In the earliest days of the COVID-19 pandemic, parents and physicians were heartened to hear that the disease was sparing children. Most kids had mild, moderate or asymptomatic cases. Although this is still true, news media have recently reported that some children are developing a serious multi-system inflammatory condition as a complication of COVID-19 infection that can damage the heart and other organs. On May 14, The Centers for Disease Control and Prevention (CDC) issued a health advisory, providing background on a few recently reported cases, outlining case definition and recommending that health care providers report cases to local, state, and territorial health departments.
Infectious disease experts at Stanford Children’s Health want to help inform parents about this new entity linked to COVID-19, which has been named by the CDC as multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).
“We want to reassure families that this complication is very rare,” said Roshni Mathew, MD, clinical assistant professor of infectious disease at Stanford Children’s Health. Her team is closely monitoring reports about the disease as scientists around the world work to understand MIS-C. “Even though this is rare, and we don’t want parents to become alarmed, it’s wise for them to know what to watch for,” Mathew said.
Physicians in New York, London and elsewhere have described the symptoms of MIS-C as: persistent fever, a rash or changes in skin color, red eyes or conjunctivitis, abdominal pain, and swollen lymph nodes. If parents notice any of these symptoms, they should call their pediatrician for advice on next steps.
“The key is to identify this early so the child can receive appropriate treatments to help with the body’s inflammatory response.” said Mathew. Kids admitted to the hospital would also be carefully monitored for complications such as cardiac problems.
Children with MIS-C don’t always show respiratory symptoms of COVID-19, according to news reports.
COVID-19 and Kawasaki disease
Parents may also be wondering about a widely-reported case of an infant treated in early March at Lucile Packard Children’s Hospital Stanford for Kawasaki disease, which is also a pediatric inflammatory condition. The infant was admitted through the Stanford Emergency Department. Following admission protocol, she underwent testing for the novel coronavirus, SARS-CoV-2, and was found to have the virus. The care team noted that she did not have the typical respiratory symptoms associated with COVID-19. She received anti-inflammatory treatment for Kawasaki disease and quickly recovered.
Because the cases of MIS-C in Europe and New York have similar features to Kawasaki disease, this case has drawn a lot of attention. While the infant treated at Packard Children’s Hospital in March met some of the features per the CDC case definition for MIS-C, it is important to note that the patient was not nearly as sick as the cases being described elsewhere.
“What we saw was classic Kawasaki disease,” Mathew said. “It appears that what they’re seeing in New York has Kawasaki-like features but is more severe. Drawing these distinctions is tricky in a pandemic because we are learning as we go.”
Complete clinical descriptions of the children in New York have yet to be published, making it difficult for experts to know exactly how the cases compare, Mathew added. The baby treated in March is home with her family and doing well. To date, the hospital has not since seen any other cases of classic Kawasaki disease with positive COVID-19, nor seen cases of MIS-C.
“We are well-prepared to take care of any future cases, and we have been reassured that the majority of children are reported to have recovered from this condition,” said Mathews.