Multisystem Inflammatory Syndrome in children (MISC-C) and COVID-19: What providers should know

While the majority of cases of COVID-19 in children result in no symptoms or mild symptoms, some hospitals have recently reported an increased  number of cases of children with a multisystemic inflammatory syndrome that shares many characteristics with Kawasaki disease, an inflammatory disease of childhood that can affect blood vessels. Once referred to as PIMS, this new syndrome has been named multisystem inflammatory syndrome in children, or MIS-C by the Centers for Disease Control.

While research on the apparent link between COVID-19 and MIS-C is limited, scientists around the country are working to learn more about the correlation. In this Q & A,  Dr. Negar Ashouri, pediatric infectious disease specialist at CHOC Children’s, shares information about MIS-C .

What is MISC-C?

MIS-C is a condition where different body parts – such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs – become inflamed. Many children with MIS-C have previously been diagnosed with COVID-19 or have been exposed to COVID-19.

Is MISC-C dangerous?

MIS-C can be serious, but most children have recovered. MIS-C, like Kawasaki disease, can be a very uncomfortable illness because it causes prolonged fever, irritation and inflammation in many tissues of the body. The main concern with MIS-C and Kawasaki disease is heart and blood vessel involvement.

Conditions that involve inflammation in the heart, such as MIS-C or Kawasaki disease, can affect the heart in different ways. They may cause the heart muscle to be irritated and inflamed, affecting the overall function of the heart.

Or, it can weaken the wall of one or more of the coronary arteries causing them to bulge or balloon out. Blood clots can form in the ballooned area and possibly block the blood flow through the coronary artery. When this happens, the heart muscle will no longer receive an adequate supply of oxygen-rich blood, and the heart muscle can be damaged.

Dr. Negar Ashouri, pediatric infectious disease specialist, CHOC Children’s

What are the symptoms of MIS-C?

Though not all children will have the same presentation, these are common symptoms:

  • A fever that won’t go away
  • Abdominal pain, diarrhea or vomiting
  • Bloodshot eyes
  • Rash or changes in skin color

Patients with the following symptoms ought to seek emergency care:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

How is MIS-C diagnosed?

In addition to exploring medical history and performing a physical exam, additional tests may include:

  • Blood tests
  • Echocardiogram 
  • Electrocardiogram
  • Chest X-ray
  • Abdominal ultrasound

How is MIS-C treated?

Kawasaki and MIS-C are best treated in the hospital by a qualified multidisciplinary group of pediatric specialists who will work to to reduce inflammation and minimize long-term heart damage. Treatment may include plasma transfusions to reduce inflammation, steroids, aspirin, antibiotics or supportive oxygen.

Is MIS-C contagious?

MIS-C is not contagious.

What are the long-term effects of MIS-C?

MIS-C is a new illness and medical professionals are actively studying it to learn more,. Children who have had serious cases of MIS-C should be followed by a multidisciplinary group of specialists who will watch oversee their care.

Learn more about the infectious disease team at CHOC Children’s.

Webinar to explore roles of intelligence, innovation in pediatric aspects of COVID-19

An upcoming collaborative symposium co-hosted by the Sharon Disney Lund Medical Intelligence and Innovation Institute at CHOC Children’s (MI3), will explore how innovation and intelligence can assist pediatric healthcare in a post-COVID-19 environment.

Held May 18 from 1 to 3 p.m. PDT, the live interactive webinar will feature speakers from children’s hospitals and health systems throughout the country, including Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer and medical director of MI3.

Here’s a list of speakers and their topics:

  • Srinivasan Suresh, MD, MBA, FAAP – VP, CIO, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA  — Importance of Data for AI for COVID-19
  • Dawn Wolff – Chief Strategy Officer, Children’s Mercy Hospital, Kansas City, Mo. –  Leveraging Innovation Assets in a Time of Crisis
  • Omkar Kulkarni, MPH – Chief Innovation Officer, Children’s Hospital Los Angeles – KidsX. Health – Accelerating Pediatric Digital Innovation through Collaboration
  • Leanne West – Principal Research Scientist, Georgia Tech Research Institute (GTRI), Children’s Healthcare of Atlanta Pediatric Technology Center, Atlanta, Georgia and President of ICAN, International Children’s Advisory Network   Offering the Pediatric Patient’s Perspective– Pediatric Patient Panel featuring ICAN Kids
  • Jennifer Olson SVP, System Operations & Chief Strategy Officer, Children’s Minnesota, Minneapolis, MN   Innovation: A Strategic Recovery Element of Resuming the Business of Pediatric Healthcare
  • Sherry Farrugia – COO/CSO- Children’s Healthcare of Atlanta Pediatric Technology Center –  Rapid Deployment of Innovation
  • Vasum Peiris, MD, MPH – Center for Devices and Radiological Health, Office of Strategic Partnerships and Technology Innovation, U.S. Food and Drug Administration
  • Kevin Maher, MD – Children’s Healthcare of Atlanta, Emory University – Connection between COVID-19 and Kawasaki disease.

