• The Star Staff

Why is COVID killing so many young children in Brazil? Doctors are baffled

By Ana Ionova

Fretting over a fever in her toddler that wouldn’t break, the mother took the young girl, Letícia, to a hospital. Doctors had worrisome news: It was COVID-19.

But they were reassuring, noting that children almost never develop serious symptoms, said the mother, Ariani Roque Marinheiro.

Less than two weeks later, on Feb. 27, Letícia died in the critical care unit of the hospital in Maringá, in southern Brazil, after days of labored breathing.

“It happened so quickly, and she was gone,” said Marinheiro, 33. “She was everything to me.”

COVID-19 is ravaging Brazil, and, in a disturbing new wrinkle that experts are working to understand, it appears to be killing babies and small children at an unusually high rate.

Since the start of the pandemic, 832 children 5 and under have died of the virus, according to Brazil’s health ministry. Comparable data is scarce because countries track the impact of the virus differently, but in the United States, which has a far larger population than Brazil, and a higher overall death toll from COVID-19, 139 children 4 and under have died.

And Brazil’s official number of child deaths is likely a substantial undercount, as a lack of widespread testing means many cases go undiagnosed, said Dr. Fátima Marinho, an epidemiologist at the University of São Paulo.

Marinho, who is leading a study tallying the death toll among children based on both suspected and confirmed cases, estimates that more than 2,200 children under 5 have died since the start of the pandemic, including more than 1,600 babies less than a year old.

“We are seeing a huge impact on children,” said Marinho. “It’s a number that’s absurdly high. We haven’t seen this anywhere else in the world.”

Experts in Brazil, Europe and the United States agree that the number of children’s deaths from COVID-19 in Brazil appeared to be particularly high.

“Those numbers are surprising. That’s a lot higher than what we’re seeing in the United States,” said Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics’ committee on infectious diseases, and a pediatrics infectious disease specialist at the University of Colorado Anschutz Medical Campus. “By any of the measures that we’re following here in the United States, those numbers are quite a bit higher.”

There is no evidence available on the impact of variants of the virus — which scientists say are leading to more severe cases of COVID in young, healthy adults and driving up death tolls in Brazil — on babies and children.

But experts say the variant appears to be leading to higher death rates among pregnant women. Some women with COVID are giving birth to stillborn or premature babies already infected with the virus, said Dr. André Ricardo Ribas Freitas, an epidemiologist at São Leopoldo Mandic College in Campinas, who led a recent study on the impact of the variant.

“We can already affirm that the P.1 variant is much more severe in pregnant women,” said Ribas Freitas. “And, oftentimes, if the pregnant woman has the virus, the baby might not survive or they might both die.”

Lack of timely and adequate access to health care for children once they fall ill is likely a factor in the death toll, experts said. In the United States and Europe, experts said, early treatment has been key to the recovery of children infected with the virus. In Brazil, overstretched doctors have often been late to confirm infections in children, Marinho said.

“Children are not being tested,” she said. “They get sent away, and it’s only when these children return in a really bad state that COVID-19 is suspected.”

Dr. Lara Shekerdemian, chief of critical care at Texas Children’s Hospital, said that the mortality rate for children who get COVID-19 remains very low, but children living in countries where medical care is uneven were at greater risk.

“A child that might just need a bit of oxygen today may end up on a ventilator next week if they don’t have access to the oxygen and the steroid that we give early in the disease process,” Shekerdemian said. “So what might end up as a simple hospitalization in my world can result in a child needing medical care they simply can’t get if there’s a delay in access to care.”

A study published in the Pediatric Infectious Disease Journal in January found that children in Brazil and four other countries in Latin America developed more severe forms of COVID-19 and more cases of multisystem inflammatory syndrome, a rare and extreme immune response to the virus, compared with data from China, Europe and North America.

Some of the children who have died of the virus already had health issues that made them more vulnerable. Still, Marinho estimates that they represent just over one-quarter of deaths among children under 10. That suggests that healthy children, too, seem to be at heightened risk from the virus in Brazil.

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