Mild COVID case yields dangerous aftermath for Brawley teen
BRAWLEY -- When Brawley resident Sonya Casados woke up to find her 13-year-old daughter, Isabella, in bed completely pale and shivering intensely, she instantly knew something was very wrong.
“She had no color. Her lips were nude, and her nostrils were blue,” Casados recalled of the incident that took place early December. “I thought, ‘What the heck is happening to her?’ I rushed her to the hospital.”
As health officials at Pioneers Memorial Hospital ran tests on Isabella, including a spinal tap for what they believed might be meningitis, Sonya Casados tried to find answers to her daughter’s sudden illness by backtracking the previous day.
For Isabella, the day before seemed ordinary as she powered through online classes with a stiff neck and a mild headache.
“I felt soreness from my back of my skull and my neck, with a little headache,” Isabella recalled.
Once online classes finished, Isabella napped for much of the afternoon. It wasn’t until her mother checked on her after noticing she had skipped dinner that she realized Isabella had developed a fever.
“Even though the fever was high, I thought it was because I hadn’t caught it all day or she got sick while she was sleeping,” Casados said. Like most parents, Casados had her daughter jump in the shower and take a combination of Tylenol and Motrin with the hope of breaking her fever.
Unfortunately as the night came, Casados noticed the medication was no match for her daughter’s fever. She had Isabella spend the night in her bed to monitor her throughout the night and provide her medication every few hours.
It was just before
6 a.m. when Casados awoke to what felt like an earthquake shaking her bed. That was when she saw Isabella intensely shivering and realized her daughter’s illness had become much worse and they rushed to the hospital. Days would pass before physicians would be able to confirm with Casados that Isabella was suffering from MIS-C, Multisystem Inflammatory Syndrome in Children.
Discovered in late April of last year, the rare illness has seen a spike among primarily Latino and African American children two to six weeks after they have come into contact with COVID-19, according to Dr. Adriana Tremoulet, pediatric infectious diseases physician at Rady Children’s Hospital-San Diego.
“What’s happening is that the body is responding to the virus that it saw about two to six weeks ago,” Tremoulet said.
“The child is no longer infected with COVID. What they are positive for is the antibody to the virus.”
As a result, certain children who develop MIS-C have a huge inflammatory response to the virus, which can include, fever and severe abdominal pain with inflammation in their gut as well as vomiting and diarrhea. There can also be signs of eye redness, lips being red, a rash on the palms of the hands or on the wrist of the hands and feet, Tremoulet said.
“The main concern we see is that the function of the heart can be impaired,” the doctor added. “The heart is a pump and it is not pumping well for many children with MIS-C, causing their blood pressure to go down.”
For Isabella, the symptoms that came from MIS-C felt completely different from what she had experienced when she caught COVID-19 weeks earlier.
“I had no symptoms (with COVID-19) just a positive test result,” Isabella said. “With MIS-C I had a stiff neck, soreness and a throbbing headache, nauseous and anxiety.”
The worry, frustration and confusion Casados felt for her daughter compounded the grief she had already been feeling following the death of her own mother from COVID-19 at PMH just a week earlier.
“I hadn’t even really come to terms with her death when we returned to the hospital for my kid,” Casados recalled. “I was planning funeral arrangements while I was waiting to hear from doctors about Isabella.”
Despite their best efforts to provide Isabella a diagnosis during her first visit, physicians at PMH eventually released her with some antibiotics and told her mother to follow up with their own family doctor, Casados recalled.
“We were there for over eight hours running tests and she still had a fever when she was released,” Casados said. “I didn’t want to be pumping my kid with Tylenol every three hours if it wasn’t working, and no one knew what was happening to her.”
Although Casados made sure to follow up with her child’s private physician the next day, it took about two days at home before she decided to bring Isabella back to PMH once she noticed her daughter’s eyes had become increasingly swollen and red.
