Tag Archives: Children

Some signs children may not transmit COVID-19, two UK epidemiologists say

By Guy Faulconbridge

LONDON (Reuters) – There are tentative signs that children may not spread the novel coronavirus as much as adults, two top epidemiologists said on Tuesday, though they cautioned that the bad news was that human immunity may not last that long.

As Europe and the United States try to get back to work after the first deadly wave of the novel coronavirus outbreak, world leaders are trying to work out when it is safe for children and students can get back to their studies.

The signs are that children may not spread it as much as adults, Dr Rosalind Eggo, who is on committees that advise the British government on its infectious disease response, told members of parliament’s upper house.

“We think that children are less likely to get it so far but it is not certain, we are very certain that children are less likely to have severe outcomes and there are hints that children are less infectious but it is not certain,” said Eggo of the London School of Hygiene & Tropical Medicine.

John Edmunds, a member of Britain’s Scientific Advisory Group for Emergencies (SAGE), told the House of Lords’ science committee that it was striking how children did not seem to play much of a role in spreading the novel coronavirus.

“It is unusual that children don’t seem to play much of a role in transmission because for most respiratory viruses and bacteria they play a central role, but in this they don’t seem to,” said Edmunds, a professor at the London School of Hygiene and Tropical Medicine.

“There is only one documented outbreak associated with a school – which is amazing,” Edmunds said.

But he added there was potentially bad news, though, that human immunity to the novel coronavirus may not last long.

(Reporting by Guy Faulconbridge; editing by Michael Holden)

T cells play a role in fighting coronavirus; COVID-19 affects children differently

By Nancy Lapid

NEW YORK (Reuters) – The following is a brief roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Immune system’s T cells play a role in attacking the coronavirus

While the immune system’s B cells make antibodies that block the novel coronavirus, its T cells provide another line of attack, according to new research. Researchers found that T cells from recovered patients can target the virus. That is promising news for vaccine developers because it is “consistent with normal, good, antiviral immunity,” Shane Crotty, from the Center for Infectious Disease and Vaccine Research at the La Jolla Institute for Immunology in California, told Reuters. “The types of immune responses targeted by many candidate vaccines are now shown to be the types of immune responses seen in COVID-19 cases that successfully recovered from the disease.” Furthermore, some people who never had COVID-19 nonetheless had T cells that could attack the virus, Crotty’s team reported on Thursday in the journal Cell. This suggests that past exposure to other coronaviruses (such as those that cause the common cold) had somehow primed their T cells to recognize and attack this new coronavirus. That might influence their susceptibility to COVID-19 disease, he said, either preventing them from getting infected or from developing severe disease.

Coronavirus affects adults and children differently

Children appear to have much lower rates of infection with the new coronavirus than adults, but most reports on COVID-19 in youngsters have focused only on small groups. A team of Chinese researchers has analyzed data from 24 earlier studies involving a total of nearly 2,600 children with COVID-19, enabling them to shed light on ways in which the virus acts differently in pediatric patients. They reported on Sunday in the Journal of Medical Virology that the most common laboratory test abnormality observed in adults was a low level of immune cells called lymphocytes (B cells and T cells). This condition, known as lymphopenia, developed in up to 80% of adults but in less than 10% of children. On the other hand, children – particularly infants – were more likely to have elevated levels of cardiac enzymes that indicate heart injury. They also found additional differences. The rates of severe illness and critical illness in adults were 14% and 5%, respectively (according to earlier reports). That compared with 4.4% and 0.9% in children. Fever occurred in up to 99% of adults but in 43% of children; cough in up to 82% of adults but 43% of children. Shortness of breath and acute respiratory distress syndrome (ARDS) were rare in children, but digestive tract symptoms like diarrhea were more common in kids than in grownups.

