Let’s start with what we know about COVID-19.
COVID-19 is a disease that is caused by a novel (i.e. new) coronavirus – SARS-CoV 2. It was first recognized in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. The first confirmed pediatric case of COVID-19 was March 2, 2020. As of May 17, 2020, CDC data for which age demographics are available show that children (0-17 years old) make up about 3% of confirmed cases in the U.S. COVID-19 remains an uncommon disease in pediatrics.
What about MIS-C? Where did this come from? On April 26, 2020 health care providers in the United Kingdom began to report a severe inflammatory syndrome in previously healthy children. It was similar to toxic shock syndrome and Kawasaki disease. These children had a persistent fever, elevated inflammatory markers (blood tests), low blood pressure and multiorgan (heart, skin, gut, kidneys, brain and blood) involvement. These patients had either tested positive for COVID-19 or had a significant exposure. The original name given was Pediatric Inflammatory Multisystem Syndrome (PIMS). The CDC renamed it MIS-C on May 14, 2020 in order more specifically define criteria for diagnosis, treatment and data collection.
In May, the New York City Health Department began to receive similar reports. Many, but not all, of the children in New York had tested positive for COVID-19. The CDC released an advisory to health care providers on May 14, 2020 to look out for this rare and unusual syndrome.
For those into numbers, consider that in NYC as of 5/17/20 only 3% (4,955) of their total cases (190,408) have been in children. Of those 4,955 confirmed cases in children, there have been 145 cases of MIS-C. In summary, about 3% of all COVID-19 cases in NYC have been in children, and only 3% of those 3% have experienced MIS-C. So while yes it is a serious syndrome, it is thankfully quite rare.
Let’s briefly compare Virginia to NYC (we know this isn’t comparing apples to apples because of the population sizes, but it does give more perspective for us). As of May 17, NYC has had about 3,000 MORE pediatric cases of COVID-19 than all of Virginia, and more than half of Virginia’s pediatric cases (1,030 of 2,048) have been in Fairfax, Alexandria and Prince William (i.e. Northern Virginia). These data are not shared to diminish the impact this syndrome has on a patient or their family. But we think it’s helpful for parents at our practice to keep perspective on how rare this is, especially in Richmond, VA. And hopefully this helps you to worry less.
Scientists and clinicians are hard at work studying MIS-C and developing effective treatment. Having lots of experience treating toxic shock syndrome and Kawasaki disease has helped. Typically patients are monitored closely and treated in intensive care units.
When should you worry as a parent? Keep in mind that COVID-19 remains uncommon in children and MIS-C is a VERY rare condition (see above). Symptoms that would indicate that your child needs to be evaluated include:
-a persistent fever
-rash or changes in skin color
-abdominal pain, vomiting or diarrhea
-confusion or difficulty arousing your child
We are here for you. Call if you have any questions or concerns. As always, Healthychildren.org is an excellent resource offered by the American Academy of Pediatrics that is frequently updated.