Coronavirus Chronicles — Hitting Kids Hard

Almost a year ago Dr. Sanjay Gupta, in the role of medical correspondent for CNN, reported on Dr. Christian Sandrock, who assesses patients at the UC Davis School of Medicine Post-COVID-19 Clinic.​ This is an extremely complicated job, because symptoms are not consistent even within the same victim. One day the toes are attacked, the next day the eyes.

This is a good opportunity to quote another expert, Dr. Eleftherios Mylonakis of Brown University who says, “The immune response can include all the organ systems in the body.” When it gets riled up about an intruder like the coronavirus,​ the defensive apparatus can also exacerbate an existing condition or create a new medical problem that will stick around indefinitely.

Many a long-term illness can be somewhat adjusted to, and the patient can become grudgingly accustomed to living with it. But not when the location of the pain and the extent of the disability change all the time! The uncertainty of long COVID is infuriating and exhausting.​

Two mutually supportive pandemics

Childhood Obesity News has been looking at the reality that not only do children get COVID, they also get Long COVID. Since the virus is attracted to body fat, it could be that obese children are at extra risk; and it is certain that kids with PASC (post-acute sequelae SARS-CoV-2 infection) are more likely to develop obesity. Like adults, kids with post-acute COVID fall victim to exercise intolerance and profound fatigue.​

In October of 2021, journalist Ryan Prior interviewed Jamie Richmond and her two teenage daughters, Veronica and Audrey, who all caught the virus, at a point in history where one out of 10 cases in the U.S. involved children — and furthermore, “it’s likely underreported because it relied on state data that is inconsistently collected.”​ Prior wrote,

Both girls now have a host of problems, including postural orthostatic tachycardia syndrome, which causes a person’s heart rate to shoot up upon standing and lead to dizziness or fainting.

This is not the ideal situation for exercising off any extra calories.

At DePaul University in Chicago, researchers have been separately interviewing adults and children afflicted by the long-haul version of the disease. The leader of the team is Professor Leonard Jason, who specializes in the study of post-viral symptoms in similar contagions. After mononucleosis, for instance, many young people go on to develop chronic fatigue syndrome. Dr. Jason is quoted as saying,

If you look at all the pandemics from the Spanish flu on down, a certain number of people never get better. At least 10% six months later seem to still be having symptoms. With Covid-19, I think the rates could be very much higher.

Amy Frentheway and her children (15,13, and 11) all had COVID-19 whose symptoms included “bone-crushing fatigue.” The mother told the reporter,

My kids have that same thing now too, with lots of brain fog. Some days they wake up and just go back to bed.

Families feel underserved and sometimes even ignored by a swamped medical system that is still looking for answers itself, and is unable to tell them if or when the horror will end. They find validation and moral support in online groups where they can share their experiences and, if not receive tangible help, at least be reassured that they are not alone in this bewildering and seemingly hopeless nightmare.

A 13-year-old basketball star Joeyanna Hodnett’s father was sick with COVID for a few weeks, while her mother tested positive but was asymptomatic. The teenager herself experienced “chest pain, muscle aches, headaches, burning skin sensations and an inability to move her arms and legs.” Then she started fainting, which is never a desirable trait in an athlete, even one who can move their limbs. After a few days in the hospital and consultations with a wide range of specialists, and despite taking 18 pills every day, the girl who used to be able to run seven miles was still unable to walk for more than 10 minutes at a time.

Your responses and feedback are welcome!

