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Covid: the enigmas of the transmission of the virus in children
The coronavirus was already present in
Italy
more than a year ago: this is shown by the analysis of the oropharyngeal test of a 4-year-old boy who went to the emergency room in
Milan
on November 30, 2019 with respiratory symptoms and vomiting that lasted more than a week.
The next day, measles-like spots appeared on his skin, but the boy suffered from another disease.
The test, observed months later, has shown that the cause of the disorders was
Covid
, more than three months before its official appearance with "patient 1" from
Codogno
,
Mattia Maestri
, on February 20, 2020. This has been done revealed a study from
Milan State University
published in the journal Emerging Infectious Diseases.
The child had not been abroad
The boy, who could therefore be considered the new Italian "patient 1", lives in Milan and did not travel abroad before falling ill.
But, according to a study by Harvard University that caused a sensation in June,
Sars-CoV-2
would have already been present in
China
between August and October last year, and therefore it is not difficult to think of unknown cases of "import" given the amount of commercial, cultural and other exchanges between Italy (Lombardy in particular) and China.
"It is, therefore, an infection that was contracted locally. Neither the child nor the parents had traveled in the previous days," says
Gian Vincenzo Zuccotti
, dean of the Faculty of Medicine of the State University of Milan and director of the Unit of Pediatrics and Pediatric Emergencies at
Hospital Vittore Buzzi
.
This is the reconstruction of the researchers: "On November 21 the child presented with a cough and rhinitis. About a week later, on November 30, he was transferred to the emergency room with respiratory symptoms and vomiting. On December 1 he developed a measles-like rash On December 5 (14 days after the onset of symptoms) an oropharyngeal smear was performed for the clinical diagnosis of suspected measles. "
Negative result.
Skin manifestations
"The clinical course of the patient is similar to what other authors have reported," the study authors continue, "maculopapular lesions are among the most observed skin manifestations during the
Covid
pandemic
and several studies have indicated a late onset in patients younger".
Analysis of the sample showed an RNA sequence 100% identical to the reference sequence of
Sars-CoV-2
(called "
Wuhan-Hu-1
"), as well as sequences from other strains that have circulated the world in later stages. .
Therefore, the researchers clarify, "it has not been possible to accurately determine the origin of the identified strain."
In the study, samples of 39 patients, aged between 8 months and 73 years, were analyzed: only the 4-year-old boy tested positive for
coronavirus
.
"The idea was to retrospectively investigate all cases of exanthematous disease identified in Milan between September 2019 and February 2020 that tested negative for measles," explains
Silvia Bianchi
, one of the study's authors.
In fact,
coronavirus
infection
can cause a
Kawasaki-
like syndrome
and skin manifestations common to other viral infections.
That the virus had been circulating for some time was conceivable and its prolonged and silent spread in northern Italy could partly explain the devastating impact of the first wave.
Subtle circulation
"The case described helps us to better understand what we saw in February," continues Zuccotti, "we find, a few days after the discovery of patient 1 diagnosed in Codogno, with overflowing hospitals, full of
Covid
patients
. The pandemic has taught us that the effects of our lack of protection are not seen immediately, but after about 4 weeks. Even at the time of the first emergency it was unthinkable that everything would have happened in a few days, that the hospitals would be saturated in that way overnight " .
That situation, argues Zuccotti, "was undoubtedly a reflection of something that had occurred in the previous months. We can imagine a subtle circulation of the virus, perhaps at first not intense enough to be detected. And now, with the discovery of this In this case, we can understand something else. Circulation would become increasingly important until it reached the most vulnerable populations. And, precisely for this reason, hospitals were quickly filled. "
Before this work came an investigation of
the National Cancer Institute of Milan
carried out in collaboration with the State, to detect the presence of antibodies in early September 2019 in blood samples among those collected from almost 1,000 people enrolled in a test of cancer screening that began in July of last year.
"The difference," Zuccotti clarifies, "is that in that case the presence of antibodies was precisely investigated, and the question arises that they might not be specific for
Sars-CoV-2
, but for other
coronaviruses
. We went looking for it. viral RNA and that is why we found the virus in the sample taken from the child ".
The spike protein of the coronavirus
The new study, coordinated by
Elisabetta Tanzi
, was carried out in the laboratory accredited by the
WHO
for the surveillance of
measles
and
rubella
.
"The RNA sequence of the
coronavirus
was observed in the test that was performed on the child at that time through a molecular biology test," explains Gian Vincenzo Zuccotti, "there was no doubt because what we have identified is the Spike protein with which the virus binds to human cells. Another study showed us that the sequence matches that of the
Wuhan
strain
. The hypothesis that
Sars-CoV-2 has been
circulating in Italy since last year is also confirmed by other analyzes, such as the found the virus in Milan's sewage, and the clinical experience of pneumonia and respiratory syndromes of unclear origin between December and January. Our research also shows the importance of epidemiological surveillance systems such as measles. Such realities, not always supported and adequately funded, they allow the retrieval of samples that are stored for a longer period of time and attempt to reconstruct the natural history of certain infections
, like this sudden appearance.
If there hadn't been a similar laboratory with their material, we wouldn't be here today. "
"A quality and sensitive virological surveillance system is an essential tool for rapidly identifying emerging pathogens and monitoring the evolution of outbreaks in a population," confirms
Antonella Amendola
, head of measles surveillance at the
MoRoNET Laboratory
.
"The results of the study provide indications on future efforts to implement for the control of infectious diseases and on the need to implement virological surveillance at the territorial level as a priority strategy for an adequate response to pandemic emergencies."
The consequences of Covid in children
Professor Zuccotti still sees children with
Covid-
related skin symptoms in
hospital
.
"They are complications that appear after the completion of the infection, when children are already negative for
Sars-CoV-2
but still have a significant production of antibodies," explains the expert, "in younger children, the classic manifestation of
Covid
is similar to that of the
Kawasaki
at the level of the blood vessels. In older children, from the age of 8, and then until adolescence there may be more severe forms with systemic inflammation and heart involvement. Some children need resuscitation, but luckily all of our little patients have recovered so far. "
What are the treatments used in children?
"First,
antibodies,
" says Zuccotti, "but if they are not enough to improve the clinical situation in 24 hours, we resort to
cortisone
, even in high doses, which is always decisive. Children develop different symptoms than adults: lung can be affected but almost never seriously, while abdominal pain is usually present which is rare, on the contrary, in the most advanced age groups ".
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