Doctor: COVID-19 can cause leukemia and diabetes. There are more and more such patients in the wards

A hypothesis has emerged that SARS-CoV-2 may induce and accelerate the occurrence of diseases to which we are genetically predisposed. In our hospital we are seeing an increase in patients with newly diagnosed leukemias and diabetes – says Monika Wanke-Rytt, MD, PhD, deputy head of the Department of Infectious Diseases and Paediatrics at the University Clinical Center of the Medical University of Warsaw.

1. A significant proportion of patients are referred to hospital too late. Both parents and primary care physicians fail to catch the first symptoms of type 1 diabetes early enough, explains Wanke-Rytt
2. When asked about a comorbid disease that is most life-threatening in the case of coronavirus infection, she replies: obesity in children
3. There are patients, children aged 12-14, whose weight varies between ninety and one hundred kilograms – he explains
4. As she adds, an obese patient has a breathing problem. His chest is under tremendous pressure from fat
5. More information can be found on the Onet homepage

Is the manner in which your hospital works very different from the one you operated in before the pandemic?

Dr. Monika Wanke-Rytt: Our hospital is a clinical facility, we have very specialized clinics – incl. endocrinological, nephrological, gastrological, diabetic, and most of them are centers for patients who are chronically ill or only diagnosed with rare diseases. Often these patients have nowhere to be treated, apart from our facility, not only in Mazovia, but also in the vicinity. So, if we have limited capacity to receive these patients who require exceptional care, and we have because we had to convert some of the wards into covid ones, they don’t get help, just. The waiting time for some scheduled hospitalizations has increased significantly. The previous year was particularly difficult, for several weeks the planned diagnostics was completely suspended, in fact, we only recently kicked out of this backlog. Nevertheless, we still have an influx of new patients. So the creation of covid wards, which were not supposed to be, but still have to be, is at the expense of general pediatrics and at the expense of specialist places.

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PAP: Which units did you have to transform into covid ones?

MW-R .: First of all, the one that was intended for this purpose, i.e. the infectious one, and the entire pediatric ward, where mainly acute children are admitted, now these patients have to be admitted to other wards. Speaking of acute modes, I mean those patients who have RSV (affected airways) or norovirus (diarrhea and vomiting) infections. We also have an intensive care unit, which has just been half converted into a covid unit, which means that we have fewer intensive care places for other patients in our hospital. And this poses a real threat to the continuity of this department’s work, although the anesthesiology team does two and three steps to cover all the places, both covid and non-covid, but in such times as we have, in the absence of anesthesiology doctors and nurses, it is extremely difficult .

PAP: Are there any patients in the NICU covid now?

MW-R: Yes. Now we have one, although this is changing – we have recently had from one to three cases diagnosed with severe COVID-19. When one comes out, the next comes.

PAP: How old are these children?

MW-R .: Usually patients over 12 years of age go to intensive therapy. From infants, we have only recently had one case – co-infection with SARS-CoV-2 and RSV. At the very beginning of the pandemic, a several-week-old patient was hospitalized, who developed neurological disorders in the course of COVID, which resulted in death. Most likely, the patient had comorbidities.

PAP: What is the death rate among children in the case of severe COVID-19?

MW-R .: Apart from the patient I mentioned, no patient died and let it stay that way.

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PAP: Children experience the infection differently than adults?

MW-R .: It is a bit different with each successive wave. In this, the fourth, we have a division into small children who have the disease the same as always, i.e. with a fever of up to 38 degrees C., an infection of the respiratory tract. Many patients have problems with the digestive system – i.e. diarrhea and vomiting. However, in older patients, over 12 years of age, this course is more severe. Symptoms of lung tissue involvement, dyspnoea, decreased oxygenation are evident, these children require oxygen therapy. There are many more infections of this course than in the previous waves, which may be related to the fact that previously there were lockdowns, children had limited contact with each other, but it may also be related to the new, more virulent Delta variant.

PAP: You said that young patients require increased oxygen therapy, how is it carried out?

MW-R .: We use a specialized Airvo, i.e. a device for high-flow oxygen therapy. We serve oxygen heated and moisturized through a mustache, which many people may associate with television.

PAP: Do you use respirators for the youngest patients?

