Post-COVID Coronavirus Effects in Children and Babies Appear to Be Far Worse Than We Thought

Written By Humayra Ali
Coronavirus effects in children post-covid

Yes, the statistics of a child or baby dying from COVID-19 is indeed low (Jama Pediatrics); however, they aren’t completely immune from it. The American Association of Pediatrics (AAP) reported that there has been a marked increase in pediatric COVID-19 incidences. According to the report, there were 179,990 new child cases reported, representing a 90% increase in child cases over a 4-week timeframe during July and August, 2020. In sum, coronavirus cases in children are on the rise, unfortunately (see the report from AAP and the Children's Hospital Association).

Children are typically resilient when it comes to recovering from a sickness. Sadly, some children aren’t recovering their health and strength after contracting COVID-19. A new disease, called multisystem inflammatory syndrome in children (MIS-C), has compromised many children’s health around the world since it was first discovered in early 2020.  

As of August 6, MIS-C, also known as a pediatric multisystem inflammatory syndrome or PIMS, was identified in at least several hundred kids across the country, ranging in age from less than 1 to 20. About two-thirds of those children didn't have underlying conditions before being diagnosed with MIS-C.  

What is MIS-C in children with Covid -19 (graphic courtesy of VaxTherapy)

What is MIS-C in children with Covid -19 (graphic courtesy of VaxTherapy)

The condition can emerge in children even after very mild coronavirus infections. And, would you think that a mild case of coronavirus would yield a milder case of MIS-C? Well, think again. A mild case does not guarantee that a subsequent MIS-C won't be very serious. In fact, in some cases it can even be fatal!

What is frightening is that children can have no upper respiratory symptoms, which are classic symptoms of COVID-19, and still develop MIS-C. What’s more is they may have no symptoms at all or no indication of having the disease, but still may develop this uncontrolled inflammation a few weeks later.

The researchers conducted a comprehensive new review of medical research into MIS-C this year. This review analyzed 39 observational studies involving 662 child/pediatric patients in total who developed the syndrome. While 470 of these children (71%) were admitted to the intensive care unit, sadly 11 had died (1.7%). Although this observed death rate for children with MIS-C does seem to be low, roughly about 1.7 percent of all children in this analysis, this figure is much higher than the 0.09 percent mortality rate observed in children with COVID-19.

The average length of hospital stay was about 8 days. Fever, abdominal pain or diarrhea, and vomiting were the most common initial presentation. Also common were conjunctivitis and rash. However, the blood serum markers of inflammation, clotting elements, and heart abnormalities were considerably high. Mechanical ventilation (or breathing tubes) and extracorporeal membrane oxygenation (when blood is circulated out of the body, passed through a membrane to oxygenate it because the lungs can no longer do that, and then it is returned to the body) were necessary for 147 (22.2%) and 29 (4.4%) children, respectively. Abnormal echocardiography or EKG (which shows the size and shape of the heart indicating how well it is working) was observed in 314 out of 581 children (54%) with reduced heart muscle contraction (which is necessary for pumping out oxygen-rich blood to the rest of the body) was the most common abnormality. Other heart abnormalities included dilation of coronary blood vessels, and aneurysm of a coronary vessel (in ~10% of children), which could put them at higher risk of future heart-related serious events.

This review also mentions that MIS-C is marked by severe inflammation in multiple parts of the body; other than the heart, lungs, kidneys, brain, skin, eyes, and more are also involved. The symptoms resemble two other conditions such as Kawasaki disease and toxic shock syndrome, but the magnitude and spread of overall inflammation in MIS-C are far worse.

The reason MIS-C can be fatal because it affects multiple organ systems, be it the heart, the lungs, the kidney, the gut or the neurological system, or a simultaneous involvement of a combination of these systems. Several months into the pandemic, now we are beginning to understand what MIS-C can look like, but there is much we still don’t know about the syndrome, especially what the long-term effects will be in the children who experience this condition and implications within pediatric health care.

The principal researcher said that these children will require significant observation and follow-up with repeat ultrasounds to determine if this is something that will resolve or will linger for the rest of their lives. If the latter, then it is quite unfortunate to those children who were previously healthy, but then were among the very small percentage of individuals who developed MIS-C after COVID-19 infection.

While there's still a lot we don't know about MIS-C, the current evidence supports that it is something to be taken very seriously. For many children, MIS-C is a COVID-19 associated condition that is much worse than the COVID-19 they have already experienced.

The authors mention that the children will typically show signs and symptoms of MIS-3 about 3 to 4 weeks post coronavirus infection and many of them will progress to a massive drop in blood pressure, to the point where the body's vital organs do not get oxygen and nutrients, and heart/lung failure. Because children with this condition decompensate rapidly, early medical attention is crucial when MIS-C is suspected to save lives. Most of these children will need to be managed in an intensive care unit (ICU). Children will likely survive this massive inflammatory condition with steroids, IVIG, a multidisciplinary team of healthcare providers, and in some cases with immunomodulatory agents.

If you liked this post, check out our featured guest post: Dr. Nahreen Ahmed as she takes us through a “typical” day in the Covid ICU.

You may also like the following posts:

Humayra Ali
Previous

Will there be an End to Covid-19, Coronavirus? An Expert Perspective.
Next

Impacts of AstraZeneca's COVID-19 Vaccine Trial Pause