“Pediatric Aspects of COVID-19” is co-hosted by International Society for Pediatric Innovation (iSPI) and Artificial Intelligence in Medicine.

Register for the session here.

CHOC study aims to determine COVID-19 antibodies present in Emergency department staff

A CHOC Children’s Hospital study could determine how many patient-facing clinicians and staff in its emergency department have COVID-19 fighting antibodies, easing concerns of asymptomatic carriers exposing others to the virus in an acute care setting.

Using rapid serological testing, the monthlong study will determine the prevalence of viral exposure and incidence of new exposure among staff at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.

Serological blood testing looks for antibodies developed by the body to fight infection. Antibodies indicate the likelihood of past or recent infection or exposure. While researchers are still learning about COVID-19, it is also possible those who have been exposed to the virus and recovered have produced antibodies to protect them from the infection.

“While COVID-19 antibody screening is in its infancy, CHOC Children’s is pleased to help share data and contribute to this important conversation as the world’s scientific community unites in a race toward universal testing, antiviral treatment, and the development of a vaccine in order to permit a scientifically-based return to  normalcy,” said study co-principal investigator Dr. Terence Sanger, CHOC’s vice president of research and chief scientific officer.

Dr. Terence Sanger, study co-principal investigator and CHOC’s vice president of research and chief scientific officer.

Under the study, participants will undergo rapid antibody serology testing for immunoglobin G (IgG) and immunoglobin M (IgM) against COVID-19 novel coronavirus through a simple finger prick once per shift, with results available in three minutes. Additionally, all subjects will undergo viral RNA testing on their first day of the study, as well as on any day that they show IgM positive for antibodies.

In early results, all 107 people tested so far had negative results on reverse transcriptase polymerase chain reaction (RT-PCR) tests, a COVID-19 test, and all were negative for IgGs against COVID-19. Two tested positive for IgM but their viral RNA testing was negative.

As the study progresses, up to 250 subjects are expected to enroll total, with about 100 participants being tested each day.

Secondary outcomes include determining a correlation between antibody serology and DNA testing for acute infection, test-retest reliability of serology testing, evidence for direct transmission of infection between healthcare workers, and potential for reinfection in previously infected convalescent patients. 

Antibody screening could become an additional element of  CHOC’s toolkit in protecting patients, families, physicians and staff against COVID-19. Already, the hospital conducts health screenings, requires appropriate masks and personal protective equipment and practices social distancing, in addition to stringent cleaning practices.

All combined, an additional critically important benefit of the study would be the establishment of a “safe zone” in the emergency department by reducing concerns that an asymptomatic staff member or clinician could transmit the disease to a patient seeking care, or their family, despite CHOC’s strict safety and infection prevention precautions.

Hospitals and health systems nationwide are reporting declining emergency department visits, attributed to patients delaying care out of fear of contracting COVID-19 in the facility. For example, more than half of respondents in a recent NRC Health survey have delayed healthcare for themselves or someone in their home because of the virus, and 60 percent of respondents thought there was an elevated risk when visiting their providers.

Suggesting the national trend has impacted CHOC, its current emergency department volume is about 25 percent less than typical this time of year, yet patient acuity is much higher than typical.

“Seeking prompt and expert care for children in emergent situations is critically important – especially during a pandemic,” said Dr. Theodore Heyming, medical director of CHOC’s emergency department and principal investigator of the study. “We understand how frightening COVID-19 is for parents and children alike. We are excited by the possibility that this study could further prove CHOC as a haven for worried parents, and a source of safe and expert pediatric care during this outbreak – and always.”

Dr. Theodore Heyming, medical director of CHOC’s emergency department and principal investigator of the study.

The study, expected to run through mid-May, is aided by WytCote, an Irvine-based technologies solutions company that has enabled access to testing kits from Jiangsu SuperBio Medical Inc.

“This pandemic is impacting all our communities and WytCote recognized that gaining access to such testing could play a critical role towards limiting the spread of the virus. We are pleased to be partnering with CHOC Children’s to support the testing and use of this new coronavirus antibody test,” said Frank Gomez, WytCote’s CEO/Founder.

Learn more about the CHOC Children’s Research Institute

Mental health resources to share with patients, families during COVID-19

For many providers, the COVID-19 pandemic has prompted a flurry of tough questions from patients and their families: How do I explain this to my children? How do I help my child understand why their birthday party is canceled? How do I maintain normalcy while my child is out of school and stuck at home?

If you’re also fielding these questions from worried caregivers, this compilation of resources from CHOC Children’s — with more to come — can help address these questions and more:

Helping kids cope with COVID-19 stress

How to teach kids resilience throughout COVID-19

How parents can cope with COVID-19 stress

Establishing structure and routine for kids during COVID-19

Activity ideas for kids during COVID-19

7 ways to help reduce Coronavirus (COVID-19) anxiety

How to talk to kids about disappointment during COVID-19

Kid-friendly mindfulness and meditation strategies to cope with
COVID-19

Find more information to share with patients and families about COVID-19 at choc.org/coronavirus.