Doctors Warn Pediatric Multi-System Inflammatory Syndrome Could Be Caused by COVID-19

At the onset of the COVID-19 pandemic, the US breathed a collective sigh of relief due to early reports that the illness wasn't affecting children as much as the rest of the population. That's still largely true—most who fall severely ill after being infected with the new coronavirus are over the age of 65 and/or have underlying conditions. But now, the medical community is warning Americans that the virus could have rare but serious consequences for children.

As of May 20, the New York State Department of Health was investigating 146 reported cases of a mysterious illness that, health officials speculate, could be related to COVID-19. That's up from 64 cases as of May 5. So far, the illness has claimed the lives of three young New Yorkers, ages 5, 7, and 18. The New York City Health Department sounded the whistle on the illness on May 4 after reporting that doctors in the NYC area had seen at least 15 cases.

At a recent media briefing, New York Governor Andrew Cuomo said 14 other states and five European countries were investigating similar cases of what the state called "Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19."

Advisories from New York's state and city health departments note that the illness presents similarly to Kawasaki disease, an "acute febrile illness of unknown etiology [unknown cause]" that primarily affects children younger than 5 years old, and/or toxic shock syndrome. Though it's not known what causes Kawasaki disease, the condition is the leading cause of acquired heart disease in the US, per the CDC—that's important, as complications from the disease can lead to coronary artery dilatations and aneurysms later in life.

Subsequently, the Centers for Disease Control and Prevention (CDC) issued an alert to doctors urging them to report suspected cases of the illness, which it described as "Multisystem Inflammatory Syndrome in Children," or MIS-C. Young people under age 21 with fever and inflammation might meet the CDC definition if they are ill enough be hospitalized with multiple organ systems affected. The agency says the condition may affect the heart, kidneys, lungs, blood vessels, GI tract, skin, and nerves. Doctors who have ruled out other plausible diagnoses might consider this syndrome if a child has COVID-19, was recently infected, or was exposed to the virus in the four-week period prior to the onset of symptoms.

The CDC followed up with guidance for parents, urging them to contact their child's doctor, nurse, or clinic right away if they suspect their child has MIS-C. The list of possible symptoms includes:

• fever
• abdominal pain
• vomiting
• diarrhea
• neck pain
• rash
• bloodshot eyes
• feeling extra tired

The CDC added that any child exhibiting any of these emergency warning signs of MIS-C or any other concerning symptom requires immediate medical attention:

• trouble breathing
• persistent chest pain or pressure
• new confusion
• inability to wake up or stay awake
• bluish lips or face
• severe abdominal pain

In New York State, the affected children range in age from the very young (under age 1) to young adults (ages 20-21), with the majority of cases between the ages of 5 and 14, Cuomo said. Sixty percent of the children have tested positive for the COVID-19 virus, and 40% have tested positive for antibodies to the virus, while 14% were positive for both. "That means children either currently had the virus or could have had it several weeks ago and now have the antibodies," the governor explained. The presence of antibodies suggests they had been exposed to the virus at some point. Seventy-one percent were treated in hospital intensive care units, and 43% remain hospitalized.

Per the NYC news bulletin, patients had "subjective or measured fever," and "more than half reported rash, abdominal pain, vomiting, or diarrhea," while fewer than half reported any of the typical respiratory symptoms common with COVID-19.

Doctors in the US were first alerted to the problem in April by doctors in the United Kingdom. The Guardian recently reported there have been 12 cases in the UK, and all patients were directed to the intensive care unit.

While doctors are still investigating this mysterious illness—and while many have said it presents similarly to Kawasaki disease—it's important to note that there's not enough information right now to directly link Kawasaki disease and COVID-19. "[There's] no way we're going to say coronavirus [is] causing Kawasaki" disease right now, Frank Esper, MD, pediatric infectious disease expert at Cleveland Clinic Children's tells Health. Adam Ratner, MD, a pediatric infectious disease specialist at NYU Langone Health echoes that statement, saying that, while the possibility of a correlation between the two illnesses is noteworthy, experts still aren't sure that one exists.

"As with many things in this pandemic, understanding [this illness] is going to require cooperation—we're going to have to work together," Dr. Ratner adds. A statement on these pediatric cases from Mount Sinai Hospital in New York says: "We do not know if the underlying condition is COVID-19 or another inflammatory process but we want to reassure the public that this is a very rare occurrence."

But if the illness is linked to coronavirus, it's one more reason to take COVID-19 seriously no matter how old you are, Dr. Esper says. "It reiterates that children can get very sick from coronavirus," he says, adding that if a young patient is admitted with the symptoms of the illness, doctors should definitely screen for COVID-19.

The NYC Health Department underscores the importance of that, suggesting that if the mysterious inflammatory condition is suspected in a pediatric patient, they should be immediately referred to a specialist. "Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications," according to the bulletin, which added that patients possibly suffering from this mysterious illness should be treated with intravenous immunoglobulin and aspirin.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.