A New Coronavirus Threat to Children

The coronavirus has largely spared children. Most confirmed to be infected have had only mild symptoms. But doctors in Europe and the United States have recently reported a troubling new phenomenon: Some children are becoming seriously ill with symptoms that can involve inflammation in the skin, eyes, blood vessels and heart.

The condition, which doctors are calling “pediatric multisystem inflammatory syndrome,” is so new that there are still many unanswered questions about how and why it affects children. Here’s a summary of what is and isn’t known so far.

Symptoms can include fever, rash, reddish eyes, swollen lymph nodes and sharp abdominal pain. They do not usually include two common hallmarks of Covid-19: cough and shortness of breath.

The syndrome can bear some resemblance to a rare childhood illness called Kawasaki disease, but as doctors learn more, they are emphasizing that the two conditions are not the same.

Both involve a surge of inflammation in the body and can have serious effects on the heart. But Dr. Steven Kernie, chief of pediatric critical care medicine at Columbia University and NewYork-Presbyterian Morgan Stanley Children’s Hospital, said the new syndrome appears to affect the heart differently. While Kawasaki disease can produce coronary aneurysms when left untreated, the new syndrome seems to mostly involve inflammation of coronary arteries and other blood vessels.

And though shock is a rare complication of Kawasaki disease, the new syndrome has sent many of the children into a kind of toxic shock with very low blood pressure and an inability of the blood to effectively circulate oxygen and nutrients to the body’s organs, Dr. Kernie said.

The coronavirus primarily affects adults by entering cells in their lungs and replicating, often causing respiratory failure. But this childhood syndrome “seems to be less a lung-specific disease,” Dr. Kernie said.

While most of the hospitalized children with the syndrome need some additional oxygen, and a few have required ventilators, the effect on the lungs seems to be driven by an inflammatory response that affects many other parts of the body as well.

A hospital in Manhattan reported the death of a child who appeared to be afflicted with the syndrome. A 14-year-old boy in England died after developing the syndrome, according to a study in the journal Lancet.

There is no good data on how many children have developed the syndrome, but it appears to be a small number so far. On May 8, Gov. Andrew M. Cuomo said there had been 73 reported cases in New York state and that the health department was investigating several child deaths as other possible cases. A handful of cases have been reported in other states, including Louisiana, Mississippi and California. There have been at least 50 cases reported in European countries, including Britain, France, Switzerland, Spain and Italy.

Hospitals have seen cases in children of all ages, from infants to older teenagers.

Dr. Katie Schafer, a general pediatrician who has a private practice in Birmingham, Michigan, a suburb of Detroit, said that because there were still many unknowns about the condition, parents of children who have symptoms should take them to pediatricians rather than assuming that a rash or fever or abdominal pain is only a sign of a typical childhood illness.

“This is presenting very much like a common childhood illness, which it is not,” she said. “This is a novel diagnosis that doesn’t exactly have a name, doesn’t exactly have a timeline, doesn’t exactly have a protocol. We didn’t learn about this in medical school.”

Many of the children who have become sick with the syndrome either tested positive for the coronavirus at the time of their symptoms, or had positive antibody tests suggesting they may have been infected weeks earlier. Dr. Schafer said it was possible that “this may be a post-infection condition and not necessarily part of the acute phase of Covid.”

Treatments have included steroids, intravenous immunoglobulin, high-dose aspirin and antibiotics, as well as supportive oxygen through the nose, a mask or, in the most serious cases, a ventilator. Most children who are intubated can be removed from the ventilators within a few days, doctors said.

It’s unclear. Children who have had serious effects on their hearts will need to be monitored by cardiologists in case there is residual heart damage. Others will undoubtedly need to be followed by their pediatricians to keep track of any lingering effects.

Children may be at greater risk for this syndrome because their immune systems are not fully developed, Dr. Kernie said. But there are no clues yet as to why some children get sick and not others. Many of the children have been previously healthy. And the syndrome doesn’t seem to run in families, but Dr. Kernie’s hospital and others are doing genetic testing to see if there is a predisposition or genetic reason one child becomes very sick while siblings seem unscathed.

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