Coronavirus: What we know about the rare inflammatory disease in children

The vast majority of virus-related deaths worldwide have occurred in the elderly or already ill, with youngsters largely escaping unscathed. Nevertheless, NHS doctors have been told to look out for signs of “multi-system inflammation” after intensive care units in London saw children with unusual symptoms, some of whom tested positive for the coronavirus. The Royal College of Paediatrics and Child Health (RCPCH) previously advised parents call 999 or take their child to A&E if they: Become pale, mottled or abnormally cold to touch Pause in their breathing, have an irregular breathing pattern or grunt Have severe breathing difficulties, while becoming agitated or unresponsive Go blue around the lips Have a seizure Become extremely distressed, confused, lethargic or unresponsive Develop a rash that does not disappear with pressure, like when pressed under a glass Have testicular pain, especially teenagers The 10 cases in Bergamo emerged between 18 February and 20 April; compared to 19 cases in the five years up to mid-February. “We noticed an increase in the number of children being referred to our hospital with an inflammatory condition similar to Kawasaki disease around the time the [coronavirus] outbreak was taking hold in our region,” said study author Dr Lucio Verdoni from Hospital Papa Giovanni XXIII. “Most children will make a complete recovery if they receive appropriate hospital care.” Lead author Dr Lorenzo D’Antiga added how other coronavirus hotspots like New York have seen similar cases. “Our study provides the first clear evidence of a link between [the coronavirus] infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus,” he said. While it may sound far-fetched that a respiratory infection could affect the heart, the virus triggers an immune response that can impact any part of the body. Many incidences may have gone unnoticed in youngsters who developed no symptoms, or just a mild cough that may have been dismissed as a cold or hay fever. Speaking at a Science Media Centre briefing, Professor RussellViner – president of the RCPCH – pointed out the number of coronavirus deaths among children in the UK could be counted on two hands. “In our experience, only a very small proportion of children infected with [the coronavirus] develop symptoms of Kawasaki disease,” said Dr Annalisa Gervasoni, an author of the Italian study. “However, it is important to understand the consequences of the virus in children, particularly as countries around the world grapple with plans to start relaxing social distancing policies.” “[You need to] think about how we balance risk in our daily lives,” said Professor Viner. NHS England issued an urgent alert to GPs to be aware of the condition, but stressed no link had been established with the coronavirus. Writing in an editorial linked to the Italian study, Professor Viner said: “Although the article suggests a possible emerging inflammatory syndrome associated with COVID-19, it is crucial to reiterate – for parents and healthcare workers alike – that children remain minimally affected by [the coronavirus] infection overall. “In particular, if this is an antibody-mediated phenomenon, there might be implications for vaccine studies, and might also explain why some children become very ill with COVID-19, while the majority are unaffected or asymptomatic.” Professor Alastair Sutcliffe from University College London added: “There is apparently a small risk but no grounds for panic. “COVID is a worldwide living experiment and an opportunity to study many effects of this terrible plague on illnesses other than COVID; and this insight into this Kawasaki-like disease is just one more brick in the wall”.