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.

SHIRA SCHOENBERG

BEACON HILL

Gov. Charlie Baker lays out a plan for Massachusetts to become the world’s biggest COVID-19 tester, with testing targets for the end of July and December. (CommonWealth)

The Baker administration walks a fine line in a standoff between the mayor of North Adams and Crane Stationery Co. The state essentially gave the green light for Crane to reopen, but now the Baker administration is saying the mayor is within his right to demand proof the company is only doing essential stationery work. The mayor is fining the firm $1,000 a day until it provides the proof. (Berkshire Eagle)

Herald columnist Michael Graham says waiting for the end of the pandemic would mean the state never reopens.

The Legislature sends a short-term borrowing bill to Gov. Charlie Baker’s desk. (MassLive)

MUNICIPAL MATTERS

Municipal governments across the state are poised to take a big financial hit from the pandemic. (Boston Herald) So far, Boston — and the MBTA — have avoided any layoffs or furloughs. (Boston Herald)

Municipalities are taking a revenue hit from the closure of recreational marijuana stores. (MassLive)

Boston Mayor Marty Walsh hints at closing some city streets to vehicles to allow more room for bicyclists, pedestrians, and outdoor dining. (Boston Globe) In Worcester, some businesses are looking for ways to expand into outdoor spaces. (Telegram & Gazette)

Massachusetts will distribute $500 million in coronavirus relief funds to municipalities. (MassLive)

Fall River Mayor Paul Coogan said “lab delays” contributed to the spike in Wednesday’s confirmed case count in the city and said he supports easing restrictions on businesses next week. (Herald News)

Worcester pastor Kristopher Casey sues the city and the state after he was fined for defying Gov. Charlie Baker’s orders and holding in-person worship services with more than 10 people during the pandemic. (MassLive)

New Bedford Mayor Jon Mitchell said the city will give free masks to all residents who want one through a partnership with the American Red Cross and Joseph Abboud Manufacturing Corporation. (Standard-Times)

HEALTH/HEALTH CARE

State audits are uncovering a significant number of nursing homes that are not in adherence with a 28-point checklist of infection control procedures, according to industry sources. (CommonWealth) The federal Occupational Safety and Health Administration is investigating deaths and hospitalizations of employees at a handful of nursing homes and speciality hospitals in Massachusetts. (WGBH)

At Massachusetts General Hospital, Dr. Jarone Lee is worried about a second surge. (CommonWealth)

Scientists say a “cocktail” of several drugs may end up being the best approach to treating COVID-19. (Boston Globe)

The US Centers for Disease Control and Prevention issues broad guidelines for reopening schools, child care centers, and public transit systems. (NPR)

Central Massachusetts hospitals are among those losing millions of dollars responding to coronavirus. (Telegram & Gazette)

WASHINGTON/NATIONAL/INTERNATIONAL

A national poll finds 6 of 10 people who are working outside their house fear getting exposed to coronavirus and infecting others in their household. (Washington Post)

ELECTIONS

The Springfield Republican endorses Democrat John Velis over Republican John Cain in the special election for the 2nd Hampden/Hampshire Senate seat.

BUSINESS/ECONOMY

Recommendations for the state’s beaches, compiled by the Reopening Advisory Board to address issues related to the coronavirus threat, caught Cape Cod legislators off guard. (Cape Cod Times)

Working from home is likely to become part of the “new normal,” say business leaders. (Boston Herald)

Two Catholic churches in the Neponset section of Dorchester are asking permission to merge. (Dorchester Reporter)

Two big business groups express guarded optimism about the state’s economy — but they largely don’t represent the hard-hit hospital sector. (Boston Globe)

Restaurants petition the state to be allowed to reopen for sit-down dining. (Gloucester Daily Times)

EDUCATION

Boston Public Schools families are struggling with remote learning along with severe financial hardships, according to a survey conducted by the district. (Boston Globe)

ARTS/CULTURE

Summer camps are beginning to cancel their sessions for the year as it gets closer to their scheduled start times with no clear green light to resume such activities. (Boston Globe)

CASINOS

You’ve got to really want it. The state’s casinos won’t be opening soon, and when they do the experience is likely to be very different, complete with masks, temperature readings, and plexiglass between players and dealers. (CommonWealth)

Jonathan Cohen says the state should stop selling lottery tickets during the pandemic, even if the move would be costly for cities and towns. (CommonWealth)

CRIMINAL JUSTICE/COURTS

State courts are planning to start opening for some in-person business this summer, but the shift to virtual proceedings is likely to remain for the long haul. (CommonWealth)

Public defenders are struggling to represent their clients as courthouses temporarily close and delay proceedings, and as they can no longer visit their clients in jail. (MassLive)

Massachusetts gun laws are headed for challenges before the US Supreme Court. (WBUR)

PASSINGS

Win Bettinson, a popular radio personality at WJDA in Quincy from 1952 to 1990, has died at 100 of COVID-19. (Patriot Ledger)