It is already common sense to report that the elderly and people with comorbidities inspire greater care when it comes to the new coronavirus. There is, however, another group of patients that, although not part of the risk range, are also of concern. In children and adolescents, covid-19 can evolve into the so-called Pediatric Multisystemic Inflammatory Syndrome (SMIP), which presents more serious symptoms, which can lead to death.
In Bahia, between August and October, the number of confirmed cases increased by 150%, from 14 to 35. According to data from the State Health Department of Bahia (Sesab), during this period, 53 notifications were registered for the syndrome, which can reach patients from 0 to 19 years old, 35 cases and two deaths confirmed. In this age group, 410 children and adolescents were hospitalized across the state – 46 died.
Despite representing only 8.5% of Bahian children’s hospitalizations, SIMP cases are worrisome because, according to doctors, they tend to take patients to ICUs more frequently. In Bahia, there are only 39 nursing beds and 31 ICU beds for covid pediatrics.
This Wednesday, pediatric bed occupancy reached 49% for wards and 74% for ICUs, with 19 and 23 occupied beds, respectively. The numbers ignite the Sesab alert, which guarantees that the situation is worrying. The portfolio has mainly recommended the suspension of face-to-face classes.
In Salvador, according to the monitoring of the Municipal Health Department, there are 27 ICU beds and 27 clinicians reserved for pediatrics. On Wednesday afternoon, 20 and 16 were occupied, respectively, which brings the occupancy rate to 74% in ICUs and 59% in wards. The SMS was contacted by the MAIL to tell about the actions aimed at the direct combat of Covid in children and adolescents, but did not answer the questions until the closing of this edition.
On the subject, Mayor ACM expressed concern and said he was evaluating with his team the reasons for the increase to decide what measures will be taken going forward in Salvador. “Every movement to increase cases represents an alert for the city hall. There was this movement that caught our attention and we will wait to see if the increase is momentary or if it is something permanent. But it is clear that all of this has a direct influence on conversations for returning to school, ”he declared.
In order to happen, the Pediatric Multisystemic Inflammatory Syndrome needs to be associated with a previous condition of infection with the new coronavirus. “There is an imbalance between the immune response and the inflammation of the body, it is as if that immune response was rampant. Until then, for the syndrome to occur, one of the criteria is the previous infection by covid-19 ”, explains Anne Galastri, an infectious pediatrician in the Department of Pediatric Infectology at the Bahia Society of Pediatrics.
The specialist also details that in the cases of SIMP, the patient even improves the common condition of the covid only after symptoms of the syndrome appear, such as high and persistent fever, injuries to the body, conjunctivitis, edema, which can progress to tachycardia and even inflammation of the heart or kidney issues. “In general, these are days of symptoms that worsen gradually and more generally. It is not sudden ”, explains the doctor.
Anne Galastri also calls attention, the increase in the number of cases was expected: “Notifications for this syndrome only became mandatory in August. So, the number was already expected to grow. Although the mandatory notification by the Ministry of Health took place only in August, the national portfolio has already drawn attention to the issue since May “.
On May 20, the Ministry of Health issued an alert, in partnership with the Pan American Health Organization (PAHO) and the Brazilian Society of Pediatrics (SBP), in order to draw the attention of the pediatric community to the identification of SIM-P in the country and provide guidance on the clinical management of cases.
Parents need to pay attention to symptoms
Parents of children and adolescents should be aware of changes in their children’s behavior so that they are treated quickly. Doctor Anne Galastri recommends that those responsible maintain direct contact with the pediatrician who accompanies their child and always pay attention to signs of seriousness.
“Among the symptoms for going to the hospital are difficulty in breathing, prostration, seizure, dehydration and long periods without eating or urinating”, he points out. In case of non-treatment or incorrect care, the disease can progress to death. “The patient needs to receive medications to block these inflammations throughout the body. There are treatments with immunoglobulin, anticoagulant, corticotherapy, for example. It is important that the child is seen in a hospital capable of providing necessary support for the case, with the availability of an ICU. Often, changes occur in several organs, which makes intubation necessary ”, he adds.
The syndrome was first reported in London, where health professionals noticed an increase in Kawasaki syndrome with a correlation with coronavirus infection. For the patient to enter the parameters of the new syndrome it is necessary, according to the criteria of the Ministry of Health, to be in the age group between 0 and 19 years old, and to be hospitalized with the presence of high fever, of at least 38ºC, and persistent after three days.
The child and adolescent with suspected disease still have to exhibit at least two of the following symptoms: non-purulent conjunctivitis, bilateral rash or signs of mucocutaneous inflammation; arterial hypotension or shock; myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities; evidence of coagulopathy; acute gastrointestinal manifestations, such as vomiting, diarrhea or abdominal pain.
To characterize the condition of SMIP, the existence of elevated inflammation markers must still be analyzed. The child should have a positive test for coronavirus or a history of contact with contaminants. Diagnosis of other infectious causes that cause inflammation should also be ruled out.
*With the guidance of reporting head Perla Riberio