COVID-19, children, facts and fear

Reports of a new inflammatory syndrome linked to COVID-19 in children have surprised doctors and shocked parents over the past two weeks. For all of the challenges that this pandemic has brought, particularly for families with young kids, it had been somewhat reassuring that children seemed to be getting sick at much lower rates than adults. What are parents supposed to do with this information, particularly the reports of several deaths of New York children linked to the new syndrome?

I am a pediatric infectious diseases specialist at an academic children’s hospital. My colleagues and I are used to seeing complicated cases and have had the privilege of caring for the small group of children who have required hospitalization for COVID-19. At times, we may lose sight of the fact that what we see is a small slice of a much larger pie. The vast majority of COVID-19 cases in children are mild. Most kids who are infected probably have no symptoms at all.

Even now, months into lockdown, we are still in the early stages of understanding how this new virus works. In some ways, it is much like influenza or other common viruses: It is transmitted efficiently, often causes pneumonia, and can lead to serious illness, particularly in the elderly. In other ways, it is unique.

The new hyperinflammatory syndrome, currently called PIMS, is likely a rare complication of COVID-19 in children. Some cases have resembled Kawasaki disease, an enigmatic immune disorder causing high fevers, rash, cracked lips, and swollen hands and feet. Some have tested positive for COVID-19, and some have not. It is crucial to determine whether a child has Kawasaki disease, as it can affect the heart if not treated promptly. It’s not clear yet whether this COVID-related process is Kawasaki, something related or a distinct entity altogether.

For that reason, we — physicians, public health professionals and laboratory scientists — have a lot of work ahead. We need to collaborate across disciplines and institutions, and fast. We are off to an encouraging start. The New York’s city and state health departments are leading the way, requiring hospitals to report all cases of Kawasaki-like diseases, regardless of COVID-19 test results, and releasing an interim definition for PIMS cases. They are rightly casting a wide net, because we are just beginning to understand this new syndrome.

As a scientific community, we need to do three things.

First, gather data, and lots of it. Some will come from these health department reports, and some from individual doctors keeping track of what they are seeing. Second, we need to be smart about how we synthesize those data. Coming up with clear case definitions and clues from laboratory test results will bring us to the third step: working together.

Because PIMS remains — thankfully — rare, we need researchers across states and countries to collaborate rather than compete. Epidemiologists need consistently collected data from a large number of patients, many more than a single hospital can provide. Blood samples from patients with and without the syndrome will allow scientists to decipher the specifics of how the immune system has been affected in these children. Large collaborative clinical studies will allow us to identify better ways to diagnose and treat this new entity. The tools are there to make this happen, and the best thing that we can do for these kids is to all pull in the same direction.

The advice for families is simpler. Parents should not panic about this new twist in the coronavirus saga. COVID-19 remains a mild disease in nearly all children. As the virus has spread in the population, it is not surprising that we are still identifying new, rare complications. You should continue to trust your judgment about how your child is doing, reach out to your pediatrician if you need to, and stay safe.

Ratner is the director of the division of pediatric infectious diseases at Hassenfeld Children’s Hospital at NYU Langone Health.