
Post-Covid heart damage in some children: study - claudeganon
https://news.uthscsa.edu/post-covid-syndrome-severely-damages-childrens-hearts-immense-inflammation-causing-cardiac-blood-vessel-dilation/
======
GhostVII
_The team reviewed 662 MIS-C cases reported worldwide between Jan. 1 and July
25_

So does that mean there are only a total of 662 cases reported worldwide?
Because if so, this doesn't seem to be a significant issue.

Edit: yes, it seems like there are only a few hundred cases in the US [0], not
a significant risk. I've seen this article in a few places and everyone seems
to interpret it as saying a significant portion of children have a damaged
heart after COVID, which just isn't true. Not a problem with the article, just
peoples critical thinking skills.

[0] [https://www.cdc.gov/coronavirus/2019-ncov/covid-
data/infogra...](https://www.cdc.gov/coronavirus/2019-ncov/covid-
data/infographic-mis-c.html)

~~~
stefan_
I don't think anyone is systematically screening positive COVID cases for this
kind of damage. The 662 is the severely affected ones that end up in the ICU,
but how many others have inflammatory damage?

~~~
altcognito
Correct, 15% of athletes who shows some or no symptoms ended up with
myocarditis:

[https://www.nytimes.com/2020/08/23/sports/ncaafootball/colle...](https://www.nytimes.com/2020/08/23/sports/ncaafootball/college-
football-myocarditis-coronavirus.html)

If we screened kids who merely tested positive and found 15% had serious
longer term reprecussions, how would this change opinion surrounding policy?

~~~
PragmaticPulp
Careful, Myocarditis isn’t necessarily indicative of long-term heart damage.
Mild myocarditis is not uncommon with any viral infection.

Myocarditis should be watched for, but it’s critically important that we
discuss severity and relative occurrence rather than reducing the discussion
to a binary yes/no.

Sadly, whenever you see a news article that omits specific statistics it’s
prudent to check the facts. It’s easy to drive clicks by removing critical
details to make side effects sound more permanent or more common than they
are.

~~~
adrr
Is it common for Athletes to have to sit out the year because they caught the
flu? Flu is so pervasive.

------
glofish
This is one of those titles that pull on the heartstrings ... "oh think of the
children" then it turns out it is a complication that affects a vanishingly
small segment of the population.

Then we use the fear to impose rules that severely affect 100% of the
children: for example not letting people go outside or go to school.

All part of the relentless propaganda of scaremongering where the weak want
everyone to be equally afraid.

~~~
rorykoehler
I don't understand this attitude. It's not about fear it's about precaution.
Why does everything have to be so extreme?

~~~
just-juan-post
If it's truly about precaution and the greater safety of others then you would
agree that we should ban alcohol.

~~~
rorykoehler
No. Alcohol doesn't possess viral properties.

~~~
username90
Your freedom to buy alcohol results in kids getting beaten and killed by their
alcoholic parents. Are you really so selfish that you think beer is more
important than kids?

/s

See, the argument is the same.

~~~
rorykoehler
I don't know if you're being serious or not with your final sentence (the
positioning of the /s is throwing me off) but for the people who don't get it
there has never been an alcoholic beating or drunk driver that resulted in
millions of innocent people dying around the world in such a short period time
with millions more suffering from potential long term health problems.

------
beagle3
When I checked before, it seemed that Kawasaki incidence dropped to 0, and
MIS-C cases had the expected prevalence of Kawasaki - meaning that basically,
it was a change in classification and not a new disease (and not necessarily a
new condition).

But I haven’t been keeping track recently.

~~~
pbhjpbhj
So you consider their differential diagnosis to be wrong. They clearly
considered Kawasaki as a comparison too.

Could you indicate your source and credentials?

Is Kawasaki syndrome already considered a post-viral problem?

