Summer is arriving, and with it the hope that the virus will decrease during the warmer months. The season is usually a time of exploration and outside fun, especially for children. This year, however, new concerns about the impact of COVID-19 on children, and the need to continue to limit social interaction, may make this summer unlike any other.
We continue to learn many aspects of the way this virus affects people before, during and after the symptoms of illness have passed. Early in 2020, reports told us the people most likely affected by COVID were over 65. In the past three months we have learned this isn’t accurate. This virus is not selective in about which respiratory tract to infect. We also now know that children are becoming infected and that their symptoms are not like those of adults. An unusual pattern began emerging in April, with warning messages coming from clinicians in UK and then the US.
On May 14th the Center for Disease Control issued a Health Advisory describing a multisystem inflammatory syndrome (MIS) in children. They have labeled this MIS-C because it is associated with COVID-19. The presenting symptoms are not always respiratory. Instead, children experience a persistent fever and low blood pressure along with gastrointestinal and/or kidney issues and neurologic and hematologic abnormalities. The CDC has provided a case definition of MIS-C for clinicians to incorporate into their assessment of people under the age of 21 years.
The Royal College of Pediatrics and Child Health in the UK has also provided a detailed description and clinical assessment for children who present with MIS-C. They also note that SARS CoV2 test may be positive OR negative, but health care providers should proceed with further work ups, and a consult with an infectious disease specialist. The American Academy of Pediatrics (AAP) followed the CDC with their own advisory. They remind parents that most children who are infected with COVID-19 have mild cases but urges them to contact their pediatrician if their child appear sick.
Dr. Sara Goza, president of the AAP, describes the symptoms seen in some children with this syndrome.
- Persistent fever
- Serious abdominal pain
- Trouble breathing
- A sudden rash
- An overall ill feeling
At the same time she also cautions that we are learning more daily about how this virus affects people: “It’s important to keep in mind that while more cases of MIS-C are starting to pop up, it’s still relatively uncommon. I would caution parents not to panic. The key is if your child is sick, call your pediatrician.”
The research related to how this virus affects children has been rapid and impressive, but it is still unfolding. One point from a recent article in the Journal Pediatrics suggests that the virus may remain in the upper respiratory tract in children, rather than the lower tract where it affects adults. This may mean children play a role in community transmission of the virus.
Summer is a time to enjoy the outdoors. Since no one can forecast the extent of this disease spread, we can enjoy some summer activities while continuing to be mindful of how it spreads in close groups, on our hands, face and with our breath.