Coronavirus-related illness can be dangerous to children. What SC parents should know
Just weeks before the new academic year is set to begin, South Carolina still sits in uncertainty, facing one of the worst COVID-19 outbreaks in the nation but with a desire to get students back in school buildings.
The debate centers on the question of safety and whether keeping students out of school is a bigger threat to their well-being than the risk of COVID-19 spreading among schoolchildren.
A day after the first child death from COVID-19 was reported in South Carolina, health officials flagged the first few cases of a rare coronavirus-related complication that can be deadly in children. Questions have been raised about what that could mean for the state’s children, the prospect of reopening schools and whether this changes how the state responds to the outbreak.
Statewide, there have been more than 56,000 positive cases of coronavirus confirmed since March. Only two of those coronavirus cases — both patients are under the age of 10 — were identified to have the complication, known as MIS-C.
Two other children, one in Charleston and one in Columbia, were presumed to have MIS-C, according to Dr. Elizabeth Mack of the Medical University of South Carolina. All four of the children have since recovered, said Mack, chief of the hospital’s pediatric critical care division. One of the patients was treated at MUSC, Mack said.
Between March 15 and May 20, officials had identified 186 cases of MIS-C in 26 states throughout the country, according to the U.S. Centers For Disease Control and Prevention.
What is MIS-C and how serious is it?
MIS-C, which stands for multisystem inflammatory syndrome in children, is a rare complication that has been “associated with coronavirus,” according to a June article in the New England Journal of Medicine.
Hospitals around the world have reported the condition in patients under 21 who were either previously diagnosed with COVID-19 or did not know they had been infected with coronavirus but tested positive for antibodies. Even children who never displayed symptoms of COVID-19 can later have MIS-C as a “wacky immune response,” Mack said.
Symptoms of MIS-C include: redness of the eyes, lips and tongue; swelling of the hands and feet; rapid heartbeat; inflammation of the heart; gastrointestinal symptoms; rash; fever and more, according to Dr. Robin LaCroix, a pediatric infectious disease specialist with Prisma Health-Upstate.
Children with MIS-C are not thought to be contagious unless they have active coronavirus at the same time, said Mack, who also is a spokesperson for the American Academy of Pediatrics.
MIS-C shows similarity to Kawasaki disease, an immune response syndrome that primarily affects children and is familiar to pediatricians. Kawasaki disease, which was first discovered in Japan decades ago, causes widespread inflammation and swelling, fever, red eyes and more. Scientists do not know what exactly causes Kawasaki disease, according to the U.S. Centers for Disease Control and Prevention.
The median age of children with MIS-C was just over 8 years old, according to an article published in the New England Journal of Medicine. Researchers have not identified children who are more susceptible to the inflammatory syndrome. However, some children with long-term lung and heart function issues could have more difficulty recovering from MIS-C, LaCroix said.
Perhaps one of the more severe symptoms of MIS-C is a coronary-artery aneurysms, which were found in 8% of MIS-C patients, according to one New England Journal of Medicine article.
If a child is displaying symptoms of illness, such as redness, swelling and fever, parents should consider taking the child for medical evaluation. Treatment for MIS-C is similar to that for Kawasaki Disease — both include suppressing the dramatic immune response to reduce inflammation. Most children’s hospital stays have been between five and eight days long, LaCroix said.
Though fatalities from MIS-C are rare, it is common for the condition to become severe, studies show. One study, which examined 95 confirmed cases of MIS-C in New York found that although 80% of MIS-C patients needed intensive care, two patients died.
A separate New England Journal of Medicine article studied 186 patients with MIS-C throughout the country and found that 2% of patients died, according to the article. A May study by the European Centre for Disease Prevention and Control examined 230 suspected cases of MIS-C througout the European Union and found two patients died.
Will this prevent schools from reopening?
S.C. educators have been warning that if the number of coronavirus cases continue to increase throughout the state, schools might not resume in-person classes.
However, the positive identification of MIS-C in two South Carolina children does not change the official recommendations for schools reopening in the fall, said S.C. Department of Education spokesman Ryan Brown in an email.
Pediatricians like Mack say that unlike MIS-C, which is rare, there has been a concerning and widespread uptick in child welfare issues caused by students being out of school and away from teachers for months. The American Academy of Pediatrics has recommended that schools strive for in-person instruction this fall when it is safe to do so.
Recommendations for K-12 schools reopening are based on S.C. Department of Health and Environmental Control metrics that evaluate counties’ risk by tracking the number of new COVID-19 cases in the last two weeks, determining whether the number of new cases is rising and measuring the percent of tests in a county that come back positive, according to the department.
As of July 6, 39 counties have “High Recent Disease Activity,” and the other 7 are considered “medium,” according to DHEC.
Schools are able to do with that information what they will. For example, Richland 2 — the largest school district in the Midlands — plans to forego in-person classes if the risk level is still “high.”
Richland 2 schools will resume traditional, in-person classes only if Richland County’s risk level is considered “low,” a designation no county in S.C. has as of July 6.
Other school districts are finalizing school reopening plans.
What can I do to protect my child?
When it comes to guarding children against the coronavirus, responsibility falls on the shoulders of adults, Mack said. Grown up South Carolinians should follow instructions health officials have been repeating for months:
- Wear face coverings in public
- Maintain a physical distance of at least 6 feet
- Avoid large gatherings, especially indoors
- Wash hands frequently
- Disinfect high-touch surfaces often
- Avoid touching the eyes and nose
- Stay home when feeling ill
In lieu of a statewide mandate, South Carolina municipalities have crafted stopgap measures, like ordinances requiring face coverings in public. But the state’s outbreak of COVID-19 is still one of the worst in the world, according to data from the New York Times. More than 1,000 new cases are emerging each day.
As leaders, educators and parents debate the question of returning to school in several weeks, health officials and physicians say there are simple steps the public can take to curb the spread.
Scientific evidence so far suggests that children are less likely than adults to contract the coronavirus, to have severe symptoms from COVID-19 and to transmit the virus to many others, LaCroix said. Studies have also found that the virus spreads from adults to children much more often than between children, she said.
“Us being sure that as adults, we’re protecting the children is one of the big components that we need to take moving forward,” she said.
Mack recommended parents get children up-to-date on vaccinations to prevent them from becoming ill with preventable viruses and pathogens. She also said families should disinfect high-touch surfaces (door knobs, bed rails, light switches) and try to maintain a “closed and safe” environment as much as possible. That means avoiding play dates and other gatherings, as well as higher-risk environments like group classes and indoor gyms, she said.
“All of these topics, they start to feel overwhelming. It starts to feel like we have no control,” Mack said. “But almost all of this relates to our behavior ... We do have control. We can modify the trajectory of our wellness.”
This story was originally published July 14, 2020 at 5:00 AM with the headline "Coronavirus-related illness can be dangerous to children. What SC parents should know."