U.K. Health Officials Warn Coronavirus-Related Inflammatory Condition Could Be Emerging in Children

Health officials in the U.K. have warned doctors that children are falling ill with a serious condition needing intensive care treatment, characterized by abdominal pain and heart problems, which may be linked to the coronavirus.
According to the Health Service Journal, which covers the U.K.'s National Health Service, the alert was sent to family doctors in North London by their clinical commissioning group.

These alerts are a standard way of making sure clinicians are aware of any potential emerging conditions so children can be given the right care quickly.

The Health Service Journal reported the alert warned of an apparent rise in children of all ages presenting with "a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK."

It went on: "There is a growing concern that a [COVID-19] 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."

It was not clear how old the children who had been falling sick were and if they had any underlying conditions.

The Paediatric Intensive Care Society shared the alert on Twitter, which reportedly stated that the cases have "common overlapping features of toxic shock syndrome and atypical Kawasaki Disease with blood parameters consistent with severe COVID-19 in children." A life-threatening condition, toxic shock syndrome occurs when bacteria gets inside the body and lets off harmful toxins. Kawasaki Disease, meanwhile, is a condition which generally affects those under the age of five, and is characterised by a rash, swollen glands in the neck, dry cracked lips, red fingers or toes, and red eyes.

*Urgent alert*

Rising no of cases presenting to #PedsICU with multi-system hyperinflammatory state, overlapping features of toxic shock syndrome & atypical Kawasaki disease, bloods consistent with severe #COVID19 - seen in both #SARSCoV2 PCR +ve AND -ve

Please share widely pic.twitter.com/Bj6YHLJ8zi

— Paediatric Critical Care Society (@PICSociety) April 26, 2020

"Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation," the alert read. It stated that health care workers have seen these symptoms both in children who have tested positive for COVID-19 and those whose results were negative. Some of the children appeared to have antibodies which suggested they may have previously been infected with the coronavirus.

"There is a growing concern that a SARS-CoV-2 related inflammatory syndrome emerging in children in the UK or that there may be another yet identified infectious pathogen associated with these cases," according to the alert.

PICS said it wished to bring the alert to the attention of pediatricians as well as those who work in anaesthesia and adult intensive care "who may be involved in the management of sick children."

Professor Simon Kenny, NHS national clinical director for children and young people, said in a statement to Newsweek: "Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to COVID-19, but it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.

"The advice to parents remains the same: If you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital."

Experts in the field acknowledged the alert's importance but highlighted that most children develop a mild form of COVID-19, and deaths are rare.

Professor Adilia Warris, paediatric infectious diseases specialist at the University of Exeter, explained in a statement that a multi-system inflammatory state is where there are a lot of cytokines, proteins given off by immune cells, "which de-arrange a number of body functions, but the most important being leading to leaky blood vessels, causing low blood pressure and fluid accumulation in the lungs and other organs being in urgent need of intensive care treatment to support the function of the heart and the lungs (and sometimes other organs as well like the kidneys)."

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 recognized pathogen.

Warris said: "The absolute number of those cases are very low (a hand full 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."

Ian Jones, professor of virology, University of Reading, said: "We need more data on the suggested link between SARS-CoV-2 and a widespread state of hyper-inflammation, especially in children.

Referring to the coronavirus by its scientific name, he said: "It's too early to know if this is [a] distinct aspect of SARS-CoV-2 or, for example, something else noted by the extended confinement with observant parents."

Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, the U.K's professional body for paediatricians, said in a statement that in light of the alert the body's advice remains the same: "Parents should be reassured that children are unlikely to be seriously ill with COVID-19 but if they are concerned about their children's health for any reason, they should seek help from a health professional."

Viner 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."

Parents can find more information on the Royal College of Paediatrics and Child Health's website, he said.

Rosalind Smyth, director and professor of child health at UCL Great Ormond Street Institute of Child Health, said that the evidence to date suggests around half of children with COVID-19 have a fever, around 40 percent have a cough, and fewer than 10 percent have gastrointestinal symptoms.

"However, our understanding of this condition in children is limited. COVID-19 does present, in adults, as an inflammatory disease affecting a number of organs."

She said: "We should investigate fully these children, with SARS-CoV-2, who present with a multi-system inflammatory disease to assess whether this is a presentation of COVID-19."

Dr. James Gill, honorary clinical lecturer at Warwick Medical School, commented: "Whilst it is easy to draw conclusions suggestive of a connection with COVID19 there is not sufficient evidence to substantiate that the signal has any clinical significance."

He said: ""Regardless of source, multi-system inflammatory diseases are exceptionally serious for children and already stretched intensive care teams, so keeping an extra eye out for new symptoms arising in the patients we see is always a good thing."

The message for the public, he said, is to double down of current guidance including staying inside, staying safe, and contacting health care providers if parents are worried about themselves or their children.

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

  • CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
  • A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
  • Cloth face coverings can be fashioned from household items. Guides are offered by the CDC. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html)
  • Cloth face coverings should be washed regularly. A washing machine will suffice.
  • Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

  • Clean hands frequently with soap and water, or alcohol-based hand rub.
  • Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
  • Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
  • Avoid touching your hands, nose and mouth. Do not spit in public.
  • Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

  • Avoid close contact with others if you have any symptoms.
  • Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
  • If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
  • Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
  • Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask and glove usage

  • Healthy individuals only need to wear a mask if taking care of a sick person.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective when used in combination with frequent hand cleaning.
  • Do not touch the mask while wearing it. Clean hands if you touch the mask.
  • Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
  • Do not reuse single-use masks.
  • Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
  • The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.
covid-19, coronavirus, getty
A child draws with chalk on a road in Nantes, France, on April 27, 2020, as the country is under lockdown to stop the spread of the COVID-19 pandemic caused by the novel coronavirus. LOIC VENANCE/AFP via Getty Image