After 3 Children Die, a Race to Investigate a Baffling Virus Syndrome
在3名儿童死亡后，一场调查令人困惑的病毒综合症的竞赛开始了
Joseph Goldstein and Jesse McKinley约瑟夫·戈德斯坦和杰西·麦金利
May 23, 2020, 10:14 PM GMT+8
2020年5月23日晚上10:14 GMT+8
A family walks through New York's Prospect Park, May 16, 2020. (Benjamin Norman/The New York Times)
2020年5月16日，一家人走过纽约展望公园。(本杰明·诺曼/《纽约时报》)
NEW YORK — Blood will be collected from dozens of children in New York to determine whether they share any genetic variations that might make them susceptible to a mysterious syndrome linked to the coronavirus.
纽约——将采集纽约数十名儿童的血液，以确定他们是否具有可能使他们易患一种与冠状病毒有关的神秘综合征的基因变异。
Tissue samples from at least one of the three patients to have died from it — ages 5, 7 and 18 — have been sent to a public health laboratory for intensive testing.
三名分别为5岁、7岁和18岁死于该病的患者中的至少一名患者的组织样本已被送往公共卫生实验室进行强化检测。
A team of more than 30 disease detectives — epidemiologists, clinicians and statisticians — is poring over thousands of pages of medical records.
一个由30多名流行病学家、临床医生和统计学家组成的疾病侦探团队正在仔细研究数千页的医疗记录。
Even as doctors and scientists around the world race to develop treatments and vaccines for COVID-19, New York state has become the center of a parallel effort to investigate an unnerving aspect of the outbreak: an illness that is sickening a small but growing number of children.
就在世界各地的医生和科学家竞相开发针对COVID-19的治疗方法和疫苗的时候，纽约州已经成为了一项平行行动的中心，目的是调查这场疫情令人不安的一个方面:一小部分儿童患病，但患病人数在不断增加。
The ailment has now been reported in at least 161 children in New York, making the state’s caseload one of the largest publicly reported anywhere. Hundreds of other children across the United States and in Europe have also been sickened with the illness, now called multisystem inflammatory syndrome.
目前，纽约至少有161名儿童被报告患有这种疾病，这使得纽约州成为公开报告患病人数最多的州之一。在美国和欧洲，还有数百名儿童也患有这种疾病，现在被称为多系统炎症综合征。
The syndrome can be characterized by severe inflammation of the heart, blood vessels, the gastrointestinal tract or other organs, believed to be caused by a reaction to the coronavirus. The inquiries into why it is occurring and whether a treatment can be found could have an impact on how authorities handle the reopening of schools and other activities for children.
该综合征的特征是心脏、血管、胃肠道或其他器官的严重炎症，据信是对冠状病毒的反应引起的。对为什么会发生这种情况以及能否找到治疗方法的调查，可能会对当局如何处理学校和其他儿童活动的重新开放产生影响。
Doctors in New York involved in the effort say that not since health officials began investigating the connection between Zika in pregnant women and microcephaly in 2015 and 2016 has there been such an urgent search to understand a mysterious threat to children.
参与这项工作的纽约医生表示，自从卫生官员在2015年和2016年开始调查孕妇寨卡病毒和小头症之间的联系以来，还没有出现过如此紧急的调查，以了解这种对儿童的神秘威胁。
“We’re looking at everything possible — therapies, diagnostics, clinical picture — and we’re trying to pull this all together,” said Dr. Howard Zucker, the state health commissioner.
州卫生专员Howard Zucker博士说:“我们正在寻找一切可能的方法——治疗方法、诊断方法、临床图片——我们正在努力把这些方法结合起来。”
He added, “It does keep you up at night. It’s the worry that, is there something we’re going to figure out in six months from now, and we’re going to say, ‘How did we not think about that possible therapy? How did we not figure out that this would have helped?’”
他补充道:“它确实会让你晚上睡不着。我们担心的是，是否有一些事情我们要在六个月后弄清楚，然后我们会说，‘我们怎么会没有想到可能的治疗呢?我们怎么就没想到这有帮助呢?’”
The rush to understand the syndrome has seemed to strike a chord with Zucker, who is trained in pediatric cardiology and has reviewed charts of patients with the illness.