Coronavirus can infect patients taking hydroxychloroquine

Taking hydroxychloroquine for other medical conditions might not protect against the new coronavirus, French doctors say. The drug had nearly become a standard of care for patients with COVID-19 in many hospitals, even though randomized trials have not yet confirmed its value. But people around the world use decades-old hydroxychloroquine to treat malaria as well as inflammatory conditions like lupus and rheumatoid arthritis, and researchers are seeing occasional cases of coronavirus infection in these patients despite long-term use of the drug. A report on Sunday in the Journal of Antimicrobial Chemotherapy describes two such patients, one with rheumatoid arthritis and the other with a condition called mixed connectivitis. The authors say they also know of at least three other patients in Italy who became sick with COVID-19 despite taking hydroxychloroquine for chronic arthritis. “Patients actually taking long-term hydroxychloroquine are potentially immunosuppressed patients since they are living with chronic inflammatory diseases and thus do not represent the general population exposed to COVID-19,” the French doctors acknowledge. “However, these observational data are not in favor of a universal protective effect of hydroxychloroquine.”

New barcoding technique can help process 100,000 screening tests per day

A big challenge in preventing the spread of the new coronavirus is to identify and quarantine infected people who do not have symptoms. Laboratory workers can test blood samples from thousands of patients per day, still not enough to efficiently screen heavily populated areas. Now researchers at the OSU James Comprehensive Cancer Center in Columbus, Ohio say they have a way to screen over 100,000 samples per day. Their system, dubbed REMBRANDT, makes copies of the virus and introduces two barcodes that simplify patient identification. Barcoding of samples for screening is not new, but the OSU method takes a unique biochemical approach, aiming for a single barcoding and virus-copying step. “Barcodes on products in the supermarket and molecular barcodes for REMBRANDT work the same way,” investigator Richard Fishel told Reuters. “In this case, each patient has a unique combination of letters that allows for their simplified identification. With ten Next Generation sequencing machines, REMBRANDT can test every Ohio resident for COVID-19 infection every 10 days – an important step in contact tracing and reducing the spread of infection.” His team’s report, published on Sunday on the preprint server bioRxiv, has not yet been peer reviewed. “Our next step,” Fishel said, “will be to collaborate with hospitals and public health departments to clinically validate REMBRANDT and make it available to a wider audience.”

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

U.S. to tell doctors to report cases of COVID-19 inflammatory syndrome in kids

By Julie Steenhuysen

CHICAGO (Reuters) – U.S. health officials said on Wednesday they will issue an alert telling doctors to report cases of a rare life-threatening inflammatory syndrome associated with COVID-19 in children to their state and local health departments.

The alert from the U.S. Centers for Disease Control and Prevention (CDC) will be released on Wednesday or Thursday, an agency spokesman said in an emailed statement.

U.S. scientists have been working to understand the inflammatory syndrome associated with exposure to the new coronavirus, which has stricken children in Italy, Spain, Britain, and the United States.

In New York, more than 100 children are reported to have developed the syndrome, which may occur days to weeks after a COVID-19 illness. At least three children have died, the state reported on Saturday. All three tested positive for the new coronavirus or had antibodies to it, suggesting the syndrome is linked to COVID-19.

The syndrome shares symptoms with toxic shock and Kawasaki disease, with symptoms such as fever, skin rashes, swelling of the glands and, in severe cases, inflammation of arteries of the heart.

Scientists are still trying to determine whether the syndrome is linked with the new coronavirus because not all children with it have tested positive for the virus.

(Reporting by Julie Steenhuysen; Ediiting by Chizu Nomiyama and Bill Berkrot)

Rare syndrome tied to COVID-19 kills three children in New York, Cuomo says

By Nathan Layne

(Reuters) – Three children in New York have died from a rare inflammatory syndrome believed to be linked to the novel coronavirus, Governor Andrew Cuomo said on Saturday, a development that may augur a pandemic risk for the very young.

Both Cuomo and his counterpart in the neighboring state of New Jersey also spoke on Saturday about the pandemic’s growing toll on mental health, another factor on the minds of governors as they weigh the impact of mounting job losses against health risks in moving to loosen restrictions on daily life.

Nearly all of the 50 U.S. states will have taken steps to relax lockdown measures by this weekend, including states like Arizona and Mississippi, which are reporting increasing infections of COVID-19, the disease caused by the virus, highlighting the risk of a new wave of outbreaks.

Cuomo told a daily briefing that he was increasingly worried about a syndrome that shares symptoms with toxic shock and Kawasaki disease, which he said included inflammation of the blood vessels and potentially fatal damage to the heart.

He said three children – including a five-year old disclosed on Friday – have died from such symptoms while also testing positive for COVID-19 or related antibodies, suggesting a link that was still not fully understood.

