Ariani Roque Marinheiro at her home last month in Maringá, Brazil. Her daughter, Letícia, a toddler, died in February from Covid-19. Photo / Victor Moriyama, The New York Times
Experts believe Brazil's overloaded hospital system and uneven access to health care are among the reasons babies and small children are succumbing to the virus at a high rate.
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 February 27, Letícia died in the critical care unit of the hospital in Maringá, in southern Brazil, after days of laboured 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 paediatrics 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 hospitalisation 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 Paediatric 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.
Even before the pandemic began, millions of Brazilians living in poor areas had limited access to basic health care. In recent months, the system has been overwhelmed as a crush of patients have flooded into critical care units, resulting in a chronic shortage of beds.
"There's a barrier to access for many," said Dr. Ana Luisa Pacheco, a paediatric infectious diseases specialist at the Heitor Vieira Dourado Tropical Medicine Foundation in Manaus. "For some children, it takes three or four hours by boat to get to a hospital."
The cases in children have shot up amid Brazil's broader explosion in infections, which experts attribute to President Jair Bolsonaro's cavalier response to the pandemic and his government's refusal to take vigorous measures to promote social distancing. A lagging economy has also left millions without income or enough food, forcing many to risk infection as they search for work.
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.
Letícia Marinheiro was one such child, her mother said. A healthy baby who had just started walking, she had never been sick before, Marinheiro said.
Marinheiro, who got sick along with her husband Diego, 39, believes Letícia might have lived if her illness had been treated with more urgency.
"I think they didn't believe that she could be so sick, they didn't believe it could happen to a child," said Marinheiro.
She recalled pleading to have more tests done. Four days into the child's hospitalisation, she said, doctors had still not fully examined Letícia's lungs.
Marinheiro is still unsure how her family got sick. She had kept Letícia — a first child the couple had badly wanted for years — at home and away from everyone. Her husband, a supplier of hair salon products, had been cautious to avoid contact with clients, even as he kept working to keep the family financially afloat.
For Marinheiro, the sudden death of her daughter has left a gaping hole in her life. As the pandemic rages on, she says, she wishes other parents would quit underestimating the dangers of the virus that took Letícia away from her. In her city, she watches as families throw birthday parties for children and officials push to reopen schools.
"This virus is so inexplicable," she said. "It's like playing the lottery. And we never believe it will happen to us. It's only when it takes someone from your family."
Written by: Ana Ionova
Photographs by: Victor Moriyama
© 2021 THE NEW YORK TIMES
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