Source: “Almost a third of people with ‘mild’ Covid-19 still battle symptoms months later, study finds,” CNN.com, 02/19/21
Source: “Patients With Long Covid Face Lingering Worrisome Health Risks, Study Finds,” NYTimes.com, 04/22/21
​Source: “Kids struggle with Covid-19 and its months of aftermath,” CNN.com, 10/12/21
Image by Foxcroft Academy/CC BY 2.0

Coronavirus Chronicles — COVID-19 and Kids, Yes, It Happens 

Hot off the presses: The New York State Department of Health (NYSDOH) sent out an announcement to every official, functionary, bureaucrat, clinician, and news outlet in the state. There was recently a sharp upward trend in COVID-related pediatric hospitalizations. In other words, kids get it worse now than ever. The focus is December 5, 2021, through December 19, the week when the number of New York City children hospitalized by the virus multiplied by four. It gets worse:

• Approximately half of the admissions are less than five years of age and thus vaccine ineligible.
• For the most recent week… none of the 5-11-year-old patients was fully vaccinated (compared to 16.1% overall in that age group).

Here is what NYSDOH wants authority figures to do:

​Counsel parents that although COVID-19 is usually mild in children, there are risks of serious illness and sequelae for children, and if not isolated they can contribute to community transmission.

Unbelievably, despite the ever-mounting evidence, there are still people who will declare that children don’t catch it, or don’t develop serious cases. But they do, and they also get long-haul COVID and/or the mysteriously similar multi-system inflammatory syndrome, or MIS-C.​

An update on MIS-C

Meanwhile, discussion of MIS-C continues. Is it or is it not the same as “long COVID” in pediatric format? In 2020 Dr. Bo Stapler wrote, “MIS-C is thought to be an abnormal immune response to the novel coronavirus that often occurs after the acute infection has passed.” To some minds, it might as well be considered just a different phase of COVID. A MIS-C diagnosis…

[…] broadly includes fever, a positive test for SARS-CoV-2 or a clear exposure, elevated markers of inflammation, and evidence that multiple organ systems are affected (for example, two or more of the following symptoms: rash, swelling of the hands or feet, red eyes, blood clots, swollen lymph nodes, abdominal pain, diarrhea, seizure, or stroke).

It is taking a while for word to circulate that children can get sick and stay sick. The numbers are low enough for skeptical adults to treat the matter cavalierly, but the numbers are likely to grow. Natasha Hinde recounted the experiences of several children and their families for HuffPo:

An informal survey of parents in the group found children affected were most commonly experiencing fatigue, sore throat, gastrointestinal issues, headaches, muscle pain, and weakness months after first becoming sick…​

Young Thomas, for instance, when interviewed, had suffered for a year, with constantly swollen glands, mysterious high fevers, and pain everywhere. The writer called him “a 6-year-old in a 90-year-old’s body” and he holds the unenviable honor of being the first child diagnosed with long COVID by the Royal Manchester Children’s Hospital. ​
​
Your responses and feedback are welcome!

Source: “The Latest on the Mysterious Inflammatory Syndrome in Children,” Elemental.com
Source: ‘”‘A 6-Year-Old In A 90-Year-Old’s Body’ – The Children Devastated By Long Covid,” HuffPost
Source: “HEALTH ADVISORY: Increase in COVID-19 Pediatric Hospitalizations,” Health.NY.gov
Images by Nik Anderson/CC BY-ND 2.0

Coronavirus Chronicles — Fat Cells and Long COVID

The revelation that COVID hides in fat cells, provoking the release of inflammatory cytokines and other kinds of trouble, is causing a bit of a stir. Well-known journalist Glenn Greenwald was chastised as being irresponsible for tweeting the news, although he did mention that the study was not yet peer-reviewed. The important thing is,

What’s new from this new study is obesity’s role in long COVID due to storage in fat cells.

He is talking about a multi-author study, with most of them being from Stanford University School of Medicine. Many additional experts are acknowledged for their assistance in such areas as logistic support, data analysis, immunological assays, and other very niche fields.

A sinister association

Multisystem Inflammatory Syndrome (which affects children) is a lot like “long COVID,” or post-acute sequelae SARS-CoV-2 infection (PASC) as it is now officially known. Childhood Obesity News has mentioned before a theory associated with both — namely, that the virus can lurk undetected in body cells so it seems to be gone, but it’s not.

