The lingering Long COVID - children are shrouded in horror inflammation at all times

Post-COVID conditions are a series of new, recurring, or ongoing health problems that people experience after being first infected with the virus that causes COVID-19. Most people with COVID-19 get better within days to weeks after infection, so at least 4 weeks after infection is the start of illness after COVID-19 is first detected. Anyone who is infected can experience post-COVID conditions.

It appears that COVID-19 is currently causing only general symptoms that are similar to those reported by patients with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic diseases that can occur following infection.

But what has been overlooked is that some people develop new health conditions after getting sick from COVID-19. Although accurate conclusions cannot be drawn in the short term, researchers have shown that many diseases that have appeared in the past two years are likely to belong to the long-term new crown syndrome.

The COVID-19 virus can affect and destroy the immune system in the human body for a long time. The most obvious situation is that children with low immunity are inflamed in various systems or organs around the world. In Taiwan, children with encephalitis have a rapid onset. It's something that worries parents.

Multisystem inflammatory syndrome in children (MIS-C)

"Multiple System Inflammation Syndrome" is an immune response after infection with new coronary pneumonia. Although the virus is cleared after the confirmed person recovers, there may be a rare high inflammatory reaction and multiple organ system damage, which usually occurs after the diagnosis and recovery. 2 to 6 weeks; according to foreign studies, the fatality rate is about 1% to 2%, and the age of onset is 6 to 12 years old.

MIS-C usually develops within 6 weeks of contracting COVID-19 in children and almost always requires hospitalization. Although the cause is not yet known, the body can "activate" an inflammatory response in multiple parts and systems at the same time, such as the skin, eyes, gastrointestinal tract, heart, lungs, kidneys, brain, etc., resulting in a variety of symptoms, including vomiting, Diarrhea, abdominal pain, headache, conjunctivitis, rash, swollen lymph nodes, sore throat, cough, and fever lasting more than 3 days.

Based on current observations. Children's encephalitis is likely to belong to one of the children's multisystem inflammatory syndrome.

Encephalitis in children

At present, many children in Taiwan have died of encephalitis. Since this wave of epidemics, not only has the proportion of children infected with the epidemic increased significantly, but also children have been diagnosed with encephalitis one after another, and many children with encephalitis have died. Because the new coronavirus will infect the olfactory and taste nerves, which may enter the brainstem as the nerves cause violent changes. Once the brainstem is touched, it is "difficult to rescue".

Since mid-April, in New Taipei, Keelung, Tainan and other places, there have been reports of 5 children who died of encephalitis after contracting the epidemic. This group of children between the ages of 2 and 10 has different types of encephalitis. The most common feature is that the course of the disease changes too quickly.

Judging from the figures, there are currently 29 cases of severe children in Taiwan, 15 of whom have symptoms of encephalitis. Chen Shizhong, commander of the Epidemic Prevention Command Center, admitted that this number is higher than that of neighboring countries. "It is a warning sign." Because the brain does have receptors for the new coronavirus, it is very likely that the new coronavirus, like enterovirus 71, breaks through the blood of children. The brain barrier, or through the nerve cells in the nasopharynx, directly causes damage to the brain.

To confirm which pathogenic mechanism is involved, gross autopsy is required to find evidence. Although the pathogenesis of encephalitis caused by the new coronavirus is still unknown, the bigger problem is still to come.

Even if the new coronary encephalitis recovers, there may be serious sequelae, and the protective effect of the vaccine is limited.

Although the number of children severely ill with encephalitis is decreasing, and there have been no new deaths from encephalitis in the past 10 days, the number of moderately ill children with hallucinations, behavioral changes, and atypical febrile cramps is also increasing, due to the From the experience of type 71, children who survive often also have serious sequelae.

A more complicated point is that, for the eight severe prodromal factors formulated by the command center and pediatric experts, poor consciousness, persistent lethargy, persistent vomiting, muscle jumping convulsions, etc., are similar to the prodromal symptoms of enterovirus complicated by severe disease. However, the use of drugs has been very different.

As for the treatment of new coronary encephalitis in children, the past experience with enterovirus 71 plays an extremely important role.

In the face of the enterovirus 71 offensive, intravenous human immunoglobulin (IVIG) was the most important treatment tool. Twenty-four years later, IVIG is still one of the options for the treatment of childhood encephalitis caused by the new coronavirus and the treatment of cytokine storms. However, due to the unknown pathogenesis, it is better for doctors to be more cautious in the process of drug use, and try to be more cautious when it is most likely to happen. Find a balance between the two mechanisms of the virus attacking the brain and the cytokine storm.

Drugs such as corticosteroids and monoclonal antibodies that were not available in 1998 were used when brain pressure was very high at the beginning, but some experts worry that if the virus really invades the brain directly, these drugs may cause bad effects, so The current consensus is to use one dose first, but there is no conclusion about when to use it later.

In addition, although vaccination is the most effective way, in the face of the sequelae caused by Long COVID, vaccines cannot be avoided.

Omicron has a low risk of death, but scientists are now more concerned and puzzled by the aftermath of Long COVID that lingers for months after infection. Scientists want to know whether the breakthrough infection of most vaccinated people also has long-term symptoms . A study found that the COVID-19 vaccine, while highly resistant to hospitalization and death, had little protection against Long COVID.

Vaccines were developed in the early stages of the epidemic. At that time, scientists and patients did not know that there would be long-term symptoms. Therefore, vaccines were not designed to avoid Long COVID. Now scientists know that infection with COVID-19 will have such consequences, and vaccine design needs to be re-examined.

Long-term symptoms are caused by the virus attacking the whole body and causing severe sequelae. More and more studies have shown that one of the main risk factors for Long COVID is the concentration of the virus during acute infection. So it seems like the best way is not to get the virus, but parents can do that if their child unfortunately gets infected and develops inflammation.

What can parents do when children have severe encephalitis?

Although there are still many unknowns about how the new coronavirus damages the brains of children, from the care of parents, the treatment of emergency physicians, to the process of intensive care, all have taken a good first step with high vigilance.

If parents find that their child is suspected of having severe prodromal symptoms, they can also videotape the child’s seizure, which will make it easier for doctors to understand the symptoms than text descriptions, reduce communication errors between the two parties, and improve the treatment effect.