Nearly since the start of the COVID-19 pandemic, we’ve heard that children were at lower risk of severe COVID-19 infection. However, in late June the New England Journal of Medicine published two articles describing a dangerous complication of COVID-19 in children.
Earlier this year, physicians treating children with COVID-19 in the United Kingdom began reporting serious complications resembling Kawasaki disease or toxic shock syndrome. The condition caused failure of multiple organs and, rarely, death. This May, in consultation with public health experts from New York (the epicenter of the COVID-19 pandemic at that time), the CDC named the condition Multisystem Inflammatory Syndrome in Children, or MIS-C.
The new articles in the New England Journal of Medicine summarize what we currently know and have learned about this condition. The first article, by the New York State and CDC MIS-C Investigation Team, described the first 99 known cases of MIS-C in New York State between March 1 and May 10, 2020. The most common symptoms were fever, rash, red eyes, swollen hands or feet, abdominal pain, nausea, vomiting or diarrhea, Kawasaki disease, heart inflammation, headache, or confusion. Cases peaked about a month after the peak of the COVID-19 epidemic in New York. Black and Hispanic children bore the brunt of this condition: nearly half of the children with MIS-C were Black, and one in three were Hispanic. Eight in ten children required treatment in the intensive care unit; most recovered within five days but tragically, two died in the hospital.
The second article, by the Overcoming COVID-19 Investigators, described 186 patients with COVID-19 in 26 states, excluding cases described in the New York State article. Surprisingly, the children described in this study had more organ failure than the children described in New York. It may be that physicians in New York hospitals, who were treating COVID-19 on a daily basis, were better able to identify milder cases of MIS-C which may have gone unidentified in areas that then had lower rates of COVID-19. The second study also had fewer cases of MIS-C among Black, non-Hispanic children, possibly reflecting demographic differences between New York and the states in this study. As in the New York study, cases of MIS-C peaked about a month after cases of COVID-19.
These studies shed new light on MIS-C, but many questions remain to be answered. The delayed peak and signs of inflammation in affected children suggest that MIS-C may be an abnormal immune response to COVID-19 recovery. This raises troubling concerns as to whether COVID-19 vaccines might cause similar side effects in children. I would hope that vaccine developers would include children in Phase 3 clinical trials of potential COVID-19 vaccines in order to identify their safety and rates of side effects in children.
It’s also unclear whether adults also develop a delayed inflammatory response to COVID-19. So far, most of the publications summarizing COVID-19 has focused on the initial infection; it will be important to better describe late and long-term effects of COVID-19 in all ages.
Finally, it’s important to remember that older adults and people with certain chronic conditions are still at higher risk for severe COVID-19. And most children with COVID-19 do appear to have a milder course. But as we look ahead to the fall and potential school reopenings, it’s important to keep in mind that some children may have very severe, even deadly complications of COVID-19. We need to vigilantly protect everyone against COVID-19, not only the higher risk groups.
For now, the best advice I can give you is the same advice I’ve been giving you all along: wash your hands frequently and teach your kids to wash theirs, stay six feet away from other people, clean surfaces daily and wear face masks in public. In addition, call your child’s doctor immediately if he or she develops fever, rash, red eyes or abdominal pain as these may be signs of a serious medical condition.
😷 Dr. B