Now, back to the new paper under discussion which says,

[I]f adipose cells constitute a reservoir for viral infection, obesity may contribute not only to severe acute disease, but also to long-COVID syndrome.

One of our posts said,

Unfortunately, obesity appears to guarantee a pretty much perpetual state of inflammation. Adipose tissue, aka fat, causes low-grade inflammation that is a constant background in the bodies of obese people.

This is of course the exact kind of environment the virus likes to move in and take advantage of, and capitalize on.

Back to the current, 18-author paper:

In this report, we demonstrate that human adipose tissue from multiple depots is permissive to SARS-CoV-2 infection and that infection elicits an inflammatory response, including the secretion of known inflammatory mediators of severe COVID-19.

Adipose tissue, or fat, has different kinds of cells. Here are some important words:

Importantly, we demonstrated infection and inflammation in adipose tissue adjacent to critical organs such as the heart and intestine, thus pointing to the potential for adipose tissue potentiation of organ damage in severe COVID-19. Collectively, our data implies that infection in adipose tissue may partially explain the link between obesity and severe COVID-19.

It is beginning to look as if both obesity and the virus will continue to be inescapable aspects of life. Neither one of them will go away unless the other does too. It is almost like the current dilemma is payback for the decades of refusal to face up to the public health crisis of obesity and take it seriously.

Your responses and feedback are welcome!

Source: Glenn Greenwald on Twitter
Source: “SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19,'” BioRxiv.org, 10/25/21
Images by Photography Montreal/Public Domain and g4ll4is/CC BY-ND 2.0

Coronavirus Chronicles — More About Bariatric Surgery and COVID-19

A few weeks ago, correspondent Lindsay Peyton wrote for the Houston Chronicle that bariatric surgeries have increased during the pandemic because people understand the link between obesity and COVID-19, and believe that acting promptly in proceeding toward surgery will help them avoid the virus. Heather Sarten, who is director of bariatric navigation at HCA Gulf Coast Division, explains that most of the massive amount of work involved in preparing for this type of surgery can be done remotely. Consequently, she said, “As soon as we opened up and were able to do surgery again, we were jam packed.”

It has been known for some time that patients who are overweight or obese are more likely to develop severe COVID-19, and more likely to die as a result. Suspicions ultimately came closer to certainty: the virus can directly infect fat cells. In fact, it loves to go after “certain immune cells within body fat.” Then, it causes an immune response that makes everything worse. Journalist Roni Caryn Rabin clarifies,

Body fat used to be thought of as inert, a form of storage. But scientists now know that the tissue is biologically active, producing hormones and immune-system proteins that act on other cells, promoting a state of nagging low-grade inflammation even when there is no infection.

Dr. Catherine Blish said, “We’re seeing the same inflammatory cytokines that I see in the blood of the really sick patients being produced in response to infection of those tissues.” Dr. David Kass of Johns Hopkins notes that, as the inflammatory response picks up momentum, cytokines cause additional inflammation, which in turn calls for the release of more cytokines. In trying to defend itself, the body sabotages its own integrity. (The good news is, this discovery could lead to treatments that specialize in penetrating fat.)

In league with others

SARS-CoV-2 is not the first villain to hide in fat. Dr. Vishwa Deep Dixit, who teaches comparative medicine and immunology at Yale, notes that flu and HIV are both prone to conceal themselves there. Somehow, the virus seems to understand that the immune system is at a disadvantage when dealing with what, for a truly obese person, is effectively their largest bodily organ — the mass of fat.

The senior study authors, Dr. Blish and Dr. Tracey McLaughlin, point out the societal implications:

Most American adults are overweight, and 42 percent have obesity. Black, Hispanic, Native American and Alaska Native people in the U.S. have higher obesity rates than white adults and Asian Americans; they have also been disproportionately affected by the pandemic, with death rates roughly double those of white Americans.