MW-R .: We are doing everything so that there is no such need. But sometimes it happens that the patient requires intensive care and therefore intubation because our standard methods were not enough. Most often these are patients who have comorbidities such as obesity. However, looking at the worldwide results of research on ventilator mortality, which fortunately mainly affect adult patients, I believe that everything must be done to avoid the need for this ventilator. Nevertheless, it is unavoidable in very severe infections.

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PAP: It has been heard that in many cases a ventilator is the basic tool used in patients infected with SARS-CoV-2. The patient is put into a pharmacological coma, so it will be easier to handle.

MW-R .: If it is so, it is very pessimistic. I have no insight into the situation of adult hospitals, I do not know what standards of conduct are implemented, but if this is the case – I am against it.

PAP: There is one more issue – ventilator operation is not something that can be learned in a week.

MW-R .: You can’t, it requires specialist knowledge and practice.

PAP: But it happens that this respirator is operated by, for example, a dermatologist or surgeon, people who just happened to be on call.

MW-R .: I think that, unfortunately, it can happen, although I counted on the fact that in the next wave of infections, hospitals would be better prepared. I can also imagine that there are hospitals that are not at all adapted to serving such COVID patients. Not only do they not have the appropriate staff, trained in this field, but also do not have specialized equipment. And I imagine that if a hospital like this gets a heavy covid patient who is choking, it will either offer him oxygen through a mask, which will be ineffective, or intubate. And it is not the fault of the hospital or the doctors, but of the body responsible for equipping the facility and training the staff. These people, if they really wanted to save one patient or another, perhaps they will not know how to do it. Besides, they may not have specialized equipment that is not cheap.

PAP: We hear a lot about comorbidities that make patients defenseless against this virus. What’s the biggest threat?

MW-R .: Obesity in children. We are in Europe at the forefront when it comes to overweight affecting the youngest. There are patients, children aged 12-14, whose weight varies between ninety and one hundred kilograms. Obese patients are usually not healthy. They have less efficient heart and less efficient muscles. If we have a slim patient who can help with the accessory muscles in breathing, intercostal muscles, diaphragm, then in the case of those with high obesity, we have a different situation. In addition, there are hormonal disorders. However, perhaps the most important thing is that the obese patient simply has a problem with breathing. His chest is under tremendous pressure from fat.

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PAP: Are there more and more young patients?

MW-R .: We have been observing for a week that there are fewer of them. Maybe because a large number of schools are in quarantine. Let’s wait to see what happens next. What worries me now is the increasing number of patients with PIMS. If you look at foreign publications and our experience to date, coming out of the pandemic wave, we fall into the PIMS wave. It is a pocovidic complication characteristic of pediatric patients who have often been infected with SARS virus without even knowing it or with few symptoms. From 3 to 6 weeks after infection, high fever, gastrointestinal symptoms, rash, conjunctivitis appear. The child’s condition is so serious that it always requires hospitalization and a decision regarding further treatment. Fortunately, in the case of PIMS, we have effective treatment that, if implemented early, gives 19% cure. If there is anything I can recommend, get your children vaccinated against COVID-XNUMX as soon as possible. The vaccine is effective and recommended by Polish and foreign scientific societies.

PAP: Apart from covid, which affects everyone so much, what is the biggest problem in pediatrics?

MW-R .: In our hospital, we are seeing an increase in patients with newly diagnosed leukemia and diabetes. In the case of diabetes, these are patients who are admitted to the hospital in a state of severe ketoacidosis, on the verge of life and death. They require treatment under intensive care, and after stabilization, they go to the Diabetes Department. Unfortunately, we see that a significant proportion of these patients are referred to hospital too late. Both parents and primary care physicians do not catch the first and most important symptoms of type 1 diabetes early enough. Alarming signals include increased thirst, frequent urination, including at night.

PAP: Why such a rash of diabetes in young patients?

MW-R .: In the case of autoimmune and genetic diseases, we do not know everything yet. Recently, there has been a hypothesis that SARS-CoV-2 may somehow induce and accelerate the onset of diseases for which we are genetically predisposed. I will not be authoritative on this subject, but we observe diabetes and leukemia more than before. It may also be the case that our patients who come to us in serious condition have been neglected in the area. They showed up there too late, someone did not notice the first symptoms, which resulted in the children being in a more serious condition than before.

Interviewer: Mira Suchodolska

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