After 3 Children Die, a Race to Investigate a Baffling Virus Syndrome
在3名兒童死亡後，一場調查令人困惑的病毒綜合症的競賽開始了
Joseph Goldstein and Jesse McKinley約瑟夫·戈德斯坦和傑西·麥金利
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，一家人走過紐約展望公園。(本傑明·諾曼/《紐約時報》)
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.
紐約——將採集紐約數十名兒童的血液，以確定他們是否具有可能使他們易患一種與冠狀病毒有關的神秘綜合徵的基因變異。
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.
三名分別為5歲、7歲和18歲死於該病的患者中的至少一名患者的組織樣本已被送往公共衛生實驗室進行強化檢測。
A team of more than 30 disease detectives — epidemiologists, clinicians and statisticians — is poring over thousands of pages of medical records.
一個由30多名流行病學家、臨床醫生和統計學家組成的疾病偵探團隊正在仔細研究數千頁的醫療記錄。
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.
就在世界各地的醫生和科學家競相開發針對COVID-19的治療方法和疫苗的時候，紐約州已經成為了一項平行行動的中心，目的是調查這場疫情令人不安的一個方面:一小部分兒童患病，但患病人數在不斷增加。
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，紐約至少有161名兒童被報告患有這種疾病，這使得紐約州成為公開報告患病人數最多的州之一。在美國和歐洲，還有數百名兒童也患有這種疾病，現在被稱為多系統炎症綜合徵。
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.
該綜合徵的特徵是心臟、血管、胃腸道或其他器官的嚴重炎症，據信是對冠狀病毒的反應引起的。對為什麼會發生這種情況以及能否找到治療方法的調查，可能會對當局如何處理學校和其他兒童活動的重新開放產生影響。
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.
參與這項工作的紐約醫生表示，自從衛生官員在2015年和2016年開始調查孕婦寨卡病毒和小頭症之間的聯繫以來，還沒有出現過如此緊急的調查，以瞭解這種對兒童的神秘威脅。
“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.
州衛生專員Howard Zucker博士說:“我們正在尋找一切可能的方法——治療方法、診斷方法、臨床圖片——我們正在努力把這些方法結合起來。”
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?’”
他補充道:“它確實會讓你晚上睡不著。我們擔心的是，是否有一些事情我們要在六個月後弄清楚，然後我們會說，‘我們怎麼會沒有想到可能的治療呢?我們怎麼就沒想到這有幫助呢?’”
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.
急於瞭解這種綜合徵的做法似乎引起了祖克的共鳴，他曾接受過小兒心臟病學培訓，並看過這種疾病患者的病歷。
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.
他在一次採訪中描述了試圖治療其中一名受害者的醫生的沮喪之情。當時，這名患者正在與一種沒有名字的綜合症作鬥爭。孩子嚇壞了;心臟功能惡化，呼吸也隨之惡化。
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嚨，積極的、維持生命的措施——機械的和藥理學的——被部署，即使是在進行一系列測試試圖確定疾病的原因的時候。
The young patient did not survive.
這個年輕的病人沒有活下來。
“Everything was done for that child,” Zucker said. “Everything.”
“一切都是為了那個孩子，”扎克說。“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.
在上週召開的視頻會議上，紐約州幾名兒科醫生匆忙召集了一場討論，其中一名醫生提到他所在醫院的病例激增了40多個。
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.
另一位醫生談到了患有心臟病的兒童的心臟問題。三分之一的人談到如何治療布朗克斯的一名14歲少年，該少年入院時狀況良好，但隨後迅速惡化。
“Twenty-four hours later, he was aggressively delirious and had to be restrained and sedated,” that doctor, H. Michael Ushay, recalled.
“24小時後，他嚴重昏迷，必須加以控制和鎮靜劑，”那位名叫h邁克爾烏沙(H. Michael Ushay)的醫生回憶說。
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,醫學兒科急救護理部門主任在蒙蒂菲奧裡兒童醫院,說他不確定孩子的下滑是由於疾病或對藥物反應的男孩在醫院,其中包括類固醇和氯胺酮。
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，也就是在紐約市冠狀病毒爆發的一個月後，這種新綜合徵的首批病例開始引起醫生的注意。
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.
幾乎立即,醫生注意到在一些患者的症狀有著驚人的重疊,一個叫川崎病的罕見的兒童疾病,其中包括血管和炎症的症狀的範圍可以從發紅的眼睛受損的冠狀動脈可導致心臟病發作和動脈瘤。
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.
但患川崎病的兒童中，有一小部分最終會被送進重症監護室或需要生命支持。然而，有相當數量的新綜合徵患者確實如此。
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.
紐約衛生署(New York City 's Department of Health)的流行病學家艾倫·李博士(Dr. Ellen Lee)在4月下旬瀏覽她的醫學討論小組時，偶然發現了一種神秘疾病的報告，這種疾病影響了英國的兒童，似乎與冠狀病毒有關。症狀包括腹痛和心臟發炎、虛弱。
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.
