Life In The Time of COVID-19

Suffer The Poor Children

There remains a lot about SARS-CoV-2 and COVID-19 that we don’t know. What was “common knowledge” yesterday could be proved wrong tomorrow. The risk of morbidity and mortality in children was one of the things we thought we knew but now appears that we didn’t.

SARS-CoV-2, the currently accepted scientific name for the coronavirus that causes COVID-19, appears to be the precipitating cause of a newly recognized syndrome that causes destruction of multiple organ systems in children.
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This syndrome is so recently recognized it is still referred to by many names, Pediatric Multisystem Inflammatory Syndrome, P-MIS (how the state Department of Health has been referring to it up to now), Multisystem Inflammatory Syndrome in Children, MISC (Center for Disease Control designation since this weekend), Kawasaki Disease-like syndrome, and Toxic Shock-like Syndrome. For all I know by the time you read this there will be an agreement on one of these or something totally different.

MISC was recognized only a few weeks ago. May 5 an article in the New York Times talked about a mysterious ailment in children possibly related to COVID-19. At that time, it was recognized in 15 hospitalized children with no deaths. As of Sunday May 17, there were 137 recognized cases with three deaths in New York. Other countries and regions having been alerted to this phenomenon are now reporting this.
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At first children presenting with symptoms of this were misdiagnosed. They had none of the hallmark symptoms of COVID-19, i.e. viral pneumonia and other respiratory symptoms. They appeared to have Toxic Shock Syndrome or Kawasaki Disease but no reason for developing that was found. They hadn’t been recently ill.

Nevertheless a few specialty physicians in children’s hospitals thought to test these children for SARS-CoV-2 and some tests came back positive. Later in the approximately first hundred children recognized with MISC in New York, 40 percent had a positive test for SARS-CoV-2 and 60 percent had a positive antibody test which as most of us are aware of means it was highly probable that they had the disease even if there weren’t respiratory symptoms.

While so far there appears to be only a 2-3 percent risk of fatality in children with MISC we do know that there is damage to critical organ systems in the body: heart, lungs, vascular, kidneys, liver, etc. There is a very good argument that this may lead to permanent impairment of these organs such as in the case of many other infectious diseases in children in which initial symptoms appear to fully resolved. For example, scarlet fever, rheumatic fever, Lyme disease, and viral cardiomyopathy.
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While there only appears to be a relatively small number of these cases so far (small statistically but what solace is that to a parent whose child develops this) it is totally unclear what long-term health consequences may occur in sub-acute forms of this syndrome. It is quite possible that a child who is infected develops this but not badly enough to be brought to a physician and diagnosed. Considering how Americans get upset about potential disease processes that have demonstrated miniscule risk, what response can we expect if this is now recognized as a long-term consequence of a child who is infected with SARS-CoV-2.
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So, what can we do? One should seek immediate medical care for a child who has:
• Prolonged fever (more than five days)
• Difficulty feeding (infants) or is too sick to drink fluids
• Severe abdominal pain, diarrhea or vomiting
• Change in skin color – becoming pale, patchy and/or blue
• Trouble breathing or is breathing very quickly
• Racing heart or chest pain
• Decreased amount of frequency in urine
• Lethargy, irritability or confusion
Early recognition by pediatricians and referral to a specialist including critical care is essential.
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Additionally, we need to reopen smartly. Based on news reports, pictures, and videos there appear to be a very large number of people who haven’t gotten the message about the requirements to remain open.
One, things will close down again if the transmission rate of the disease goes above 1.0. If we close down after opening because of a spike of cases many economists say that economic disruption could be worse than we have seen so far. Therefore, prevent spread!

This can be easily done by following all social distancing regulations and recommendations. Flaunting these may make someone feel empowered but it is only putting their health and the health of all those around them at risk. Possibly more important to those who are behaving badly, flaunting will lead to more infections which will lead to a new shutdown which will lead to continued economic pain.

Stay safe. Be smart.