Cuomo, who has emerged as a leading national voice on states’ response to the coronavirus crisis, said state health officials were reviewing 73 similar cases, which have rattled a prior assumption that children were largely not susceptible to the novel coronavirus.

“We are not so sure that is the fact anymore. Toddler, elementary school children are presenting symptoms similar to Kawasaki disease or toxic shock-like syndrome,” Cuomo said. “It’s very possible that this has been going on for several weeks and it hasn’t been diagnosed as related to COVID.”

Cuomo said state health officials had partnered with the New York Genome Center and the Rockefeller University to look at whether there is a genetic basis for the syndrome and have been asked by the federal Centers for Disease Control and Prevention to develop national criteria for identifying and treating cases.

The syndrome shares symptoms with toxic shock and Kawasaki disease, which is associated with fever, skin rashes, swelling of the glands, and in severe cases, inflammation of arteries of the heart. Scientists are still trying to determine whether the syndrome is linked with the new coronavirus because not all children with it have tested positive for the virus.

At a separate briefing, New Jersey Governor Phil Murphy said the death of a four-year old disclosed on Friday was not related to the syndrome. “This is a very specific situation with this blessed little kid and we are going to leave it at that.”

‘TOXIC MIX’

New York and New Jersey are at the epicenter of the pandemic in the United States, accounting for nearly half of the 77,737 American deaths from COVID-19, according to a Reuters tally, and the two states have among the strictest lockdown rules still in place.

They are also at the center of a devastating economic toll underscored in government data released on Friday showing the U.S. unemployment rate rose to 14.7% last month, up from 3.5% in February and shattering the post-World War Two record of 10.8% set in November 1982.

Cuomo said his state has seen increasing reports of mental health issues, substance abuse and domestic violence, all tied to the economic stress and isolation of the lockdowns.

On Friday a study released by the Well Being Trust and the American Academy of Family Physicians estimated an additional 75,000 people could lose their lives to suicide, drugs and other contributors to “deaths of despair” stemming from the crisis.

Murphy echoed those concerns.

“The cure for the health crisis is keeping people isolated,” Murphy told his briefing. “You add to that job loss, small businesses that have been crushed. It’s a toxic mix.”

Cuomo said 226 New Yorkers died from COVID-19 on Friday, up from 216 a day earlier, but less than half the levels recorded two weeks ago. He said hospitalizations and intubations continued their downward trend, further evidence the state has gained a measure of control over the virus.

Murphy said an additional 166 residents of his state had died over the past 24 hours from COVID-19, bringing its total fatalities to 9,116, while total cases rose by 1,759 to 137,085.

On a positive note, Murphy said the number of people hospitalized for the disease continued to fall, with the 422 patients discharged over the past 24 hours outpacing the 364 newly admitted for treatment.

Yet Murphy warned against complacency and said his constituents should continue to practice social distancing.

“We are not out of the woods, folks. Let’s not forget that,” he said.

(Reporting by Nathan Layne in Wilton, Connecticut; Editing by Daniel Wallis and Dan Grebler)

UK says some children have died from syndrome linked to COVID-19

By Guy Faulconbridge and Kate Holton

LONDON (Reuters) – Some children in the United Kingdom with no underlying health conditions have died from a rare inflammatory syndrome which researchers believe to be linked to COVID-19, Health Secretary Matt Hancock said on Tuesday.

Italian and British medical experts are investigating a possible link between the coronavirus pandemic and clusters of severe inflammatory disease among infants who are arriving in hospital with high fevers and swollen arteries.

Doctors in northern Italy, one of the world’s hardest-hit areas during the pandemic, have reported extraordinarily large numbers of children under age 9 with severe cases of what appears to be Kawasaki disease, more common in parts of Asia.

“There are some children who have died who didn’t have underlying health conditions,” Hancock told LBC Radio.

“It’s a new disease that we think may be caused by coronavirus and the COVID-19 virus, we’re not 100% sure because some of the people who got it hadn’t tested positive, so we’re doing a lot of research now but it is something that we’re worried about.”

Children were until now thought to be much less susceptible than their parents or grandparents to the most deadly complications wrought by the novel coronavirus, though the mysterious inflammatory disease noticed in Britain, Spain and Italy may demand a reassessment.

