One of very few relative bright spots of the coronavirus pandemic has been that children tend to have milder symptoms. The World Health Organization declared that the “vast majority” of kids who contract COVID-19 will recover fully, and pediatric deaths from the disease have been rare.
Parents, though, have been rattled by recent headlines about a small but growing number of young children being hospitalized with a serious inflammatory condition similar to Kawasaki disease, which causes blood vessels to become inflamed and is a leading cause of heart disease in children. News emerged Friday that one child in New York has died as a result of the disease, and one child in England is known to have died.
“We are seeing something that is unusual, and that we haven’t really seen in a group of children before,” Dr. Deepika Thacker, medical director of the Cardiac Inpatient Unit with Nemours Children’s Health System in Delaware, told HuffPost.
Here’s what doctors and researchers know so far about the matter.
The symptoms are similar to Kawasaki disease.
Kawasaki disease is an illness first recorded in the late 1960s that tends to affect young children (75% of cases are in kids under the age of 5, according to the American Heart Association). It’s typically marked by a fever, rash, red eyes, swollen lymph nodes, irritation in the mouth, lips and throat, and swollen hands and feet — although patients do not necessarily have all of those symptoms. Its cause is unknown and no specific blood test is available for Kawasaki disease, but experts do know it can lead to serious complications like coronary aneurysms and heart problems days after symptoms start.
What doctors are seeing now is a relatively small number of cases of a similar inflammatory syndrome in coronavirus hotspots in the U.S. and Europe (the continent where it was first detected). Many doctors are calling this new condition “pediatric multisystem inflammatory syndrome.”
It’s not fully clear what the syndrome is at this point.
Although this syndrome bears a lot of resemblance to Kawasaki disease, it is unclear whether it is the same thing.
“There are similar clinical features to a certain extent, in terms of fever and rash, but there’s a lot more abdominal complaints. So, abdominal pain, diarrhea, vomiting,” Thacker said.
“The children we’re seeing are somewhat older and the ethnic distribution is somewhat different — we’re not seeing it in people from Asia as much as we are in other groups, so it hasn’t really been reported from China, Japan or Korea,” Thacker said. That’s surprising, given that Kawasaki disease is generally more common among children of Asian and Pacific Island descent.
The inflammatory syndrome doctors are now seeing in children might ultimately be labeled Kawasaki disease, Thacker said, or it could turn out to be an entirely new syndrome that happens to share many of the same characteristics.
Experts believe it *may* be an immune response to COVID-19.
Doctors still don’t know exactly what causes Kawasaki disease. It isn’t contagious. Many believe it occurs following a viral infection that subsequently triggers a strong immune response. Basically, a child’s body begins to attack itself.
And that might be behind the current COVID-19 connection.
The coronavirus “may trigger an immune response similar to what occurs in Kawasaki,” Dr. Michael Portman, director of Seattle Children’s Kawasaki Disease Clinic, told HuffPost. “In fact, we know that the virus does trigger a hyper-immune response.”
Indeed, many adult patients are being treated for “cytokine storms,” where immune cells in the body begin attacking it.
That hypothesis — that the virus responsible for COVID-19 triggers a hyper-immune response in some children — could also help explain why cases only began to be reported somewhat recently, weeks and months after children in certain hotspots started coming down with COVID-19.
And yet not all children who have had this inflammatory response have tested positive for COVID-19, so at this point there remains a lot that experts simply do not know.
It’s (likely) rare.
As of Tuesday, 64 suspected cases of this inflammatory syndrome in children had been reported in New York City, and dozens in Europe. It is difficult to say how that stacks up against how many children have been diagnosed with COVID-19 overall, given the many challenges with testing in the U.S. In general, the data doctors and researchers have to work with at this moment is just not particularly good.
Given that, it is possible that as doctors become more aware of the possible connection between these Kawaski-esque symptoms and COVID-19 in children, more cases will be documented.
“I’m hesitant to say how rare this is,” Portman said. “I could say today that I think it’s rare, but it could burgeon out tomorrow.”
Parents should absolutely be taking this seriously — and talking to doctors with concerns about it.
In general, children who receive early treatment for Kawasaki disease with things like intravenous immunoglobulin respond well. And while many questions remain about the best treatment for this particular inflammatory syndrome, there are many methods doctors can try.
“Children seem to have good response to treatment, good recovery, and they do not seem to have long-lasting damage, and that’s a reason to be hopeful,” Thacker said. “I think my take-home for parents would be please, don’t panic.”
But parents should pay close attention to children who have symptoms of COVID-19, and talk to their pediatrician if they see things like a rash, gastrointestinal distress or a fever that lasts for several days. Much of the initial public health messaging around COVID-19 was to treat the condition at home as much as possible, but experts say parents should absolutely get immediate care for their children if they have any concerns.
“If your child has persistent fever for four or five days, parents should seek medical attention,” Portman said. “There was a message that if you only have fever and mild symptoms, you should stay home. For children, I don’t think that is the correct message.”
Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of press time, but its guidance around COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
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