World, Europe

New global trend of COVID-19 linked disease in children

Italian doctors report in new article that Kawasaki disease among some patients may be linked to COVID-19

Karim El-Bar   | 14.05.2020
New global trend of COVID-19 linked disease in children

LONDON

Italian doctors have reported evidence linking the novel coronavirus with a Kawasaki-like inflammatory disease.

In an article published on Wednesday in the peer-reviewed weekly medical journal The Lancet, doctors in northern Italy said they found proof for COVID-19's suspected link with Kawasaki disease, an illness that can inflame and swell blood vessels that supply blood to the heart.

The new evidence came from Bergamo, the city at the center of the country's coronavirus crisis with the highest rates of deaths and infections in the country.

Medical records from the Papa Giovanno XXIII hospital showed that 10 out of 19 cases of Kawasaki disease in the past five years were reported between mid-February and mid-April.

The article reported that eight of these 10 had tested positive for COVID-19, with the remaining two possibly being false negatives, indicating a 30-fold increase after the coronavirus pandemic erupted.

The hospital's doctors wrote that there was a "strong association" between the coronavirus and Kawasaki disease and that this should be taken into account when considering how and when to ease lockdowns.

"Our study provides the first clear evidence of a link between Sars-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus. I have no doubt that Kawasaki disease in these patients is caused by Sars-CoV-2," said lead author Dr. Lorenzo D'Antiga, director of child health at the hospital.

Co-author and pediatric specialist at the hospital Dr. Annalisa Gervasoni, underlined that though only a "very small proportion" of children infected with COVID-19 developed symptoms of Kawasaki disease, "it is important to understand the consequences of the virus in children, particularly as countries around the world grapple with plans to start relaxing social distancing policies."

Around 25% of children with Kawasaki disease experience heart complications, according to the UK's National Health Service.

It is mainly found in children under five years old and its symptoms include fever, rashes, red eyes, red and puffy hands and feet, and abdominal pain.

Only one in 1,000 children normally suffer from the condition, and only a small number of those require intensive care.

UK deaths

There are between 75 and 100 children in the UK currently receiving treatment for Kawasaki disease.

In the UK, a 14-year-old boy with no underlying conditions died of a rare disease linked to COVID-19, local media reported on Tuesday.

The boy was one of eight cases treated at Evelina London Children's Hospital over a 10-day period in April. He spent six days in intensive care and tested positive for the coronavirus after his death.

According to an article by doctors at Evelina published in The Lancet, the hospital had seen 20 cases of the disease in children as of last week, the youngest of whom was four years old. All of the children except the 14-year-old boy survived.

"All children were previously fit and well," said the report in The Lancet. "We suggest that this clinical picture represents a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 (COVID-19) infection manifesting as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome."

Health Secretary Matt Hancock said experts were investigating the trend with "great urgency," but said it was rare.

Evelina's medical director Dr. Sara Hanna was quoted by the Daily Mirror as saying: "We probably saw the first case in the middle of March. We had a child admitted with something very like Kawasaki -- a bit like something we call toxic shock syndrome. In the last two weeks, we have just seen this cluster of children where some of them look very like Kawasaki,

"They have a high persistent fever, they have got red eyes, they have got a rash, they have got swollen hands and feet."

Dr. Hanna said the timing of this outbreak was "suspicious."

International problem

The trend was not limited to the UK and Italy, with the US, France, Spain and Switzerland all also having reported cases.

Dr. D'Antiga said in Wednesday's article: "We are starting to see case reports of children presenting at hospital with signs of Kawasaki Disease in other areas hit hard by the COVID-19 pandemic, including New York and South East England."

Three children have died in New York due to inflammatory complications linked to the coronavirus.

"This virus has been ahead of us every step of the way in this country. We were told children are not affected by COVID virus. Great, Sigh of relief. Less than 1% of New Yorker's hospitalized with COVID-19 are under 20 years old," New York State Governor Andrew Cuomo said at a press conference on Wednesday.

"Now we're finding out that might not be 100% accurate either. Now we are seeing cases, looking at 102 cases where children who may have been infected with the COVID virus show symptoms of an inflammatory disease like Kawasaki disease or toxic shock syndrome."

Dr. Charles Schleien, chair of pediatrics at Northwell Health in New York, was quoted by USA Today as saying: "First of all, we never see these many kids with Kawasaki. Usually, we'll see a few kids a year. We won't see three dozen over a period of a few weeks. So, given the numbers and given the fact it's not acting exactly like Kawasaki, it looks like it's probably a post-COVID-19 infection inflammatory disease."

"The good news is that, like Kawasaki disease, almost all the kids are treatable," he added. "It is highly likely that, with treatment, they're going to be fine. It's not like the fear of COVID-19 where we know there are no treatments and it's a matter of luck."

After originating in China last December, COVID-19 has spread to at least 188 countries and regions. Europe and the US are currently the worst-hit regions.

The pandemic has killed over 300,000 worldwide, with total infections exceeding 4.4 million, while more than 1.55 million people have recovered from the disease, according to figures compiled by the US’ Johns Hopkins University.

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