“It is rare, although it is very significant for those children who do get it, the number of cases is small,” Hancock, one of the ministers leading Britain’s COVID-19 response, said.

He did not give an exact figure for the number of deaths.

Kawasaki disease, whose cause is unknown, is associated with fever, skin rashes, swelling of glands, and in severe cases, inflammation of arteries of the heart.

Britain’s National Health Service says the syndrome only affects about eight in every 100,000 children every year, with most aged under 5.

There is some evidence that individuals can inherit a predisposition to the disease, but the pattern is not clear.

Children either testing positive for COVID-19 or for its antibodies have presented gastrointestinal symptoms such as abdominal pain, vomiting and diarrhea in the last two weeks, the Spanish Pediatric Association said on Monday.

Though the children were otherwise in good health, their condition could evolve within hours into shock, featuring tachycardia and hypotension even without fever.

Most cases were detected in school-age or teenage minors, and sometimes overlapped with Kawasaki disease or toxic shock syndrome (TSS).

Parents should be vigilant, junior British interior minister Victoria Atkins said.

“It demonstrates just how fast moving this virus is and how unprecedented it is in its effect,” Atkins told Sky News.

Professor Anne Marie Rafferty, the president of the Royal College of Nursing, said she had heard reports about the similarity between cases in infants and Kawasaki syndrome.

“Actually there’s far too little known about it and the numbers actually at the moment are really too small,” told Sky News. “But it is an alert, and it’s something that’s actually being explored and examined by a number of different researchers.”

(Reporting by Guy Faulconbridge and Kate Holton in London and Clara-Læïla Laudette in Madrid; editing by Michael Holden and Angus MacSwan)

Despite coronavirus, Americans fight for their right to a birthday party

By Barbara Goldberg

SOUTH ORANGE, N.J. (Reuters) – Reuben Goodman’s parents had to think fast and get creative when the COVID-19 pandemic scuppered their plans to throw a New Jersey bowling party to celebrate their son’s fifth birthday.

Emily and Dan Goodman instead decided to combine a variety of coronavirus-safe activities for their son, an avid Star Wars fan. The day includes a social-distancing treasure hunt of sorts; dancing in the streets in his Storm Trooper costume, with friends kept at a contagion-proof distance; and a virtual Zoom party featuring treats delivered to the homes of Reuben’s playmates and left outside their front doors.

Reuben Goodman dressed as Star War Trooper dances outside of his house on his 5th birthday party during the outbreak of the coronavirus disease (COVID-19) in South Orange, New Jersey U.S., April 14, 2020. REUTERS/Eduardo Munoz

Their aim was to make their pre-schooler feel like the center of the universe on his special day, even though he was unable to have a traditional party this year.

“Parents are trying very hard to create positive birthday memories,” said Emily Goodman, a communications executive who has been working at home in self-quarantine since mid-March under orders of her office in New Jersey. “He knows we can’t be close to our friends because of the invisible germs.”

The Goodmans are not the only Americans who have had to adapt to restrictions on social life in the wake of the pandemic, which has forced the cancellation of traditional birthday bashes for both young and old.

U.S. deaths from the novel coronavirus have topped 25,400, doubling in one week, according to a Reuters tally, as officials debate how to reopen the economy without reigniting the outbreak.

Despite the outbreak, Americans are still finding ways to have fun. In many small towns across the country, local police and fire departments are staging parades in front of children’s’ homes on their birthdays, complete with flashing lights and sirens.

Friends and families are using Zoom video conferencing to throw virtual parties, featuring renditions of “Happy Birthday,” a song that has become a coronavirus anthem. (Health experts say a thorough hand-washing takes 20 seconds, about the time it takes to sing “Happy Birthday” twice.)

In San Diego, California, when a former U.S. Marine couldn’t go anywhere for her 104th birthday, her friends brought the party to her front lawn.

“Well, I can’t believe it. It’s amazing,” Ruth Gallivan gasped, as honking cars festooned with birthday decorations drove by at a safe distance.

Anxiety around birthdays is spiking for children struggling with the concept of social distancing, Anthony Field, founder of the Wiggles, a popular Australian musical act, told Reuters in an email.

“Parents have told us their child is worried that if no one can come to their party, ‘Does it mean (I) still turn 4?'” said Field, better known as the Blue Wiggle.

