Acute Inflammatory Illness in Children Temporally Linked to COVID-19 aka Multi Inflammatory Syndrome in Children (MIS-C)
GOAL: Awareness of the Syndrome, early identification of its signs that can be recognized by parents/caregivers, EMS systems, and other first responders, with transport to an appropriate hospital for further evaluation & care.
Background: Two labels for one scary syndrome. The first one is from the WHO and the second one is from the CDC for the U.S. The “temporally linked” to COVID is important since no one is sure yet that COVID-19 and this syndrome are cause and effect, but the vast majority of the cases reported have children either testing positive for SARS-CoV-2 or having antibodies to it (showing previous infection). Typically, the COVID infection occurred without any symptoms or with mild symptoms which did not seem to indicate COVID. Other times, the child was found during contact tracing as one who had been exposed to another, had a family member that had been sick with COVID, or lived in a particular area with a spike in COVID cases that matches up to the timeline. In general, this Inflammatory Syndrome can occur anywhere from two to six weeks after the COVID-19 infection, with four being the most common. First identified in late March in the UK, other countries began finding it, in small numbers in other countries in Europe, then found in New York City in early May, with Canada putting out a Health Advisory on May 12 and the CDC following on May 14. Reportedly, about a thousand cases have been found worldwide. No one is sure if this is a brand-new syndrome sharing signs & symptoms with some old ones, or if it is the body responding to the COVID-19 infection with either complete or incomplete Kawasaki Disease (KD) and/or Toxic Shock Syndrome (TSS).
MIS-C puts the patient at risk for serious and life-threatening medical complications, depending on what system(s) are affected. No one is still quite sure of the cause or pathways of it, but believe that the Syndrome is an inflammatory process which is part of an uncontrolled immune response or, in some cases, may be a septic event. There can be damage done to the many of systems of the body including cardiac, hematologic, neurological, gastrointestinal, renal, and skin.
Either way, time matters. If these children are found and treated effectively in the first couple of days, they do really well and leave the hospital quickly. If treatment is delayed, the syndrome takes better hold and causes more persistent damage requiring more supportive treatment and even death.
Until more is known about this Syndrome, the most important thing is early recognition by the parents or caregivers (believe them that something is wrong or has changed). Be aware and looking for it just as you are/were for COVID-19. Spread the word to your friends, family, religious leaders, to anyone who can get the word out. It may save a life.
Although there are mostly minor differences in the Case Definitions of the virus, the one most relevant to EMS is that the WHO uses ages 0-19 and the CDC uses < 21. Canada hasn’t finalized their Case Definition yet but promises that it will be out soon. The complete case definition is harder for EMS to utilize, and is appropriate for hospital settings where more in depth testing is possible.
For our purposes, the signs and symptoms were blended and mostly taken from the CDC list provided for parents to recognize the Syndrome, while the WHO’s case definition symptoms, that can be assessed in the pre-hospital environment, are included.