Although this particular study had not yet been peer-reviewed, its publication struck a chord with many other researchers. An academic unrelated to the study, Dr. Philipp Scherer, paraphrased a popular Las Vegas advertising slogan — “Whatever happens in fat doesn’t stay in fat.”

At the same time, and although the pandemic has caused an increase in demand for obesity treatment in the United Arab Emirates, a childhood obesity clinic in Abu Dhabi has been telling parents that surgery is not necessarily the quick fix they envision it as. These doctors want parents to take more responsibility, and stop feeding their kids — because if they can’t handle that change of lifestyle today, they will not be successful in losing weight despite surgical intervention.

Your responses and feedback are welcome!

Source: “Here’s why bariatric surgeries have increased during the pandemic,” HoustonChronicle.com, 11/28/21
Source: “The Coronavirus Attacks Fat Tissue, Scientists Fin,” NYTimes.com, 12/14/21
Source: “UAE child obesity clinic tells parents that diet not surgery is the answer,” TheNationalNews.com, 12/18/21″
Image by Damian Zech/CC BY 2.0

Coronavirus Chronicles — Bariatric Surgery and COVID-19, Continued

Although this could change, since the beginning obesity has been the biggest predictor of COVID-19 fatality. For this and other reasons, bariatric surgery has been making it through the pandemic quite satisfactorily.

Dr. Matthew Hutter of Harvard Medical School is well aware of the close entanglement between COVID-19 and obesity, and is able to articulate how the medical profession has coped with the challenge. Since a large part of bariatric surgery is preparation and another large part is maintenance, this type of intervention is very amenable to the telehealth format. Even the pre-surgical sitdowns with the anesthesiologist and the pre-admission testing can be conducted remotely. The stay is short — “When patients come to the hospital, they are tested within 72 hours before surgery to ensure they are COVID-19 free […] and they go home the next day after surgery.”

The ability to follow patients remotely is priceless. In a way that is atypical of most disease processes, fending off obesity is a long-term proposition. With a “completely virtual option,” as long as both sides fulfill their obligations, it seems to work. Dr. Hutter speaks of the advantages of being “almost 100% telehealth”:

We have more focused discussions, and we’re able to have more frequent meetings as people don’t have to worry about things like daycare, parking or driving into Boston.

Of course, anything can be argued, but this sounds like a collection of best practices. If there must be such a thing as bariatric surgery, this is very likely how it should be done.

A paper published by a government website in February outlined why obesity worsens the virus. The weakened lungs labor extra hard just to push the excess weight around while inhaling and exhaling. Also, obesity often travels in company with type 2 diabetes, hypertension, cardiovascular disease, atherosclerosis, and even cancer. Then, there are the hypercoagulopathy and hyperinflammation often associated with obesity. COVID also promotes blood clotting, and having two different conditions that both do so is not recommended.

This work also pointed out that, on top of the usual difficulties in adhering to the program, pandemic anxiety contributes to “increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery.” In conclusion:

This study showed that the COVID-19 pandemic has impacted patients’ ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

Another angle is presented by Sage Publishing, which said in April of this year,

The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs.

While the writer acknowledges that cutting back was initially necessary, caution has to be weighed against “the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis.” In other words, do the benefits outweigh the risks?

The conclusion is,

From the patient’s perspective, postponing surgery has been deleterious and efforts to safely reintroduce bariatric programs should be promoted.

Your responses and feedback are welcome!

Source: “Bariatric Surgery in the Time of COVID-19,” MassGeneral.org 01/08/21
Source: “The impact of COVID-19 pandemic on bariatric patients’ self-management post-surgery,” NIH.gov, 02/19/21
Source: “Serious Impacts of Postponing Bariatric Surgery as a Result of the COVID-19 Pandemic: The Patient Perspective,” SagePub.com. 04/07/21
Image by Daniel Lobo/Public Domain