As the COVID-19 pandemic surged in New York City doctors started seeing children with a mysterious illness that was fatal in some rare cases. A new paper examines this illness — called pediatric multisystem inflammatory syndrome or MIS-C — in 33 patients and finds that even though the symptoms are dangerous, doctors can treat it, leaving few lingering issues.
“This is treatable as compared to COVID itself,” Dr. Charles Schleien, an author of the paper and chair of the pediatrics department at Northwell Health Cohen Children’s Medical Center, told TODAY. “As severely as the kids presented, almost all of them resolved or are resolving (their symptoms).”
The paper in the Journal of Pediatrics conducted by Feinstein Institutes for Medical Research bolsters what experts understood about MIS-C from reports from Europe.
“It just reinforces many of the things we've already known, which is that a significant number of patients with this disease can (become) very sick,” Dr. Kevin Friedman, a pediatric cardiologist at Boston Children’s Hospital and associate professor at Harvard Medical School, who did not participate in the study, told TODAY. “But that actually most of these kids respond very nicely to therapy.”
In some ways, MIS-C resembles Kawasaki disease, a vascular inflammatory syndrome most commonly in children age 5 and younger. Children with Kawasaki disease experience prolonged fever, rash, red swollen hands and feet, cracked lips and inflammation that can injure the coronary arteries. In the paper, more than half of the children with MIS-C displayed symptoms consistent with Kawasaki disease, but there are differences. The research from New York City found that MIS-C is more likely to impact older children, the median age was 8.6 years old and MIS-C seemed to affect the heart more.
“The overlap is mostly in the high fever and then the fact that the heart can be involved in the same type ... of coronary artery enlargement,” Friedman said. “MIS-C is more likely to affect the heart directly, like the pumping.”
In almost all the children with MIS-C analyzed in this new research, 97%, experienced gastrointestinal symptoms including diarrhea and abdominal pain.
“From a symptom perspective that was the biggest surprise,” Schleien said.
But this can present a challenge to parents as tummy troubles occur so frequently with young children.
“It’s so hard to parse out because they are so common,” Schleien explained.
Shock and low blood pressure is another symptom characteristic of MIS-C. That’s why Schleien said that parents should call a pediatrician or seek help if their child experiences stomach problems and a fever for more than a day.
“It’s important to get your kid's attention because you don’t want a kid to be home with shock, let alone low blood pressure, day after day because they can die,” he said.
MIS-C seems linked to the surge of coronavirus cases in an area. Schleien said New York City cases have slowed and Friedman said Boston’s cases are lessening, too. But the experts believe as COVID-19 cases increase in other areas, more children will have MIS-C. Recently cases have been reported in Nebraska, North Carolina, Washington and Indiana.
In most cases, children with it don’t have symptoms of COVID-19 but they have the antibodies showing they had been exposed to it at some point.
“They even might be asymptomatic or very minimally symptomatic. But, then they can get very, very sick several weeks later,” Dr. Nicole Salazar-Austin, an assistant professor in the division of pediatric infectious diseases at the Johns Hopkins School of Medicine in Baltimore, Maryland told TODAY. “We're still talking about a very small number of children (with MIS-C).”
Even though MIS-C occurs infrequently, understanding it can occur remains important.
“But MIS-C is a real risk for kids and both pediatricians and people in the community need to know that it exists,” Salazar-Austin said. “So that kids can get treated early before complications arise.”
Overall, COVID-19 does not sicken children as gravely.
“One thing that's been that's been very clear is that when kids have acute COVID-19 they don't get as sick as adults,” Salazar-Austin said.
A recent paper in Nature supports this: When children under 20 develop COVID-19 they do not get as sick.
“The kids are still largely spared, not 100%, but compared to adults, particularly the elderly, they are very much spared — even if you include MIS-C,” Friedman said. “People have got some theories why but no definitive evidence.”