complications are likely due to other factors such as immune responses or electrolyte imbalances.
Based on the results of their study, the researchers have created a checklist for pathologists to use when evaluating COVID-19 at autopsy to provide consistency in investigating and reporting cardiovascular pathologic findings.
"This study demonstrates the importance of the autopsy in helping us determine what is occurring in the hearts of individuals passing away due to COVID-19," says Halushka.