Rare illness linked to coronavirus kills New York five-year-old

A 5-year old boy has died in New York from a rare inflammatory illness believed to be linked to the coronavirus, highlighting a potential new risk for children in the pandemic, Governor Andrew Cuomo says.

Rare illness linked to coronavirus kills New York five-year-old

A 5-year old boy has died in New York from a rare inflammatory illness believed to be linked to the coronavirus, highlighting a potential new risk for children in the pandemic, Governor Andrew Cuomo says.

Cuomo told a daily briefing that the boy died in New York City on Thursday.

He said health officials were investigating 73 similar cases reported across New York where children have exhibited symptoms similar to Kawasaki disease or toxic shock-like syndrome linked to COVID-19, the respiratory illness caused by the coronavirus.

"While rare, we are seeing some cases where children affected with the COVID virus can become ill with symptoms similar to the Kawasaki disease or toxic shock-like syndrome that literally causes inflammation in their blood vessels," he said.

Cases of rare, life-threatening inflammatory illnesses in children associated with exposure to COVID-19 were first reported in Britain, Italy and Spain but doctors in the United States are starting to report clusters of kids with the disorder, which can attack multiple organs, impair heart function and weaken heart arteries.

"This would be really painful news and would open up an entirely different chapter," Cuomo said. "I can't tell you how many people I spoke to who took peace and solace in the fact that children were not getting infected."

This emerging syndrome, which may occur days to weeks after a COVID-19 illness, reflects the surprising ways that this entirely new coronavirus infects and sickens its human hosts.

Scientists are still trying to determine whether the syndrome is linked with the new coronavirus as not all children have tested positive for the virus.

The syndrome shares symptoms with toxic shock and Kawasaki disease, which is associated with fever, skin rashes, swelling of glands, and in severe cases, inflammation of arteries of the heart.

Normally one of the busiest places on Earth, midtown Manhattan is practically deserted as New York strains from so many coronavirus cases.

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Rats are infecting humans with hepatitis

"Suddenly, we have a virus that can jump from street rats to humans."

Rats are infecting humans with hepatitis

In 2018, infectious disease experts at the University of Hong Kong came across an unusual patient.

The 56-year-old man, who had undergone a liver transplant, was showing abnormal liver functions with no obvious cause.

Tests found that his immune system was responding to hepatitis E – but they couldn't actually find the human strain of the hepatitis E virus (HEV) in his blood.

Hepatitis E is a liver disease that can also cause fever, jaundice and an enlarged liver. The virus comes in four species, which circulate in different animals; at the time, only one of these four was known to infect humans.

With tests for that human strain of HEV negative, the researchers redesigned the diagnostic test, ran it again – and found, for the first time in history, rat hepatitis E in a human.

"Suddenly, we have a virus that can jump from street rats to humans," Dr Siddharth Sridhar, a microbiologist and one of the HKU researchers who made the discovery, said.

It was such an unusual and unprecedented infection that the team wondered if it was a "one-off incident, one patient who was in the wrong place at the wrong time".

The news comes as the world gradually transitions out of coronavirus pandemic lockdown.

But then it happened again. And again. Since that first study, 10 more Hong Kong residents have tested positive with rat hepatitis E, also known as rat HEV.

The most recent case came a week ago; a 61-year-old man with abnormal liver function tested positive on April 30. And there might be hundreds more infected undiagnosed people out there, Dr Sridhar said.

The human strain of hepatitis E is typically transmitted through fecal contamination of drinking water, according to the World Health Organisation.

But the rat strain poses a new mystery: nobody knows exactly how these people are getting infected. In the two years since the discovery, researchers have yet to identify the exact route of transmission from rats to humans.

They have theories – maybe the patients drank contaminated water like the usual human strain, or handled contaminated objects – but nothing's been definitively proven.

The 61-year-old recent patient has authorities particularly stumped; there were no rats or rat excrement in his home, nobody else in his household has shown symptoms, and he has no recent travel history.

"Based on the available epidemiological information, the source and the route of infection could not be determined," Hong Kong's Centre for Health Protection (CHP) said in a statement on April 30.

The man is still in the hospital, and the CHP's investigation is ongoing.

What we know, and don't know

The research team and city authorities have been trying to better understand this new health threat since 2018.

