Salud
Los médicos sopesan el impacto del COVID-19 en los niños a medida que aumenta la vacuna
Un mes después de que su hijo Eran se recuperara de un caso leve de COVID-19, Sara Bittan llevó al niño de tres años a la sala de emergencias. Tenía fiebre alta, sarpullido, los ojos y la parte inferior del cuerpo estaban hinchados y enrojecidos, le dolía el estómago y lloraba de dolor.
Finalmente, diagnosticado con el raro síndrome inflamatorio multisistémico en niños (MIS-C), también conocido como síndrome inflamatorio multisistémico pediátrico, o PIMS, Eran fue hospitalizado en octubre durante una semana y se recuperó por completo, dijo Bittan.
«Es importante para mí decirles a los padres, a las madres de todo el mundo que existe un riesgo. Ellos deben saber», dijo Bittan. «Él sufrió mucho y yo sufrí con él».
Dos años después de la pandemia de COVID-19, los médicos de todo el mundo están aprendiendo más sobre cómo la enfermedad afecta a los niños.
Si bien los casos de enfermedad grave y muerte siguen siendo mucho más raros entre los pacientes pediátricos que entre los adultos, decenas de miles de niños pueden tener problemas con sus efectos. Los Centros para el Control y la Prevención de Enfermedades (CDC) de EE. UU. Citan al COVID-19 como una de las 10 principales causas de muerte entre los niños de 5 a 11 años.
Una parte muy pequeña puede sufrir graves complicaciones, como PIMS, que afecta a menos del 0,1% de los niños infectados. El «COVID prolongado», la persistencia de los síntomas semanas o meses después de la infección, afecta tanto a los niños como a los adultos.
Un número creciente de países está haciendo que las vacunas COVID-19 sean elegibles para los niños más pequeños. La Unión Europea comenzará una campaña para vacunar a niños de 5 a 11 años la próxima semana, mientras que una campaña de vacunación similar en Estados Unidos que comenzó en noviembre parece estar perdiendo impulso.
Los médicos esperan que los conocimientos adquiridos no solo mejoren el tratamiento, sino que también ayuden a los padres a comprender los riesgos del COVID-19 al considerar la posibilidad de vacunar a sus hijos.
«Long COVID y PIMS son una consideración importante para vacunarse», dijo Liat Ashkenazi-Hoffnung, quien dirige la clínica post-coronavirus en el Centro Médico Infantil Schneider de Israel.
El PIMS, que generalmente ocurre unas semanas después de la infección por coronavirus, es causado porque el sistema inmunológico se acelera repentinamente, creando inflamación en el corazón, los pulmones, los riñones, el cerebro y los órganos gastrointestinales. Los niños afectados pueden pasar hasta dos semanas en el hospital y algunos requieren cuidados intensivos.
El CDC citó cerca de 6,000 casos de PIMS en todo el país, incluidas 52 muertes. Se estima aproximadamente en 3 casos por cada 10,000 niños, según Audrey Dionne del Boston Children’s Hospital, aproximadamente en línea con algunas estadísticas europeas y con la estimación israelí de uno de cada 3,500 niños infectados y una tasa de mortalidad del 1% -2%.
El Ministerio de Salud de Singapur cita seis casos de PIMS entre más de 8.000 casos pediátricos de COVID-19.
‘MUY DESCARGADO’
Los médicos dicen que han aprendido cómo tratar mejor la afección con la mayoría de los niños en recuperación. Los estudios realizados en el Reino Unido con niños seis meses y un año después de PIMS muestran que la mayoría de los problemas se habían resuelto.
«Los niños de la segunda ola y ahora de la tercera ola (de COVID-19) se están beneficiando de la información de la primera ola», dijo Karyn Moshal, experta en enfermedades infecciosas pediátricas del Hospital Great Ormond Street de Londres.
Una evaluación de seis meses realizada por Moshal y sus colegas publicada en The Lancet encontró que el daño orgánico es poco común en los niños hospitalizados con PIMS. Los síntomas persistentes, como la fatiga mental y la debilidad física, a menudo persistieron, pero se resolvieron con el tiempo.
«Se cansan más rápido. Por lo tanto, el trabajo escolar se ve afectado porque solo pueden concentrarse durante un período de tiempo más corto», dijo Moshal. «Comprender esto es importante tanto para las familias como para los jóvenes porque pueden desanimarse mucho, y también para que las escuelas y los profesores sepan cómo afrontarlo».
Varios estudios en el Reino Unido y los EE. UU. Han encontrado que es más probable que PIMS afecte a niños negros, hispanos y asiáticos, aunque aún se desconocen las razones.
Identificar el COVID prolongado en los niños presenta un desafío mayor. Determinar su prevalencia depende de qué síntomas se examinan y de quién se recopila la información: médicos, padres o los propios niños, dijo Ashkenazi-Hoffnung.
Estimaciones cautelosas encuentran que alrededor del 1% de los niños con coronavirus sufrirán COVID durante mucho tiempo, dijo Zachi Grossman, presidente de la Asociación Pediátrica de Israel.
Ashkenazi-Hoffnung dijo que su clínica ha tratado a unos 200 niños por COVID prolongado.
Ella cree que probablemente sea sólo la «punta del iceberg» entre los niños y adolescentes previamente sanos, que meses después de haber sido infectados sufren síntomas como dificultad para respirar, fatiga, dolor de pecho, dolores de cabeza, temblores y mareos.
«Puede afectar drásticamente la calidad de vida», dijo.
Acciones simples como subir escaleras, correr para un autobús o simplemente pararse o caminar son intolerables, dijo Ashkenazi-Hoffnung. Algunos niños han desarrollado síntomas similares al asma o pérdida de audición, y algunos niños pequeños que habían estado caminando volvieron a gatear porque estaban muy cansados y doloridos.
La mayoría de los niños se recuperan con el tiempo, dijo, con la ayuda de fisioterapia y medicamentos. Alrededor del 20% todavía está luchando.
Ashkenazi-Hoffnung y Moshal notaron una carga adicional observada en los niños que sufrieron PIMS o COVID prolongado: una sensación de estigma y vergüenza.
«Me sorprendió bastante esto», dijo Moshal. «No se puede atribuir culpa o vergüenza por estar infectado con una enfermedad».
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