IF THERE HAS BEEN one bright spot with the dangerous COVID-19 disease, it had been that children were largely spared.
Since the pandemic started, Massachusetts has reported 3,111 COVID-19 cases in people under age 19, or 3.7 percent of the 82,182 confirmed cases. Only 54 of those infected were hospitalized and no one under 19 has died.
But perhaps no longer.
First, reports trickled out about “COVID toes,” lesions on the feet of children and young adults who were otherwise asymptomatic.
Now, even more scary (and apparently unrelated), doctors in the coronavirus hotspot of New York over the last couple of weeks started identifying a new pediatric disease referred to as “pediatric multi-system inflammatory syndrome” or PMIS. New York Gov. Andrew Cuomo announced Monday that at least three – maybe five – children had died and 100 children were presenting with symptoms of the disease, which is apparently linked to COVID-19.
Similar cases have been reported among children in Europe and the United Kingdom since April.
On Tuesday, NBC Boston reported that Boston Children’s Hospital had seen four children presenting with the illness, apparently occurring around six weeks after a child was exposed to COVID-19. The Boston Globe reported Wednesday that cases were also reported at Mass General in Boston and Baystate Children’s Hospital in Springfield. A Boston Children’s doctor told the Globe that cases had occurred in younger children, older children, and teenagers.
The symptoms are similar to Kawasaki disease, a rare illness that causes inflammation in the blood vessels, and toxic shock syndrome. The symptoms include prolonged fever, fatigue, abdominal symptoms such as pain or diarrhea, and sometimes rashes, bloodshot eyes, red, cracked lips, and swollen hands or feet. More seriously, some patients experience heart inflammation, kidney injury, or excessive blood clotting. Unlike most COVID-19 patients, they may not exhibit respiratory symptoms.
Public Health Commissioner Monica Bharel sent a memo Thursday to health care providers requiring them to immediately report PMIS cases to the Department of Public Health and to test these patients for COVID-19. Bharel said nine cases have been reported so far by Massachusetts hospitals.
According to Children’s Hospital in Boston, some children require hospitalization and intensive care; others are treated with medication; and some need only supportive care.
Children’s Hospital researchers are investigating why only some children with COVID-19 get sick. One theory is it relates to the body’s immune response to coronavirus creating inflammation in some kids who are genetically susceptible.
The new reports of illnesses in children may reshape not only the public health debate, but also discussions about reopening. While schools are closed for the rest of the year, summer camps are debating whether to open. Day care centers have been ordered closed until June 29, but state officials have not yet said when they will then be allowed to reopen or under what conditions.
A reopening commission chaired by Lt. Gov. Karyn Polito and Secretary of Housing and Economic Development Mike Kennealy plans to release its plan Monday. A separate Department of Education working group is planning for reopening schools next fall.
On Thursday, the Department of Education sent a memo to school districts announcing its 27 working group members, who represent teachers’ unions, school superintendents, school committees, counselors, nurses, parents, students, charter and private schools, and bus companies as well as police officers, firefighters, and public health officials. The committee will look at physical and virtual learning environments; teaching and learning; operations and business services; and behavioral health and social and emotional learning.
Previously, discussions about children tended to focus on whether they are carriers of COVID-19 who could endanger more vulnerable adults. Now, it is becoming increasingly clear that protecting children’s health will be vital too.