Pediatric Hepatitis, a Medical Rorschach Test

The mysterious outbreak of pediatric hepatitis has affected nearly 300 children in 20 countries. At least 16 children have needed liver transplants and one child died. No one knows what is causing it, though that hasn’t stopped many people from speculating.

anti-vaxxers are blaming vaccines, of course. They reflexively blame vaccines for everything and will do so for the next pediatric ailment that arises. The fact that most affected children are unvaccinated isn’t a barrier for them. Lockdowns opponents are blaming lockdowns, of course. They reflexively blame lockdowns for everything will do so for the next pediatric ailment that arises. The fact that many affected children are from places like Alabamawhere the lockdowns ended long ago, isn’t a barrier for them. They are also not bothered by the fact that children as old as 16 have been affected, though they spent their childhood in a pre-COVID world.

Naturally, many people were quick to blame COVID, though there’s a plausible case to be made for this. Certainly, the cause seems to be something contagious. Why else would it be happening in so many different parts in the world? Moreover, COVID is still a relatively new virus, it’s been full of surprises already, and it’s everywhere. Perhaps new variants are affecting children differently. The initial MIS-C cases surprised a lot of people too, though there have now been over 7,800 cases of this devastating disorder in the USA alone.

Additionally, there’s precedent. A case series reported on 4 children who developed “significant hepatitis as the primary manifestation of COVID-19 infection”, while another paper reported on a 1-month old infant with this condition. A report from India described 37 cases pediatric hepatitis due to COVID, though they were not severe. They also described 10 children with MIS-C hepatitis, who were very sick. Three of these children died. Another report on 44 children with MIS-C found that “Hepatitis is common in children with MIS-C and is associated with a more severe presentation.” Another study from Israelfound that 11 out of 12 children with pediatric hepatitis contracted COVID last year.

As such, it’s entirely possible that pediatric hepatitis is a rare manifestation of COVID, which is just now being widely recognized and reported. Given that hundreds of millions of children contracted the virus around the world, even rare events add up. Perhaps doctors are only now collectively noticing and reporting these cases- a medical version of the Baader-Meinhof phenomenon or frequency illusion. Basically, if people start looking for something specific, they might find more examples of it than they expected. If I had to place a bet, I’d say COVID is to blame for all of the above reasons.

Reasonable people, such as Dr. Clay Jones, have argued that COVID is unlikely to be responsible. If COVID was to blame, why so many cases are popping up now, two years into the pandemic? Moreover, in a sample of children from the UK, where most cases have occurred, only 16% of the cases tested positive for COVID. in to CDC investigation of 9 children in Alabama, all cases tested negative for acute COVID infection, none had a known history of prior infection, and the liver biopsies of 6 children showed no viral inclusions or particles. However, these children were not tested for antibodies against SARS-CoV-2, and the liver biopsies were not stored specifically for the SARS-CoV-2. The CDC and health authorities from the UK suggested that an adenovirus may be responsible, though as Dr. Farid Jalali, a liver specialist, pointed out this is a common viruses and likely an incidental finding as it is not known to have caused hepatitis before.

Hopefully people with the relevant expertise will figure it out, though it will be a challenge. At present, there is no standard definition of the disorder. France, for example, apparently excludes children who test positive for SARS-CoV-2. Additionally, children also make lower antibodies to the SARS-CoV-2, complicating the ability to rule-out COVID with this test. Those who pronounce its cause with great certainly are revealing more about themselves than pediatric hepatitis. It’s become a medical Rorschach test.

Whatever the cause may be, the reaction to this new condition illustrates the point I made previously: we’ve grown numb to the suffering and death of children from known causes. This week alone, nineteen children were added to the grim COVID death tally maintained by the American Academy of Pediatrics. There were no news articles about this. There was no outrage on social media. Why would there be? It was just an average week.

Overall, over 1,500 children have died of COVID in the US and tens of thousands more have been hospitalized, many needing ICU-level care and mechanical ventilation. Even though these serious outcomes are largely preventable with a vaccine for children older than 5-years, because they are from an old, established cause, they’re not interesting to most people. They’ve receded into the background and are overshadowed by pediatric hepatitis.

This condition is shiny and new-for now.

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

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