Jacob, a well-known children’s immunologist agreed to meet with us, but asked to remain anonymous. He has a twinkle in his eyes you can only find in the kind eyes of pediatricians.
“As a children’s immunologist I have three main areas of interest,” Jacob told us, “Allergies are a given, of course. Another area of interest includes primary immune-deficiencies – kids who are born with errors in their immune system, leading to life-threatening infections at a young age. Similar to what was presented in the movie “bubble boy”. Yet these diseases are considered quite rare. And lastly, autoimmune diseases in which the immune system attacks the body instead of defending it. It’s a large field of work, and every doctor finds their own expertise in the field. I specialize in allergies and immune deficiencies.”
Different diseases = different severities
“In more severe cases, kids need a bone marrow transplant as soon as possible. There is a high chance of success with these transplants, meaning the child can go on to live an entirely normal life.” Jacob smiles widely. You can tell this is what he’s here for – saving lives. “It’s honestly incredible.”
“With the less severe cases, in which a transplant isn’t an option, you can treat kids with antibodies separated from the fluid in the blood from healthy blood donations. The antibodies (or immunoglobulins) are separated from the rest of the blood and are given in an intravenous transfusion once every 3-4 weeks. This treatment can strengthen the immune system of kids who don’t create the right antibodies naturally. There are also kids that need to take antibiotics regularly as a preventive treatment for their entire life, and these kids are also reliant on good hygiene to stay healthy.
These diseases can vary in severity. A child can make it to five years of age without anyone knowing something is wrong, and a different child can’t make it to five days without having the entire hospital staff on their toes. Eventually, it’s the doctor’s job to ensure these kids have the most normal lives they can.
In the most severe cases of immune deficiencies, up until the transplant, the child is placed under home quarantine and isn’t allowed near anyone but the mother. We instruct the mother to stay away from people too, so that she doesn’t infect the child by accident. The food that the kid can eat is only sterile food, it must be cooked so that potential germs die. Of course, washing hands before touching the child is of utmost importance. In severe cases, we even recommend using a face mask near the child, even at home. “
Immune compromised children
There are over 350 diseases that affect the immune system in children, according to Jacob. “There are a lot of parents and children that need to wash their hands much better than others and need to pay close attention to their hand hygiene. In schools, that’s a real problem. Kids don’t wash their hands nearly as much as they should, so even if the child themselves tries to keep to a high level of hand hygiene, the kids around them can put them in danger. Theoretically, kids can die after contracting infections at school. I like to believe we stop that before it happens, with antibiotics and other treatments, but that’s not always the case.” Pain is evident over Jacob’s face, clouding over the man’s expression.
“There are a number of diseases that are transferred through low hand hygiene and that’s really risky, kids with immune-deficiencies have a much higher chance of getting an infection when they are hospitalized and have a lower chance of making it out alive than a healthy child who was hospitalized for any reason. We need to change how some hospitals and dome schools handle hand hygiene so that immune-compromised children can lead a normal life there.”
“When COVID-19 first started spreading, there was a great deal of unease in the medical community,” Jacob shared with us. He fidgets in his seat uncomfortably, seeming to recall the first days of the pandemic. “We were extremely worried about the kids with immune-deficiency, we didn’t know much back then – but now a few kids with immune deficiencies have already contracted coronavirus around the world. Surprisingly, the number of deaths is lower than we anticipated. The coronavirus itself isn’t as violent as you’d think – instead, it activates the immune system in an extreme way, and that’s what causes most of the deaths. Recent research focuses on stopping the virus from spreading from cell to cell, but also on stopping the immune system reacting to it. Children with immune deficiencies don’t have that extreme reaction because their immune system is compromised, so they usually do reasonably well with COVID 19. Nowadays doctors are trying to use steroids and other therapies that attenuate the immune response to the virus consequently helping covid-19 patients.” Jacob shakes his head. “It’s a turn we didn’t expect back in the very early days of Covid-19.”
Hand hygiene and immune deficiencies
“I heard about a kid that kept coming into the ER with severe infections. When we sat down properly to talk about it, the doctors realized the child’s family “didn’t believe in hand washing” and has never practiced it. That explained it, point-blank.
If I had anything I could relay to immune-compromised children and their families, is listen to the rules, comply with regulations. They’re so important, they’re there for a reason. Wash your hands as much as possible, wear a face mask, and practice social distancing.
These are things that can help immune-compromised children even after the world has dealt with COVID-19: social distancing, good hand hygiene, and more, can keep you safe.”