The Margin: What parents should know about the mysterious coronavirus-related disease affecting children: pediatric multisystem inflammatory syndrome

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Health officials are increasingly sounding the alarm on what could be a COVID-19-related illness in children that’s been reported in at least 14 states and five European countries.

The rare but possibly life-threatening condition, which is being called pediatric multisystem inflammatory syndrome, or PMIS, presents with symptoms that often differ from kid to kid, and can include fever, stomach pain and rashes, as well as red eyes, loss of appetite and lethargy. This is similar to what’s seen in Kawasaki disease, a rare inflammatory condition which tends to hit one in 10,000 American children under five, as well as toxic shock syndrome, a complication from an infection that can include fever, low blood pressure, vomiting and rashes.

The New York State Department of Health is investigating more than 100 cases of this mysterious new malady, which is showing up in patients ranging from infants to 21-year-olds, Gov. Andrew Cuomo revealed on Wednesday. Three children in New York have died.

“It’s a wide array of symptoms, as you can see, which makes it even harder for parents to know exactly what they’re dealing with,” Cuomo said during his daily coronavirus presser.

“As a parent, I can tell you this is a parent’s worst nightmare, right?” Cuomo continued. “We thought that children were not specifically affected by the virus. To now find out they might be, and it might be several weeks later … this is truly disturbing.”

The CDC is also expected to issue an alert any time now that tells doctors to report cases of this to their state and local health departments, Reuters reported. And Dr. Anthony Fauci mentioned it during his Senate testimony on Tuesday, describing the “children presenting with COVID-19 who actually have a very strange inflammatory syndrome.” He added, “I think we better be careful that we are not cavalier in thinking that children are completely immune to the deleterious effects (of the virus).’’

But just how dangerous is it, and how come we’re only hearing about this now? Dr. Purvi Parikh, a pediatric allergist and immunologist at NYU Langone Health, walked MarketWatch through what is known about PMIS. Keep in mind, however, that we’re still learning about both COVID-19 and this new illness in children, so this information is subject to change. Stay up-to-date by checking your local health department or visiting the CDC’s coronavirus website.

What is pediatric multisystem inflammatory syndrome? And what is Kawasaki disease?

PMIS is a new health condition that has started appearing in children during the COVID-19 pandemic and it shares similar symptoms to Kawasaki disease, marked by a persistent fever that lasts several days, inflammation and poor function in one or more organs. Kawasaki disease also presents suddenly, although it’s usually only seen in children under 5. PMIS is showing up in patients up to 21 years old, although most of the New York cases have involved kids between the ages 5 and 14. While most children do fully recover, some children get sicker more rapidly, and this can lead to organ failure if left untreated. Three children in New York have died.

“In the last few weeks, we’ve started to get reports out of Europe that this is occurring,” Parikh explained, noting that adults have also suffered severe immune system reactions to the coronavirus, called cytokine storms. One theory is that “the immune system is just having a very hyperactive response to this coronavirus,” she said. “We were already seeing a lot of this in adults with COVID-19. A lot of the damage the virus causes is not really the infection itself; it’s how your immune system reacts to it.”

What are the symptoms?

According to the New York City Department of Health and the Boston Children’s Hospital, common symptoms include:

• A fever (100.4 degrees Fahrenheit) lasting more than 4 or 5 days

• Your kid is “off” — showing lethargy, irritability, sluggishness or confusion

• Severe abdominal pain, diarrhea or vomiting

• Rash

• Conjunctivitis, or red or pink eyes

• Enlarged lymph node (“gland”) on one side of the neck

• Red, cracked lips or red tongue that looks like a strawberry

• Swollen hands and feet, which might also be red

• Patchy blue or pale skin discoloration

• Difficulty feeding infants, or child is too sick to drink fluids

• Racing heart or chest pain

• Decreased amount or frequency of urine

Why do we think this is related to the novel coronavirus?

The reason why this syndrome is being linked to the coronavirus is because most of the children afflicted by it so far have tested positive for COVID-19, or they have COVID-19 antibodies. Cuomo revealed that 60% of the 102 cases that the state is investigating tested positive for COVID-19; 40% tested positive for the antibodies to the virus; and 14% tested positive for both. U.K. health officials have also reported that many children presenting with this unusual diagnosis have had COVID-19. And as Parikh noted, some adult COVID-19 patients have suffered a similar exaggerated systemic immune response, called a cytokine storm, that causes organ damage.

