How Is Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19?

At the beginning of 2020, people across the globe became aware of and took measures to safeguard themselves against COVID-19 caused by the SARS-CoV-2 virus. Many took comfort in believing that children infected with COVID-19 were left comparatively unharmed.

But in late April 2020, medical practitioners in the United States and Europe began to observe a small but increasing number of cases of kids afflicted with a new multisystem inflammatory syndrome that seemed to be associated with COVID-19. Doctors started treating very sick children, many of whom tested positive for COVID-19, with some combination of fever, rash, gastrointestinal problems, red eyes, swollen hands and feet, all of which are symptoms related to inflammation.

What is clear is that Multisystem Inflammatory Syndrome (MIS-C) is a serious health issue that requires prompt medical attention. Here’s everything you need to know about Multisystem Inflammatory Syndrome – how it is caused, the risks associated with it, if any, and much more.

What Is Multisystem Inflammatory Syndrome?

MIS-C is a rare but serious condition in children in which the body’s immune system overreacts to the SARS-CoV-2 infection, causing inflammation of the body’s multiple organ systems. It can affect the lungs and other respiratory organs, heart, blood vessels, kidneys, gastrointestinal organs, eyes, skin, and nervous system, and it can lead to impaired organ function, shock, and even organ failure. In most cases of MIS-C, though, children experience inflammation in only some of these organs.

How Is MIS-C Linked to Coronavirus?

Almost all children who had been diagnosed with MIS-C had also tested positive for antibodies to SARS-CoV2, the virus that causes COVID-19.

While most kids with COVID-19 experience mild symptoms and do not require advanced medical care, the virus seems to set off an unrestrained immune response in a small number of children, leading to inflammation across the whole body, or MIS-C.

What Causes MIS-C?

Although the cause of MIS-C is not yet known, it is considered to be a late immune response to SARS-CoV-2 infection, leading to inflammation that damages organs. According to researchers at Yale School of Medicine, in 99% of documented MIS-C cases, children either had antibodies to the coronavirus or had tested positive for a current SARS CoV-2 infection, meaning they had a prior infection. In the remaining 1% of cases, the kids had been exposed to an individual with COVID-19. Another possibility is that there are genetic factors that make some children susceptible to MIS-C.

Risk Factors of MIS-C

According to the Center for Disease Control and Prevention (CDC), in the U.S., more Latino and Black children have been diagnosed with MIS-C as compared to children of other races and ethnicities. Studies are underway to help understand why MIS-C affects these kids more than others. Most children with MIS-C are found to be between the ages of three and 12 years old, with an average age of 8 years old. Some cases of MIS-C have also been identified in older children and in babies.

Symptoms of MIS-C in a Child

In most cases, children diagnosed with MIS-C have had a fever of 100.4°F or more for a minimum of 24 hours. The fever usually continues for four to seven days. The other symptoms associated with MIS-C may include the following:

1. Vomiting, diarrhea, or stomach pain
2. Red eyes
3. Skin rash
4. Respiratory problems, including coughing, having an increased rate of breathing, or feeling “short of breath”
5. Chest pain or discomfort
6. Swollen lymph nodes in the neck
7. Swollen hands or feet
8. Strawberry tongue (red swollen tongue with bumps that resembles a strawberry)
9. Cracked lips
10. Confusion
11. Headache
12. Fatigue
13. Muscle pain
14. Sore throat

Symptoms of MIS-C usually start appearing two to five weeks after the child is infected with the novel coronavirus. In most cases, COVID-19 runs a mild course in the child and is often asymptomatic. Due to this, the child can have COVID-19 but may be unaware of the infection.

How Is MIS-C Diagnosed?

Currently, MIS-C is diagnosed on the basis of symptoms like continuous fever and dysfunction of organs, like the heart or kidneys. In addition to a clinical assessment and antibody testing, the doctor may order some of the following tests to look for inflammation and other signs of MIS-C:

1. Imaging tests, such as a chest X-ray, an echocardiogram, an abdominal ultrasound, or a CT scan
2. Laboratory tests, like blood and urine tests which include tests that look for an abnormal level of inflammatory markers in the blood
3. Other tests, depending on signs and symptoms

The child should also have tested positive test for COVID-19 or have been exposed to the virus anytime within the past four weeks, although neither is really necessary to make a diagnosis. Testing will also be done to rule out other possible causes like infections.

MIS-C Prevention

The best way to prevent MIS-C is to continue taking measures to help prevent exposure to COVID-19.

1. Encourage your child to wash his hands often, using soap and water for about 20 seconds. In case soap and water are unavailable, use an alcohol-based hand sanitiser.​
2. Prevent your child from coming in contact with people who are sick, and ensure he maintains a 6-foot distance from people outside your household.
3. Encourage your child to always wear a mask when outside.
4. Clean and disinfect all surfaces at home daily.
5. Wash all laundry and plush toys as required on the warmest setting recommended, and dry them completely.

Treatment of Multi-System Inflammatory Syndrome in Children

Children who appear to have MIS-C need to be kept under close observation. Some of them may need to be admitted to a hospital, while a small number may require intensive care. Treatments currently include IV immunoglobulin (used to treat Kawasaki disease), anticoagulation to limit blood clotting, and anti-inflammatory drugs (drugs blocking IL-1 or IL-6 and corticosteroids). Other treatments may be carried out depending on the laboratory test results.

Kids with serious cardiac complications will need to be continuously observed, with repeat echocardiograms to keep track of their coronary and heart arteries.

When to See a Doctor

If your child has any of the symptoms listed above, or is critically sick with other signs and symptoms, get in touch with the doctor immediately. Call 911 or your local emergency number, or take him to the nearest emergency room. The doctor may want to perform tests like blood tests or imaging tests of the heart, chest, or abdomen to check for other signs of MIS-C and areas of inflammation.

MIS-C is a newly identified medical condition that can affect children in rare cases, putting their health at risk, and so parents are understandably concerned. It is important to remember that, in general, children cope better with COVID-19 as compared to adults. Only a small number of kids seem to develop the symptoms of MIS-C, and most of them have recovered quickly. While we understand you may not be comfortable visiting the hospital during these testing times, it’s important not to delay medical attention for a child with MIS-C.

Also Read:

How to Talk to Your Child About Coronavirus Without Instilling Fear in His Mind
Toys and Games to Keep Kids Entertained During the Coronavirus Outbreak
Fun Ways to Get Children to Wash Their Hands