What is the COVID-19 Multi-System Inflammatory State?

Are kids with COVID-19 developing symptoms of Kawasaki disease?

Breaking News – The CDC reports at least 694 confirmed cases of MIS-C and 11 deaths in the United States. (see below)

Kids aren’t supposed to get serious COVID-19 symptoms, right?

As we are learning more and more about SARS-CoV-2, that seems to be holding true most of the time.

That doesn’t mean that kids are unaffected though.

Remember, it is still thought that kids get asymptomatic infections that they can spread to everyone else. And tragically, they sometimes get life-threatenimiscng infections.

What is the COVID-19 Multi-System Inflammatory State?

What else are we seeing when kids get SARS-CoV-2?

As they reassure parents that “serious illness as a result of COVID 19 still appears to be a very rare event in children,” the Paediatric Intensive Care Society issued a statement discussing an NHS England email alert about kids presenting with a type of multi-system inflammatory disease.

“The alert indicated ‘the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation’.”

PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease

This statement followed the release of a study in Hospital Pediatrics, COVID-19 and Kawasaki Disease: Novel Virus and Novel Case, that discussed a similar case.

“We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And an alert of more frequent cases of Kawasaki disease in France and Italy.

“In several Italian centers, where the incidence of Covid-19 was higher – Professor Ravelli told ANSA – more frequent cases of Kawasaki disease have occurred than we have observed before the arrival of the coronavirus.”

Coronavirus: Prof. Ravelli, investigation of Kawasaki disease report (google translated)

And New York.

“The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17-May 1,2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock).”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Following a report of 15 cases in New York City, the New York State Department of Health issued an advisory to healthcare providers about 64 potential cases throughout the state.

As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.
As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.

And next came an alert from the CDC on what they are calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

MIS-C case definition

Most people will find the MIS-C case definition more helpful than the new name.

Also helpful is a recommendation to “report suspected cases to their local, state, or territorial health department.”

“This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.”

Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children

So what does this mean?

It may means that we can add SARS-CoV-2 to the list of possible viruses that can trigger Kawasaki disease.

“Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And continue to be reassured that “serious illness as a result of COVID-19 still appears to be a very rare event in children.”

“If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care,as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Still, everyone should be on the alert for MIS-C, especially as COVID-19 cases once again surge.

More on COVID-19 in Kids

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking about the new coronavirus that is all over the news right now.

Breaking News: we have seen community spread in the US, at least nine 41 deaths, and more cases in more states. (see below)

What do you think of the news of the 2019 novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

Experts say don't panic about the 2019 novel coronavirus.

Are you ready to put on a mask, never leave your home, or just wait and see what happens?

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking and want to wait and see what happens over the next few days, weeks, and months.

So what’s going on?

A new coronavirus, 2019-nCoV SARS-CoV-2 has been detected in Wuhan, China and it is spreading, killing some people.

Why is this a concern?

While there are coronaviruses that are very common, even causing many cases of the common cold, there are others that are much more serious.

Seasonal coronavirus are very common during cold and flu season.
Seasonal coronavirus are very common during cold and flu season.

These include the coronaviruses that cause SARS and MERS.

A worldwide outbreak of severe acute respiratory syndrome caused by SARS-CoV caused 8,098 cases and 774 deaths in 2002-03. It also started in China.

MERS-CoV, which causes Middle East Respiratory Syndrome, has been causing cases and deaths since 2012.

What’s Next With COVID-19?

Why are experts concerned about SARS-CoV-2?

Check for Travel Alerts and Warnings before your next trip.
Check for Travel Alerts and Warnings before your next trip.

Mostly because of past experiences with SARS and MERS.

There is also the fact that there is no treatment or vaccine for 2019-nCoV.

Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.
Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.

And no, your doctor won’t be able to routinely test you for SARS-CoV-2. Testing can be done for those who are high risk, but it still involves sending the specimens to a lab at your local or state health department or the CDC.

That shouldn’t put you into panic mode though…

“Two cases of 2019-nCoV have been reported in the United States. Both patients had recently returned from Wuhan, China. More cases are likely to be identified in the coming days, including more cases in the United States.”

COVID-19 Frequently Asked Questions

Unless you have recently traveled to Wuhan, China an area where there is a COVID-19 outbreak or have had close contract with someone who traveled to an area with a lot of cases while they were sick, then you likely aren’t at much risk to get sick with this virus.

“For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is certainly not something to ignore though.

Since first being detected in Wuhan, China on December 29, 2019, cases have spread to 28 41 46 64 72 134 other countries.