急于了解这种综合征的做法似乎引起了祖克的共鸣，他曾接受过小儿心脏病学培训，并看过这种疾病患者的病历。
He described in an interview the frustrations of doctors trying to treat one of the victims, who at the time was battling against a syndrome that did not have a name. The child was in shock; cardiac function had deteriorated, and with it, breathing.
他在一次采访中描述了试图治疗其中一名受害者的医生的沮丧之情。当时，这名患者正在与一种没有名字的综合症作斗争。孩子吓坏了;心脏功能恶化，呼吸也随之恶化。
Tubes were fed down the patient’s throat, and aggressive, life-sustaining measures — mechanical and pharmacological — were deployed, even as a battery of tests were run to try to determine the cause of the illness.
管子被送入病人的喉咙，积极的、维持生命的措施——机械的和药理学的——被部署，即使是在进行一系列测试试图确定疾病的原因的时候。
The young patient did not survive.
这个年轻的病人没有活下来。
“Everything was done for that child,” Zucker said. “Everything.”
“一切都是为了那个孩子，”扎克说。“一切。”
During a hastily assembled discussion among several pediatricians in New York state that occurred over videoconference last week, one doctor spoke of a surge of more than 40 cases at his hospital.
在上周召开的视频会议上，纽约州几名儿科医生匆忙召集了一场讨论，其中一名医生提到他所在医院的病例激增了40多个。
Another doctor spoke of troubling heart ailments in children afflicted with the illness. A third talked about treating a 14-year-old in the Bronx who was admitted in good condition but then rapidly deteriorated.
另一位医生谈到了患有心脏病的儿童的心脏问题。三分之一的人谈到如何治疗布朗克斯的一名14岁少年，该少年入院时状况良好，但随后迅速恶化。
“Twenty-four hours later, he was aggressively delirious and had to be restrained and sedated,” that doctor, H. Michael Ushay, recalled.
“24小时后，他严重昏迷，必须加以控制和镇静剂，”那位名叫h迈克尔乌沙(H. Michael Ushay)的医生回忆说。
The illness was so baffling that Ushay, medical director of the pediatric critical care division at Children’s Hospital at Montefiore, said he was not sure whether the child’s downturn was caused by the disease or a reaction to the medicine the boy was given at the hospital, which included steroids and ketamine.
Ushay的疾病是如此令人困惑,医学儿科急救护理部门主任在蒙蒂菲奥里儿童医院,说他不确定孩子的下滑是由于疾病或对药物反应的男孩在医院,其中包括类固醇和氯胺酮。
The first cases of the new syndrome began to draw doctors’ attention in late April and early May, about a month after the height of the coronavirus outbreak in New York City.
4月底和5月初，也就是在纽约市冠状病毒爆发的一个月后，这种新综合征的首批病例开始引起医生的注意。
Almost immediately, doctors noticed that in some patients the symptoms bore a striking overlap to a rare childhood illness called Kawasaki disease, which involves inflammation of the blood vessels and whose symptoms can range from redness of the eyes to damaged coronary arteries that can lead to heart attacks and aneurysms.
几乎立即,医生注意到在一些患者的症状有着惊人的重叠,一个叫川崎病的罕见的儿童疾病,其中包括血管和炎症的症状的范围可以从发红的眼睛受损的冠状动脉可导致心脏病发作和动脉瘤。
But with Kawasaki disease, a fraction of children end up in an intensive care unit or requiring life support. Yet a significant number of the patients with the new syndrome do.
但患川崎病的儿童中，有一小部分最终会被送进重症监护室或需要生命支持。然而，有相当数量的新综合征患者确实如此。
Dr. Ellen Lee, an epidemiologist at New York City’s Department of Health, was reading through her medical discussion groups in late April, when she came across reports of a mysterious illness affecting children in England that seemed to be linked to the coronavirus. The symptoms included abdominal pain and an inflamed, weakened heart.
纽约卫生署(New York City 's Department of Health)的流行病学家艾伦·李博士(Dr. Ellen Lee)在4月下旬浏览她的医学讨论小组时，偶然发现了一种神秘疾病的报告，这种疾病影响了英国的儿童，似乎与冠状病毒有关。症状包括腹痛和心脏发炎、虚弱。
She asked her team to call hospitals to inquire if they were seeing anything similar. Some had not. Others had treated children with matching symptoms but had not understood they were seeing something new. Within a day or two, Lee’s team had learned of nine cases.
