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At first, the belief that COVID-19 doesn’t always affect children as severely as it strikes adults came as a welcome relief. Older adults and people with compromised immune systems were at higher risk, but on the whole, kids didn’t appear to be as afflicted, or get as sick when they were. At least that was the initial understanding clinicians had of the disease caused by the coronavirus. Now doctors and scientists are rethinking that assumption, after identifying clusters of cases that point to a potentially dangerous syndrome they say is related to COVID-19 in kids, but with a different pathology and sometimes fatal outcomes.
The symptoms vary greatly, as does their severity. Many of these affected children have been admitted into intensive care and placed on life support. Some have reportedly suffered heart damage and other organ failure. The Centers for Disease Control and Prevention has confirmed at least three children have died, but doctors speculate there are probably more. With clinical symptoms more closely mirroring Kawasaki disease and toxic shock syndrome than the COVID-19 symptoms doctors have come to expect, there’s still much the medical community doesn’t know about this newly observed disease.
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This brings up some tough questions. What’s the disease called and how is it affecting kids? How deadly is it? How is it being treated, and will it delay the reopening of schools? This story draws on available information from sources like the CDC and World Health Organization, and will continue to be updated as new details come to light. It is not intended to serve as medical advice.
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What’s the disease called and how is it linked to the coronavirus?
The CDC and the WHO have dubbed this condition “multisystem inflammatory syndrome in children,” (PDF) or MIS-C. It’s also been called both “pediatric multisystem inflammatory syndrome” and “pediatric hyperinflammatory syndrome.”
In the early stages of the pandemic, doctors noted that it seemed like fewer children than adults had bad enough COVID-19 symptoms to require a hospital stay. A series of studies soon supported those suspicions. They showed how some kids did get sick, but far less frequently than adults. And it seemed children could definitely spread the disease, but adults spread it faster. Word got around that kids were relatively safe from the worst effects of the virus, and parents breathed a sigh of relief.
In time, however, clusters of unusually dire pediatric cases started to pop up. Most of these kids were testing positive, if not for coronavirus itself then for antibodies that suggested they had been infected at some prior point. But these kids weren’t arriving at the hospital with typical COVID-19 complaints. Notably, reports say, although they had fewer respiratory problems than expected, these kids were actually a lot sicker than many adult patients. They were among the first pediatric patients identified (PDF) with this new syndrome.
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The reason experts believe the illness affecting these kids is related to the novel coronavirus and COVID-19, the disease it causes, is because of how many of them tested positive for it. It’s true that tests for some of the children with these symptoms came back negative, but doctors pointed to concerns about the accuracy of some COVID-19 tests as a possible explanation for those exceptions.
Because many of these patients tested positive for antibodies — meaning they’d contracted the coronavirus possibly several weeks prior — doctors began to suspect that what was happening wasn’t a direct result of the virus itself, but rather some kind of reaction their bodies were having to an infection that had otherwise already cleared up.
What’s been happening to kids who are presumed to get COVID-19?
The symptoms reported by patients and doctors vary. Doctors have observed persistent fever, red eyes and skin rash, as well as low blood pressure, inflammation, pale and sometimes blue lips and skin, trouble breathing and lethargy.
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The most severe reports describe blood clots, chest pain, elevated heart rate and organ failure, including, in extreme cases, cardiac arrest. Children with MIS-C don’t always complain of respiratory problems the way doctors have come to expect from COVID-19 patients. But beyond these and a few other symptoms, doctors concede little else is known for sure about this illness. All they say is certain is that it requires immediate medical attention.
What are Kawasaki disease and toxic shock? How are they related to MIS-C?
Kawasaki disease is an inflammatory illness of unknown cause that primarily affects children 5 and younger. Toxic shock syndrome is a complication that arises from a bacterial infection and also causes inflammation. It is deadlier than Kawasaki disease, but both conditions share a number of symptoms with MIS-C, including fever, red eyes, skin rash and body pains. MIS-C is considered distinct, however.
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Knowledge about multisystem inflammatory syndrome remains limited, but some children who have recovered have talked to the media about their experiences.
One teenage boy, speaking to the New York Times, described the feeling as “like someone injected you with straight-up fire” during his hospitalization for heart failure.
A 12-year-old girl told the Washington Post she remembered having “weird” bluish lips and feeling “super tired” before doctors say she went into cardiac arrest.
Doctors say another 12-year-old girl developed a blood clot that stopped her heart. “It felt like someone was stabbing my leg,” she told NBC, who reported that it took 45 minutes of CPR to get it started again.
How does coronavirus cause all of those symptoms?
So far no one knows for sure, but some doctors believe it may be some kind of delayed reaction of the child’s immune system that is abnormal and unusually aggressive. Doctors speculate that while trying to fight off the virus, their immune systems overreact and start damaging normal, healthy cells, like those in their organs. They suggest this also could be what leads to the dangerous drop in blood pressure often observed.
Is MIS-C common? How many kids have had it?
A recent survey counted over 200 instances of the disease, but with total coronavirus infections surpassing 5 million confirmed cases worldwide, experts say this illness is still quite rare and that the vast majority of patients have so far responded well to treatment. Most have fully recovered.
When was MIS-C and the link to COVID-19 discovered?
In early April, a prepublication article in the journal Hospital Pediatrics reported an infant admitted and diagnosed with both Kawasaki disease and COVID-19. Since then, doctors have reported clusters of pediatric COVID-19 cases that presented with Kawasaki disease (PDF) and related symptoms, such as persistent fever, reddened eyes, skin rash and joint and abdominal pain.
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Are there any treatments?
There are no official courses of treatment nor any known cures for MIS-C or the coronavirus at this time (although there are several promising coronavirus vaccine candidates already in clinical trials). Doctors have reported positive outcomes, however, with the treatments they’ve prescribed.
New research published in the American Heart Association journal Circulation reports that children suffering from heart failure as a result of this syndrome who were then treated with a combination of steroids and antibodies acquired from donated blood — a treatment called immune globulin therapy — overwhelmingly recovered. Heart function was reportedly restored within a matter of days in most cases using this standard anti-inflammatory therapy.
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The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.