Children with baffling corona-linked syndrome may be have 'cytokine storm'

Children, aged between 5 to 13 years, who are showing up mysterious syndromes, such as fevers, rashes and strange blood readings, post the coronavirus surge in the United States, may have been experiencing a 'cytokine storm'-- a condition where the body starts to attack its own cells and tissues rather than just fighting off the virus, a study has found.

The Washington Post cited the study, published in the American Journal of Emergency Medicine, claiming that the mysterious syndrome has been linked to COVID-19 and have developed almost exactly one month after the peak of coronavirus surge across the states, especially New York City.

There have been at least five children in the United States who have died from the coronavirus-related condition: three in New York State, a 15-year-old girl in Maryland, and a child in Louisiana.

The Centers for Disease Control and Prevention earlier this month issued an alert warning to the doctors to be on the lookout for what they are calling multisystem inflammatory syndrome in children, or MIS-C, which is now believed to have impacted approximately 300 US children. It appears to have some characteristics in common with Kawasaki disease, a rare illness that typically impacts children under the age of 5 and whose cause is unknown.

But Christopher Strother, the director of emergency medicine at New York's Mount Sinai Hospital, described it as the paediatric version of the "cytokine storm" occurring in some adults with severe illness from the novel coronavirus.

"When adults get covid they might get that terrible lung disease from the inflammatory response," he said.

"This seems a version of how that looks in kids," he added further.

Among the four children showed up at the Mount Sinai Kravis Children's Hospital in late April and early May, the first was Malcolm Edgar, a previously healthy 13-year-old from Brooklyn. Edgar, an athlete who is the third baseman and pitcher on a competitive baseball team, had had six days of fever that shot up to 104 degrees. When he woke up on the 25th, he had bloodshot eyes and a rash on the trunk of his body. His tongue had what they described as an odd "strawberry texture."

At the hospital, doctors ran a battery of tests and his initial vitals seemed fine, except for a slightly elevated heart rate. So they gave him fluids and asked him to wait for the results. Strother recalls that the report he got from the doctor overseeing Malcolm's care was that "he was walking around the ER eating cheese," and that "he actually looked quite well."

But as the night wore on and the nurses kept checking his blood pressure, his readings plummeted. Malcolm himself remembers he was very tired, but not in any pain and that he had been begging to go home.

"I was kind of confused about what was going on," Strother said in an interview to the Post on Thursday.

"Everything seemed fine in my checkup, and then they said my blood pressure was low and that's when everything got crazy," he was quoted as saying.

Over the next few days, his situation became dire. Imaging showed that he appeared to have pneumonia in both lower lungs, and as he progressed to respiratory failure, he was put on a ventilator.

Blood tests showed markers of inflammation and clotting were off-the-charts elevated. Malcolm's heart was not working properly, as his arteries showed signs of being enlarged. Meanwhile, three tests doctors gave him for active COVID-19 infection came back negative, but an antibody test was positive, indicating he had a prior infection.

All four children have recovered, Strother said, and are back home now.

Malcolm lost 20 pounds during his 11-day stay at the hospital but did so well after he was off the ventilator that he walked out of the hospital to the cheers of the staff. He's returned to his school's Zoom classes and is now strong enough to play some basketball in his backyard and go walk around the local high school track with his dad. He expects to be able to return to playing sports by July.

Strother urged doctors who see children with persistent fever to err on the side of caution when monitoring them and ordering tests.

"The trouble is the children look pretty good even when their blood pressure starts to go down," he said. "You have to be vigilant.