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Montefiore in the News

May 19, 2020

What We Know About the Covid-Related Syndrome Affecting Children

Melinda Wenner Moyer | May 19, 2020

For parents, one of the most reassuring aspects of the coronavirus has been that it largely spares children, only causing mild symptoms. But recent reports of a new life-threatening pediatric inflammatory syndromeare worrying many families. Children in Europe, Britain, and now the United States are being hospitalized for this mysterious illness, which can harm kids’ hearts and other organs, often requiring intensive care.

According to Gov. Andrew M. Cuomo, as of May 12, New York was investigating 102 cases of this syndrome and three deaths, and cases have been reported in 14 other states so far as well. Thankfully, this new syndrome is still quite rare and it is treatable, and most kids who develop it fully recover. Here’s what parents need to know and what they should do if they’re concerned about their children’s health.

Doctors suspect Covid-19 iinvolved, but they aren’t certain.

No one knows for sure whether this new syndrome, which is now being called pediatric multisystem inflammatory syndrome, or P.M.I.S., is linked to the coronavirus, but many doctors think so. “I do think that this is related to Covid,” said Dr. Eva Cheung, M.D., a pediatric cardiologist and critical care specialist at NewYork-Presbyterian Morgan Stanley Children’s Hospital, which has treated more than 35 patients so far with the syndrome. 

The vast majority of children who’ve fallen ill in New York have either tested positive for active Covid-19 infection or have had antibodies suggesting that they were exposed to the virus at some point. A few kids have tested negative for both active infection and antibodies, and it’s unclear what that means. It’s possible that these negative tests were inaccurate, Dr. Cheung said, because many coronavirus antibody tests are unreliable.

What’s interesting, though, is that most of the children who’ve gotten sick — even those whose tests indicated prior coronavirus exposure — did not report having a recent respiratory illness. This suggests that these children were either exposed to the coronavirus but didn’t get sick, or that they had very mild symptoms, said Dr. George Ofori-Amanfo, M.D., the division chief of pediatric critical care medicine at Mount Sinai Kravis Children’s Hospital.

Even if Covid-19 is involved, it’s unclear what happens to make these children so sick.

Dr. Ofori-Amanfo suspects that children who develop this syndrome were exposed to the coronavirus, and that their bodies for some reason mounted an exaggerated — and ultimately dangerous — immune response, much like the “cytokine storms” that have caused some adults to fall quite ill in the later stages of infection.

They may “have an abnormal and aggressive immune response to Covid — and that immune response is so aggressive that it affects other organ function and affects their ability to maintain their blood pressure,” Dr. Ofori-Amanfo said. This may then cause their bodies to go into rapidly progressive shock, requiring medications and, in rare cases, the use of life support to take over the job of their heart and lungs.

Still, doctors stress that no one yet knows for sure what is going on. “We don’t even exactly know what this disease is,” said Dr. Rebecca Pellett Madan, M.D., an associate professor of pediatric infectious diseases at the N.Y.U. Grossman School of Medicine.

The syndrome has been compared to several known conditions, but it’s probably new.

When it first arose, many doctors noticed that this new syndrome had features similar to Kawasaki disease, a rare condition that typically afflicts children under 5, causing their blood vessels to become inflamed. But although its symptoms are similar, and both are conditions marked by widespread inflammation, most doctors do not think this current syndrome is the same thing as Kawasaki. “They may share features,” Dr. Cheung said, but “I truly do think that this is its own syndrome.”

The pediatric inflammatory syndrome also looks a lot like toxic shock syndrome, which occurs when the body goes into shock because it has been exposed to toxins released during bacterial infections. But Dr. Ofori-Amanfo said that none of Mount Sinai’s patients had evidence of a bacterial infection in their body, so it was likely that the pediatric inflammatory syndrome, again, looked similar to toxic shock syndrome but was not actually the same thing.

 

The symptoms are noticeable and serious.

The good news is the new pediatric inflammatory syndrome is easy to spot — its symptoms are serious enough that parents should be able to notice them. All patients developed a fever of 101 or higher that didn’t go away, said Dr. James Schneider, M.D., a pediatric critical care specialist at Cohen Children’s Medical Center in Queens, which has treated more than 40 patients so far with the syndrome. Dr. Cheung agreed, adding that kids with temperatures of 99 or 100 probably aren’t at risk. “That is not what we’ve seen here. The patients that we’ve seen that have needed admission to the hospital have had pretty moderate to high fevers,” she said.

