- Gemma Mullin, Digital Health Reporter, 27 Apr 2020, Updated: 27 Apr 2020, 16:56
NHS doctors have been sent an urgent alert warning of a rise in kids admitted to intensive care with a coronavirus-related condition.
An apparent spike in cases of youngsters suffering with an “inflammatory syndrome” has been recorded in the last few weeks.
The Paediatric Intensive Care Society said that the unidentified condition requires intensive care – with cases reported across the UK.
They say the syndrome has the characteristics of serious Covid-19, while abdominal pain and gastrointestinal symptoms, like vomiting and diarrhoea have also been seen by doctors.
Medics warned the cases have features of toxic shock syndrome and atypical Kawasaki Disease, an inflammatory condition that attacks blood vessels and the heart.
These conditions can cause harmful internal swelling, fever and breathing problems – which are all also the main symptoms of coronavirus.
But as it appears to be a completely new condition, the exact warning signs are unclear.
Cases have only started to emerge in the past three weeks – as the country reached the peak of its epidemic, according to the memo.
In the alert, sent to GPs in North London, health chiefs said: “There is growing concern that a [Covid-19] related inflammatory syndrome is emerging in children in the UK.
“Over the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.”
It’s unclear whether the mysterious syndrome is slow to develop or is so rare that it has only become apparent during the peak of the epidemic in the UK.
So far, the number of children affected has been small – and mostly in London – but senior paediatricians are concerned.
The “urgent alert”, seen by the Health Service Journal, was issued on Sunday night by the Paediatric Intensive Care Society.
It stated: “Please refer children presenting with these symptoms as a matter of urgency.”
However, NHS England has said that there is no confirmed link between Covid-19 and Kawasaki-like diseases, adding that advice to parents hasn’t changed.
Prof Simon Kenny, NHS national clinical director for children and young people, said: “Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to Covid-19.
“But it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.
“The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.”
Rare syndrome
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said: “We already know that a very small number of children can become severely ill with Covid-19 but this is very rare.
“Evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection.
“New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.”
Global reports
Dr Elizabeth Whittaker, a paediatrician at St Mary’s Hospital in London, said that medics in other countries had reported the same illness.
She wrote on Twitter: “Our Italian and Spanish colleagues also report it. Numbers are small but significant.
“We want primary care /A&E to be vigilant so those affected are in the right place to get appropriate supportive care if needed.”
Some of the children have tested positive for Covid-19 and others appear to have had the virus in the past.
But to make matters more confusing, some of the reported cases haven’t had coronavirus at all.
Paediatricians and GPs are being advised to refer children with symptoms urgently to paediatric infectious disease experts and intensive care doctors.
Prof Rosalind Smyth, director at UCL Great Ormond St Institute of Child Health, said: “We know, from the evidence to date that most children with Covid-19 who have come to medical attention have mild symptoms.
“Around half of children have a fever and about 40 per cent have a cough.
“In reported case series, fewer than 10 per cent have gastrointestinal symptoms.
“However, our understanding of this condition in children is limited.
“Covid-19 does present, in adults, as an inflammatory disease affecting a number of organs.
“We should investigate fully these children, with SARS-CoV-2, who present with a multi-system inflammatory disease to assess whether this is a presentation of Covid-19.”
Few serious cases in kids
As yet, there have been relatively few serious cases of Covid-19 in children.
That doesn’t mean that kids can’t catch the virus – in fact, the youngest known case was only 30 hours old.
But based on the limited information available, the symptoms in children appear to be mild, or they may even be asymptomatic.
For that reason, experts have warned that children may be “super-spreaders” of the virus.
Dr Sarah Jarvis, GP and clinical director of Patient Access, told The Sun Online: “On the whole, most children who are infected with coronavirus have a milder illness than adults, particularly older and more vulnerable patients.
“There has been a recent warning to GPs to be on the look-out for children with coronavirus-type symptoms – cough and fever – as well as tummy symptoms such as tummy pain, diarrhoea and vomiting.
“There is a concern that this could be an unusual complication of coronavirus.”
She added: “It’s important to stress that if this does turn out to be a complication of coronavirus, it’s likely to be a rare one.
“But parents of any child who seems very unwell should always seek medical help.
“The NHS is very much open for business for urgent problems, whether connected to coronavirus or not.”
Experts say it’s unclear why Covid-19 isn’t impacting children as much as adults.
Especially because children’s immune systems aren’t as robust as adults and they tend to overreact.
Dr Nathalie MacDermott, from King’s College London, told the BBC: “You’d expect it to go haywire and it’s not doing that.
“There must be something this virus does that is not as readily stimulating the immune system in children, but what that is is unclear.
“They don’t seem to be mounting a disproportionate immune response and some seem to be asymptomatic.”
