The New York Times

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

RIO DE JANEIRO – Annoyed by her toddler’s fever, which was not going to break, the mother took the young girl Letícia to a hospital. Doctors had worrying news: it was COVID-19. But they were comforting, noting that children almost never develop serious symptoms, said mother, Ariani Roque Marinheiro. Less than two weeks later, on February 27, Letícia died after days of shortness of breath in the intensive care unit of the hospital in Maringá in southern Brazil. Sign up for The Morning Newsletter from the New York Times. “It happened so quickly and she was gone,” said Marinheiro, 33. “She was everything to me.” COVID-19 is ravaging Brazil and appears to be killing babies and toddlers at an abnormally high rate in a worrying new fold that experts are working to understand. According to the Brazilian Ministry of Health, 832 children under the age of 5 have died from the virus since the pandemic began. Comparable data is rare as countries track the effects of the virus differently. In the United States, where the population is far larger than Brazil and the overall death toll from COVID-19 is higher, 139 children under the age of 4 have died. And Brazil’s official child death toll is likely to be significantly outnumbered as many cases go undiagnosed due to a lack of widespread testing, said Dr. Fátima Marinho, epidemiologist at the University of São Paulo. Marinho, who conducts a study to determine the death toll among children based on suspected and confirmed cases, estimates that more than 2,200 children under the age of 5 have died since the pandemic began, including more than 1,600 babies under one year old. “We’re seeing a huge impact on children,” said Marinho. “It’s a number that is absurdly high. We haven’t seen this anywhere else in the world. “Experts in Brazil, Europe and the US agree that the number of child deaths from COVID-19 appeared to be particularly high in Brazil. “These numbers are surprising. That’s a lot more than in the US, ”said Dr. Sean O’Leary, vice chairman of the American Academy of Pediatrics’ Infectious Diseases Committee and an infectious disease specialist at the University of Colorado Anschutz Medical Campus. “With any of the actions we’re taking here in the US, those numbers are a lot higher.” There is no evidence of the effects of variants of the virus on babies and children that scientists say lead to more severe COVID cases and increase the death toll in Brazil in young, healthy adults. However, experts say the variant leads to higher death rates in pregnant women. Some women with COVID give birth to stillborn or premature babies who are already infected with the virus, said Dr. André Ricardo Ribas Freitas, an epidemiologist at São Leopoldo Mandic College in Campinas, who recently led a study on the effects of the variant. “We can already confirm that the P.1 variant is much more difficult in pregnant women,” said Ribas Freitas. “And often, when the pregnant woman has the virus, the baby cannot survive or both of them die.” The lack of timely and adequate access to children’s health care when they get sick is likely a factor in the death toll, experts said. In the US and Europe, experts say early treatment was key to the recovery of children infected with the virus. In Brazil, overworked doctors were often too late to confirm infections in children, Marinho said. “Children are not tested,” she said. “They are being sent away, and only when these children return in really bad shape will COVID-19 be suspected.” Dr. Lara Shekerdemian, director of intensive care medicine at Texas Children’s Hospital, said the death rate for children who receive COVID-19 remains very low, but children who live in countries where medical care is uneven are at higher risk were. “A child who may only need a little oxygen today may be put on a ventilator next week if they don’t have access to the oxygen and steroid we give at the beginning of the disease process,” Shekerdemian said. “What in my world could end up as a simple hospital stay can result in a child in need of medical care that they simply cannot get if access to care is delayed.” A study published in the Pediatric Infectious Disease Journal in January found that children in Brazil and four other Latin American countries developed more severe forms of COVID-19 and more cases of multisystem inflammatory syndrome, a rare and extreme immune response to the virus, with data from China, Europe and North America. Even before the pandemic began, millions of Brazilians living in poor areas had limited access to basic health care. In the past few months, the system has been overwhelmed as a large number of patients in intensive care units have flooded, resulting in a chronic shortage of beds. “For many there is a barrier to entry,” said Dr. Ana Luisa Pacheco, specialist in pediatric infectious diseases at the Tropical Medicine Foundation Heitor Vieira Dourado in Manaus. “For some children, it takes three or four hours by boat to get to a hospital.” The cases in children have skyrocketed amid the wider explosion of infections in Brazil, which experts attribute to President Jair Bolsonaro’s careless response to the pandemic and his government’s refusal to take firm action to promote social distancing. A backward economy has also left millions with no income or enough food, forcing many to risk infection in search of work. Some of the children who died from the virus already had health problems that made them more vulnerable. Still, Marinho estimates that they account for just over a quarter of deaths among children under 10 years of age. This suggests that healthy children in Brazil also appear to be at increased risk from the virus. Letícia Marinheiro was one such child, her mother said. A healthy baby who had just started walking, she had never been sick, said Marinheiro. Marinheiro, who fell ill with her husband Diego, 39, believes Letícia might have lived if her illness had received more urgent treatment. “I think they didn’t believe she could be so sick, they didn’t believe it could happen to a child,” said Marinheiro. She remembered asking for more tests. Four days after the child was hospitalized, the doctors had not yet fully examined Letícia’s lungs. Marinheiro is still unsure how her family got sick. She kept Letícia – a first child the couple had desperately wanted for years – at home and away from everyone. Her husband, a supplier of hair salon products, had been careful to avoid contact with customers even though he continued to work to keep the family financially alive. For Marinheiro, the sudden death of her daughter left a gaping hole in her life. As the pandemic rages on, she wishes other parents would stop underestimating the dangers of the virus Letícia took from her. In her town, she watches families throw birthday parties for children and push officials to reopen schools. “This virus is so inexplicable,” she said. “It’s like playing the lottery. And we never believe it will happen to us. It’s only when someone in your family needs it. “This article originally appeared in the New York Times. © 2021 The New York Times Company