Published: 08th July 2021
Doctors warn of fatal multi-organ disease in children during the COVID-19 pandemic
Symptoms of the Multisystem Inflammatory Syndrome manifest three to six weeks after the COVID wave and mostly targets children
With the second wave of COVID-19 coming to an end, the doctors have warned of an impending wave of Multisystem Inflammatory Syndrome or MIS-C across south India that may hit children in a big way. The number of children coming to the hospital with MIS-C syndrome has increased and doctors believe this is just the beginning.
The disease mainly affects children exposed to COVID-positive individuals in their household or have been infected themselves. The symptoms begin to manifest in persons three to six weeks after a wave of COVID sweeps through the adult population, doctors said, adding that it is only a matter of time before the MIS-C wave will begin to take over the young population. The disease is an immune system-mediated hyper inflammation that seems to target children, adolescents, and young adults; more than 50 percent of those suffering from MIS-C develop heart problems. The severity of heart damage in patients is what determines the outcome of the illness.
“MIS-C has been observed to correlate with the COVID wave in adults--the larger the COVID wave, the bigger is the MIS-C wave. Since the current COVID wave in South India has been the largest so far, we are anticipating a huge MIS-C wave in Kerala and South India in the months to come. Symptoms of MIS-C include a rapidly progressing state of high-grade fever with poor function of several organ systems especially the heart and gastrointestinal organs and are found mostly in COVID negative cases. A child with MIS-C may have been completely asymptomatic if they had COVID-19 infection previously and may not have been tested simply because of lack of symptoms. MIS-C starts to manifest within a period of 4 to 6 weeks of having survived COVID,” said Dr Suma Balan, rheumatology at Amrita Institute of Medical Sciences (AIMS), Kochi.
MIS-C needs to be treated by administration of steroids and intravenous immunoglobulin along with supportive management which requires intensive care in most cases. Some children need breathing support and medications to support the failing heart. Because of the high costs of intravenous immunoglobulin, the treatment for MIS-C incurs a high cost.
Elaborating on how MIS-C can affect the heart, Dr Mahesh Kappanayil, Clinical Professor, Department of Pediatric Cardiology, Pediatric CMR Services, said, “It is critical to identify the extent to which the heart is affected by way of ECGs, blood tests, and intensive monitoring. In some cases, children may require pacemaker implantation to support heartbeat. The heart shows excellent recovery if supported well during the critical phase of the illness. If the heart is significantly affected, such children need to be given specific medicines to improve heart pumping and to maintain blood pressure, in addition to the overall treatment of MIS-C.”
Explaining the treatment protocols to be followed, Dr Sajith Kesavan, Senior Consultant and Head, Department of Pediatric Pulmonary and Critical Care added, “When MIS-C affected children become sick enough to need intensive care, they also usually need IVIg treatment. Though expensive, this treatment can save a lot of lives. Because of its multisystem presentation, a wide range of medical professionals may need to be consulted by those suffering from it. If a child is suspected to be suffering from MIS-C, a history of a possible COVID link must be explored and an appropriate treatment suggested accordingly.”
Dr C Jayakumar, head and professor at the Department of Pediatrics, School of Medicine added “In MISC there is the involvement of gastrointestinal tract, lung, kidney, and skin in addition to the cardiac issues. This condition can be fatal if not recognised early and should be managed adequately with steroids, intravenous immunoglobulins, immunomodulatory, and in some cases extracorporeal membrane support. During the COVID pandemic, irrespective of the fact that one has had COVID or not, if there is fever or other symptoms, medical care must be sought at the earliest. Please do not ignore symptoms of any disease in this season of the pandemic.”
The best ways to tackle MIS-C are through prevention by ensuring vaccination of all adults in contact with children and management and through timely identification and treatment of the infection. Unless these measures are observed strictly, children will continue to be affected by this deadly disease which may even prove to be fatal if not treated at the earliest.