They've made some progress. Their diagnostic tests have been refined and improved. They've spread awareness among the health care sector so doctors know to test for rat HEV, and launched public awareness campaigns.

Scientists are testing rat populations citywide to try to identify clusters before they can jump to humans, which has provided data on how many rodents in the city carry rat HEV and which areas have the most rats.

But there is still much that remains unknown. They don't know how long this virus' incubation period is – meaning how long it takes for patients to get sick after exposure.

They're still trying to find a treatment, as the medication used to treat the human variant of hepatitis E has had mixed results on patients with rat HEV.

And, of course, the biggest unknown that continues to vex scientists is the how.

Not knowing how the virus jumps from rats to humans makes it very difficult to prevent further infections – or even to make sense of all the data researchers have collected.

For instance, people who live in rat-infested areas should theoretically be at higher risk, yet some infected patients come from neighbourhoods with low rat numbers.

"What we know is the rats in Hong Kong carry the virus, and we test the humans and find the virus," Mr Sridhar said.

"But how exactly it jumps between them – whether the rats contaminate our food, or there's another animal involved, we don't know.

"That's the missing link."

One solution could be to just get rid of all the rats in Hong Kong, but rat eradication is a long, complicated feat that isn't very feasible.

It would require reducing places they can shelter as well as their access to food, with measures like preventing food from being discarded in back alleys.

For now, all authorities can do is urge people to take preventative measures, like washing their hands before eating, storing food properly or in the fridge, and keeping the household clean and disinfected with minimal nesting places for rodents.

This could be happening everywhere

This likely isn't just a Hong Kong problem, or even a recent one, experts say. Rat HEV could be infecting people in New York or Paris, and we just don't know it – because nobody is testing for it.

"My feeling is, this has been going on for a long time," Dr Sridhar said.

"2017, 2018 is definitely not the first time it's happened in the world."

Within Hong Kong, the 11 confirmed cases are likely just the tip of the iceberg, he added. Doctors were able to test them for rat HEV because they sought medical attention for symptoms, or were receiving checkups because of pre-existing conditions or transplants.

But there may be hundreds of infected cases in the community, who don't fall in these categories and haven't been diagnosed, he said.

Many people with hepatitis E only experience mild symptoms, and in some cases don't even know they're infected or go to the hospital.

But the virus can have serious health consequences, particularly for patients with weakened immunity.

Young, healthy people with no pre-existing conditions may be able to recover on their own – but for vulnerable populations, it could cause chronic hepatitis that patients can't shake off, as well as long-term liver damage and tissue scarring.

Apart from the 11 cases in Hong Kong, only one other case has been confirmed globally – a man in Canada, who had previously travelled to Africa.

He went to the hospital after experiencing hives, nausea, severe jaundice and an inflamed liver, and tested positive for rat HEV, according to a report in February 2019.

The only reason authorities caught this case was because they used a broad type of test that detects many strands of hepatitis E virus, said researchers in the report, which was published in the Journal of Infectious Diseases. Otherwise, "the diagnosis might have been missed", the report said.

This is the problem – most countries aren't testing for rat HEV, so there's a good chance they're just missing diagnoses, Dr Sridhar said.

It takes a specialised test, like the one HKU designed, to specifically look for rat HEV in humans. It's not a difficult test to make, but it hasn't been adopted widely because nobody thought until recently that rat HEV was even a threat to humans.

For instance, in Europe a "lack of awareness by physicians and poorly standardised diagnostics led to under reporting" in hepatitis E cases, according to Cornelia Adlhoch of the European Centre for Disease Prevention and Control (ECDC) and Sally Baylis of Germany's Paul-Ehrlich-Institut, in a letter published this March in the journal Hepatology.

Only last year did the ECDC finally develop guidelines for how to collect data and report information on hepatitis E, said the letter – but these new guidelines focused on the human variant and didn't include rat HEV, leaving what Dr Sridhar calls "a blind spot in our diagnostics".

This blind spot, and the possibility that the virus is infecting people globally without any control measures, place some of society's most vulnerable people at risk – the elderly, HIV-affected communities, those with pre-existing conditions, and more.

"This should not be happening," Dr Sridhar said.

"We need ongoing vigilance in the public to control this unusual infection.

"I really hope that public health authorities take the first step and look at how much their populations are actually being exposed to rat hepatitis E."

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