According to a new scientific statement from the American Heart Association that details what has been learned about how to treat, manage, and even prevent cardiovascular complications in children and young adults after COVID-19 disease or SARS-CoV-2 infection, heart complications are uncommon but treatable. The statement was published today in Circulation, the Association’s main magazine.
The most recent research also suggests that resuming to sports and strenuous physical activities once cardiac symptoms have subsided is safe, while extra screening may be recommended for kids who have more severe symptoms.
More study is also needed, particularly investigations on the long-term cardiovascular effects of COVID-19 in children and young people, according to the new statement. Children with congenital heart disease (heart disease or deformities present at birth) had low rates of infection and consequences from SARS-CoV-2, the virus that causes COVID-19 disease, according to the volunteer writing group’s extensive study. The American Heart Association’s scientific statement is an expert overview of current research that could inform future guidelines.
“Two years into the pandemic and with vast amounts of research conducted in children with COVID-19, this statement summarizes what we know so far related to COVID-19 in children,” said Chair of the statement writing group Pei-Ni Jone, M.D., FAHA, director of 3D Echocardiography, the Kawasaki Disease Clinic and Quality in Echocardiography at Children’s Hospital Colorado in Aurora, Colorado.
“We focused on the effects of this virus for those with congenital or other heart diseases, as well as the latest data about the potential association of the COVID-19 vaccines with heart complications in children and young adults. While there is a lot we know, this public health emergency needs ongoing research to understand the short- and long-term impacts on children.”
According to the most recent studies, SARS-CoV-2 infection causes modest symptoms in youngsters. Children accounted for 17.6% of total COVID-19 cases and around 0.1 percent of COVID-19 deaths in the United States as of February 24, 2022. Furthermore, young individuals aged 18 to 29 contribute for 21.3 percent of COVID-19 cases and 0.8 percent of deaths.
According to research, there are a few reasons that may explain why children are less prone to severe COVID-19 infection: 1) Children’s bodies have less receptors for attaching to the SARS-CoV-2 virus, and 2) children’s immune responses may be weaker due to a different cytokine response than adults and trained immunity from other vaccines and viral infections.
While infants with congenital cardiac disease have had low infection and mortality rates from SARS-CoV-2, having an underlying genetic condition, such as trisomy 21 (commonly known as Down syndrome), appears to be linked to a higher risk of severe COVID-19 infection.
Although there are no particular COVID-19 antiviral medications, the statement highlights available treatments for children with COVID-19. Remdesivir and dexamethasone are two examples for youngsters of varying ages.
Although much has been learned about how the virus impacts children’s and young adult’s hearts, how to best treat cardiovascular complications and prevent severe illness and continued clinical research trials are needed to better understand the long-term cardiovascular impacts. It is also important to address health disparities that have become more apparent during the pandemic. We must work to ensure all children receive equal access to vaccination and high-quality care.
Pei-Ni Jone
Remdesivir is the only antiviral drug currently approved by the United States Food and Drug Administration (FDA) for the treatment of people ages 12 and older who are hospitalized with COVID-19 and have risk factors for severe disease and the need for supplemental oxygen, and it works best when given as soon as symptoms appear. For children with more severe disease who require breathing support, dexamethasone, which has been found to lessen the risk of death in adults with COVID-19, is recommended.
Heart-related complications in children with COVID-19 are uncommon. Case reports of cardiac complications include:
- cardiogenic shock, where a suddenly weakened heart can’t pump enough blood to meet the body’s needs;
- myocarditis (inflammation of the heart muscle); pericarditis (inflammation of the pericardium, a thin, sac-like structure that surrounds the heart); and
- arrhythmias (irregular heartbeats and rhythms).
In children with severe COVID-19 that damaged the heart, sudden cardiac death and death following extensive medical and life support therapy have happened. A new multisystem inflammatory syndrome in children (MIS-C) has been detected around the world since the onset of the COVID-19 pandemic, with as many as half of the cases including inflammation of the heart muscle or heart arteries.
MIS-C was diagnosed in one out of every 3,164 children infected with SARS-CoV-2 during the first year of the pandemic. Intravenous immunoglobulin (IVIG) has been used alone or in combination with infliximab or other immunomodulatory medications to treat children who develop MIS-C.
Within 1 to 4 weeks of being diagnosed with MIS-C, the majority of children’s hearts recovered completely. MIS-C is associated with a 1.4-1.9 percent chance of long-term morbidity and death.
The bulk of MIS-C cases were among youngsters of Black or Hispanic origin, according to medical records. More research on MIS-C is needed to figure out why persons of certain racial or ethnic groups are disproportionately affected, as well as the risk factors for this disorder.
Returning to sports and intensive physical activity for children and young people who have had COVID-19 has been a focus of research and investigation. According to the most recent research, persons who had a minor COVID-19 infection or infection without symptoms are safe to return to sports once all symptoms have resolved.
Before returning to sports, it is advisable to explore some cardiovascular diagnostics, such as echocardiography, blood testing for cardiac enzyme levels, and other heart function screenings, for kids with a more serious SARS-CoV-2 infection or who develop MIS-C.
COVID-19 vaccinations can prevent patients from contracting COVID-19 and reduce the risk of MIS-C by 91% in children aged 12 to 18. Some people are worried that the mRNA COVID-19 vaccinations would cause heart inflammation. According to the findings, the benefits of vaccination outweigh the danger of developing vaccine-associated myocarditis.
For example, 11,000 COVID-19 cases, 560 hospitalizations, and 6 deaths are estimated to be prevented for every 1 million doses of the mRNA COVID-19 vaccines given to males aged 12 to 29 years (the highest risk group for vaccine-associated myocarditis), whereas 39 to 47 cases of myocarditis are expected.
The FDA has given Emergency Use Authorization for the Pfizer-BioNTech mRNA vaccine for children aged 5 and up, as well as full approval for all adults aged 16 and up.
In youngsters, viral infection is the most common cause of myocarditis. Prior to the COVID-19 pandemic, about one to two out of every 100,000 children in the United States were diagnosed with myocarditis, according to data from the US Centers for Disease Control and Prevention.
Myocarditis caused by a viral infection like COVID-19 is also more common in children than in adults. Myocarditis in children and young people is still being extensively monitored by the CDC, with a possible link to the mRNA COVID-19 vaccinations being investigated.
More study is needed to better understand the processes and best treatment options for SARS-CoV-2 infection, vaccine-associated myocarditis, COVID-19 and MIS-C long-term outcomes, and the impact of these disorders on the heart in children and young adults. Furthermore, the development of new antiviral medicines must be investigated in pediatric clinical trials.
“Although much has been learned about how the virus impacts children’s and young adult’s hearts, how to best treat cardiovascular complications and prevent severe illness and continued clinical research trials are needed to better understand the long-term cardiovascular impacts,” Jone said.
“It is also important to address health disparities that have become more apparent during the pandemic. We must work to ensure all children receive equal access to vaccination and high-quality care.”
The American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts), the Council on Hypertension, and the Council on Peripheral Vascular Disease collaborated on this scientific statement.
Scientific statements from the American Heart Association help people learn more about cardiovascular illnesses and strokes and make better health-care decisions. Scientific Statements summarize what is currently known about a subject and what areas require further investigation.
While scientific statements can drive the establishment of guidelines, they do not provide clinical advice. The American Heart Association’s official clinical practice recommendations are found in its guidelines.
