The reports about complications apparently spawned by COVID-19 have alarmed parents, pediatricians, and infectious disease experts throughout the world. The seeming connection between the virus and a rare but serious health condition called Multi-System Inflammatory Syndrome in Children (MIS-C) began emerging in the spring.
“This whole concept that children didn’t get (serious complications from) COVID has really drastically changed,” Dr. Evelyn Montalvo Stanton, chair of the pediatric department at the UNLV School of Medicine, told the Las Vegas Review-Journal.
According to Montalvo Stanton and a colleague, UNLV Medicine infectious disease expert Dr. David Di John, the complications of MIS-C are significant, including high fever, abdominal pain, vomiting, rash, diarrhea, respiratory symptoms, swollen extremities, lethargy, and headache.
“Of the children with COVID-19 I’ve treated, three had to go on ventilators, including one with MIS-C,” said Di John, noting that there have been fewer than a dozen of the MIS-C cases locally so far. “Fortunately, all children have gone home.”
Di John and Montalvo Stanton, along with UNLV medical student Cole Crosby, recently produced a paper on Multisystem Inflammatory Syndrome in Children for a new UNLV pediatric subspecialty medicine newsletter to be sent to pediatricians in Southern Nevada.
“We want to be a source of good information for the community,” noted Montalvo Stanton, adding that the most solid information possible on children and COVID-19 is particularly critical at this time, with children possibly heading back to school soon.
Call on us
“We’d like physicians in the community to feel free to call on us for our thoughts and knowledge base,” Di John said.
UNLV Pediatrics has 15 full-time and one part-time UNLV School of Medicine faculty, 36 residents, and two chief residents. In addition to seven general pediatricians, there are specialists in pulmonology, neurology, behavioral development, gastroenterology, infectious diseases, adolescent medicine, and endocrinology — the most pediatric subspecialties under one roof in Nevada. Children who need surgery can be referred to the UNLV Pediatric Surgery Clinic led by Dr. Michael Scheidler.
Until the emergence of the inflammatory syndrome, what had been reported about the novel coronavirus and children was much less threatening — children make up far fewer confirmed cases of the novel coronavirus and generally are less likely to develop severe complications.
The Centers for Disease Control and Prevention (CDC) found children represent 22 percent of the U.S. population, but only around 5 percent of confirmed COVID-19 cases — 1.7 percent of cases in the 0-9 age group and 3.8 percent of cases in the 10-19 age group.
Though the CDC reported 29 people under the age of 14, and 142 people between the ages of 15 and 24, have died in the U.S. from the virus during the pandemic (the Southern Nevada Health District reported two children have died from it in Clark County), health experts say underlying health conditions often played a large role in their deaths.
The mystery of what causes MIS-C — it can cause different organs to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs — has added to public concern over COVID-19 and children.
“We do not yet know what causes MIS-C,” the CDC says on its website. “However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.”
As of July 15, CDC had received reports of 342 cases and six deaths from MIS-C. Most cases are in children between the ages of 1 and 14 years with the average age of 8 years. To date, the Southern Nevada Health District has reported no deaths from MIS-C.
Di John, the lead writer on the inflammatory syndrome paper, pointed out that many of the symptoms of the syndrome are the kinds that pediatricians have often counseled parents on how to manage at home. But now, he said, symptoms must be looked at through a different lens. “Early recognition by pediatricians and prompt referrals to the emergency department, and to inpatient specialists and intensivists, is essential,” he wrote. “Pediatricians and subspecialists should consider this syndrome, particularly when other microbial causes or diagnoses have not been identified.
“Management of COVID-19 and MIS-C patients should be multidisciplinary,” Di John wrote, “and will vary depending on manifestations and extent of the illness. Remdesivir and other antivirals may be potentially useful in patients with active COVID-19 disease. Due to the multi-system manifestations of MIS-C, broad-spectrum antibiotics may be beneficial. For children who suffer from subsequent shock or organ failure, the standard of care should be followed. A significant proportion with MIS-C may require intensive care.”
Variety of treatments
Depending on the severity of their illness, patients are treated in a variety of ways, Di John said, including anticoagulants, IV immunoglobulin (IVIG), steroids, and respiratory support and ventilators. Others receive immunomodulating drugs which affect what doctors call the “cytokine storm,” the severe immune reaction that causes many of a patient’s symptoms.
Di John said that at this time, it is impossible to predict who will develop the syndrome. He noted that one of his patients developed the syndrome a few weeks after testing positive for COVID-19. The Southern Nevada Health District reported that there have been hundreds of children who have tested positive for COVID-19, with few having to be hospitalized.
As difficult as diagnosing and treating COVID-19 and MIS-C sometimes can be, Di John said we shouldn’t expect it to get any easier any time soon.
“Things will be even more challenging in the fall, when influenza season typically begins,” he said.