Most kids also develop serious abdominal pain that get progressively worse over time. It’s not a garden-variety kids’ stomach ache; it’s serious pain that is often accompanied by vomiting and diarrhea and is “severe enough for the parent to be worried,” said Dr. Ofori-Amanfo. For some kids, the pain has been so bad that parents and doctors assumed the child had appendicitis and needed surgery, said Dr. Nadine Choueiter, M.D., a pediatric cardiologist at the Children’s Hospital at Montefiore in the Bronx.

Many kids with the syndrome — but not all — develop rashes, too. The rashes are red and often appear on the hands, forearms and chest, Dr. Ofori-Amanfo said, although they can appear anywhere. They typically turn white when you press on them, and then turn red again when you stop. They also usually cover a large area — a child’s entire face, for instance, or a substantial part of their arms or legs. “It’s not like a tiny speck of a rash. It’s pretty diffuse,” Dr. Cheung said.

Kids with the syndrome sometimes also have red eyes, cracked lips, a sore tongue, swollen hands and feet and they might complain of muscle soreness and not want to walk. But these symptoms are not as common as the fever and abdominal pain, doctors said, and some of the symptoms may come and go. “Sometimes the skin and the eye findings kind of wax and wane to the point that one doctor will go in the room and say ‘I saw a rash,’ and then another doctor goes in the room three hours later and the rash is entirely different,” Dr. Choueiter said.

  • Frequently Asked Questions and Advice

Updated June 24, 2020

  •  What’s the best material for a mask?

Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.

  •  Is it harder to exercise while wearing a mask?

commentary published this month on the website of the British Journal of Sports Medicinepoints out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.I’ve heard about a treatment called dexamethasone. Does it work?

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

  • What is pandemic paid leave?

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

  • Does asymptomatic transmission of Covid-19 happen?

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

  • What’s the risk of catching coronavirus from a surface?

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

  • How does blood type influence coronavirus?

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.H

  • How many people have lost their jobs due to coronavirus in the U.S.?

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

  • What are the symptoms of coronavirus?

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. 

  • How can I protect myself while flying?

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • What should I do if I feel sick?

If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Doctors haven’t identified any conditions or medical histories that put children at risk for the syndrome — except for coronavirus exposure.

“All our patients have been previously healthy patients, with no underlying illnesses,” Dr. Ofori-Amanfo said. Some of the kids who developed the syndrome even had multiple siblings who remained perfectly healthy.

Doctors are also seeing the syndrome in both sexes, but “we are seeing it in slightly more boys than girls — like 60 percent boys, 40 percent girls,” Dr. Choueiter said. The age range is wide, too; the Children’s Hospital at Montefiore has seen the syndrome in kids from 5 months to 20-years-old. It has not been observed in adults.

The one thing that clearly puts children at risk is living in an area with a lot of Covid-19 cases. But again, because kids who get sick with the syndrome didn’t necessarily have any Covid-19 symptoms, it can be hard for parents to know if their children might be at risk. 

If your child develops a fever and seems unwell, contact your pediatrician.

If you child has a persistent fever above 101 — and especially if they develop other symptoms consistent with the syndrome, like a bad stomach ache — contact your pediatrician. “Ask to speak to them over the phone or do a telemedicine visit and have your pediatrician walk through the steps of what to look for,” Dr. Pellett Madan suggested. Dr. Cheung agreed, noting that in geographical areas where this syndrome has appeared, hospitals are making sure that local pediatricians know what to look for and what to do.

If your child has a fever but is in good spirits and is eating and drinking and not complaining about pain, you don’t need to rush them to the emergency room, but again, stay in touch with your doctor. On the other hand, if your child really seems unwell — isn’t eating or drinking, doesn’t want to move much and especially if they develop a rash or red eyes along with a high fever — it’s not a bad idea to go directly to the E.R., Dr. Pellett Madan said.

Remember that this syndrome is rare, and that most kids recover.

It’s estimated that hundreds of thousands of children around the country have contracted the coronavirus, and the vast majority only have very mild symptoms. This serious syndrome is “still a very rare occurrence,” Dr. Schneider said. Your child is probably going to be fine.

Even the few kids who do go on to develop this inflammatory syndrome usually get better. “Some of them don’t even go to the intensive care unit. They’re with us for a few days, less than a week and they go home,” Dr. Choueiter said. They’re typically treated with what’s called “supportive care” to ease their symptoms: They might get fever reducers to lower their temperature, IV fluids to keep them hydrated, medications to increase blood pressure if it drops, and steroids or other drugs to quell the inflammation. Ultimately, “most of these children do fine,” Dr. Choueiter said.

Melinda Wenner Moyer is a mother of two and a science journalist who writes for Slate, Mother Jones, Scientific American and O, The Oprah Magazine, among other publications.