Mysterious illness linked to COVID-19 makes some kids sick. NC doctors offer advice.
Children rarely get severe cases of COVID-19, but there are new symptoms of a mysterious illness linked to the coronavirus that parents should be looking out for, UNC Health pediatric experts say.
Children across the nation are being diagnosed with a rare disease doctors are calling “pediatric multi-system inflammatory syndrome.” It can affect organs, including the heart, and cause severe illness. Three children in New York reportedly died from this syndrome recently, but UNC Health Care said it has not seen any cases so far.
Children with the illness present symptoms including fever, skin rashes that resemble a bad sunburn and gastrointestinal issues such as abdominal pain, vomiting and diarrhea.
At a media briefing Wednesday, Dr. Eveline Wu, a clinical assistant professor of pediatric allergy, immunology and rheumatology at UNC-Chapel Hill, said doctors think this syndrome is the body’s reaction to the immune system fighting the COVID-19 virus.
Not all the patients with this syndrome are testing positive for COVID-19, Wu said, but doctors suspect it is related to the coronavirus pandemic because of the cluster of cases in areas that have been hit hard by COVID-19, like New York, and because of the timing of the cases.
What is the new syndrome?
When the immune system is trying to eliminate germs in the body, it goes through a sequence of events that are tightly controlled. If that is disrupted, it can have unexpected negative consequences, Wu said.
In this case, that response can make multiple organs very sick, including the heart, and might look similar to conditions in children like Kawasaki disease and toxic shock syndrome.
Kawasaki disease primarily affects children under 5 and is characterized by inflammation in blood vessels and is the most common cause of acquired heart disease in children, according to the CDC. It is treatable, and symptoms include a fever that lasts several days, red eyes, a rash, cracked lips, swollen neck glands, swelling in the hands and feet and gastrointestinal issues.
Toxic shock syndrome is a rare, life-threatening condition caused by certain types of bacterial infections and toxins in the body. It can cause dramatic drops in blood pressure, which can make patients really sick, Wu said. It presents similar symptoms as Kawasaki disease.
Wu said medical providers should now have a higher degree of suspicion because there could be additional indications to test patients for COVID-19. Parents might now have a reason to bring children to a doctor if they’re experiencing these newly associated symptoms.
Is COVID-19 more prevalent in children than we think?
About 630 children in North Carolina have tested positive for the coronavirus. No one under the age of 17 has died from COVID-19, according to the state health department. But, the actual number of cases in children is probably higher because children typically have mild symptoms or none at all.
“There have likely been a number of children who have had COVID-19 but no one even knows they have it because they are asymptomatic,” said Stephanie Davis, physician-in-chief at N.C. Children’s Hospital and chair of the Department of Pediatrics at UNC-CH.
At the media briefing, Davis said there is no way for parents to know whether their child has had COVID-19 if he or she has no symptoms. The only way parents could suspect anything is if they know their child was exposed.
UNC Health Care is screening all children that are coming in for emergency surgeries or procedures. They are doing rapid testing of children in the ER before admitting them to the in-patient unit, according to Davis.
They are not testing every child who comes to a clinic, but they are screening children by taking temperatures and asking questions about cough or other symptoms.
Davis said three children admitted to the UNC Medical Center in Chapel Hill have tested positive for COVID-19, but only one had specific respiratory symptoms. The two others were coming in for necessary surgeries and were tested before those procedures.
The other positives cases in children they’ve seen were not serious enough that they needed to be hospitalized, Davis said.
Children suffering from COVID-19 typically have a cough, fever, abdominal pain, diarrhea and vomiting. The children that get very sick have other conditions, such as chronic lung disease, that may set them up for being more at risk for getting more sick when they acquire COVID-19, according to Davis.
Children can pass coronavirus to other children, parents, grandparents and other adults even if they are asymptomatic. The six feet apart social distancing rule helps limit that spread.
What should parents do?
Parents should pay close attention to the new symptoms and continue to keep things clean inside their homes to help protect their children, Davis said. At home, wipe down toys, disinfect surfaces like door handles and counter tops, make sure kids are properly washing their hands and ask kids not to touch their face.
Parents should also keep their kids away from people who are sick and call their primary care physician if their child develops a fever or cough.
Davis said there has been a delay in bringing children in for evaluations because of anxiety and fear during the COVID-19 pandemic. They’ve seen children who are more sick with other ailments in the emergency room because parents waited to bring their child to the medical center.
“That can cause more harm than good, and we want to make sure parents understand that,” Davis said.
Physicians are also concerned about that fear resulting in a drop in routine vaccinations for diseases like measles.
Wu, Davis and the North Carolina Pediatric Society are asking parents to bring their children in for these checkups and immunizations, especially for children under 2.
Dr. Susan Mims, president of NCPeds, said in a statement that well visits and on-time vaccinations are “critical to keeping children healthy during the pandemic and beyond.”
Most pediatric practices are using telehealth options, keeping well visits and sick visits separate, and have special COVID-19 policies to keep patients and families safe during office visits, according to NCPeds.
Wu said parents can safely bring children to clinics, which are removed from the hospital so there’s limited exposure to COVID-19. She said patients and medical providers are screened for symptoms, staff have proper personal protective equipment and the clinics are respecting 6 feet of physical distance where they can.
This story was originally published May 13, 2020 at 2:58 PM.
