Multinational case reports on a small number of children who have had COVID-19, or possibly exposed to the novel coronavirus, tell of a potentially fatal widespread reaction that could lead to cardiac or respiratory failure and shock. The New York State Department of Health issued an urgent Health Advisory to health-care workers on May 6, 2020, identifying signs and symptoms of this condition in children.¹ This syndrome is potentially (or temporarily) associated with COVID-19 and has been called the Pediatric Multi-System Inflammatory Syndrome.¹

Though pediatric cases were first reported in Italy, Spain, and Great Britain, from this report we know that 64 suspected cases have been reported in children in New York State hospitals with symptoms compatible with multisystem inflammatory syndrome. This is a non-typical presentation for children infected SARS-CoV-2 who usually have only mild symptoms with extremely rare manifestations of serious illness.

Parents, pediatricians, and family practice physicians should be aware of these symptoms in patients under 21 years of age:

Persistent fever (four or more days)
Rash
Stomach illness (abdominal pain, vomiting, or diarrhea)
Swollen lymph nodes
Eye irritation

The Health Advisory intended to make a broad audience aware that this syndrome has features which overlap with Kawasaki Disease (another disease leading to inflamed blood vessels) and Toxic Shock Syndrome. Blood testing will show elevated inflammatory markers. There may be clinical evidence of cardiac, respiratory, renal, gastrointestinal or neurological disorders. Inflammations of the heart and other cardiovascular changes have progressed in some patients to shock which have required cardiac and respiratory support in intensive care. Pediatric Multi-System Inflammatory Syndrome should be considered when other infectious causes have not been identified. Diagnostic tests to detect the presence of SARS-CoV-2 must be performed. Physicians should assume a heightened level of awareness to early recognize symptoms of this syndrome and make prompt referrals to in-patient and critical care specialists.

The possibility of a small number of children developing Pediatric Multi-System Inflammatory Syndrome potentially associated with COVID-19 should raise awareness by all, but not be a cause for panic. Even most children who have the syndrome recover fairly quickly. However, these children will usually require at least one follow up evaluation by a pediatric cardiologist. Other useful information is available online.²

References
1.Health Advisory: Pediatric Mult-System Inflammatory Syndrome Potentially Associated with Coronavirus Disease (COVID-19) in Children. New York Department of Health. Issued May 6, 2020, accessed May 11, 2020.
2. Ormseth, M. 2020. Syndrome similar to Kawasaki disease linked to coronavirus at Children's Hospital Los Angeles. Published on msm.com May 8, 2020 accessed May 8, 2020.

*Randy Guliuzza is ICR’s National Representative. He earned his Doctor of Medicine from the University of Minnesota, his Master of Public Health from Harvard University, and served in the U.S. Air Force as 28th Bomb Wing Flight Surgeon and Chief of Aerospace Medicine. Dr. Guliuzza is also a registered Professional Engineer.