Kids, Kawasaki Disease, and COVID-19: What Parents Should Know

Kids, Kawasaki Disease, and COVID-19: What Parents Should Know

While children are only a small minority of those who test positive for COVID-19, we’re starting to see evidence of a rare, but serious, complication in children that resembles a condition known as Kawasaki disease. Here’s what doctors say we should read out for.

One of the few comforting things about this pandemic is that kids have mostly been spared. Children aren’t immune to the virus SARS-CoV-2,but they do seem to be only a small minority of those who test positive. Unfortunately, nothing in epidemiology isever that simple, and we’re starting to see evidence of arare, but serious, complication in children that resembles acondition known as Kawasaki disease. But this condition is very treatable. So here’s what doctors say we should watchout for.

On May 14, the US Centers for Disease Control Issued an advisory to healthcare practitioners, based on casereports from the United States, the UK, and elsewhere, to be on the lookout for Kawasaki-like symptoms. Kawasaki disease is a rare condition that mostly affects very young children. It shows up in about ten to twenty out of every hundred thousand children under five.

Symptoms include a high, persistent feverand widespread inflammation across the body. This can cause swelling of the walls in certainarteries. Other symptoms can include swollen lymph nodes, especially near the neck; redness and rashesacross the body; and things like diarrhea, vomiting, jointpain, and peeling skin on the hands and feet, especially around finger and toe-tips. Medications can ease the fever and inflammation, but there can be permanent damage if the diseaseisn’t treated. Up to a quarter of untreated children endup with damage to their coronary arteries, which are thevessels that supply blood to the heart. Now, like we said, Kawasaki disease is usuallyreally rare. So it’s definitely strange to see a bunchof cases of something that looks a lot like it pop up at the sametime. But that’s what a number of doctors andhealth officials have noticed. The cases the CDC was warning about seemedto mimic the known symptoms of Kawasaki disease, including persistentfevers and inflammation. It’s not clear if these new cases are actuallyKawasaki disease, or just something like it. But the symptoms are close enough that doctorsfirst began calling it “Kawasaki-like”.

At least two other names have been proposed,so you might hear people talking about MIS-C in the US, or PIMS-TSin Europe. They're the same thing, it's just that researchershaven't agreed on a name -- or even if it needs a new one. One large hospital in Italy had ten of theseKawasaki-like cases in two months, from mid-February to mid-April,compared to nineteen diagnoses of Kawasaki disease overthe past five years. That study also saw a difference in the averageage of cases. Kawasaki disease normally affects kids withan average age of three, but these patients were closer to seven anda half. This could have been down to the small samplesize, though. Doctors in the UK have noticed a similar spikein the number of kids presenting with Kawasaki-like symptoms. And the state of New York has had about onehundred MIS-C cases.

New York’s governor has said that they andfourteen other states are investigating even more potential cases. Unusually for Kawasaki disease, some of thosecases are in young adults, from their early to mid-twenties. Now, we don’t know what exactly causes Kawasakidisease. It’s likely a result of something triggeringthe immune system. Viruses, bacteria, and environmental causeshave all been suggested, though we aren’t certain yet. A 2005 study even linked cases of Kawasakidisease to a coronavirus called HCOV-NH, which is similar to one thatcauses the common cold. Later studies cast doubt on the connection. But in many of these new cases, the kids hadtested positive for SARS-CoV-2 after these symptoms appeared. This may be what doctors arecalling a post-infectious inflammatory syndrome. This means it generally shows up later, afterthe initial viral infection is over. But we don’t know exactly how yet. It could be a case of the immune system overshootingand attacking the body, or it could be something else. The fact that it only shows up after the infection is more or less done might explain why we’reonly noticing it now, months into the pandemic. Or, it might just be that in the rush to treatthe pandemic and save lives, an uptick in a rare syndromemight simply go unnoticed for a time.

This is why the heads-up to doctors from theCDC might be important. Hopefully, doctors -- and parents -- willknow to be on the lookout for these rare symptoms, so that kids whoare affected can get treated in time. We here are internet people, not doctors, but wedo suggest you call one if your kid shows unusual symptoms. Remember, that’s stuff like a high fever,abdominal pain, and feeling extra tired. We’ll leave some resources for you parents out there in the description. But don’t freak out, because even with theincreased number of cases, this is still super rare. Big picture, it’s important to rememberthat children have an overall low burden of illness from thispandemic. And this Kawasaki-like problem is both uncommonand treatable. But it’s good to look out for things likethis.

Doctors and families can stay vigilant to avoid permanent effects. Plus, understanding what’s going on in these children might help us understand the immune responseto the virus, and why the majority of children seem onlymildly affected.

It’s also a reminder that doctors and scientistsare learning more every day about how SARS-CoV-2 affectsthe body. It’s not always what we expect, but it’sa problem we can solve.

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