她讓她的團隊打電話給醫院，詢問他們是否看到類似的情況。一些沒有。另一些人對症狀相同的兒童進行了治療，但不知道他們看到了新的東西。在一兩天內，李的團隊就發現了9個病例。
“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，它只是試圖從供應商那裡獲得儘可能多的信息，以瞭解他們看到了什麼，什麼是不尋常的，”李說。
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.
她的團隊成員聯繫了疾病控制和預防中心。他們詢問了紐約市的法醫辦公室，看看是否有兒童在最近死亡時表現出任何症狀。他們向其他主要城市的衛生部門進行了調查。似乎沒有人知道多少。
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、衛生部和市政府官員就會非常清楚地意識到，這種新症狀正迅速成為紐約兒童的威脅。
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.
據該州衛生部高級官員弗里德里希(Marcus Friedrich)說，全州約70%的重症患者都在重症監護室接受治療。弗里德里希說，有些人需要吃藥來提高血壓，19%的人使用了機械呼吸機。
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.
醫生們說，少數人甚至需要更激烈的干預，包括體外膜肺氧合，也就是把血液從身體中分離出來，通過膜肺進行氧合，然後再把血液泵回病人體內。
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.
醫生們在採訪中說，大多數新綜合徵患者之前都是健康的，沒有任何潛在的健康問題。病例的激增和發病時間的選擇使許多醫生得出結論，認為這種疾病與冠狀病毒有關。
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.
雖然不是全部，但很多患病兒童的冠狀病毒或抗體檢測呈陽性，這表明他們之前接觸過這種病毒。但根據對家長的採訪，醫生通常得出結論，孩子們幾周前就接觸過這種病毒。
“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，還是幾周後身體對病毒的反應?”布朗克斯區雅可比醫療中心(Jacobi Medical Center)的兒科重症監護室主任小愛德華·康威(Edward Conway Jr.)問，他懷疑是後者。
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.
西奈山衛生系統(Mount Sinai Health System)的兒科重症監護科主任喬治·奧夫裡-阿曼弗(George Ofori-Amanfo)博士說，時間的滯後和炎症的跡象讓許多醫生懷疑，這種新綜合徵是由“對COVID接觸的一種侵略性的、異常的免疫反應”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.
到目前為止，醫生們一直在進行類似的治療，就像他們對患有川崎病的兒童所做的那樣。患者經常接受類固醇的聯合治療;靜脈注射的免疫球蛋白，一種從捐獻的血液中提取的抗體豐富的血清，聚集了成千上萬的人;和靜脈注射阿司匹林。
So far, many patients have responded well, four doctors said in interviews.
四名醫生在採訪中說，到目前為止，許多病人的反應都很好。
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.
布朗克斯區的一名少年說，有一天晚上他醒來，胸部中心有一陣刺痛的感覺，他意識到出事了。當他一邊吃著麥圈一邊看YouTube視頻時，這種事情又發生了。
“My arms also started to become numb,” the teenager, David Vargas, 17, recalled.
“我的胳膊也開始變得麻木，”17歲的少年戴維巴爾加斯(David Vargas)回憶說。
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.
他在曼哈頓西奈山克拉維斯兒童醫院(Mount Sinai Kravis Children’s Hospital)接受了近一週的住院治療。他說，檢測結果顯示他感染了冠狀病毒，之後心臟受損。
“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.
“被告知你的心臟可能受傷是一件非常可怕的事情，”大衛說，他在醫院裡畫醫生和護士的肖像來打發時間。
“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.”
“發生在我身上的這件事讓我覺得很神秘，”他回憶說。“但我意識到，我不是唯一一個在黑暗中的人。醫生們並不真正瞭解我的病情以及為什麼會發生這種情況。”
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.
上週末，他出院了，醫生要求他去看心臟病專家進行後續檢查。他還被告知至少在6個月內不要運動——這讓大衛很失望，他在高中棒球隊中不僅打籃球，還打外野和三壘。
As more patients with the syndrome emerge, doctors say they have been struck by the variety of ways the new illness seems to manifest.
隨著越來越多的患者出現，醫生們說，他們對這種新疾病的各種表現方式感到震驚。
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，醫生們開始描述一些病例，這些病例的患者出現了腦炎或其他涉及中樞神經系統的症狀，而中樞神經系統是身體的一部分，最初似乎並不是該綜合徵的焦點。
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.
威斯特徹斯特縣瑪麗亞·法瑞瑞兒童醫院的邁克爾·格威茨醫生說，至少有一名患者患有格林-巴利綜合徵，表現為暫時性癱瘓。
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說，一名死於這種新綜合徵的7歲男孩患有嚴重的頭痛，當醫生試圖喚醒他時，他的反應越來越遲鈍。他說:“死於該病的孩子腦部腫脹嚴重。”
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.
科恩兒童醫學中心,在皇后區和拿騷縣治療40多個新綜合症患者最多的國家——一個醫生希望一些新綜合徵的患者的數量在最近幾天開始放緩。
“We’re starting to see a flattening” of the number of cases, the doctor, James Schneider, said.
醫生詹姆斯·施耐德(James Schneider)說，病例數量“開始變得平緩”。
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.
但該市衛生部門的Lee說，現在還不知道病例數量是在減少還是在激增。