What to Know
- The Centers for Disease Control and Prevention has confirmed the link between COVID-19 and a rare, potentially deadly syndrome in children
- The syndrome has now been reported in nearly half the nation's states, including New York, New Jersey and Connecticut. New York City alone now has 89 officially confirmed MIS-C cases by the CDC definition
- Symptoms include persistent fever, rash, abdominal pain, diarrhea, conjunctivitis, enlarged lymph nodes and swollen hands and feet, and more
Have questions about MIS-C? NBC 4 New York reporter Melissa Russo, who broke the story on NYC's first cases, will answer questions in a live Reddit AMA on Friday 5/29 at 11 a.m. ET here.
Doctors who treated some of the earliest cases of the COVID-related illness that has sickened more than 200 children in the tri-state have shared what they have learned about the condition — including how quickly it can cause an otherwise healthy patient to be left in dire condition.
The doctors at Mount Sinai Hospital’s Pediatric Emergency Department treated the four previously healthy children in early May, and all four were later moved to the department’s ICU, according to the study published last week in the American Journal of Emergency Medicine. All tested negative for COVID-19 after a nasal swab test, however previous exposure to the disease was confirmed after each had the coronavirus antibodies.
What was observed in each of the children – ages 1, 10, 12 and 13 – was an abnormal auto-immune response to COVID-19, what the doctos called an exaggerate cytokine storm. All were treated with immunoglobulin as well as immunosuppressive drugs that are more commonly used to treat rheumatoid arthritis, according to the study.
“Some healthy children are becoming critically ill due to a rare, exaggerated inflammation response produced several weeks after a COVID-19 infection, even if that infection was very mild,” said study co-author Dr. Jennifer E. Sanders, an assistant professor at the Icahn School of Medicine at Mount Sinai.
The authors of the study urge emergency physicians to be on high alert for the multi-system inflammatory syndrome in children, even if the children exhibit weak or no symptoms of the coronavirus. Patients may start with symptoms similar to that of Kawasaki disease – with a fever, rash, conjunctivitis, abdominal pain and diarrhea for many – but then the condition may quickly worsen in a manner similar to toxic shock syndrome, according to Dr. Temim Waltuch, who co-authored the study. Some children who the I-Team has documented have appeared to be showing only slight symptoms, but within days — if not hours — had their conditions worsen dramatically, leaving them in a coma and on a ventilator.
“Vigilance in assessing for these symptoms will be critical to help identify these patients early in the clinical course,” she said. “As we continue to learn more about this syndrome, it is important for parents to be aware of the signs and symptoms to look out for in their children and to seek immediate care if they are concerned, but to also remember that thus far this still appears to be a rare event in children following a recent COVID-19 infection.”
Sanders said that the threshold for lab testing among young patients showing the symptoms should be low, and all patients – no matter how healthy they may seem at first – should be treated with a level of caution. Some whose conditions worsen quickly require fluid resuscitation and possibly intubation, as other cases in New York and New Jersey have shown.
New York was investigating at least 179 cases of the illness as of Friday, less than two weeks after the CDC confirmed a link between the coronavirus and what is has termed multisystem inflammatory syndrome in children (MIS-C).
The cases span a wide age demographic, affecting infants to young adults, though most cases are in kids age 1 to 14. Three children in New York have died. Ninety-three percent of the kids displaying symptoms tested positive for COVID-19 or its antibodies.
New York City health chief Dr. Oxiris Barbot said Friday the city had confirmed 124 cases of MIS-C, up from 89 about two weeks ago.
Children have been less affected by COVID than adults overall; people younger than 20 account for just 1 percent of New York's total hospitalizations. But the emergence of the syndrome has prompted the medical community to rethink how it looks at COVID and kids. Cases of multisystem inflammatory syndrome in children (MIS-C) have now been identified in nearly half the nation's states, just weeks after News 4 first drew attention to the emerging illness in New York.
New Jersey's total stands at 26 MIS-C cases; the state reported no new ones on Thursday. Six children remain hospitalized; no deaths have been reported.
New York City Mayor Bill de Blasio has put out a comprehensive fact sheet for parents and launched a citywide ad blitz advising them of the symptoms. Cuomo, meanwhile, told hospitals to prioritize COVID-19 testing for kids who present with them.
The CDC issued a recent health alert to physicians providing them with diagnostic guidance. The diagnostic criteria for MIS-C include a fever of at least 100.4 degrees for at least 24 hours, evidence of inflammation in the body and hospitalization with problems in at least two organs (such as the heart, the kidneys or the lungs). The CDC also requires a positive test for COVID-19, the antibodies, or a known exposure within four weeks before symptom onset.