Alberta doctors say that children who develop the rare inflammatory condition Multisystem Inflammatory Syndrome in Children, also known as MIS-C, after a COVID-19 infection can often end up in the ICU.
As of May 28, Alberta Health said there have been 23 confirmed cases of MIS-C since March 2020 and each case required hospitalization. Doctors say the actual number of cases is likely higher due to a lag time in reporting.
Alberta’s first confirmed case of MIS-C was reported in May 2020. Alberta Health says there have been no deaths associated with MIS-C; all 23 cases have recovered.
Dr. Daniah Basodan, a pediatric rheumatologist at the Stollery Children’s Hospital, said the majority of patients are between six and 10 years old, though there have been patients as young as toddlers and as old as teenagers. She said some children had symptomatic SARS-COVID-2 while others had an asymptomatic infection.
The inflammatory syndrome, which can affect multiple body systems, can cause a persistent fever lasting at least three days, a rash, conjunctivitis (also known as pink eye), really red lips as well as swelling of the hands or feet.
Children may also experience abdominal pain, vomiting or diarrhea. One side effect is inflammation of the heart.
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“We actually started seeing cases back in the fall of 2020. We had our peak cases in December to January and we were seeing about one to two cases per week,” said Basodan.
“At the moment, we are somewhere [around] one case every two weeks.”
Dr. Joan Robinson, a pediatric infectious disease physician at the Stollery Children’s Hospital, said it is still not understood why some children develop the inflammatory condition. When they do, she says, it is typically two to eight weeks after they have had a SARS-COVID-2 infection.
Robinson said it’s not known for certain if all cases require hospitalization.
“But we do think that most cases do require hospital care. In fact, in Alberta, roughly half of them ended up in the intensive care unit because they developed shock.”
Basodan said MIS-C patients who come in with shock or low blood pressure are more likely to get admitted to the ICU.
“They might need medications to support their heart and to support their blood pressure,” she said.
The condition can be treated with steroids and intravenous immunoglobulin.
“Most children are dramatically better within one day and often then go from ICU to the ward the next day. The median stay, the average stay, is about six days in hospital,” Robinson said.
The condition is often compared to Kawasaki disease, another inflammatory disease, but much about why MIS-C develops is a mystery.
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“We don’t understand why these children have a different immune response… It’s really difficult to understand why some children get it. It’s probably way under 1 in 1,000 children who get infected with SARS-COVID-2 who go on to have MIS-C,” Robinson said.
“There’s a lot of different theories in terms of how the immune system, once it’s recovered from COVID-19 infection, might be the source for this… inflammatory response but we don’t understand this process fully,” said Basodan.
As for whether there are any long-term impacts on children, both doctors said it still is not clear.
“We are hoping there are no long-term consequences but certainly a tiny percentage of children will die when they have MIS-C. I don’t think there have been any deaths yet in Canadas but there have been deaths in the U.S.,” Robinson said.
Likewise, Basodan said most patients recover but the long-term impacts of MIS-C remain unknown.
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