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Twenty-four hours ago, in PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication, we looked at early reports of an unusual syndrome reported in pediatric patients suspected (or known) to have COVID-19 infection.
Since then, the UK's media has been filled with reports on this alert, including:
NHS on alert over new coronavirus-related syndrome putting children in intensive care
Coronavirus alert: Rare syndrome seen in UK children
At least 12 UK children have needed intensive care due to illness linked to Covid-19
Although we don't have a lot of details yet on this syndrome, it has been described as having features of both toxic shock syndrome (TSS) and atypical Kawasaki disease.
While we await further details, a number of UK medical experts have weighed in on what is known, and their comments can be found on the Science Media Center (SMC). There are currently five responses on the SMC website to these reports, but more will probably be added in the days to come.
A few excerpts from 3 of the contributors, so follow the link to read them all in their entirety.
APRIL 27, 2020
Expert Reaction to an Urgent Alert has been Issued to Doctors About a Serious Coronavirus-related Condition in Children
An urgent alert has been issued to doctors by the Paediatric Intensive Care Society (PICSUK) regarding a serious coronavirus-related condition in children.
Prof Ian Jones, Professor of Virology, University of Reading, said:
“We need more data on the suggested link between SARS-CoV-2 and a widespread state of hyper-inflammation, especially in children. A general inflammatory syndrome was reported for selected Covid-19 patients recently in University Hospital Zurich and curiously, a general inflammation of blood vessels in children, Kawasaki disease, was once suggested to be linked to a related coronavirus, NL63, which uses the same receptor as SARS-CoV-2, although this was later found not to be the case. It’s too early to know if this is distinct aspect of SARS-CoV-2 or, for example, something else noted by the extended confinement with observant parents.”
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said:
"We already know that a very small number of children can become severely ill with COVID-19 but this is very rare – evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection.
“New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.
“However our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with COVID-19 but if they are concerned about their children’s health for any reason, they should seek help from a health professional.”
See here for more information: Guidance for parents on symptoms and seeking advice.
Professor Adilia Warris, Paediatric Infectious Diseases Specialist, University of Exeter, said:
What do we currently know about COVID-19 in children?
“Children have so far accounted for between 1% and 5% of diagnosed COVID-19 cases, have often milder disease than adults and deaths have been extremely rare.
“The largest series of paediatric cases originates from China, with 5.6% of 2143 children showing severe disease (e.g. needing oxygen), and 0.6% needing intensive care treatment.
“So far, children with underlying compromised immune systems or using immunosuppressive treatments (corticosteroids) are not at increased risk for developing severe Covid-19 disease.
“Children are unlikely to contribute to the transmission of COVID-19 in the population.
Is this likely to be COVID-19 or another, as yet unidentified, infectious pathogen?
“As we don’t know yet the full range of clinical presentations caused by COVID-19, we keep every possibility open that clinical presentations which can’t be explained by other causes, might be caused by COVID-19, or even a not yet recognized pathogen. As the inflammatory presentations referred to in the news, which a look-a-like with severe sepsis in children, asks for targeted management related to the causative pathogen, we consider both COVID-19 as well as a yet unrecognized pathogen in our differential diagnostic considerations.
“Please do consider that the absolute number of those cases are very low (a hand full at the moment). The call to ask if other colleagues have comparable experiences over the last week is so we are able to define what is going on, and if there is reason for additional assessment into this.
What is a multi-system inflammatory state?
“A clinical presentation where a lot of cytokines are produced which de-arrange a number of body functions, but the most important being leading to leaky blood vessels, causing low blood pressure and fluid accumulation in the lungs and other organs being in urgent need of intensive care treatment to support the function of the heart and the lungs (and sometimes other organs as well like the kidneys).
How much do we know about this condition? What do we need to know?
“What is the underlying cause, and how to best treat it.
Should people be worried?
“No, but as emphasized by the royal college for child health and paediatrics, if parents have genuine concerns about the health of their child, they should contact the GP and/or paediatrician.”(Continue . . . . )
