IN our column last week, we briefly mentioned a new hyperinflammatory toxic shock syndrome discovered among children after getting COVID-19 infection, first reported in the United Kingdom on April 26, 2020. The clinical presentation could be confused with Kawasaki Disease. This new distinct entity, which luckily is rare, has been termed MIS-C Syndrome. It seems only children exposed to COVID-19 are at risk for this novel syndrome. In general, children are believed to be at a lower risk to get infected with COVID-19 compared to adults, especially the seniors.
Latest COVID-19 statistics: Global total – 4,967,800 cases, deaths – 329,002 (23 countries, no COVID-19 in Antarctica); United States – 1,563,408 cases, deaths – 94,000; Philippines – 12,988 cases, deaths – 848; Russia – 300,000 cases, deaths – 2,888; Spain – 278,908 cases, deaths – 27,789; China – 82,969 cases, deaths – 4,638.
What is MIS-C?
MIS-C refers to the newly-observed rare and unique Multisystem Inflammatory Syndrome in children (median age: 9 to 11, but could be up to 20) associated with nCorona virus pandemic, seen 4-6 weeks after COVID-19 infection, affecting various organs. This was contained in the CDC Advisory on May 14, 2020. All of the children had fever (100.4 or higher), 90 percent had stomachache, 75 percent had pink eyes (conjunctivitis) and cracked lips (blisters), and 50 percent had skin rash. Some had nausea and vomiting. There were no respiratory symptoms.
The medical community is still learning more about this distinct disease linked to COVID-19. There are about 220 cases of MIS-C found in the USA, 145 of them in New York; three children (ages 5, 7 and 18) have died from it. Other nations have also reported MIS-C cases. Luckily, this syndrome is rare, and deaths are even rarer but, nonetheless, parents have to be on guard and continue to follow established guidelines to avoid getting CVOID-19 infection in the first place. Rare as it is, MIS-C could be very severe and fatal in some instances. It is still a question if this multisystem inflammatory syndrome is specific to children or if it also occurs among adults with COVID-19.
What is Kawasaki Disease?
This is an acute febrile episode (also known as Kawasaki Syndrome) that primarily affects children under age 5. Its cause is unknown. It is not related or associated with COVID-19. First described by Tomisaku Kawasaki in Japan in 1967, the initial case outside Japan was in Hawaii in 1976. Signs include fever, skin rash, redness of the white of the eyes, swollen lymph glands in the neck, swollen hands and feet, inflammation of the mouth, lips, and throat, with “strawberry” tongue. Highest incidence (9 to 19 per 100,000) is in Japan but it is found worldwide. Since 1982, there were several outbreaks in the U.S. Kawasaki is the leading cause of acquired heart disease (coronary dilatation and aneurysms from vasculitis) in children. The standard use of IV immunoglobulin and aspirin significantly lowers coronary artery pathology.
Mortality rate is about 1.25% and 2.35% among those with cardiac complications.
Could both affect kids?
Yes, but very rarely. The first such case reported was a baby girl in the San Francisco Bay Area, who developed both the MIS-C, post COVID-19, and also Kawasaki Disease late in March 2020, and has fully recovered.
In general, children with COVID-19 have milder symptoms or none at all compared to adults. Death rate in COVID-19 for those 80+ years old is between 14.8 % to 21.9%, and among children 10-19 years of age is 0.2%. There are no deaths reported among 9 years old and younger.
The signs and symptoms of Strep throat could also be similar to those of MIS-C and Kawasaki, with subtle medical differences which physicians, especially pediatricians, could discern and differentiate after complete examination and laboratory tests.
Obviously, accurate and early diagnosis is vital for proper treatment. Parents with concerns should call their physician promptly.
What causes COVID-19 deaths in children?
Children are known to be at a lower risk to acquire COVID-19 and when infected, they have mild symptoms or are asymptomatic, with faster recovery and lower death rate. With the discovery of this new Multisystem Inflammatory Syndrome in children, deaths among them are now deemed to be due to MIS-C, unless proven otherwise or unless they were immune-compromised to begin with, or with other co-morbidities.
Is there a resurgence of COVID-19?
There are countries and cities with a second wave of COVID-19 breakout after re-opening following a lockdown. Among them are South Korea, Singapore, Wuhan, Lebanon, Iran, Italy. More countries, including the U.S. might (hopefully not) experience a resurgence after re-opening if the guidelines are abandoned and people become careless. This, obviously from a breakdown in continuing the COVID-19 guidelines to prevent the spread of SARS-CoV2 virus, which we advocated with an acronym, Fight COVID-19 with C-O-V-I-D: Cover face to scratch, sneeze, or cough; Omit non-essential travels; Voluntary quarantine; Intensive hand washing; Distancing is social. Like other past viral infections, a second or more waves might follow, and graver, depending on people’s behavior and discipline (or lack of it).
Does UVC light destroy SARS-CoV2?
UVC radiation from the sun was discovered in 1801 and in 1892 it was shown that it was primarily the ultraviolet portion of the spectrum that had bactericidal power. UtraViolet-C (UVC) light (wavelength 254 nm) has been known to be germicidal and virucidal, and lately found to deactivate and eradicate SARS-CoV2 virus that causes COVID-19. However, the rays are harmful to the eyes and skin when exposed to the UVC light. This light has been used to sterilize empty ICU rooms, operating rooms, ERs, surgical and dental equipment, etc. and very useful at home, especially for those who use CPAP equipment for sleep apnea, and for sterilizing toothbrush, toys, cellphones, tablets, jewelries, and any other items, including food. A small room, like the laundry room, or big box with cover, could be used for sterilizing. UVC lamps can also sterilize an entire room (empty) for less than 30 minutes. The food industry uses UVC light to sterilize food products (meat, fruits, vegetables) before shipping them out. UVC light has been used for decades to sterilize water, as a part of the reversed osmosis multi-stage water filtration system in city water plants and under-the-sink system at home around the world.
Columbia University’s David Brenner, professor of biophysics, is coming out with a low-cost Far-UVC light, a new version with very short wavelength (205-230 nm) which will destroy viruses like SARS-CoV2, and is also safe to humans, pets, and plants in the room. The Far-UVC lamp will be a unit like the electric mosquito/fly zapper available today. The Far-UVC lamp will be up on the ceiling or walls, with automatic on and off timers, to constantly destroy viruses and kill bacteria in the air and on surfaces, including clothing and our body in any room, like in buildings, offices, theaters, restaurant, public places, and our homes. It will condition the air to be free of bacteria and viruses, before they get on us and into our body. Google Far-UVC light for more details.
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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Public Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com; Email: [email protected]