Pediatric Hepatitis, a Medical Rorschach Test

Nearly 300 children in 20 countries have been affected by the mysterious outbreak of pediatric hepatitis. There have been at least 16 children who have needed a transplant. No one knows what is causing it.

They are blaming vaccines. They blame vaccines for everything and will do so again and again. The fact that most affected children are unvaccinated isn't a barrier for them. Lockdowns opponents are blaming them. They blame lockdowns for the next ailment. The fact that many of the affected children are from places like Alabama isn't a barrier for them. They don't care that children as old as 16 have been affected, even though they spent their childhood in a pre-COVID world.

There is a plausible case to be made for this, and many people were quick to blame it. The cause seems to be spreading. Why would it be happening in so many different places? COVID is a relatively new virus, it has been full of surprises already, and it is everywhere. Maybe new variants are affecting children differently. There have been over 7,800 cases of this devastating disorder in the USA alone, and the initial MIS-C cases surprised a lot of people.

There is precedent. A case series reported on 4 children who developed significant hepatitis as the primary symptom of COVID-19, while another paper reported on a 1-month old infant with this condition. There were 37 cases of children being affected by COVID, though they were not severe. There were 10 children with MIS-C who were very sick. Three children died. A report on 44 children with MIS-C found that hepatitis is common and is associated with a more severe presentation.

It's entirely possible that a rare form of COVID is the cause of the child's disease. There were hundreds of millions of children who contracted the virus around the world. Maybe doctors are only now noticing and reporting these cases as a medical version of the Baader-Meinhof phenomenon. If people start looking for something specific, they might find more examples than they expected. If I had to place a bet, I would say COVID is to blame for all of the reasons.

Dr. Clay Jones has argued that COVID is unlikely to be responsible. If COVID was to blame, why are there so many cases now? In a sample of children from the UK, where most cases have occurred, only 16% of the cases tested positive for carbon dioxide. In a CDC investigation of 9 children in Alabama, all of them tested negative for acute COVID infections, none had a known history of prior infections, and all of the children had no evidence of viral particles. The children were not tested for the antibodies against the disease, and the biopsies were not stained for the disease. The CDC and health authorities from the UK suggested that an adenoviruses may be to blame, though as Dr. Jalali pointed out, this is a common virus and not known to have caused hepatitis before.

It will be a challenge, but hopefully people with relevant expertise will figure it out. There is no standard definition of the disorder. France excludes children who test positive for the disease. The ability to rule out COVID with this test is hampered by the fact that children make lower antibodies to the SARS-CoV-2. Those who say their cause is great reveal more about themselves than those who say it's a disease. It is a medical Rorschach test.

We have grown numb to the suffering and death of children from known causes, and the reaction to this new condition illustrates that point. Nineteen children were added to the grim COVID death tally this week. There were no news stories about this. There was no outrage on social media. Why would there be? It was an average week.

Over 1,500 children have died of carbon dioxide in the US and tens of thousands more have been hospitalized. Even though these grave outcomes are preventable with a vaccine for children older than 5 years, they are not interesting to most people.

This condition is new and shiny.