At Least Four Coronavirus Cases in Israel Show Youths Suffering From Heart Problems

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An Israeli child undergoing a coronavirus test with a swab.
An Israeli child undergoing a coronavirus test with a swab.Credit: Emil Salman

At least four children and teens who became infected with COVID-19 in Israel have also developed heart problems, raising questions about a possible connection between the medical conditions.

Another teenager hospitalized at Hadassah University Hospital in Jerusalem, who suffers from a myocardium infection, has been tested for the coronavirus but is still awaiting results.

A discussion of the issue is expected Thursday at the Health Ministry.

In one case, Hadas Biton, 11, from Elad in central Israel, was diagnosed with the coronavirus in early April. As with most children, her illness was very mild. Last week, when she was in isolation with her family in the Kinar Hotel, on Lake Kinneret in northern Israel, she developed high fever, stomach pains and lost her appetite. She was taken to Poriya Hospital in Tiberias, where her condition worsened and tests showed a possible myocardium infection.

The next day she was taken to Rambam Medical Center in Haifa, where she was diagnosed with perimyocarditis, an acute infection of the pericardium and myocardium. She was sedated, put on a respirator in the intensive care unit, and her new coronavirus tests were negative. Her condition has stabilized and she is now breathing on her own.

In another case, a 16-year-old boy arrived at Rambam and was diagnosed with a myocardium infection and general system failure. He was given six different coronavirus tests and only one was borderline positive. He is currently in serious condition, sedated and on a ventilator, and will be retested twice on Thursday.

These two cases come after at least two other cases of teens hospitalized with COVID-19 and heart problems. One was at Shaare Zedek Medical Center in Jerusalem, when a 17-year-old came to the hospital at the start of the pandemic complaining of severe chest pains. He turned out to have the coronavirus. He was diagnosed with myocarditis, was admitted to intensive care, but improved quickly and was released.

There was another case at Ha’emek Hospital in Afula, where a 15-year-old boy who was diagnosed earlier this month with COVID-19 complained of severe chest pains and difficulty breathing, but was released when his symptoms passed. After three weeks, and after two negative coronavirus tests, meaning he is considered recovered, he arrived at the hospital with severe back pains. He was found to have perimyocarditis. His condition improved, however, and he has been released.

Another 15-year-old boy with myocarditis is hospitalized at Hadassah. His repeated coronavirus testing comes up negative, but the doctors are not dismissing the possibility that he had been ill but asymptomatic at an earlier stage. To determine whether he had been exposed to the coronavirus or some other viral infection he will undergo testing for antibodies. Hadassah hospital said it is prepared to do antibody testing on teenagers in other hospitals to determine whether they have or had the coronavirus despite their negative swab tests.

These four cases are very reminiscent of reports from Britain of more than a dozen children who tested positive for the coronavirus and then came down with serious systemic inflammation, including heart problems. Some had to be hospitalized in intensive care units, while one was connected to a heart-lung machine after a regular ventilator proved not to be sufficient.

The symptoms observed in children included respiratory difficulties and fever but also gastrointestinal problems like stomach aches, vomiting and diarrhea, as well as heart infections. The UK National Health Service warned doctors of “a growing concern” about the development of inflammatory syndromes connected to the coronavirus among British children, or that there could be a secondary infection in these cases that has yet to be identified. Doctors were urged to refer children showing such symptoms to hospitals.

The heads of Israel’s pediatric departments are being told to pay attention to and report such symptoms. According to Prof. Yechiel Schlesinger, a pediatric and infectious disease specialist and director of Shaare Zedek’s Children’s Hospital, in recent days, “there are a lot of discussions in professional groups based on the reports from London. There’s a feeling that after the coronavirus, generally two to three weeks afterward, there develops a syndrome that hasn’t been totally defined, a process of a very severe multisystemic inflammation. In is reminiscent of Kawasaki disease, which expresses itself as virulent inflammation that could be dangerous.”

Schlesinger notes, however, that, “One must look at the Israeli cases very critically, and in at least some of the cases ask if the teenager has even contracted the coronavirus. It isn’t certain that some of the children even had the coronavirus.”

He did add, though, that “With the coronavirus it turns out, to date mainly in adults, that in many cases the myocardium is involved. In the cases that are now at Rambam the doctors are describing very significant disease in the myocardium.”

To sum up, he said, “We really haven’t finished studying the coronavirus and its influence. It’s clear to us that the coronavirus is involved with the myocardium, that the coronavirus touches on the [blood] clotting mechanism, and that there is something that is apparently a fulminant, multisystem inflammatory process that comes a certain period after the start of the illness and that is also expressed in children. It’s possible that it’s a post-infection reaction to the coronavirus.”

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