It has taken all Isaiah’s powers of imagination to escape the confines of his bed in the intensive care unit at Texas Children’s Hospital. He is battling multisystem inflammatory syndrome in children, or MIS-C, a dangerous but poorly understood illness that arose with the coronavirus pandemic last year. Fevered and weak, the Baytown resident was hospitalized earlier this month as the inflammation attacked his heart, kidneys and blood vessels.
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Hospitalizations like Isaiah’s were relatively rare throughout the COVID-19 pandemic. But as the delta tsunami recedes, it has left in its wake a troubling chain of infections among children too young to be vaccinated — and a deepening exhaustion among the health workers caring for them. The uncertainty about the coming months is adding to their fatigue, in a region where vaccination rates remain far below the levels required to stamp out community spread.
“Our resilience is not unlimited,” said Dr. Lara Shekerdemian, chief of critical care at Texas Children’s and the physician overseeing Isaiah’s treatment.
Shekerdemian and her staff are still reeling from the stress of the “surprise” summertime surge that sickened children at an alarming rate, inundating the five units devoted to intensive care at the nation’s largest pediatric hospital. Soft-spoken but formidable, with a gentle English accent, she leaned against a nurses’ station as she recalled recent months when patients waited in the hallways for an empty bed.
The hospital’s intensive care units are no longer jammed with young coronavirus patients, but MIS-C presents a new challenge, even as the virus appears to be in retreat.
Of the many mysteries of the pandemic, the rise of MIS-C — a rare but treatable syndrome that typically affects school-aged children weeks after a COVID exposure — may be the most puzzling for pediatricians. More than 5,200 American children have been diagnosed with MIS-C since it was first observed at the beginning of the pandemic; 46 have died.
“We never thought, 20 months ago, that it would be like this,” said Shekerdemian.
The future of the pandemic, and how deeply it may affect the
holiday season, depends, as ever, on the vagaries of viral mutation and human behavior. That’s according to Catherine Troisi, an infectious disease epidemiologist at UTHealth School of Public Health who studied HIV/AIDS before shifting her focus to coronavirus last year.
“Is a new variant going to arrive that is more infectious than delta?” Troisi said.
The answer, for now, appears to be no. The waning delta variant, which sickened children far more than previous strains, is still out-competing all other mutations.
More critical, she said, is whether mandates and other efforts aimed at vaccine hold-outs — some 30 percent of eligible Americans — will curb case counts before families gather at Thanksgiving and the winter holidays. Troisi is monitoring the data for signs of hope, both as an epidemiologist and as a grandmother who wants to visit her grandchildren at Christmastime.
But vaccination rates among Texas teenagers remain stubbornly below 50 percent, even as many high schoolers return to their classrooms unmasked. That may be a worrying harbinger for what is to come when vaccines are approved for kids ages 5 to 11, Troisi said, as some parents remain hesitant despite public health messaging promoting the shots.
“A lot of it is in our control as a community,” she said.
While children suffered from severe COVID infections at a far lower rate than adults early on in the pandemic, the idea that kids like Isaiah are safe from the disease crumbled with the delta wave, blindsiding pediatric health care providers with an unprecedented crush of childhood cases. The persistence of MIS-C is compounding their anxiety about the coming months.
“We got a false sense of security,” said Nicole Leathers, an ICU nurse manager at Texas Children’s. “And then we had this delta variant followed by a bunch of MIS-C and we were like, ‘Oh wait, this is completely different.’”
When Gia Gonzalez, 19, fell ill with a mild case of COVID last month, she monitored her son Isaiah for signs of sickness; he never showed any, so she didn’t worry.
Then came the phone call every mother dreads.
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She was finishing her shift at the Circle K convenience store where she works earlier this month when her mother called to say Isaiah was lethargic and running a high fever.
Gia rushed home to nurse her son through the night. He woke every few minutes to sip the diluted yellow Gatorade she put in his Spider-Man sippy cup. By morning, a vivid rash had bloomed across his eyes and cheeks. He was so weak he couldn’t move.
“It was scary,” Gia said. “He wouldn’t talk or eat.”
The listless boy in the bed bore no resemblance to the normally energetic 3-year-old Gia had raised: a shaggy-haired troublemaker who loved to jump on the bed and race around the backyard with his cousins. As Gia looked at her son, she felt fear and confusion. It had happened so fast.
Like the facial rash, the sudden onset of Isaiah’s symptoms is typical of the inflammatory syndrome, which can infect otherwise healthy children, even those who had no discernible signs of COVID. It usually begins two to three weeks after a COVID exposure.
When Isaiah became unresponsive the following afternoon, Gia called an ambulance. She packed a backpack of essentials, including the fraying Paw Patrol blanket that Isaiah carried everywhere. Paramedics transported them to the hospital, where he was admitted to the ICU.aside">
Timing was on his side.
Had he fallen ill during the summer surge, he may have had to wait for a bed. At its peak in late August, nearly 100 children were hospitalized daily with COVID in the greater Houston area. Two months later, pediatric COVID hospitalizations have dropped by two-thirds. But those numbers do not capture the steady trickle of patients like Isaiah, who are nominally negative for the virus but suffering from its cruel after-effects.
Gia had never heard of MIS-C, so the doctors explained the diagnosis. They told her it is treatable with intravenous medicines to protect her son’s heart, kidneys and other organs from lasting damage.
With braces taped to his hands to prevent the intravenous tubes from kinking, Isaiah barely slept their first night in the ICU. Mature beyond her years, with a streak of blonde in her dark hair, Gia lay awake beside him, their bodies fitting snugly in the child-sized hospital bed.
She is not the only one who has been losing sleep.
Even at a well-funded metroplitan hospital like Texas Children’s, the relentless pace and erratic trajectory of the pandemic has left staffers fatigued and overworked. Leathers, the ICU nurse manager, said the experience has broken down the hierarchy between doctors and nurses, and forced many to jettison the “brash, tough Navy Seal mentality” that used to predominate.
Leathers worked the pediatric ICU floors one recent Sunday, even though she wasn’t on duty. It was a taxing shift. One patient died, another went into cardiac arrest. Before the pandemic, she might have brushed it off. But instead, Leathers called her manager to decompress.
“I cried the whole way home,” Leathers said.
Isaiah was discharged from the ICU late Wednesday, but he is due back at the hospital in five days for an echocardiogram. The doctors must determine whether the inflammation has caused any lasting damage to his heart.
Gia hopes Isaiah recovers in time for his 4th birthday on Oct. 30. To celebrate, she is planning to take him trick-or-treating for Halloween. He will be dressed as Spider-Man.
Mother and son are looking forward to resuming their regular trips to the zoo, where they made bi-weekly visits throughout the pandemic.
It’s been a while since they’ve seen the monkeys.
Source : https://www.houstonchronicle.com/news/houston-texas/health/article/delta-covid-texas-childrens-misc-infection-kids-16552672.php1612