Multisystem inflammatory syndrome in children, a rare but serious illness linked to coronavirus, first emerged last spring, marking a critical turning point for the widely held understanding of the coronavirus and its impact on children. Now, there is renewed concern around the mysterious affliction (which was first reported in the U.K. and began appearing in and around New York City in May 2020) following the tragic death of 15-year-old Braden Wilson of Simi Valley, California, who is one of the 30 children who have died from the condition in the U.S. since the pandemic began. According to the The New York Times, doctors across the country have been seeing a striking increase in the number of young people with multisystem inflammatory syndrome in children, also known as MIS-C, with more patients experiencing severe symptoms than during the first wave of cases.
“As numbers of COVID cases in the country increased dramatically this winter, so did hospitalizations, severe illness, and cases in children and subsequently we saw an increase in MIS-C, or this post-inflammatory response to exposure to COVID-19,” explains Dr. Tanya Altmann, a pediatrician and spokesperson for the American Academy of Pediatrics. While the rise in cases is proportional to spikes of COVID-19 and that offers context, it’s no less worrying to parents. But Altmann assures them that severe cases are rare. “With early identification and treatment, most children are doing fine,” she says.
While multisystem inflammatory syndrome in children continues to be a factor in policy deliberations around school reopenings, gaining a better understanding of the risk is currently top of mind for parents. Here, doctors answer frequently asked questions using the knowledge they have now.
What are the symptoms?
Similar to Kawasaki disease, which typically affects children under five, and toxic shock syndrome, the most common symptoms of multisystem inflammatory syndrome in children are a prolonged fever of five or more days, severe abdominal pain, diarrhea, rash, and lethargy, says Altmann. “We are asking parents if their kids have a prolonged fever, look really sick, have trouble breathing, can’t keep down fluids, or are in severe pain to seek medical care right away as prompt treatment can help with recovery,” she explains. Why certain children are more at risk than others remains unknown, but Altmann posits that it likely has to do with a child’s immune-system response to the virus.
How fatal is it?
While any risk is unwelcome, particularly as emotions continue to run high, Altmann stresses that multisystem inflammatory syndrome in children is extremely rare. “Most kids who contract COVID-19 have mild illness and fully recover,” she explains. “Treatment depends on the symptoms and lab results, and extent of illness, but there are protocols in place for hospitals to follow to quickly treat these children, as well as follow up to decrease any long term complications.”
Dr. Edith Bracho-Sanchez, a primary-care pediatrician at New York-Presbyterian Hospital’s Broadway Practice who has been treating cases of multisystem inflammatory syndrome in children, echoes this assertion—and feels especially inclined to provide solace to the more vulnerable populations in the U.S. As the New York Times reports, 69% of reported cases have affected Latino or Black young people, which experts believe are due to social economic disparities. “As someone working in New York City within the immigrant community, a lot of my patients have parents that are essential workers,” explains Bracho-Sanchez. “I treat the kids of grocery store workers, MTA workers, and factory workers. These are the children who’ve been most exposed to COVID-19, and most of them have a very mild illness—if they have an illness at all. That still holds true.” That being said, Bracho-Sanchez believes this is a moment to revisit preconceived notions about the coronavirus. “We’ve been thinking about schools simply as vehicles of transmission for staff and parents, but now it goes beyond just bringing it home to the adults,” says Bracho-Sanchez. “We have reason to pause and rethink things because now it’s also about the safety of the children too.”
As the pandemic continues to upend the school systems, Altmann isn’t concerned that there will be an increase in MIS-C from school openings. “Schools are a controlled environment that know how to decrease transmission with all of their mitigation protocols such as distancing, masking, hand washing, disinfecting, ventilation and testing,” she explains. “We know that the rate of children infected with COVID is much less in schools compared to the community around.” Since children are largely asymptomatic carriers, it’s how they affect adults that is still continues to be the leading concern in terms of schools reopening, says Dharushana Muthulingam, an infectious-disease physician, researcher, and instructor at Washington University School of Medicine in St. Louis. The best course of action for parents is to concentrate on the facts and not let fear take over.
“This condition is certainly concerning and, of course, frightening to hear about, but it looks like things we know, whether that’s Kawasaki or other viral illnesses, and can be responsive to intensive care,” says Muthulingam. “The best way for people to feel like they have control over the situation is to keep preventing COVID-19 the best they can, and if a child is sick, take them to their pediatrician and seek out care. We should all be vigilant, but this syndrome is rare—I don’t want people to panic about it.”