Are you saying these children had Kawasaki already, or that Covid19 infection
causes Kawasaki?

~~~
beagle3
As I mentioned, I'm no longer keeping track; last I checked was in early May,
and at the time the disease was not yet called MIS-C. My sources were google
searches.

My credentials are in math and engineering, not medicine.

However, due to unfortunate personal and family issues, I've read tens of
medical papers and found statistical errors in many, maybe most of them -- I
have literally saved at least one person from a life of misery based on
finding these errors (and got apologies from department heads in two of the
world's 10 top hospitals)

I don't know if Kawasaki is considered a post viral problem - either
officially or unofficially. I did not look at the disease mechanics, only at
disease prevalence. Symptoms are close enough (and the disease having a
clinical description, NO direct biomarkers) that mis-identification is a real
problem and known issue with these kinds of rare diseases.

The disease I'm very familiar with, unfortunately, shares a lot with kawasaki
- including in how often it is misidentified as some benign condition. It was
considered, though never proved, a post-viral autoimmune disease for years --
and likely still is by many doctors -- even though the "post viral" aspect is
overwhelmingly a secondary aspect (something has to trigger the immune system,
it's sometimes a viral episode, sometimes a vaccine, sometimes spontaneously)

> They clearly considered Kawasaki as a comparison too.

Kawasaki is a clinically identified disease, as is MIS-C. There's no specific
biomarker to say "this is one and not the other". Right now, everything
COVID-19 is shiny and well funded, whereas older things are not.

> Is Kawasaki syndrome already considered a post-viral problem?

As of a few months ago, at least half of the MIS-C cases were, to the best of
everyone's knowledge, unrelated to COVID-19. see e.g.
[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)31129-6/fulltext)
which summarizes the state-of-the-art of knowledge as of May (The lancet is
written in a confusing way, but
[https://www.dicardiology.com/article/kawasaki-
inflammatory-d...](https://www.dicardiology.com/article/kawasaki-inflammatory-
disease-affects-children-covid-19) is more clear - the relation to COVID-19 is
not clear cut)

Here's a similar point: Last I checked, a few weeks ago, death from the flu
all over the world has gone to zero, though in european countries and most of
the US since June, death is as expected (statistically indistinguishable from
expected rate of death). Flu death has gone to zero; COVID death exists when
non did before. What's more likely - that FLU disappeared overnight but COVID
has exactly the same rate of death? Or that both COVID and flu take a toll on
the weaker and immune suppresed population (whose size didn't really change),
but that the deaths are all attributed to COVID even though part (perhaps a
third or half) as attributable to the flu? See e.g.
[https://www.nytimes.com/interactive/2020/04/21/world/coronav...](https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-
missing-deaths.html) \- despite the April time, it IS up-to-date as of 22-aug,
and you can definitely see the COVID death toll in europe on Mar-Jun -- but
not anymore.

> Are you saying these children had Kawasaki already, or that Covid19
> infection causes Kawasaki?

It is my belief based on knowledge of diseases OTHER than Kawasaki was that
the predisposition was there, just waiting for the trigger, and would likely
have erupted sooner or later, because of a flu, another virus, or some vaccine
-- autoimmune diseases are often triggered when the immune system goes into
high gear but them something goes wrong and they start attacking the body
instead.

I am not saying they had Kawasaki already -- they obviously did not, because
-- by definition -- Kawasaki is a set of symptoms (they did not have).
However, I'm hypothesizing that everything was ready for Kawasaki, and
something just caused it to erupt. It's also possible that COVID-19 was that
trigger, and that it causes a slightly different disease progression than
"standard" Kawasaki, although there's no such thing either- these diseases are
never textbook cases of "These 10 symptoms == kawasaki", but rather "If we
have more than 4 out of this list of 14 then we will label it Kawasaki unless
we have a better explanation".

I am being vague with specific details of the diseases I am familiar with, so
as not to out myself - it's rare enough that everyone involved knows everyone
else on a first name basis. (Though as far as anyone's concerned, I might as
well be a dog on the internet)

------
sradman
The paper _Multisystem inflammatory syndrome in children: A systematic review_
[1]:

> The literature reports that MIS-C typically manifests 3-4 weeks after SARS-
> CoV-2 infection. This may explain why many children had positive antibodies
> to SARS- CoV-2, but negative RT-PCR at the time of MIS-C evaluation.

> While children with COVID-19 present with upper respiratory symptoms, MIS-C
> is distinguishable by fever (100%), vomiting (68.2%), and abdominal
> pain/diarrhea (73.8%). The abdominal pain in MIS-C can be so severe that in
> several cases patients were presumed to have appendicitis.

Young children seem to be protected from lower respiratory manifestations of
COVID-19. My reading of this meta-analysis is that MIS-C is primarily a
gastrointestinal manifestation of COVID-19 that has progressed to vascular and
other tissues that express ACE2 receptors.

Perhaps we are placing too much emphasis on nasopharyngeal swab PCR tests and
should consider anal swabs for children with gastrointestinal symptoms.

[1]
[https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30271-6/fulltext)

------
aaron695
Or

We are talking about the human body a lot more now the media can make a
headline.

 _If_ this is from C19 one imagines many other things we don't care about kids
getting also can do it.

------
irq11
The title should be changed to reflect the fact that this is an _incredibly
rare_ complication. As of late July, only 570 MIS patients total had been
reported in the US, per the CDC:

[https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6932e2-H.pdf](https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6932e2-H.pdf)

