Although much is not yet known about children and the coronavirus, we know at this stage that cases of COVID-19 in children are increasing. And this can lead to more cases of multisystem-inflammatory syndrome in children, like MIS-C, the mysterious and sometimes fatal disease in a small proportion of children who are infected with the coronavirus.
First reported in April and May, the rare condition can cause inflammation of body parts, including organs, according to the Centers for Disease Control and Prevention. In some children, it can lead to organ failure and other life-threatening symptoms. Common signs of MIS-C include fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes or feeling extra tired.
MIS-C is still an incredibly rare, stressed expert. But with some schools reopening in person, likely to increase children’s exposure to the coronavirus, unanswered questions about MIS-C are more urgent than ever. Here’s what we now know about MIS-C and how parents can protect their children.
Are cases of MIS-C also up?
In the last two weeks of July, the nation saw about a 40% increase in cases of COVID-19 in children, according to the American Academy of Pediatrics and Children’s Hospital Association. But it is unclear at this point whether this has led to a corresponding rise in MIS-C – and there are a few reasons why, Drs. Ermias Belay, an epidemiologist and the CDC’s MIS-C expert, TODAY.
First, the syndrome usually appears two to four weeks after a child is infected with the coronavirus, so recent surgeries in the South and Southwest may right now lead to new MIS-C cases. Second, the process of reporting new MIS-C data is lengthy and can delay access to this information.
As of July 29, 570 cases of MIS-C had been reported to the CDC. Belay said the majority were in the Northeast Polder, especially New York and New Jersey, which hit their peaks early in the pandemic.
“With the increase in (COVID-19) cases in the South and Southwest, we expect cases (from MIS-C) to pick up,” he said. “We have not yet seen what we saw in other regions in the Northeast Polder, but … we expect this to change going forward.”
Belay added that he had heard “anecdotally” that hospitals and doctors in the South have seen “an increased number of cases, but that the cases have not yet been reported to (the CDC).”
The latest MIS-C data from individual states may support Belay’s suspicion. Florida, which in mid-July broke the U.S. record for the most recent cases of coronavirus in one day, had reported 31 MIS-C cases as of August 10, according to the state Department of Health. At the end of May, there were only a few cases of MIS-C reported in the state.
In Louisiana, which was particularly hard hit in March, as of August 10, 44 cases have been reported and four dead. “Louisiana is seeing an increasing number of cases of MIS-C among young people,” the Department of Health noted in a recent press release.
South Carolina, which experienced a spate of coronavirus cases in early July, had its first case of MIS-C on July 12, and at least six more have been reported. Arizona and Texas had each reported between one and 10 cases to the CDC as of August 6th.
“Our biggest challenge is that we have no way of predicting how bad MIS-C will become,” Drs. John Christenson, Medical Director of Infection Prevention for Riley Children’s Health in Indianapolis, TODAY. Riley treated 12 children with MIS-C between May and early July, reflecting the height of Indiana, Christenson said.
What do we know about MIS-C?
The syndrome occurs mainly in children infected with the coronavirus, despite having COVID-19 symptoms at the time, Belay said, adding that there is no definitive medical test for if a patient has MIS- C hat.
The age of documented MIS-C patients varies from two weeks to 20 years of age, with an average age of 8, according to CDC data. It seems more common in Latino and Black children, as well as boys. About 64% of the patients were admitted to an intensive care unit, and 10 of the 570 patients reported to the CDC died. In most patients, the cardiovascular and gastrointestinal systems were affected.
Dr Keith Meyer, medical director at Nicklaus Children’s Hospital in Miami, told TODAY that his facility, which has a dedicated MIS-C unit, has seen “a steady stream” of “one to two patients” a week since the pandemic began. He noted that older children develop the leaner cases of MIS-C, but it is not known why.
Meyer emphasizes that most children recover from the disease and that he has observed three types of MIS-C patients: mild cases that do not require medical care, which he finds to be normal; moderate cases in which the child is admitted to hospital and recovers within a few days; and cases with “severe systemic disease,” as he described.
He added that in part, due to the mild cases, it is not exactly known how common MIS-C is.
While MIS-C is often compared to Kawasaki disease, which also causes inflammation in the whole body most often in children 5 or younger, it is a “distinct” disease, said Dr. Leron Finger, chief quality officer at LCMC Health in New Orleans , TODAY. “Most of what we know is that it is real.”
It is still unclear why some children develop MIS-C after a COVID-19 infection and others do not, and the driving factor behind the severe cases is also not known, Belay said.
Per CDC, there is no official recommendation on how to treat MIS-C. But intravenous immunoglobulin (IVIG), a type of anti-antibody therapy and steroids are commonly used.
What can parents do?
Belay said the best strategy to protect children is to limit their exposure to the coronavirus by following standard protocols, such as mask-wearing, social distance and regular hand hygiene. He also said it was “very critical” for parents to know the signs of MIS-C.
For example, Christenson said he tells parents to look for fever they can’t explain, skin rashes, red eyes and gastrointestinal symptoms, such as abdominal pain.
Meyer added that even though parents may be afraid to seek medical attention because of the coronavirus epidemic, they should not call their health care provider if their children show signs of MIS-C. That is “message one”, he said.
Local coronavirus rates may also help assess a child’s MIS-C risk of attending school in person, according to Belay. The more COVID-19, the greater the risk.
That said, it is important for parents not to “panic”, said Dr. Gary Duhon, a pediatrician of critical care at LCMC Health TODAY. “It’s rare and most children do well with it,” he added.
