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An 8-year-old boy arrived at a Long Island hospital near death last week. Her brother, a boy scout, had started performing chest compressions before the ambulance team reached his home.
In the past two days alone, the hospital, Cohen Children’s Medical Center, has admitted five critically ill patients, ages 4 to 12, with an unusual disease that appears to be related in some way to Covid-19, the disease caused by the coronavirus. . Overall, about 25 children with similar illnesses have been admitted there in recent weeks with symptoms ranging from reddened tongues to enlarged coronary arteries.
The number of children in the United States showing signs of this new syndrome, which was first detected in Europe last month, is still small. None are known to have died, and many have responded well to treatment.
There is no solid data yet on how many children in the United States have become ill with what doctors call “pediatric multisystemic inflammatory syndrome.”
“This is really a disease that has been clear for two weeks, so there are a lot of things that we are trying to learn about this,” Cohen Children’s chief pediatric critical care Dr. James Schneider said in an interview. on Tuesday.
Doctors say this condition does not appear to be driven by the virus that attacks the lungs, a hallmark of coronavirus infection in adults.
While some of the children with this condition end up with respiratory problems and some have needed to use ventilators, “it appears to be a less specific disease of the lungs,” said Dr. Steven Kernie, chief of pediatric critical care medicine at Columbia University and NewYork-Presbyterian Morgan Stanley Children’s Hospital, which has treated 10 to 20 children with this condition, from infants to older teens.
He said many of his symptoms, from skin rashes to red eyes and blood circulation problems, appear to be rooted in a “general inflammatory response.”
In some patients, the syndrome appears similar to a rare childhood disease called Kawasaki disease, which can lead to inflammation of the blood vessels, especially the coronary arteries.
The symptoms of Kawasaki disease often start with fever and a rash, but when undiagnosed or untreated, the disease can lead to serious heart conditions, such as coronary aneurysms. The disease, which generally affects patients 6 months to 6 years old, is considered rare in the United States.
But Dr. Kernie said it was important to distinguish between this coronavirus-related condition and Kawasaki disease.
While some of the symptoms are similar, Dr. Kernie said, including fever, abdominal pain, and sometimes an elevated rash, there appears to be differences in how the coronavirus-related condition affects the heart.
While shock is a rare complication of Kawasaki disease, in the recent wave of coronavirus-related cases, he said, many of the children are in toxic shock with very low blood pressure and an inability of the blood to circulate. oxygen and nutrients effectively. Body organs.
But interviews with doctors in New York City and Long Island suggest that at least 50 children have been treated for the syndrome, not all in intensive care.
“I would say we’ve seen 13 patients so far,” Dr. Nadine Choueiter, of Montefiore Children’s Hospital in the Bronx, said of children treated for the syndrome at her hospital.
Still, doctors were reluctant to speculate how widespread it could be across the city. “That is the question we are constantly thinking about, and I don’t think we know the answer,” said Dr. Choueiter.
In Richmond Hill, Queens, Jayden Hardowar, 8, initially had only a mild fever, starting on April 23, her father, Roup Hardowar, said.
But several days later, Jayden began to become very weak and listless. On April 29, I was lying in bed watching a Pokemon TV episode. “Mommy,” he yelled, before he stopped breathing. Her face began to turn purple. Her 15-year-old brother, a boy scout, began performing chest compressions, stopping only when the ambulance arrived, his father said.
At Cohen Hospital in New Hyde Park, Jayden received a mechanical ventilator for three days before beginning to improve. Although Jayden tested negative for the coronavirus, he tested positive for antibodies, suggesting he may have been infected with the virus in the past few weeks or months, his father said.
In the past few days, Jayden has started to open his eyes and smile or cry at his parents during video conversations hosted by a nurse. “Last night she said, ‘I love you, mommy,'” her father said Tuesday.
Jayden is one of 11 children in the intensive care unit at Cohen Children’s who is considered to have the syndrome, the doctors said.
Similar cases have also appeared in other parts of the country.
Juliet Daly, a healthy 12-year-old girl from Covington, Louisiana, woke up on April 3 with such severe pains in her stomach that she had trouble moving. “I spent an hour in bed trying, trying to get up, and I spent half an hour going down the stairs,” Juliet said in an interview Tuesday.
Over the weekend, he had a fever and said, “I couldn’t eat and I couldn’t drink because I threw up everything.” By Monday, “my arms were cold and my lips were blue,” he said.
She was so lethargic that she “fell asleep in the bathroom,” said her father, Sean Daly.
The family took Juliet to a nearby hospital, where they were told she was experiencing an acute form of heart inflammation called fulminant myocarditis. His heart rate was very low and his heart was not pumping blood.
The hospital decided to put Juliet on a respirator and airlift her to a medical center in New Orleans, about 40 miles south. During the intubation procedure, her heart stopped and “she was arrested for just under two minutes,” Daly said. Later, in the helicopter, her heart stopped again and needed to be revived by C.P.R., she said.
After nine days in the hospital, she returned home with her parents and two brothers. “I was able to walk, but I was still wobbly,” he said. Now Juliet, who likes to ride a bike and make art, feels healthy.
Doctors in New York have noted that cases of the new syndrome began to appear about a month after a Covid-19 surge in the region. That moment suggests “it’s a post-infectious immune response to this,” said Dr. Leonard Krilov, president of pediatrics at NYU Winthrop Hospital in Mineola, New York.
In some cases, treatment for children with the new syndrome is simple and fast. Dr. Krilov recently treated a 4-year-old boy whose family had previously fallen ill with Covid-19. Weeks later, the boy had a high fever, a rash, and kidney problems. They gave him one of the standard treatments for Kawasaki disease: intravenous immunoglobulin, a serum drawn from donated blood. Within a day her fever dropped and her kidneys returned to normal, Dr. Krilov said.
Preliminary research suggests that children they are significantly less likely to become seriously ill with Covid-19 than adults. In New York City, there have been 13,724 laboratory confirmed Covid patient deaths. Six are 17 or younger, and all had underlying health conditions, according to city data.
Doctors say that despite increasing evidence that some healthy children are becoming seriously ill with this new syndrome, they still have a much lower risk of Covid-19 than adults.
“It’s a different disease in adults,” said Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Medical Center, who treated a pediatric patient with the new syndrome last week.
“It’s very, very rare, and the kids have been doing well for the most part,” Dr. Lighter said of the new syndrome. “My patient is at home and doing very well.”
