Kristin Murphy, KSL, File

Utah doctors describe rare COVID-19 complication affecting children

By Graham Dudley, KSL.com | Posted - May 21, 2020 at 7:35 p.m.



SALT LAKE CITY — University of Utah Health physicians serving at Intermountain Primary Children's Hospital briefed media members Thursday morning on a rare complication of the new coronavirus, which causes COVID-19, that has been affecting children in Europe and America.

The condition is being referred to as Multisystem Inflammatory Syndrome in Children, or MIS-C, and involves symptoms similar to those found in Kawasaki disease. The condition has drawn attention and alarm from many parents, likely because children were long considered largely impervious to the worst effects of COVID-19.

Fortunately, said Primary Children's epidemiologist Dr. Andrew Pavia, MIS-C appears to be exceedingly rare.

"There are probably less than 200 cases reported worldwide," he said — Utah currently has one confirmed case and several possible cases, he said.

The syndrome was first identified in the United Kingdom in April, Pavia said, and was subsequently found in New York state. Since then, perhaps three dozen American states have identified cases of MIS-C, as has Italy.

The syndrome appears to lag behind actual COVID-19 infections, Pavia said, sometimes appearing weeks after the fact. He said only one-third of MIS-C patients test positive for active COVID-19 infections; the rest have antibodies for the virus, marking a past infection.

Common symptoms of MIS-C are prolonged fever, abdominal pain and rash.

Other symptoms may include red eyes and swelling of the hands and feet, similar to Kawasaki disease. Fewer patients report swollen lymph nodes and sore throat as well, Pavia said.

MIS-C leads to inflammation of internal organs, he said; one of its "hallmarks" is inflammation of the heart.

"The laboratory findings are really distinctive," Pavia said. "This illness is marked by lab tests that show a really high degree of inflammation. The immune system is clearly turned on in unusual ways, and that's one of the reasons that we have a multidisciplinary team here, and throughout the country, looking at this."

Pavia said that, although scary, treatment of MIS-C has been generally very successful so far, despite doctors' limited understanding of the syndrome. A handful of deaths have been reported, but most children recover well. Pavia did say, though, that the many children require intensive care to recover.

Pediatric critical care physician Dr. Jill Sweeney said one of Utah's cases required intensive care and medication to support their blood pressure; MIS-C often causes low blood pressure and shock, she said.

But cases usually "turn around" within three to five days, Sweeney said.

Pavia said MIS-C has been identified in patients younger than 1 up to 20 years old. Kawasaki disease generally affects children about 2 to 3 years old, while the average MIS-C case has been about 7 or 8, he said.

He said it's still unclear why the syndrome appears in children and not adults. "There are a lot of things about the immune system in children that are quite different," Pavia said, "and their response to this coronavirus is quite different."

Parents should keep in mind that the syndrome is quite rare, Pavia said, but "if the child has prolonged fever, if they have severe abdominal pain, with or without a rash or red eyes, you need to contact your health care provider."

The best way to protect Utah children, he said, is to keep them from getting COVID-19 in the first place by social distancing, wearing face coverings and practicing good hand hygiene. "If children don't get infected with this coronavirus, then there's no chance they're going to develop MIS-C."

Graham Dudley

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