她让她的团队打电话给医院，询问他们是否看到类似的情况。一些没有。另一些人对症状相同的儿童进行了治疗，但不知道他们看到了新的东西。在一两天内，李的团队就发现了9个病例。
“Those early days, it was just trying to get as much information from the providers to understand what they were seeing, what was unusual,” Lee said.
“在早期，它只是试图从供应商那里获得尽可能多的信息，以了解他们看到了什么，什么是不寻常的，”李说。
Members of her team contacted the Centers for Disease Control and Prevention. They asked the New York City’s medical examiner’s office to see if any children had recently died who showed any of the symptoms. They checked with health departments in other major cities. Nobody seemed to know much.
她的团队成员联系了疾病控制和预防中心。他们询问了纽约市的法医办公室，看看是否有儿童在最近死亡时表现出任何症状。他们向其他主要城市的卫生部门进行了调查。似乎没有人知道多少。
But it would soon become very clear to Lee, the Health Department and city officials that this new syndrome was rapidly becoming a threat to children in New York.
但很快，李、卫生部和市政府官员就会非常清楚地意识到，这种新症状正迅速成为纽约儿童的威胁。
Across the state, about 70% of patients with the syndrome have been cared for in intensive care units, according to Dr. Marcus Friedrich, a senior official at the state’s Department of Health. Some required medicine to raise their blood pressure, Friedrich said, and 19% were put on mechanical ventilators.
据该州卫生部高级官员弗里德里希(Marcus Friedrich)说，全州约70%的重症患者都在重症监护室接受治疗。弗里德里希说，有些人需要吃药来提高血压，19%的人使用了机械呼吸机。
A few have required even more drastic intervention, including extracorporeal membrane oxygenation, in which blood is removed from the body and oxygenated by means of a membrane before being pumped back into the patient, doctors said.
医生们说，少数人甚至需要更激烈的干预，包括体外膜肺氧合，也就是把血液从身体中分离出来，通过膜肺进行氧合，然后再把血液泵回病人体内。
Most patients with the new syndrome were previously healthy, without any underlying health problems, doctors said in interviews. And the surge and timing of the cases have led many doctors to conclude the illness is linked to the coronavirus.
医生们在采访中说，大多数新综合征患者之前都是健康的，没有任何潜在的健康问题。病例的激增和发病时间的选择使许多医生得出结论，认为这种疾病与冠状病毒有关。
Many, though not all, of the children ill with the syndrome tested positive for the coronavirus or for antibodies to it, which indicate a prior exposure. But often, based on interviews with the parents, doctors have concluded that the children had been exposed to the virus several weeks earlier.
虽然不是全部，但很多患病儿童的冠状病毒或抗体检测呈阳性，这表明他们之前接触过这种病毒。但根据对家长的采访，医生通常得出结论，孩子们几周前就接触过这种病毒。
“Is it the virus causing this, or the body’s response to the virus after a few weeks?” asked Dr. Edward Conway Jr., chief of pediatric critical care at Jacobi Medical Center in the Bronx, saying that he suspected the latter.
“是病毒引起的，还是几周后身体对病毒的反应?”布朗克斯区雅可比医疗中心(Jacobi Medical Center)的儿科重症监护室主任小爱德华·康威(Edward Conway Jr.)问，他怀疑是后者。
The time lag and the signs of inflammation have led many doctors to suspect the new syndrome is caused by “an aggressive, abnormal immune reaction to COVID exposure,” said Dr. George Ofori-Amanfo, chief of pediatric critical care for the Mount Sinai Health System.
西奈山卫生系统(Mount Sinai Health System)的儿科重症监护科主任乔治·奥夫里-阿曼弗(George Ofori-Amanfo)博士说，时间的滞后和炎症的迹象让许多医生怀疑，这种新综合征是由“对COVID接触的一种侵略性的、异常的免疫反应”引起的。
For now, doctors have been administering similar treatments as they would to children with Kawasaki disease. Patients often receive a combination of steroids; intravenous immunoglobulin, an antibody-rich serum made from donated blood, pooled together from thousands of people; and intravenous aspirin.
到目前为止，医生们一直在进行类似的治疗，就像他们对患有川崎病的儿童所做的那样。患者经常接受类固醇的联合治疗;静脉注射的免疫球蛋白，一种从捐献的血液中提取的抗体丰富的血清，聚集了成千上万的人;和静脉注射阿司匹林。
So far, many patients have responded well, four doctors said in interviews.