In a new “Social Distancing” song, with more than 540,000 views since it went online March 29, the Wiggles assure fans that a video party counts as a genuine celebration, Field said.

In New Jersey, Reuben’s mother invited more than 20 neighbors to post drawings of Star Wars heroes and villains in their front windows, where her son could see them during a social-distancing walk on Tuesday, his fifth birthday.

Neighbors young and old agreed to dress up in futuristic costumes and join Reuben, wearing a new Storm Trooper outfit, as he danced on his front lawn. Adults would make sure everyone stayed at least the recommended six feet apart from one another.

Later, his friends were set to join him in a Zoom party that would feature a children’s musician strumming “Happy Birthday” and enjoy party goodie bags with toys that Reuben ordered from a local store and custom Star Wars cookies ordered from a local bakery. Reuben’s mother, wearing a face bandana and disposable gloves, planned to drop them off at his friends’ front doors, wiping down each one with disinfectant.

Reuben said he had another present for all the party-goers, who are presumably as tired of being separated from friends as he was. His special treat? “To look at me,” he said.

(Reporting by Barbara Goldberg; Editing by Alistair Bell)

Coronavirus tag: How the pandemic can affect young minds

By Kate Kelland

LONDON (Reuters) – It’s a bit like tag, except that you get tagged when someone coughs on you and that means you have the virus and have to go into isolation. If you come out and get tagged again, you die.

Child psychotherapists say playground games in the time of COVID-19 are becoming infused with words that many of the children playing them had never heard before: pandemic, isolation, lockdown.

So while the disease caused by the new coronavirus appears to produce relatively mild symptoms in many children, doctors and psychologists warn the impact of the outbreak and its anxiety-inducing spread may be far more traumatic.

“I’m worried we could develop a generation of children with health anxiety,” said Nikhil Chopra, a family doctor and father of two girls, aged 2 and 4, living in southern England.

His 4-year-old, normally playful and worry-free, he said, was coming home from school last week saying: “If we don’t wash our hands we could die.”

A psychotherapist who works with children in London said the games and playground talk among young children sharply reflect the new world.

Describing the coronavirus tag game, where “if you’re tagged you have to stand at one end of the playground in isolation, and if you come out and get tagged again, you die”, the therapist said fear and confusion were leading some kids to lash out.

“There’s quite a lot of ethnic diversity in the school I work in, and the Chinese children are being victimized and bullied – they are being told they’re “unclean” and “revolting” because “they eat dogs and snakes”. It’s so sad. The children are not bad, but their fear is so great that the only thing they can do is project it onto others to gain a sense of control.”

NERVOUS AND BRAVE

Across the Atlantic, 4-year-old Asher Henkoff says he’s fine when asked how the pandemic is affecting him: “I have my stuffed animals to keep me company, and I get to watch TV,” the Houston, Texas boy said, adding he feels “nerv-brave” – a mix of nervous and brave.

His mother, Alexandra Wax, says Asher has become uncharacteristically clingy, is asking non-stop questions about the new virus and has begun having accidents during the night – something he hasn’t done in years.

While some young minds will be resilient and enable those children to bounce back after the crisis, the risk for others, psychotherapists say, is that the anxiety they see around them now will impact their mental growth and future lives.

“Adults panicking is going to mean children panicking because they will be feeling very unsafe,” said Lucy Russell, a clinical psychologist in southern England and author of an online child mental health blog called “They are the Future”.

“I’m most worried not because of the distress I’m seeing in children right at this moment, but because of the distress I’m seeing in adults and how that will be transmitted to children.”

Russell and other mental health specialists such as Mary Calabrese, a Cambridge, Massachusetts-based child psychologist, say traumas like the global coronavirus pandemic can affect children particularly strongly.

Because their brains are still forming, trauma can cause the amygdala – the emotional part of the brain linked to fear and anxiety – to over-react at a time when its link to the frontal cortex – the thinking and more rational part of the brain – is not fully developed.

“The connections aren’t strong,” Russell said. “So young children tend to react emotionally to things – and the thinking, rational part of the brain can’t calm them down.”

Calming becomes a job for adults – parents, neighbors, teachers and friends – said Russell and Calabrese.

Acknowledging how hard this can be for parents and carers whose own lives are filled with anxiety and uncertainty, the specialists advise creating as much structure and predictability as possible to help children feel secure and safe.

