What symptoms should parents be on the lookout for?
This is called a syndrome because it’s not just one symptom. It’s a number of them, and there aren’t exact criteria for this illness because it’s new. What we do know is that there are rarely problems breathing as seen in adults who have COVID. Fever is a main symptom, usually a fever around 102 or 103 degrees that lasts for several days. Abdominal pain and vomiting often occur with a diffuse, red rash that can be everywhere — the inside of the mouth, the inside of eyes, on the palms of hands, on the soles of feet. It’s typically a pretty impressive rash, and there can also be a little swelling. Overall, the kids look sick. In some cases, when kids get a viral infection, they still look pretty healthy. But kids with this syndrome are kind of lethargic, and they don’t want to eat. If your child exhibits a combination of these symptoms, you should contact your pediatrician.
Does a child have to be exposed to COVID-19 in order to develop this illness?
Yes, they do. We don’t diagnose children with this syndrome unless we know they’ve been exposed to COVID. You may not know your child has been exposed because kids have such mild symptoms to primary COVID infection, so we check for antibodies. If the antibody tests are positive, then they’ve been exposed, and this [syndrome] seems to come on several weeks later. It’s probably somewhere between three and six weeks after they were exposed, but we don’t know exactly.
How common is this syndrome?
The good news is we think this is very rare. We believe the vast majority of children with primary COVID infection never got diagnosed because until recently only sick people were getting tested. In the New York City area alone, that’s probably hundreds of thousands of kids, so very few patients are developing the symptoms for this new syndrome in comparison to the number of kids who were probably exposed to primary COVID infection.
What’s the relationship between MIS-C and Kawasaki disease and toxic shock syndrome?
Only that it looks like some of the features of Kawasaki disease. The red eyes, high fever, and sometimes cracked lips, those are typical signs of Kawasaki. We know with Kawasaki disease, children can get coronary artery aneurysms, which is the real worry, and we have rarely seen this in the patients we have treated. So, we are unsure how that condition may be a part of this.
However, with this syndrome, a child’s body can go into shock, which is defined by a high heart rate and low blood pressure. It’s when the heart can’t keep up with the metabolic demands of the body. But I don’t know why people have been referring to toxic shock syndrome. That’s when there’s a release of a toxin that activates cytokine release due to infection with certain bacteria. That’s not what we believe happens here, but some of the symptoms are similar, such as the low blood pressure and the rash.