“The last visit with PMH was scary and uncomfortable in a way especially being in a COVID positive tent,” Isabella recalled. “I did have comfort with the prior nurse that stayed past her shift until the emergency flight crew arrived for me, which was nice of her.”
Nurses who had seen Isabella days prior were able to bring emergency room doctors up to speed about her condition, and after some time, they were able to make contact with other physicians at Rady Children’s Hospital who made it clear Isabella would need to seek treatment with them for MIS-C.
“What happens is the child needs to be sent to a major medical center for treatment because the main treatment is called intravenous immunoglobulin, IVIG, and that is a medication that has a lot of antibodies we all need and it also helps to boost your normal immune system’s response to actually bring down the inflammation that is happening in the body,” Tremoulet explained.
“For those living in the Imperial Valley that means being transported to the Rady Children’s Hospital.”
Many of the children treated for MIS-C at
Rady Children’s Hospital have needed to be admitted into intensive care units not only to receive these medications, but more importantly to support their heart to make it pump better until the inflammation can go down, Tremoulet said.
For Isabella, the idea of traveling to San Diego in a helicopter was overwhelming.
“I knew at this point it was serious,” she said. “Could I die? I was scared to be without my mom.”
As for Isabella’s mother, Sonya Casados was thankful the airlift her daughter had to Rady Children’s Hospital finally meant there would be answers to her daughter’s illness.
“I definitely did not know what MIS-C was before this,” Casados said. “When I arrived, I was educated on what was particularly going on with my kid.”
Isabella was able to recover after a week at Rady Children’s Hospital as doctor’s monitored her heart’s response to treatment.
“I felt stressed that my heart wasn’t working then as the days passed I felt better and learned I can recover from this,” she recalled.
Since the surge of COVID-19 cases during the holidays, Rady Children’s Hospital has observed a spike in MIS-C patients from about 20 patients in the summer and fall months to a total of 57 MIS-C patients admitted within the last two months. Of those, the majority has been Latino, Tremoulet said.
Patients admitted for MIS-C have been from age of 2 through teens, and although none of the patients treated at Rady have died from their condition, a total of 2060 cases of MIS-C have been reported in the country with a total of 30 deaths, according to U.S. Centers of Disease Control and Prevention.
“What we want the families to really know and understand is that if they see these signs in their children, it doesn’t automatically mean that it is MIS-C, but that it’s important for families to be looking out for those signs especially if there’s been COVID in the family,” Tremoulet said. “If it’s been two to six weeks and they start to see their child experience fevers, abdominal pain, rash or red eyes, seek medical attention and bring up MIS-C to the provider.”
Tremoulet said she hopes more people become aware of MIS-C especially in the Imperial Valley given its large Latino population and the several MIS-C patients that have already come from Imperial county and Mexicali.
“The fact that there’s been so little cases of MIS-C in Asia, but so many in Latin American population could speak to the amount of COVID that is happening in those populations, but I’m really interested to find out if there is also a genetic link to MIS-C, and there could be a genetic link to the COVID affecting these populations, so I think everything could be linked,” Tremoulet said.
Casados and several other families that have sought treatment for MIS-C at Rady Children’s Hospital have also volunteered to participate in clinical research to better understand MIS-C and its predominant effect on children from Latino and African American communities.
“I have been very blessed with the families we have cared for that have trusted us with not only the care of their child, but also helping us with research,” Tremoulet said.
Blood samples have been collected from patients and parents before treatment and if patients require additional medication beyond IVIG, a treatment study is conducted to figure out what’s the best treatment course for each child, Tremoulet said.
“We really have a lot of work to do in understanding MIS-C,” she added.
The Imperial County Health Department did not respond to multiple attempts for comment regarding MIS-C among those recovering from COVID-19 by press deadline.
For Isabella, the experience has made her aware of how important it is for more people to know about MIS-C symptoms and seek treatment.
“If you’re old enough to understand the symptoms, educate yourself,” she said. “Everyone is different so tell your parents when you don’t feel good and parents pay attention to us little kids and big kids.”