And because children’s minds are geared toward problem-solving, they might also respond well to reassurance that focuses on what can be done to control the spread of the virus – like washing hands and staying inside.

“Validate their fears without making it worse,” Calabrese said. “You might want to say: ‘Let’s find out together what this means’. Pull it away from them personally, and say: ‘This is why we all owe it to each other to socially distance’.”

(Reporting and writing by Kate Kelland in London. Additional reporting by Nick Brown in New York; Editing by Janet Lawrence)

In Argentina’s north, indigenous children sicken and die from malnutrition

By Miguel Lo Bianco

TARTAGAL, Argentina (Reuters) – In Argentina, once one of the world’s richest countries and long a major supplier of beef, children are dying of hunger.

In Argentina’s far northern province of Salta, in a small indigenous community plagued by extreme poverty, eight children died in January alone from malnutrition and a lack of access to clean drinking water, health authorities say.

Women from the indigenous Wichi community carry their children who are undergoing treatment for malnourishment at a hospital, in Tartagal, in the Salta province, Argentina, February 27, 2020. Picture taken February 27, 2020. REUTERS/Ueslei Marcelino

The issue affects other places, too, and has prompted the national government to announce a plan to tackle hunger. The governor of Salta has declared a public health emergency, vowing to work with the national government to provide clean water in the province.

In the province last week, children from the Wichi community, with a population of just 1,200, played barefoot in the mud, outside homes constructed by hand from wood and cloth.

In Tartagal, the small town nearest to where the Wichi live, hospital beds are filled with Wichi children battling malnutrition and a host of other health issues linked to a lack of clean water, health officials said. Sometimes, the children arrive too late to make a recovery, according to Juan Lopez, manager of the hospital in Tartagal.

Complications related to the issues led to the deaths of the eight Wichi children in January, he said. The community also has one of the country’s highest rates of infant mortality.

A spokesman for Argentina’s ministry of health said, “We are constantly liaising with the province of Salta. We are doing food assistance and health assistance.” He added that there were teams from the federal government working in the province.

Liliana Ciriaco, a 45-year-old Wichi woman, said in an interview that there had been “many sicknesses.”

“There are some pregnant women who die, there are children who die, the elderly, too, and we don’t know what is going on,” she said.

A century ago, Argentina was one of the world’s most affluent countries, but it has weathered a series of economic crises in recent decades. The latest one began in 2018. Inflation hovers above 50% and the poverty rate is at 35%. Argentina’s indigenous communities, historically poor, have been especially hard hit.

A child from the indigenous Wichi community holds onto a feeding tube at a hospital, in Tartagal, in the Salta province, Argentina, February 26, 2020. Picture taken February 26, 2020. REUTERS/Ueslei Marcelino

For the Wichi community, the lack of access to safe water is a critical problem.

“The place where they access their water source has high salinization or even chemicals that have been used for agriculture, which cause many gastrointestinal diseases, diarrhea, malnutrition and, above all, dehydration,” said Diego Tipping, president of the Red Cross in Argentina.

Argentina’s new center-left President Alberto Fernandez campaigned on promises to address hunger, poverty and unemployment. In December, he announced a plan to combat the issue in the most affected areas of the country called “Argentina Against Hunger.”

Alejandro Deane, president of the Siwok Foundation, which is dedicated to improving water access for indigenous communities in northern Argentina, called the situation for the Wichi community “disastrous.”

“There is no good news. What needs to be done? What can be done? Here we need a long-term plan, not a short-term plan,” Deane said.

(Reporting by Miguel Lo Bianco; Additional reporting by Marina Lammertyn and Cassandra Garrison; Editing by Richard Chang)

Germany tightens carnival security after driver with ‘dead’ expression injures 60

By Joseph Nasr

VOLKMARSEN, Germany (Reuters) – Germany increased security at some carnival processions on Tuesday after a local man plowed his car into a parade in the western German town of Volkmarsen, injuring around 60 people, including at least 18 children.

The incident on Monday shook Germans still struggling to take in last week’s racist gun attack on two bars in the town of Hanau which left 11 people dead.

The driver was detained at the carnival on suspicion of attempted homicide and was being treated for his own injuries.

An emergency responder said bystanders had punched the man while he tried to choke her as she leaned into the car to remove the key.

