Coronavirus Update 12 Children Centric Data
June 22, 2020
Latest numbers show that on balance COVID19 incidence and death is a mixed bag nationally with some areas showing significant increases in cases. This is not a surprise as the reopening of the local economies has increased close human interaction. This is likely to be an infectious disease that keeps us frustrated for another year or more until a vaccine is found
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
Before we look at the childhood data, let us look at the IFR or infection fatality rate. From a new Nature article, the most recent analysis of the data shows that the IFR for all humans exposed is probably 0.6% or 6 individuals deceased per 1000 infected which is 6x more deadly then seasonal influenza. However, this IFR is heavily skewed toward those over 65 and those with metabolic disease comorbidity. Separating out these higher risk individuals, leads to an IFR of 5.6% or 56 deaths per 1000 making the IFR for all others much less than 0.6% overall. (Mallapaty et. al. 2020) Thus, early predictions that SARS2 for most humans is a disease that will not kill 99+% of Americans remains true. That is a very reassuring statistic and should help everyone reduce fear and instead steadfastly focus our efforts on self care and risk prevention.
Dispassionate analysis: We are currently at 116,862 deaths from COVID this year. That is a large number for an infectious disease. However, let us put it into perspective with deaths from other issues. Roughly 647,457 Americans die annually from cardiovascular disease, 599,108 cancers deaths, 169,936 accidents and 160,201 respiratory deaths. Much of the human disease and death burden is related to poor lifestyle choices that put us at risk for death with advancing age. You can quibble over accidents and cancer as each has a non lifestyle component as well. Thus, if you really look at life in general, living long and healthy is directly related to daily choices of nutrition, movement, safety, stress reduction, sleep and chemical avoidance. This is the pivotal place at which our energy and resources should go on a day to day basis. Let us stop fooling ourselves into complacency that medicine and or the government is the pathway to health. Both are useful and necessary when called upon as is being shown now with COVID, however, I would recommend not needing either by focusing on your personal health and that of your children daily. As a provider of medicine, I long for the day where prevention is the paramount discussion and not treatment post damage.
Children continue to avoid significant negative outcomes, defined as death, in almost all cases. Less than 2% of all children infected with the SARS2 virus will go on to be admitted to an intensive care unit. Therefore, death is likely to continue to be very, very rare for children unless there is a viral mutation that alters this pattern.
Children are not developing antibodies frequently despite presumed exposure. "In the context of all evidence to date, young children appear to be less infected than adults, as well as being at lower risk for severe outcomes if infected." (Stringhini et. al. 2020) This is likely due to differences in ACE2 receptors and serum ACE2 levels. See below.
Multi inflammatory syndrome, a Kawasaki's like disease, as discussed in previous newsletters appears to be very treatable. Dr. Capone and colleagues have noted that this version of inflammatory disease was highly treatable and not associated with any deaths in their cohort. They noted that the patients were treated with intravenous immune globulin, aspirin, steroids and in some cases biological medicines. The therapies provided rapid recovery in most cases with the key point being that no deaths occurred.. They had a median length of stay of 4 days only. Many were noted to have liver, heart and kidney involvement during the hospitalization, however, these issues resolved by discharge. (Capone et. al. 2020)
ACE2, angiotensin converting enzyme 2, is noted to be in higher volumes in the serum of children and women than men and has been shown to reduce the risk of acute respiratory distress and death in infected COVID patients. (Ciaglia et. al. 2020) The ACE2 molecule has the ability to bind the SARS2 virus in the blood stream thus neutralizing its ability to bind to the ACE2 receptor, invade the type 2 pneumocyte and replicate itself. (Monteil et. al. 2020) This is a huge deal for the prevention of death which is truly the major issue that medicine is focusing on. Finding ways to increase ACE2 serum levels may be a future therapeutic strategy.
Survival for all continues in my mind to be predicated on self care and relative risk reduction. Please do not think that avoidance is the only and or best way to survive. Following the CDC recommendations for avoidance has significant value for reducing spikes of disease nationally and locally. However, we need to prepare for the inevitable time when we get exposed, develop symptoms and work to recover from illness as this is very likely to happen. Most experts agree that we are living in a new world where SARS2 exists.
Knowledge is power,
CDC Death Statistics
Mallapaty Nature Article
CDC MMWR Article
Capone J Pediatrics Article
Monteil Cell Article
Bourgonje J Pathology Article
Verdecchia European J of Internal Medicine Article
Ciaglia Frontiers in Pediatrics Article
Hirano Cell Article
Stringhini Lancet Article