Page 20 - Florida Sentinel 5-22-20

Health
As COVID-19 continues to spread, there is growing evi- dence that children may be vulnerable to a rare but serious complication triggered by the infection.
So far, studies have shown that children appear to be less vulnerable to this new coron- avirus than adults. Kids under the age of 18 represent just 1%- 2% of reported COVID-19 cases.
But new reports, from the U.S. and several European countries, suggest that in rare cases, children can have a col- lection of symptoms -- includ- ing lengthy fevers, low blood pressure, rashes, red eyes, stomach upset, and inflamma- tion of the heart and its arter- ies -- that share features of
toxic shock syndrome and Kawasaki disease.
There’s even a debate about what to call it. A group of pediatricians studying these cases around the world has named the new condition pe- diatric multisystem inflamma- tory syndrome, or PMIS. Some believe it is a more severe form of Kawasaki disease. The CDC told doctors to watch for and report cases of multisystem in- flammatory syndrome - chil- dren, or MISC, to their local health departments.
In New York, 102 cases of the rare condition have been diagnosed, and three children, ages 5, 7, and 18, have died. New York City, the epicenter of the outbreak, has more than 50 cases.
Reports of the syndrome are coming just as day cares and schools in many states are thinking through when and how they can safely reopen.
On that front, experts say parents and school adminis- trators should stay alert but not be overly alarmed.
“This is still very, very rare,” says Alan Schroeder, MD, the associate chief of re- search in the division of pedi- atric hospital medicine at Lucile Packard Children’s Hospital at Stanford Univer- sity. “This is a very uncommon complication of this infection.”
So far, 15 states and a handful of European coun- tries, including Italy, Spain, France, and the U.K., have re- ported cases of the syndrome, which shares many features of Kawasaki disease.
New Complication Comes To Light
Kawasaki disease was first described in Japan about 50 years ago. Doctors aren’t sure what causes it. It tends to strike kids soon after they fight off an infection, leading doc- tors to believe that an autoim- mune attack on the body’s own organs and tissues sets it off.
Most kids who get this dis- ease recover completely, but in very rare cases, it can cause
permanent heart damage. Cases of Kawasaki disease tend to cluster in the winter and spring. So many of these patients are being reported ex- actly when doctors would ex- pect to see an uptick in their
numbers.
But experts say the in-
crease this year has topped the charts, and it seems to be more severe than the kind of Kawasaki disease they are used to treating.
A Different Type 0f Disease?
It’s not surprising that a Kawasaki-like disease would show up after COVID-19. Pre- vious studies have implicated other kinds of coronaviruses in Kawasaki patients.
Kawasaki disease tends to strike children under 5 years old. But the syndrome linked to COVID-19 seems to affect older children, too. In New York, most of the cases have been in kids ages 5 to 14.
In very severe cases, blood pressure plummets because the heart can’t pump enough blood, or blood vessels aren’t constricting properly, causing shock. Some children have a headache, dizziness, or other nervous system complaints. Other symptoms are in the di- gestive system -- severe stom-
ach pain, diarrhea, or vomit- ing.
“A lot of them have been misdiagnosed initially with ap- pendicitis,” says Deepika Thacker, MD, medical direc- tor of the cardiac inpatient unit at Nemours Hospital for Children in Wilmington, DE.
One thing the children with PMIS don’t seem to have is trouble breathing, a cough, or other signs of a respiratory infection like COVID-19.
That makes sense, Thacker says, because this syndrome sets in after the body has fought off the infec- tion.
“It’s not really a direct at- tack by the virus on the differ- ent organs in the body,” she says. “It’s the child’s own im- mune system that’s kind of ac- tivated out of control.”
As doctors begin to see new cases of the new syndrome, they’ve noted that strangely, there haven’t been any reports of it out of China, where the virus was first identified, or Japan, where Kawasaki dis- ease tends to be more com- mon.
Thacker wonders if it might be because a different strain of the virus was more prevalent in Asia. She says cer- tain populations may also be more likely to get it because of their genes.
What To Look For Thacker says that even though the syndrome is seri- ous, parents should be reas-
sured.
First, she says, “It’s not
common.” Second, “It’s not contagious.” Once kids have this, they’ve already fought off the virus. Finally, in most cases, kids will make a full re- covery.
The New York State De- partment of Health has recom- mended that parents seek care for their child right away if they have the following symp- toms:
- A fever that lasts more than 5 days
- Severe belly pain, diar- rhea, or vomiting
- Bloodshot eyes - A skin rash
Other symptoms:
- Change in skin color -- becoming pale, patchy, and/or blue
- A hard time feeding in ba- bies, or a child too sick to drink fluids
- Trouble breathing or breathing very quickly
- Racing heart or chest pain
- Tiredness, crankiness, or confusion
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