~~~
bdcravens
It's a title, not a summary or a value judgment. The conclusions are in the
article.

~~~
irq11
It is a hacker news rule that titles cannot be clickbait or inflammatory.

This title unquestionably is missing critical context, and arguably crosses
the line into clickbait.

~~~
dang
Ok, we've edited the title to try to make it more accurate and neutral.

------
codethief
Don't want to play this down or anything but:

> Another finding from the case studies: Almost half of patients who had MIS-C
> had an underlying medical condition, and of those, half of the individuals
> were obese or overweight.

~~~
wnevets
>were obese or overweight.

Like 60% of America is obese or overweight, that is way over 200 Million
Americans [1]. I don't understand why people try to use this to downplay (I'm
not saying you are) COVID.

[1][https://www.healthline.com/health/obesity-
facts#1](https://www.healthline.com/health/obesity-facts#1)

~~~
oreaway
People downplay it because even when presented with these stats, they picture
"overweight/obese" as a stereotypical "fat person" wearing size 55 pants and
using a scooter to get around the grocery store. And they think "well _I 'm_
not fat, so I don't have anything to worry about."

In reality, a significant portion of the people reading this comment probably
are "overweight" without even realizing it. "Overweight" is classified by your
BMI, and the threshold for "overweight" is much lower than most expect.

If you are 5'6" and weigh 155 lbs, you are medically overweight. That's
someone who wears size 31 pants and size small t-shirts. Not even close to
your stereotypical "fat" person, but according to the statistics: overweight.

edit to clarify: I intentionally put "overweight" in quotes to indicate that I
am using the medical definition of "overweight", and I am _not_ saying that
someone who is 5'6" and 155 lbs is unhealthy, fat, or needs to lose weight.
Someone who is 5'6" and 155 lbs is, IMO, on the fitter side of the spectrum,
but according to the statistics, still "overweight".

~~~
graeme
Edit: I read OP’s argument the wrong way. So my comment below is based on a
misapprehension.

———-

This is foolish. BMI is used to estimate population averages. But waist
measure is vastly better. Someone with a waist of 31 at 5’6” actually has
close to ideal portions, if you’re talking about a man. (For women you need
the hip measure too).

That’s a waist to height ratio of about .47. A person with that waist probably
has a high muscle mass + low body fat.

Now, if the same person was 155, 5’6” and had a 34 inch waist, they are almost
certainly overweight.

[https://trustyspotter.com/blog/perfect-male-body-
measurement...](https://trustyspotter.com/blog/perfect-male-body-
measurements/)
[https://www.omnicalculator.com/health/Waist_Height](https://www.omnicalculator.com/health/Waist_Height)

Both people will show up as “overweight” in population averages, which isn’t
an issue as edge cases balance out over the whole population. But you’re
talking as though such a person with a 31 inch waist should actually lose
weight.

~~~
oreaway
>But you’re talking as though such a person with a 31 inch waist should
actually lose weight.

No, I'm not. I never said such a thing and I have no idea why you're building
such a strawman.