“He didn’t say a word. He looked at you empty and dead and seemed so satisfied,” Lea-Sophie Schloemer told Welt television. “It was really unnerving how satisfied he seemed.”

The prosecutors’ spokesman said the driver had not yet been in a fit state to be questioned, but was not drunk at the time of the incident. Initial tests for alcohol were negative but that was not a final assessment and there were as yet no results from the drug test.

The motive was still unclear. “We are investigating all possibilities,” he said.

He said earlier there was no sign the investigation would be handed to national prosecutors, suggesting they did not see a political motive.

While some carnival processions in the state of Hesse, home to Volkmarsen, were canceled, others were due to take place in the region on Tuesday. A police spokesman said security would be intensified.

Rose Monday is the height of the carnival season in Catholic areas of Germany, especially in the Rhineland where tens of thousands of people dress up, drink alcohol and line the streets to watch decorated floats that often mock public figures.

Prosecutors said there was no concrete reason to think the risk of attacks at parades had increased, but they urged organizers to review their security arrangements and adjust them if necessary.

Security at public events in Germany has been tightened since a Tunisian man with Islamist militant ties plowed a truck into a Christmas market in Berlin in 2016, killing 12 people. He was later shot dead by Italian police after fleeing.

LIFE-THREATENING INJURIES

A police spokesman said he could not rule out that some of the injured in Volkmarsen were in a life-threatening condition.

Police had detained the driver, a 29-year-old German from the town who had been driving a silver Mercedes car, and he would appear before an investigating magistrate as soon as his condition allowed, state prosecutors said.

“There are so far no indications of politically-motivated criminality,” Bild newspaper cited an investigator as saying.

“But we think that the perpetrator acted with intent, and that psychological problems may have played a role,” the investigator added.

Prosecutors confirmed that a second man had been detained at the scene on Monday and was accused of filming the incident. The spokesman said prosecutors were investigating whether the man had links to the driver, including checking phone records.

The street where the incident happened in the center of the small town was still cordoned off by police on Tuesday and several stores in the area were closed. Residents were in shock.

“It’s terrible. I don’t know how somebody could do this, especially to children,” said 58-year-old Rainer Bellmann.

Locals told Reuters that police had searched two homes in the town, including one apartment near to the scene that a police officer said was the home of relatives of the man.

(Additional reporting by Hans Seidenstuecker in Frankfurt, Michelle Martin and Reuters Television; editing by Philippa Fletcher; Writing by Madeline Chambers and Emma Thomasson; Editing by Andrew Heavens and Philippa Fletcher)

No place to go: Syrian families fleeing Idlib stranded on the roads

By Khalil Ashawi

AZAZ, Syria (Reuters) – Abu Abdallah has been on the road for days. After his family fled the air strikes pounding Idlib, they moved from one village to another in northwest Syria but have yet to find refuge.

“I don’t know where to take them,” the 49-year-old farmer said from his tractor on the side of a road in Azaz town, where he is stranded with his wife, four children and 20 other relatives. “This is the first time I flee my hometown. God knows where we will go.”

The family is part of the biggest exodus of Syria’s nine-year war.

Nearly a million people, mostly women and children, are trying to escape the latest wave of violence in the Idlib region, overwhelming aid agencies.

Many have nowhere to go, trapped between the fighting and the closed-off Turkish border. Families sleep outside in streets and olive groves, burning garbage to stay warm. Some children have died from the cold.

Some of the people fleeing Idlib have already been displaced more than once, after fleeing battles in other parts of Syria earlier in the conflict.

The United Nations said on Tuesday that government warplanes had struck hospitals and refugee camps as the Syrian army, with Russian backing, gains ground in the northwest, the country’s last rebel stronghold.

Before she escaped Idlib in recent days, Aziza Hadaja, 70, locked her front door.

It is the third time she has been uprooted, but in the past, she would go back home. This time, after government forces marched into her village, she does not know when or if she will return.

Along with her children and grandchildren, Hadaja is now sheltering in a makeshift tent in a field on the road out of Azaz further north.

“We came out with the clothes on our backs,” she said. “We didn’t bring a thing.”

(Reporting by Khalil Ashawi in Syria; Writing by Ellen Francis in Beirut; Editing by Alex Richardson)