The case for acute severe hepatitis caused by Covid

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Are we about the hit another pandemic, this time with hepatitis? According to the World Health Organization a mysterious case of acute, severe hepatitis is affecting children between the ages 1 month to 16 years of age with the majority being under ten years of age.  That most likely means preschool children. So far, the cases numbers are small but then again that’s how Covid-19 started. As of April 21, at least 169 cases have been detected Worldwide with cases numbers as follows.

United Kingdom) (114), Spain (13), Israel (12), the United States of America (9), Denmark (6), Ireland (<5), The Netherlands (4), Italy (4), Norway (2), France (2), Romania (1), and Belgium (1).

WHAT IS KNOWN ABOUT THIS HEPATITIS VERSION?

Unlike the usual Hepatitis variants this version is not hepatitis viruses A, B, C, D or E. The common cold virus, known as an adenovirus, has been detected in at least 74 cases (43%). COVID-19 infection was identified in 20 (11%) cases, and an infection with both COVID-19 and adenovirus 41 was detected in 19 cases (10%).

Children who develop normal viral hepatitis have liver enzymes readings of around 300 U/L or 400 U/L, but in these new cases, the levels are in the 1,000s. That means sever liver damage, often requiring transplant surgery. Quite a serious situation.

WHAT TO WATCH FOR

If have young children watch out for nausea, vomiting, belly pain, dark urine, yellow discoloration of the skin and/or eyes (jaundice), fever and fatigue. Most cases in the developing situation however did not have a fever.

What can you do to reduce risk? Best to monitor your children carefully and get a Hepatitis test as a matter of course if your child does gets sick. Addressing any issues fast could avoid permanent liver damage. Avoid getting takeout food or going to restaurants especially where chopsticks are dipped into a common food plate. Ensure children wash hands before every meal. Use bottled water when travelling even at a restaurant. Wash and clean the all bed linen, clothes, shoes, socks, school backpacks frequently. Give children fresh healthy home cooked meals. In other words takes all the precautions you have taken for Covid and then some.

WHAT IS HEPATITIS

In simple terms Hepatitis means the inflammation of the liver.  In most cases it is caused by a virus but it can also be caused by drugs, alcohol or certain medical conditions. The general symptoms of hepatitis are dark urine, grey-colored feces and yellowing of the skin and eyes, as well as fever.

WHY ACUTE SEVERE HEPATITIS IS MOST LIKELY COVID-19 RELATED

While scientists are as usual cautious for the fear for making themselves fools, all indications are it is almost certainly caused by Covid-19. Yes, it is true that 50% of the cases exhibit the adenovirus and only 11% had the Covid-19 virus. But this can be misleading. This is because a PCR tests for Covid-19 shows a negative result within a short time period (say 1-2 weeks) while the liver damage is seen much later of between 2-6 weeks. It is possible the body has expended all it’s energy warding off Covid-19 and damaging its liver in the process and then succumbing to the adenovirus in it’s weakened state.

According to this NCBI article acute liver injury at admission is a quite common finding in subjects affected by COVID-19 pneumonia.  What is unusual is, most of these patients were asymptomatic to COVID-19. That suggest that these patients were using the liver to fight the virus without showing any obvious symptoms. Could children be doing the same thing? After all, not many children especially young children developed Covid-19 symptoms but perhaps a vast swath young children may already have liver damage.

This article from May 2021 presents the case of a 10-month-old boy with marked elevation of liver transaminases and ferritin. His mother had been diagnosed with Sars CoV-2 a few weeks prior. Other than liver damage the infant showed no symptoms of Covid-19. He was alert and responsive, normotensive and eupneic. His body temperature was 37.3°C with oxygen saturation in room air of 99%. There were no cutaneous manifestations, his lung and heart auscultation were normal. Further proof that children fight Covid-19 with their liver, damaging it in the process.

This clinical case report found severe Acute Hepatitis in a COVID-19 patient. In this case a 39 old man exhibited severe myalgia, refusal to eat, headache, fever, fatigue, and weakness over a two-day period. He had no respiratory symptoms such as chest pain, coughing, sore throat and was not nauseated, vomiting, experiencing diarrhea, or abdominal pain. A few days after being discharged from hospital he experienced jaundice, recent darkening of urine, and lightening of stool. Test then revealed he had severe acute hepatitis.

WHAT IS THE CASE FOR ADENOVIRUS CAUSING HEPATITS?

The case for adenovirus causing acute severe hepatitis is rare as this article states, at least in healthy children. But it does state that hepatitis can develop in immunocompromised children. Since children who have acute severe hepatitis were otherwise healthy lends credence to the conclusion that adenovirus is not the cause of their liver damage.

Still we could not find any cases of the adenovirus (which mostly affects children) causing hepatitis. So why would the medical community blame the adenovirus with severe accurate hepatitis? A bit puzzling.

The Adenovirus-41 which is tentatively being blamed for this hepatitis outbreak primarily causes acute gastroenteritis and is usually transmitted via fecal matter as well as orally. Symptoms may also include fever, diarrhea, vomiting, and abdominal pain lasting for 10 days or so. Respiratory symptoms can occur in some individuals. But it has not been to cause hepatitis.

TYPES OF HEPATITIS

Hepatitis A – Hepatitis A is highly contagious and can spread from person to person in many different settings. In most causes only causes a mild illness or no symptoms at all. Goes away on its own and does not cause long-term liver damage. It usually spreads through sex, food or water. Food can be tainted when it’s touched by a person with hepatitis who did not wash their hands after using the bathroom. Raw shellfish, fruits, vegetables, and undercooked foods are common origins for hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren’t careful about washing hands after changing diapers.

Hepatitis B -  Mild symptoms for a short time and then get better on their own within 6 months. You get most from sex or exchange of body fluids with another person. However, some do not recover from the virus. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer. You won’t catch it if you get a vaccine.

Hepatitis C -  This is a common bloodborne viral infection with long term effects. Caused by sharing needles or having contact with infected blood. About 80% of those with the disease get a long-term infection causing cirrhosis, a scarring of the liver. There’s no vaccine to prevent it.

Hepatitis D –  A rare hepatitis variation that only occurs in combination with hepatitis B infection. It causes liver inflammation like other strains of Hepatitis, but a person cannot contract hepatitis D without an existing hepatitis B infection.

Hepatitis E – This is a waterborne Hepatitis virus that results from exposure to the hepatitis E virus. It often occurs areas with poor sanitation like the developing world especially from ingesting fecal matter that contaminates the water supply.

CONCLUSION

So, what can we do? You have to follow the same safety protocols as we did for Covid-19. If you have young children you must carefully monitor them. But the evidence seems to point that even healthy adults especially those with asymptomatic Covid-19 can also suffer severe acute hepatitis.

On the off chance it is caused by the adenovirus we must quickly address the symptoms which is primarily a stomach ache. Some real Cinnamon tea or ginger might just be the trick. Both well known to settle any stomach issues.

The Covid-19 pandemic is not over. A rough guess says it will take another 2 years before the waves of Covid-19 cases get eradicated for good. So, wear those masks, keep clean and eat healthy fresh food. And get vaccinated for Covid-19. Yes, there are risks and it is no guarantee not to get Covid-19 but the risks are greater if you don’t.

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