Doctors gear up for more children’s illnesses linked to coronavirus

Rare, serious condition can affect heart, lung, kidneys, other organs

Florida’s summer camps and youth activities now have the green light to open, which leaves parents with a difficult decision as a coronavirus-related illness that attacks children and teens creeps through the state.

The illness, in which multiple body parts — the heart, lungs, kidneys, brain, gastrointestinal tract, skin or eyes — can become inflamed, has cropped up in children and young adults under the age of 21. New York City has reported 147 children with the condition. The syndrome, known as MIS-C, has made its way into Florida with seven confirmed cases, and medical experts expect more.

While the condition is rare, it can come on quickly, require hospitalization and become lifethreatening if it affects organs such as the heart or kidneys. A half-dozen of Florida children’s hospitals say they have admitted and are monitoring children with suspected cases.

“Only a small number of children experience MIS-C, but it can be serious and require a lot of support system,” said Dr. Balagangadhar Totapally, chief of the division of critical care medicine at Nicklaus Children’s Hospital in Miami.

The most pervasive symptoms are persistent fever and abdominal pain and sometimes a rash or pink eye. A common factor appears to be prior exposure to COVID-19.

Most young people with MIS-C have antibodies against the new coronavirus, rather than an active infection. Doctors believe this suggests the syndrome may be the result of a delayed immune response that comes on about four weeks after being exposed to the new coronavirus.

“MIS-C presents a few weeks after the peak of infection in a community, so that’s right about now,” Totapally said.

Nicklaus Children’s Hospital has announced it will create a specialized unit for the treatment of children with MIS-C, a four-room pod that is part of the hospital’s 40-bed Pediatric Intensive Care Unit. The hospital already has treated a handful of children with MIS-C, Totapally said.

Totapally said Nicklaus reported its first case about 10 days ago, but he believes Florida may have more than what the state numbers reflect. Last week, the Centers for Disease Control and Prevention created guidance to diagnose MIS-C, “but borderline cases may not show up in the numbers,” Totapally said.

Wolfson Children’s Hospital in Jacksonville has two patients with confirmed cases of MIS-C, but is monitoring others who may have the syndrome. Mobeen Rathore, a physician and chief of the Uni

versity of Florida Division of Pediatric Infectious Diseases and Immunology, has said 12 patients in the Jacksonville area have been treated at Wolfson since mid-April who are now suspected to have had MIS-C. At least a dozen children in South Florida are being monitored for the illness, and if Florida follows New York’s lead, pediatricians throughout the state expect to see more children with the syndrome in the next few weeks. New York is investigating 170 cases of the illness.

While the vast majority of children with COVID-19 have a mild or asymptomatic infection, if a prior exposure is a precursor for MIS-C, the numbers in Florida indicate a significant risk.

As of Tuesday, of the more than 50,900 Florida residents known to have tested positive for COVID-19:

399 are children between the ages of 0 to 4. Of those, 28 were hospitalized at some point during their illness.

841 are children between the ages of 5-14. Of those, 24 were hospitalized at some point during their illness.

4204 are people between the ages of 15-24. Of those, 149 were hospitalized at some point during their illness.

In young children, symptoms of the MIS-C resemble Kawasaki disease, a rare and milder inflammatory illness, but teens and young adults appear to have more of an overwhelming inflammatory response. Researchers now believe that some children diagnosed with Kawasaki disease in the U.S. between January and May actually might have had MIS-C instead.

Dr. Laura D’Addese, a pediatric cardiologist, agrees based on what she has seen at Joe DiMaggio Children’s Hospital in Hollywood.

“We are seeing the entire spectrum of the disease,” D’Addese said. “Some kids are coming in very sick and requiring intensive care management with medication to support heart function and other systems. But also the diagnosis of Kawasaki disease has increased in the community and we don’t know why. It’s a little too early to give definite numbers because we are still learning about this illness.”

At Joe DiMaggio, a section within the COVID-19 unit has been cordoned off for children suspected to have MIS-C. “There is an area now where we do have children undergoing testing to rule out as to whether they have MIS-C. If they all came in presenting the same way, life would be easier for everyone involved,” D’Addese said.

Joe DiMaggio has formed teams with doctors from various disciplines — including heart specialists — to diagnose and treat patients who appear to have MIS-C. Doctors across the country are finding children with the new syndrome have damage to their hearts

“The biggest concern we have right now, especially in kids, is largely stemming from inflammation around the heart,” D’Addese said. “Even when there is mild heart involvement, the imaging looks different than what normally expect with Kawasaki.”

In South Florida, children’s hospitals are sharing research and experiences.

“When it comes to MIS-C, there is still a lot we don’t know exactly,” said Dr. Fernando Mendoza, chief medical director for Baptist Children’s Hospital in Miami. “We are pooling our resources and data to describe the symptoms in a regional sense a little better. There’s a lot of cooperation among colleagues.”

“What we do know is that children who have this can get sick very quickly,” Mendoza said. “We encourage parents not to be alarmed but be aware and know that hospitals are well prepared to treat your child in a safe environment.”

Dr. Paul Robinson, president of the American Academy of Pediatrics Florida Chapter, said the state’s pediatricians are on alert. “About 99 percent of the time the children have fevers and they look sick. It should be easy for a doctor,” he said. “If they have seen Kawasaki, they should be comfortable finding this and telling the patient to go to the hospital.”

While there is no cure for this syndrome, South Florida doctors say they are treating the symptoms, and their patients are responding. “Usually within days,” said Totapally at Nicklaus in Miami.

As of this week, more than 20 states have reported cases of MIS-C. At least four children, three in New York state and a 15-year-old girl in Maryland, have died of apparent MIS-C in recent weeks.

D’Addese at Joe DiMaggio believes Florida will see more cases of MIS-C in the coming weeks.

“We’ll probably continue to see children with this presentation a little while longer, from my experience in the ER here and my colleagues that I know around the world,” she said, adding that parents need to consider that most children who contract COVID-19 in any form are asymptomatic or have mild symptoms, and rarely die.

“Even with children who have required hospitalization, the majority of those have done well,” D’Addese said.