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News has been spreading of a new inflammatory illness in children linked to COVID-19.
So far, the illness – dubbed PIMS-TS and described as similar to the rare Kawasaki disease – has been identified in more than 100 children in New York State, and linked to three deaths there. It has been recorded in 14 other US states and there have been more than 50 cases in the UK and in European countries including France, Switzerland and Spain.
What is this new syndrome? And what effects has COVID-19 had on Australian children so far?
A boy and his mother leave a COVID-19 testing unit in Adygea, Russia.Credit:Getty Images
What does COVID-19 look like in children?
Of the 300 children in Australia who have tested positive for COVID-19, none has died and none has required intensive care.
“I think parents should be really reassured that kids, on the whole, are not being impacted nearly in the same way as adults,” says Associate Professor Asha Bowen, a paediatric infectious diseases specialist at Telethon Kids Institute and Perth Children’s Hospital. She says many children have shown no symptoms at all. Overall, she says, their symptoms are not necessarily distinguishable from a common cold or influenza.
Symptoms, in children who do have them, are similar to those seen in adults, including a sore throat and a cough. But there are some differences – Professor Bowen says children’s temperature rises are likely to be milder and they are more likely to experience abdominal symptoms such as an upset stomach.
Interestingly, and unlike with colds or flu, she says children do not seem to be spreaders of the virus – with most cases in children traced back to adults.
“That’s quite remarkable, when snotty-nosed kids are blamed and usually responsible [for spreading the flu],” she says.
So far, kids also seem much less likely to catch the novel coronavirus than flu. While 4 per cent of confirmed COVID-19 cases in Australia have been in children, data from the 2019 flu season shows 39 per cent of laboratory-confirmed cases were in children or teenagers.
What is the new syndrome found in children?
The current name for the syndrome is “paediatric inflammatory multi-system syndrome temporally associated with SARS-CoV-2” – or PIMS-TS for short.
Paediatricians around the world are noticing that children – some infected with COVID-19, some who are not – are winding up in hospitals and intensive care units with “a range of unusual and varied symptoms”, says Dr Angus Stock from the Walter and Eliza Hall Institute of Medical Research. “These include prolonged fever, abdominal pain, low oxygen levels (or shock), rashes and conjunctivitis,” he says. “Closer clinical examination has also revealed that many of these children have developed inflammation within their hearts.”
The condition of children with the new illness has varied. Some have required hospitalisation, some in intensive care.
It’s also not clear if PIMS-TS is classic Kawasaki disease (which is also a paediatric multi-system inflammatory syndrome) but Dr Stock, who specialises in researching immunotherapies for Kawasaki disease, says the symptoms are similar. “This overlap in many (but not all) of these symptoms has prompted many to speculate that COVID-19 may have triggered Kawasaki disease in these children,” he says.
Children under 14 have been allowed out of home at special times in Malatya, Turkey.Credit:Getty Images
So what is Kawasaki disease?
Kawasaki disease usually affects preschool-aged children and occurs in roughly one in 10,000 children – there are about 300 cases of it a year in Australia, says Professor Robert Booy, a University of Sydney expert in paediatric infectious diseases who studied Kawasaki disease in the UK.
The main symptoms, he says, are a high fever that lasts for at least four days, swelling of the hands and feet and a red rash on the skin, around the lips, throat or eyes. (Professor Booy says anyone who notices such symptoms in their child should take them straight to hospital.)
The disease is named for the researcher who discovered it in Japan in the 1960s. Despite the fact experts have known about the syndrome for a long time, and have been able to treat it effectively, it is still unclear what exactly causes it.
Dr Stock says it is likely many different viruses and bacteria, including coronaviruses such SARS-CoV-2, which causes the COVID-19 illness, could trigger Kawasaki disease.
Not all children who have developed PIMS-TS this year worldwide have tested positive for COVID-19. Professor Booy says it’s possible the children who didn’t test positive had recovered from COVID-19 before the new syndrome developed.
“Maybe it’s a late complication of COVID, which is why we don’t find the virus in every child with this [reaction],” he says.
Are we likely to see this new syndrome in Australia?
Firstly, experts believe the new PIMS-TS is likely to be just as rare as Kawasaki disease.
Australian experts have also pointed out that countries reporting cases of PIMS-TS have also had thousands or hundreds of thousands of COVID-19 cases. Professor Booy says it is important to remember the US has had a million cases of COVID-19 so, even if the risk of children getting this new syndrome was one in 10,000, it would occur due to the large numbers of infections.
By comparison, there have been about 7000 cases of COVID-19 in Australia, and fewer than 100 cases in children under the age of 10.
Australia’s Deputy Chief Medical Officer, Dr Nick Coatsworth, says given the low number of COVID-19 cases in children in Australia and the rarity of this Kawasaki-like illness, the risk in Australia is low.
“With that very small number of cases, the likelihood of a child getting Kawasaki-like syndrome related to COVID-19 is very, very small in Australia, so I hope that’s a reassurance to parents.”
Professor Booy thinks a handful of children here could develop it, but he believes existing treatments for Kawasaki disease, which involve giving children intravenous antibodies, will be effective for PIMS-TS too. “We will find it but we will find a small number of cases and use treatments that will work,” he says.
Dr Stock says that as well as being triggered by a viral or bacterial infection, there is also a genetic factor in developing Kawasaki disease so it is likely that the same would apply to PIMS-TS – “only a small fraction of COVID-19-infected children will ever develop this condition.”
What are health authorities doing about it?
While they believe the risk is low, the country’s paediatric hospitals have set up a surveillance system to look out for any cases of PIMS-TS or Kawasaki that show up in their wards or intensive care.
So far, Deputy Chief Medical Officer Professor Paul Kelly says there have been no spikes in Kawasaki cases and no identified instances of PIMS-TS.
Professor Booy says parents should be reassured that doctors are alert to any unusual inflammatory responses and there are potential treatments.
“As children’s doctors, we’re paying a lot of attention to this,” he says. “We’re studying this very carefully and [are] going to take part in international attempts to study it and treat it.”
Rachel Clun is a journalist at The Sydney Morning Herald.
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