All hospitals, clinical laboratories, health care facilities and local health departments in New York that discover new cases of a new pediatric multi-system inflammatory syndrome are now required to report the cases as soon as possible, New York officials announced in an advisory Wednesday.
Any suspected case of a patient under the age of 21 must be reported to the state's Department of Health. The order comes after a survey by the department found 64 cases of children presenting symptoms of the new illness affecting children that is likely linked to COVID-19.
That number came as a surprise even to some senior state health officials, who did not anticipate seeing dozens of children fall critically ill after earlier it had appeared the coronavirus was not impacting children as severely.
As the advisory stated, "Though most children who get COVID-19 experience only mild symptoms, in the United Kingdom, a possible link has also been reported between pediatric COVID-19 and serious inflammatory disease. The inflammatory syndrome has features which overlap with Kawasaki disease and toxic shock syndrome and may occur days to weeks after acute COVID-19 illness. It can include persistent fever, abdominal symptoms, rash, and even cardiovascular symptoms requiring intensive care. Early recognition by pediatricians and referral to a specialist including to critical care is essential."
New York City issued its own health alert earlier this week after identifying more than a dozen children in city hospitals who have the rare illness. At least one expert believes there are sure to be more kids affected.
The syndrome has been observed in 15 children who were hospitalized from April 17 to May 1 in the city, according to Demetre Daskalakis, the Deputy Commissioner of Disease Control with the New York City Health Department. While the full spectrum of the illness is not yet known, Daskalakis said, features of Kawasaki disease and toxic shock have been seen in patients between the ages of 2 and 15.
Gov. Andrew Cuomo did not address the matter in his daily coronavirus briefing but told MSNBC in a later interview "this is still a developing situation and we don't know all the facts," though did say there have been no reports of any children dying as a result of the syndrome.
"I don't think it's caught anyone off guard. It's developing now," the governor said, adding that the the info is "preliminary" at the moment.
"We’ve seen more than 15 … We’re seeing them every day that have required ICU admission every day," said Dr. Steven Kernie, professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons and chief of Critical Care Medicine at New York Presbyterian Morgan Stanley Children's Hospital. He said they are seeing one or two children every day with similar symptoms.
"What we’re seeing is children who have had high fever -- over 102 or 103 -- for three to four days," Kernie added. "They tend to have a rash anywhere on their body, including the palms of their hands and soles of their feet. They may have abdominal distress. Their eyes may be very red. They look ill."
He believes this is not a primary infection but the child's immune response to exposures that took place two to three weeks prior, though the child may have been asymptomatic at that time.
Four of the 15 children tested positive for COVID-19, and six tested positive for the coronavirus antibodies, signifying a previous infection.
The city's health department may only be recognizing severe cases at this point, but one doctor familiar with the illness believes there will be many more to come.
"This is happening all through Europe," Dr. Jane Newburger, director of the Kawasaki Program at Boston Children's Hospital, told NBC News. "It is definitely happening in various cities on the East Coast and in some parts of the Midwest."
Newburger said the illness may come as a "post-immune reaction to COVID," meaning the body seemingly overcompensates and essentially keeps fighting a disease that is no longer attacking the body — possibly even weeks after having contracted a virus like COVID-19.
New York City Mayor Bill de Blasio tweeted Tuesday afternoon about the cases found in the city, saying that while "we haven't seen any fatalities yet, but we are very concerned by what we're seeing. We're learning more every day about how COVID-19 affects the body. This is a ferocious disease."
New Jersey Gov. Phil Murphy and Health Commissioner Judith Persichilli said the state will reach out to physicians and the CDC, and encouraged anyone who suspects something similar in a child to reach out and get help immediately.
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Identifying the Symptoms
So what are the symptoms of pediatric multi-system inflammatory syndrome? The NYC Health Department said that all 15 children had a fever, and more than half reported having rashes, abdominal pain, vomiting or diarrhea. While it has been considered a direct symptom of COVID-19, less than half of the pediatric patients in the city displayed any shortness of breath.
Any child that shows symptoms relating to Kawasaki disease or toxic shock syndrome should be seen by a doctor as soon as possible, as the health department said early recognition and a pediatrician's referral to a specialist are essential, including admission to critical care units if necessary. Beginning treatment quickly can help prevent end-organ damage and other long-term problems, Daskalakis said in the city's medical alert.
Dr. Newburger suggests that any parent who finds their child to have a high fever and "seems unwell" should call their pediatrician and seek medical attention.
Mount Sinai Hospital previously confirmed reports by NBC New York that they are seeing the new and unusual COVID-19 related illness in several pediatric patients, up from just two on April 28. The hospital’s chief of pediatric critical care issued a warning to parents to be on the lookout for certain symptoms.
In a statement, Dr. George Ofori, Pediatric Critical Care Director at Mount Sinai Kravis Children’s Hospital said, "Some of the cases that we are currently treating entered our care presenting with symptoms such as abdominal pain, vomiting, diarrhea, and a low-grade fever. Others presented first with a rash, conjunctivitis, and/or cracked lips.”
Dr. Ofori said some patients have developed heart problems and low blood pressure that led to shock. He explained that some had been diagnosed with COVID-19 2-3 weeks before these symptoms developed.
"Whether the underlying condition is COVID-19 or the body’s response to COVID-19 is not known at this time. While it is too early to definitively say what is causing this we believe it is important to alert the public as to what we are seeing," he said.
A different source told NBC New York some of these children had no previous underlying health conditions.
The Mount Sinai statement came two days after Dr. Ofori’s counterpart at Cohen Children’s Hospital on Long Island told the I-Team in an interview they’ve seen about a dozen critically ill pediatric patients in the past weeks with similar inflammatory symptoms.
“We now have at least about 12 patients in our hospital that are presenting in a similar fashion, that we think have some relation to a [COVID-19] infection,” said Dr. James Schneider, Director of Pediatric Critical Care at Cohen Children’s Hospital in Nassau. “It’s something we’re starting to see around the country.”
“It just goes to show that COVID does not spare any age group and can lead to very serious illness, even in kids,” said Dr. Schneider.
Scott Gotlieb, former head of the FDA and a New York City emergency room physician, echoed those sentiments during an appearance on CNBC, saying the new cases appear to disprove the previous notion that coronavirus "wasn't really affecting kids."
"We certainly know that there are children who've been hospitalized, who have gotten very sick, but now it appears that there are some unusual phenomena that are affecting children — not in high numbers, these still appear to be small reports in the medical literature — but there are some unusual syndromes that children are developing, perhaps as a result of coronavirus," Gottlieb said on CNBC.