Waist measure has nothing to do with this story. This story is about COVID-19
comorbidities, of which being overweight (which is medically measured using
BMI, not waist measures) is one. BMI is all that matters in this context.

If you are 5'6" and 155 lbs, _you are classified as overweight and thus are
considered a high-risk person for COVID-19_. That has nothing to do with "you
should/should not lose weight".

And the broader point is this: if you see any stats saying "most COVID-19
deaths were overweight people", you shouldn't feel any sense of "safety"
because you think "well _I 'm_ not overweight, I wear size small!", because
there's a good chance that a lot of those COVID deaths wore smalls, too.

~~~
graeme
> If you are 5'6" and 155 lbs, you are classified as overweight and thus are a
> high-risk person for COVID-19. That has nothing to do with "you
> should/should not lose weight".

This is absolutely false. It is the adiposity that raises risk. High muscle
mass is not a risk factor. You’re got an erratic view of what we mean by
overweight: we mean excessively adipose.

I took it as implied that you thought overweight people should lose weight for
health reasons, but that isn’t the central point.

BMI approximates population averages and is useful as such, but for an
individual the correct question to ask is whether they are excessively
adipose. Someone at 5’6” with a 31 inch waist and a weight of 155 is almost
certainly not excessively adipose.

~~~
oreaway
You're completely missing the point. These studies don't give a damn about
your adipose, or how much weight you need to lose. These studies are about
whether or not you are classified as overwight, _which is based solely on BMI,
and nothing else_.

Someone 5'6" and 155 lbs is overweight and thus is considered a high risk
COVID individual, regardless of their waist size. If that person were to die
of COVID, they would be reported as "had high-risk underlying health
conditions".

That's what we're talking about in this context. Everything else you are
talking about is completely irrelevant.

Responding to your above edit (which you now have removed):

>I agree many people underestimate their own adiposity, but the given example
of 31 inch waist at 5’6” and 155 pounds indicates a trim, fit person.

This statement just highlights the entire point. You think it means "trim, fit
person", as do most others. _But the medical definitions do not agree with
you_. According to the medical definition, that person is overweight. That's
the bottom line.

~~~
graeme
Ah I misread OP as saying people downplay obesity and don’t consider
themselves fat. I took you to be giving an example of someone who thought they
were not fat but were in fact fat.

Rereading OP’s comment I see they’re instead talking about people downplaying
covid because they think it only affects people who are morbidly obese. My
mistake.

Though, I suspect probably at least 80% of the people in the overweight/obese
category legitimately have too much fat. Especially in america. Compared to
the rest of the oecd, america has a much larger portion of “morbidly obese”
within the obese category.

BMI does also underestimate obesity in some. On average it’s a reasonable
definition of overweight/obese. The example you gave is an edge case, but the
studies concern themselves with averages.

~~~
oreaway
I understand what you're saying and I see the confusion. To be more clear, I
agree with you and BMI is a terrible measure of "overweight"/"obesity".

As someone who is 5'7" and 160 pounds, I'm considered "overweight", but if you
saw me in person I'm almost certain you wouldn't think of me that way because
I look quite fit. In reality, I have a decent amount of muscle mass from being
physically active, but the BMI measure doesn't take into consideration muscle
vs fat, and thus I am technically "overweight".

My point was not that everyone who is technically "overweight" is "fat" or
"unhealthy", but rather that the COVID-19 reporting statistics that use those
words are also using that "terrible measure" of BMI, and according to BMI,
even typically-seen-as-healthy people fall under that "high risk" category,
and people should be aware of that rather than assuming they are safe from
COVID just because they are "fit".

~~~
graeme
I think you may be going a little far with this still though. Overweight is a
risk factor, and someone who is overadipose absolutely is at higher risk.

For yourself, you would make the sensible adjustment of “well I’m not
overadipose and therefore do not have higher risk from that factor”. That
doesn’t mean you’d have no effects, it merely means you lack one risk factor.

But overadiposity absolutely is a risk factor and those in that group should
be even more careful: the more overadipose, the more so.

BMI is used that way for studies because it’s a useful measure over groups.
The exceptions run both ways and balance out. It just shouldn’t be applied
blindly to individuals.