“More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

Most experts expect SARS-CoV-2 to become a pandemic, but that still shouldn’t put you into panic mode…

Experts are also working to learn more so that we know:

  • the original source of the virus – is it the animal markets in Wuhan, China?
  • the incubation period – it seems to be 1 to 14 days
  • how contagious the virus can be and how it spreads – close contact
  • how serious are the complications of infection or how deadly is this virus – so far, “reported illnesses have ranged from mild to severe, including illness resulting in death,” but the latest worldwide mortality rate of 1.4 to 3.4% is much higher than seasonal flu
  • can the virus be contained – this seems unlikely…

We got one answer recently, as it seems that people with the virus are contagious before they have symptoms.

What’s next?

Don’t panic. Plan ahead.

Stay up to date on SARS-CoV-2 information and call your health care provider if you have flu-like symptoms and recently traveled to Wuhan, China or had contact with someone who is under investigation for COVID-19.

“Limited reports of children with COVID-19 in China have described cold-like symptoms, such as fever, runny nose, and cough. Gastrointestinal symptoms (vomiting and diarrhea) have been reported in at least one child with COVID-19. These limited reports suggest that children with confirmed COVID-19 have generally presented with mild symptoms, and though severe complications (e.g., acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

CDC on Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children

And even if you are starting to get nervous, at least you don’t have to worry too much about your kids. So far, there is no evidence that children are more susceptible to COVID-19 and there are reports that they actually get milder symptoms!

Lastly, if you haven’t yet, be sure to get a flu vaccine.

Affected geographic areas include China, Italy, South Korea, Iran, and Japan.
As we see community spread in more areas, the criteria to guide evaluation of PUI for COVID-19 continues to loosen up.

If you are going to develop a fever and symptoms of lower respiratory illness during cold and flu season in the United States, especially if you haven’t traveled to a high risk area, then it is probably the flu, not the new coronavirus…

More on COVID-19 Hype or Hazard

About Those Rapid COVID-19 Tests

A company is selling rapid COVID-19 tests that promise quick results in 10 minutes. The only problem? They are not approved by the FDA…

While everyone has been talking about tests for SARS-CoV-2 infections, it is mostly the PCR tests from nasopharyngeal swabs that take a few days to get results.

The PCR tests that nobody can really get their hands on…

About Those Rapid COVID-19 Tests

Now, in addition to more and more of those tests becoming available every day, many folks are excited about rapid tests.

How rapid?

“The Food and Drug Administration has approved the first rapid point-of-care COVID-19 test, that can deliver results in less than an hour.”

FDA Approves First Rapid COVID-19 Test

The new COVID-19 test, from Cepheid, provides results, also from a nasal swab, in about 45 minutes.

Most importantly, like strep and flu tests, this new COVID-19 rapid test doesn’t have to be sent anywhere. That doesn’t mean that your pediatrician will be able to see you and run a rapid COVID-19 test anytime soon though.

“The test has been designed to operate on any of Cepheid’s more than 23,000 automated GeneXpert Systems worldwide, with a detection time of approximately 45 minutes.”

Cepheid Receives Emergency Use Authorization from FDA for Rapid SARS-CoV-2 Test

It needs the specialized, and expensive, GeneXpert System to run.

Who has these systems?

Mostly hospital labs.

And that’s great news!

Even if the test could be run in your pediatrician’s office, a lack of personal protective equipment would still limit how much testing they could do.

On the other hand, a fast test that could be run in big hospitals will help them set up centralized, mobile testing centers.

Unfortunately, in addition to the very real rapid COVID-19 test from Cepheid, we are seeing many other rapid tests pop up that are not FDA approved!

COVID-19 test results in 10 minutes? From a blood sample?
COVID-19 test results in 10 minutes? From a blood sample?

Among the tests that you should be especially wary of are those that say they give quick results from a blood sample – a serology test.

“Initial work to develop a serology test for SARS-CoV-2 is underway at CDC. In order to develop the test, CDC needs blood samples from people who had COVID-19 at least 21 days after their symptoms first started. Researchers are currently working to develop the basic parameters for the test, which will be refined as more samples become available. Once the test is developed, CDC will need additional samples to evaluate whether the test works as intended.”

Serology Test for COVID-19

Unfortunately, these types of serology tests which look at antibody levels are not yet available – at least they aren’t available in the United States.

Several companies have begun the application process with the FDA under the COVID-19 Emergency Use Authorization (EUA) though.

We will have to see if they really work and how long it takes for them to get approved.

What else isn’t available yet? There are no FDA approved home COVID-19 test kits, even though many companies and some physicians are selling them…

More on Rapid COVID-19 Tests