As many as five children in New York have reportedly died from a “pediatric multisystem inflammatory syndrome,” which pediatricians believe is triggered by the coronavirus. The syndrome, first reported in London, has been compared to other autoimmune conditions such as Kawasaki disease (KD) and toxic shock syndrome (TSS). But in interviews with Yahoo Life, multiple pediatricians say that the illness is increasingly different from those illnesses — and that the symptoms are unmistakable.
“I believe and I think many people believe it’s a different problem, a different syndrome that’s not typical Kawasaki disease,” says Dr. Stanford Shulman, a professor of pediatrics with a focus on infectious disease at Northwestern University. “This syndrome has a few features similar to Kawasaki, but many more features that are very different.”
While most of the cases have been reported in New York thus far, doctors in Boston, Philadelphia, Los Angeles and — according to Shulman — Chicago now say that they’ve seen suspected cases as well. Thus far, the pediatricians say the patients seem to be responding well to treatment and that the majority make a full recovery. Many of the kids have tested positive for COVID-19 antibodies, suggesting that they contracted the virus weeks before and recovered.
Given that timeline, experts believe that more cases will be appearing in other states in the coming weeks. To help alleviate fears among parents, here’s what the experts know thus far.
Two key symptoms are high fever and gastrointestinal distress
Shulman says that one of the biggest differences between this new syndrome and KD is the prevalence of gastrointestinal symptoms. “The symptoms patients are presenting with ... there’s lots of abdominal pain and diarrhea, which are very uncommon in Kawasaki children,” says Shulman. The other obvious symptom is a fever above 102°F for multiple days. “If a child develops high fevers, lots of abdominal pain — with or without diarrhea or vomiting — and looks really sick, they need to go to an emergency room to be evaluated.” Other symptoms to look for include rash, conjunctivitis and difficulty breathing.
Shock is likely what is driving the fatalities
Dr. Steven Kernie, chief of pediatric critical care medicine at New York-Presbyterian Hospital, has seen multiple cases of the syndrome as well and says that, aside from abdominal pain and high fever, parents should look out for symptoms of shock, such as clammy skin and racing heart rate. Shock, according to the Mayo Clinic, is defined as “a sudden drop in blood flow” that can deprive the organs of blood and oxygen.
This reaction seems to align more with toxic shock syndrome, which is caused by a bacterial infection, than KD. “It’s the shock piece that is different ... where they need to be in the ICU and they need to be on medications to help their heart work better,” Kernie tells Yahoo Life. In a press conference Monday, health officials in New York said they’ve seen evidence that shock in these patients is causing “multi-organ failure.” They note that if recognized early, shock is treatable — and that if treated early, long-term effects are likely “pretty negligible.”
It is unlikely to be contagious
Both Kernie and Shulman say the syndrome is essentially a “hyper-inflammation” in the body, typically post-infection. But while COVID-19 is very easy to pass on to others, Kernie says this syndrome is not transmissible. “It’s not running in families, and it’s not contagious,” says Kernie. “Although we’re seeing a lot of it now, we have seen things like Kawasaki disease that oftentimes occur after a viral infection, so I believe that it’s really just because of the sheer volume of kids that have been exposed to COVID that we’re seeing a cluster of cases.”
It does not appear more prevalent among Asian children
Kawasaki disease, named after the Japanese researcher who discovered it, is much more common among kids of Asian and Pacific Island descent. But Kernie says that’s not the case here. “We’ve called our colleagues in Japan who are Kawasaki experts, and they’re not seeing any of this. None. Same thing for China,” says Shulman. He notes that it’s too soon to draw any conclusions about who is most at risk, but he reveals that six out of the eight children in London with the syndrome were of Afro-Caribbean descent. “So far, the demographics are very different,” he says. No data on the demographics of the kids affected in the U.S. has been released, but the National Institutes of Health has begun studying the syndrome.
Toddlers do not appear to be at heightened risk
Another marked change from KD, which generally affects children under 5, and TSS, which is most common among teens, is the demographic affected. “The average age of this new syndrome is about 8 to 12 years old. In Kawasaki disease, the average age is 2,” Shulman says. In New York, officials say, the patients range in age from 5 to 9 years old.
Doctors have been using the same treatment used for KD, and it’s working
Treatment for KD is typically what’s known as intravenous immunoglobulin (IVIG), a concentrated amount of healthy antibodies from thousands of blood donors. While not all symptoms align with KD, this method seems to be working. “Kawasaki disease is typically treated with IVIG, and patients overall do quite well. It seems like the patients we’ve heard about have also responded to IVIG,” he says. “Most of those patients have recovered and been discharged. So that’s the good news.”
Overall, it remains rare and symptoms are tough to miss
It’s too soon to know exactly how many kids will be affected, but Shulman says he “[does] not expect this to turn out to be an extremely common problem.” Kernie agrees. “I would reassure parents that I believe it’s a rare complication,” Kernie says. Both suggest parents stay vigilant, but also take solace in the fact that if a child has this syndrome, it will likely be near impossible to miss. “The symptoms aren’t subtle. The kids look sick. They have a fever. They often have abdominal distension and diarrhea,” says Kernie. “There are diseases where you put a perfectly healthy child to bed at night and you wake up and they’re horribly sick. This is not that — it isn’t coming out of nowhere.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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