Phillippa Gordon MD, a Brooklyn pediatrician and Susan Fox, the founder of Park Slope Parents of Brooklyn, recently wrote the following in response to parents in their community expressing concerns:
We’ve received a few private emails about a "mysterious COVID-19-linked illness in children" that the media has been covering far and wide. We wanted to speak to this to help alleviate some of the fears we've heard from parents.
First and foremost, know that Kawasaki is a well-known, rare, and well-understood syndrome, and pediatricians are always on the lookout for it. Second, remember that much of the media focuses on attracting eyeballs to sell advertising; they want you to be emotionally moved by their articles using words like "mysterious," "threat," "scary," and “likely.”
Each infectious agent has a characteristic way of presenting itself. Infectious diseases can cause primary symptoms, such as fever, sore throat and swollen glands with strep, fever, and rash with measles or chickenpox, and fever, cough, and aches with flu. Infectious diseases may also predispose people to secondary complications, such as increased susceptibility to pneumonia from other viruses or bacteria in flu and in measles, or Group A strep skin infection (the so-called “flesh-eating bacteria”) in chickenpox.
Many infections have later complications caused by the body’s inflammatory response, such as inflammation of the calf muscles (myositis) after flu, inflammation of the hip joint (tenosynovitis) after chickenpox, and inflammation of the heart valves, brain, or joints (rheumatic fever) after strep infection. (This is prevented by antibiotic treatment which is why we always make you take antibiotics after a positive strep test even though you feel better.) There can be rare serious late complications of some common illnesses: for example a primary pneumonia in measles, and irreversible brain damage in flu or measles. These may be caused by the body’s overreaction to primary injury by the virus and so may not appear till later.
Doctors are aware and always on the lookout for these complications, but they are rare, and so we just ask you to stay in touch and discuss any changes with us but try not to terrify you by listing every possible rare complication. It’s one of the reasons doctors may urge you, to the point of tedium, to vaccinate your children and yourselves.
As the number of cases of coronavirus increases, we are beginning to learn more about the behavior of this pathogen and the specific features of its interaction with the human body. It seems to cause a brisk inflammatory response which can cause problems throughout the body. For example, the symptoms of headache and changes in taste and smell probably represent a direct inflammatory change in the nervous system. Inflammation of the blood vessels, known as vasculitis, is an underlying cause of many of the other problems reported: for example, temporary changes in kidney function due to vasculitis of blood vessels in the kidney, and vasculitis of the toe which has been labeled “Covid toe”. Inflammation of the blood vessels also causes abnormal blood clotting, which seems to be a major feature of the current disease, and can be treated with anticoagulant medications. Diffuse vasculitis is the cause of a rare childhood illness known as Kawasaki syndrome. It is characterized by fever, rashes, swollen glands, and redness of the conjunctiva and lips. The coronary vessels of the heart can be damaged, a complication that can be effectively prevented by treatment with immunoglobulin injections. In a few children, a Kawasaki-like syndrome appears to be emerging as a complication of coronavirus.
If your child develops unusual symptoms such as severe abdominal pain with vomiting, unusual rashes, or joint pain, you should call your pediatrician who can, if it is indicated, refer you to hospital for blood tests and an echocardiogram, and if necessary, treatment with immunoglobulins and other medications. In some of the current cases, children have needed support for breathing and circulation for a time; this is the work of pediatric intensive care medicine and is well understood and effective.
As coronavirus infection becomes widespread we are learning more about the ways in which it manifests itself, but these are not “mysterious” or incomprehensible manifestations — they are well-studied pathways of infection, and treatment protocols are understood and are being brought on board. My colleagues working in hospitals are learning day by day how to anticipate the novel effects of the current outbreak and how best to hone available treatment to its particulars.
Remember that these complications are very rare, the pediatric community is on the lookout for them and we have well -studied protocols for treating them.
As my (SF) uncle says, "Don't borrow tomorrow's troubles." Take a break from all the scary media, focus on reliable, fact-driven, sources about this and remain calm. If you have a sick child, contact your doctor, talk through the symptoms, and let them do their amazing jobs to take care of you.
Susan Fox & Philippa Gordon, MD
Park Slope Parents