四名医生在采访中说，到目前为止，许多病人的反应都很好。
One Bronx teenager said he realized something was wrong when he awoke one night with a sharp stinging sensation in the center of his chest. It happened again when he was eating Cheerios and watching YouTube.
布朗克斯区的一名少年说，有一天晚上他醒来，胸部中心有一阵刺痛的感觉，他意识到出事了。当他一边吃着麦圈一边看YouTube视频时，这种事情又发生了。
“My arms also started to become numb,” the teenager, David Vargas, 17, recalled.
“我的胳膊也开始变得麻木，”17岁的少年戴维巴尔加斯(David Vargas)回忆说。
He was hospitalized for nearly a week at Mount Sinai Kravis Children’s Hospital in Manhattan. Testing indicated that he had been infected by the coronavirus, which then had damaged his heart, he said.
他在曼哈顿西奈山克拉维斯儿童医院(Mount Sinai Kravis Children’s Hospital)接受了近一周的住院治疗。他说，检测结果显示他感染了冠状病毒，之后心脏受损。
“To be told your heart may be injured is an incredibly frightening thing,” said David, who passed the time while hospitalized drawing portraits of doctors and nurses.
“被告知你的心脏可能受伤是一件非常可怕的事情，”大卫说，他在医院里画医生和护士的肖像来打发时间。
“This thing that was happening to me felt very mysterious,” he recalled. “But I realized I wasn’t the only one in the dark. The doctors didn’t really understand my condition and why it was happening.”
“发生在我身上的这件事让我觉得很神秘，”他回忆说。“但我意识到，我不是唯一一个在黑暗中的人。医生们并不真正了解我的病情以及为什么会发生这种情况。”
He was discharged last weekend with instructions to see a cardiologist for follow-up visits. He was also told to avoid exercise for at least six months — a disappointment to David, who plays basketball as well as outfield and third base for his high school baseball team.
上周末，他出院了，医生要求他去看心脏病专家进行后续检查。他还被告知至少在6个月内不要运动——这让大卫很失望，他在高中棒球队中不仅打篮球，还打外野和三垒。
As more patients with the syndrome emerge, doctors say they have been struck by the variety of ways the new illness seems to manifest.
随着越来越多的患者出现，医生们说，他们对这种新疾病的各种表现方式感到震惊。
Recently doctors have begun describing a few cases in which patients had brain inflammation or other symptoms involving the central nervous system — a part of the body that did not seem a focal point of the syndrome initially.
最近，医生们开始描述一些病例，这些病例的患者出现了脑炎或其他涉及中枢神经系统的症状，而中枢神经系统是身体的一部分，最初似乎并不是该综合征的焦点。
At least one patient has had Guillain-Barré syndrome, which is marked by temporary paralysis, according to Dr. Michael Gewitz, of Maria Fareri Children’s Hospital in Westchester County.
威斯特彻斯特县玛丽亚·法瑞瑞儿童医院的迈克尔·格威茨医生说，至少有一名患者患有格林-巴利综合征，表现为暂时性瘫痪。
One boy with the new syndrome who died — a 7-year-old — had a severe headache and grew increasingly unresponsive when doctors tried to rouse him, Gewitz said. “The child who succumbed had overwhelming brain swelling,” he said.
Gewitz说，一名死于这种新综合征的7岁男孩患有严重的头痛，当医生试图唤醒他时，他的反应越来越迟钝。他说:“死于该病的孩子脑部肿胀严重。”
At Cohen Children’s Medical Center, on the border between Queens and Nassau County, which has treated more than 40 patients with the new syndrome — the highest number in the state — one doctor expressed some hope that the number of new patients with the syndrome was beginning to slow in recent days.
科恩儿童医学中心,在皇后区和拿骚县治疗40多个新综合症患者最多的国家——一个医生希望一些新综合征的患者的数量在最近几天开始放缓。
“We’re starting to see a flattening” of the number of cases, the doctor, James Schneider, said.
医生詹姆斯·施耐德(James Schneider)说，病例数量“开始变得平缓”。
But Lee, of the city’s Health Department, said it was too soon to know if the number of cases was slowing or still surging.
但该市卫生部门的Lee说，现在还不知道病例数量是在减少还是在激增。
