The new way COVID-19 might be affecting kids

From the earliest days of the COVID-19 pandemic, one of the main understandings was that it didn’t affect healthy kids as seriously as adults. While that still remains true, in early May reports from New York and Los Angeles have talked about a “mysterious illness” that has shown up in some kids who have been exposed to the COVID-19 virus. Shortly after, the Centers for Disease Control and Prevention (CDC) issued a health alert as well.

These broad collection of symptoms were first referred to as Pediatric Inflammatory Multisystem Syndrome (PIMS) but now are officially known as Multisystem Inflammatory Syndrome in Children (MIS-C). Some of these patients have been found to have inflammation of many organs including the heart and enlargement of the coronary blood vessels. They can present with many different symptoms including: a persistent high fever, swelling of the hands and feet, rash, and red eyes and tongue.

In most of these cases, these patients tested positive for COVID-19 antibodies (as opposed to testing positive for the actual virus). That means the child doesn’t currently have COVID-19, but did some weeks or months earlier and their body’s immune system fought it off.

In other words, MIS-C is not being caused by an active infection. Rather, it’s the result of their body’s immune response. For some reason, their immune systems are having this general inflammatory response weeks later.

MIS-C vs. Kawasaki

A lot of media reports have been connecting MIS-C with another disorder known as Kawasaki disease. It’s important to note that while similar, MIS-C and Kawasaki are not the same.

Kawasaki disease is a rare condition, affecting about 25 per every 100,000 kids in the country. It primarily affects kids under the age of 5 and its cause is not known. At Children’s Wisconsin, we’ve had nine new cases of Kawasaki in the last month or so.

It is generally rare but being the only hospital in the region dedicated to the care of kids, we do see it on a regular basis. We sometimes see a higher incidence in certain seasons and this is the time we typically see Kawasaki disease.

The primary symptom of Kawasaki is a high fever, typically greater than 102, for more than five days. Additionally, to receive a diagnosis of Kawasaki, a patient must have four out of the five following symptoms:

• Rash
  
  
• Red eyes
  
  
• Redness in palms and soles of the feet
  
  
• Changes to the lining of their nose and mouth (the mucous membrane)
  
  
• Enlarged lymph nodes

If left untreated, Kawasaki can lead to swelling of the heart and blood vessels, including the coronary arteries that supply blood to the heart muscle. That can have serious long-term health effects. However, while Kawasaki disease can be serious, if it’s caught early it is very often treatable with IV antibodies, high-dose aspirin and steroids. 

What we’ve seen at Children’s Wisconsin

In late May, Children’s Wisconsin reported seven suspected cases MIS-C to the Wisconsin Department of Health Services. It's important to remember that MIS-C is extremely rare and most kids recover.

While the prevalence of MIS-C in kids with exposure to COVID-19 indicates some potential link, the exact correlation or causation is still being investigated.

To that end, Children’s Wisconsin has created a multidisciplinary team to develop a care plan for any kid who comes to the hospital with MIS-C-like symptoms. The idea is for a relatively small group to quickly review the literature and develop a care pathway so we have a uniform approach for this patient population. This working group consists of physicians from critical care, infectious disease, hospital medicine, immunology, emergency medicine and cardiology.

When to seek care

Now and always, we are available for parents — virtually and in person — if they have any concerns about COVID-19 or MIS-C. Prolonged fever, rash, red eyes, abdominal pain — if a parent is seeing any of these symptoms, that would warrant calling a pediatrician at any time.

If parents are concerned, they should contact their child’s pediatrician by phone, MyChart message, schedule an appointment or they can talk to a pediatric care provider through our Online Urgent Care video visits. 

Joseph Block, MD Cardiologist Herma Heart Institute

Our high standard of care has always required an uncompromising approach to safety. And during this COVID-19 pandemic, we continue to ensure every visit, appointment, procedure and surgery offered across all our Children's Wisconsin locations is safe. Learn more on our COVID-19 web page.