“We don’t want people to panic…The majority of kids don’t get it. And even if they do, they do very, very well [with treatment].”

— Dr. Purvi Parikh

The Boston Children’s Hospital also suggested that coronavirus testing is not always accurate, which may be why some kids with this syndrome didn’t appear to have COVID-19. One preprint article from China has suggested that the rate of false negatives from COVID-19 tests could be 30% — that’s almost one in three. And the Abbott ID Now test missed at least 48% of COVID-19 positives in one test, according to a new NYU analysis that still needs to be confirmed.

We’ve been talking about coronavirus for months, so why are we only just seeing this illness in children now?

The short answer is, we don’t know yet, especially since we can’t be 100% sure what exactly is causing this in children until more research has been done. One theory that Parikh shared is that PMIS is a “delayed manifestation” of COVID-19 in children. “Often long after viruses are gone, they can cause inflammation or immune changes in your body,” she explained. “This could be a delayed consequence of the virus: were kids exposed or infected earlier, and now we’re seeing it? There are a lot of different possibilities.”

If one of my children gets this, can they infect my other kids?

Not at all. “The good news is the syndrome itself is not contagious. A child with this syndrome can’t cause another child to have this syndrome,” Parikh said. But she cautioned that COVID-19 is still very contagious, “and we don’t know who will have zero symptoms, mild symptoms, or severe symptoms.”

What should I do if my child has these symptoms?

Call your doctor, or your local hospital or health department. “I know there’s a fear of going to the hospital right now, but some people actually need to go. And with these kids, even though they [often] do well, they definitely need the hospital setting,” said Parikh. “They have to be monitored closely, as this can affect multiple organs such as the heart, kidney and lungs.” While you’re waiting to touch base with your doctor or to head to the ER, give your child Tylenol to treat the fever, she suggested, and plenty of clear fluids, as you would to treat any virus.

But if your child can’t keep fluids down because their nausea or vomiting is severe, or they’re losing consciousness, or are “really out of it,” Parikh added, call 911 or go to the emergency room ASAP.

How is this treated? What can parents expect if they go to the hospital?

Because each case can present so differently, treatment often varies. But one thing all of these kids have in common: they need to be treated in a hospital setting, as they should be closely monitored for organ failure. “They will probably be in a very monitored setting, even the ICU, and there probably will be frequent tests for their heart, their liver and their kidneys to make sure everything is running smoothly,” Parikh said. “That’s the only way to tell if things are going south or not.” Additionally, many of these kids are being treated with intravenous immunoglobulin, which is essentially a blood serum that gives the kids an antibody boost. Aspirin and steroids can also be prescribed to fight the immune system’s overenthusiastic response.

How long does it take to recover?

“It does vary from kid to kid, but most have been recovering within a few days to a week, so it’s not like the weeks and weeks in the hospital, like we see with the adults,” Parikh said. “Children are generally more resilient, is the thing, and that is reassuring, too.” The Boston Children’s Hospital has also noted that to date, “most children affected have done well.” The mortality rate so far is estimated at 0.1%.

“We don’t want people to panic,” said Parikh, who still cautioned parents to take this seriously. “The facts are that overall, this is still very rare. The majority of kids don’t get it. And even if they do, they do very, very well [with treatment.] So don’t be afraid of the ER.” In New York, more than half of the kids who have been treated in hospitals have already gone home.

How can I protect my children from catching this?

Practice the same social distancing and personal hygiene practices being followed to prevent the spread of COVID-19. “This underscores the need for everyone to take COVID-19 precautions, because initially we were not as strict with children, because we felt like overall they were doing pretty well,” Parikh said. This includes “continuing social distancing, frequent handwashing and the universal masking.”

And if your kids won’t keep their face masks on, “try to make it fun for them, like, they can be a superhero by doing this, and help save lives,” she suggested. “Or personalize the masks. I’ve seen a lot of really cute designs on masks for adults and kids.” She noted that while this may sound simple, “it makes a huge impact in the spread of the virus.”

Read MarketWatch’s complete coronavirus coverage here.

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