COVID-19: Alert Over Multisystem Hyperinflammatory State in Children

Nicky Broyd

April 27, 2020

Editor's note, 27th April 2020: This article was updated with additional comment.

An alert has been issued from within NHS England over rising cases in the past 3 weeks of new symptoms in children needing ICU admission that may be linked to coronavirus.

The symptoms, seen in London and other parts of the UK, are described as a multi-system inflammatory state with overlapping features of toxic shock syndrome and atypical Kawasaki disease, with blood parameters consistent with severe COVID-19.

The symptoms have been seen in children who test positive for the virus, and those with negative tests.

The alert said: "Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation."

It went on to add: "There is a growing concern that a SARS-CoV-2 related inflammatory syndrome [is] emerging in children in the UK or that there may be another as yet unidentified infectious pathogen associated with these cases."

England's CMO: COVID-19 Link 'Plausible'

Professor Stephen Powis, national medical director of NHS England told today's Downing Street briefing: "I've asked the National Clinical Director for Children and Young People to look into this as a matter of urgency… I know Public Health England are also looking into this. 

"So it's obviously important that when clinicians see these cases and worry that there might be a cluster that they alert other clinicians so that we can make sure that they are identified if they're occurring elsewhere. 

"And then, I think, quite rightly we asked our experts to look into them and to see whether they can establish any link. 

"We're not sure at the moment, it's really too early to say whether there is a link."

Government Chief Medical Adviser Professor Chris Whitty added: "I think it is entirely plausible that this is caused by this virus, at least in some cases, because we know that in adults who of course have much more disease than children do, big problems are caused by an inflammatory process and this looks rather like an inflammatory process, a rather different one.

"Therefore, given that we've got a new presentation of this at a time with a new disease...its not definite, we need to look for other causes as well but the possibility that there is a link is certainly plausible."

Emerging Evidence

The Paediatric Intensive Care Society highlighted the need for paediatricians, ICU doctors and anaesthetists to be aware of the symptoms.

In a statement, 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."

Professor Adilia Warris, paediatric infectious diseases specialist, University of Exeter, told the Science Media Centre that children have so far accounted for between 1% and 5% of diagnosed COVID-19 cases, often have milder disease than adults, and deaths have been extremely rare.

She said: "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 recognised pathogen."

She continued: "Please do consider that the absolute number of those cases are very low (a handful 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."

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