Should I be worried about MIS-C?
Unless you're well on your way to Mars, you have been hearing a lot of frightening news reports about Multisystem Inflammatory Syndrome in Children, or MIS-C. And like most parents, you probably have a lot of questions, as do we. Currently, there's much more that we don't know than what we do know. The good news is that there are a lot of physicians, epidemiologists, and researchers around the world working hard to learn more.
Over the last month reports have come out of Europe of a severe complication of COVID-19 in children. Many of these reports have described the similarities to a rare but well-known pediatric condition called Kawasaki Disease. In the last two weeks, authors in Italy and the UK published their findings in a medical journal called The Lancet. Physicians in New York State began seeing similar cases, and developed a working definition. Then on May 14th the CDC published a Health Advisory with an official case definition:
Fever lasting more than 24 hours is the single defining symptom. I realize this isn't terribly reassuring as a diagnostic feature, as fever is a common symptom in many pediatric illnesses. Other symptoms can include any combination of organ dysfunction, such as low blood pressure or involvement of cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic systems. Respiratory symptoms can be present or not. MIS-C can present during COVID-19 illness, or weeks later, and can occur even after asymptomatic infection. As time goes on and more is known, it may be easier to define this illness.
What about Kawasaki Disease (KD)? KD is a rare disease that every pediatrician knows well. It has a very clear definition of fever lasting 5 days or more and 4 or more of the following symptoms: rash, conjunctivitis, redness or swelling of the hands or feet, involvement of the lips or mouth, and enlarged lymph nodes in the neck. Children with MIS-C have had some of the same symptoms as KD, but MIS-C is a separate and more severe illness with higher findings of inflammation.
Now that you know what MIS-C is, I'm pretty sure I can guess your next question: How worried should I be? First of all, remember that even though headlines about MIS-C are common, the disease itself is very rare. Secondly, because Oregon (and you) have done such a fantastic job of flattening the curve, it will be even more rare here. But the most important thing to remember is this:
We are here for you.
We are available 24/7 by phone, we have telehealth visits available, we are using the teen clinic to see sick patients (keeping them separate from well patients in the main office), and we have our local pediatric infectious disease doctors on speed dial!
If you have any concerns at all, call us.
We especially want you to call for any combination of these symptoms as the AAP recommends:
a fever lasting more than 24 hours
abdominal pain, diarrhea or vomiting
rash or changes in skin color
your child seems confused or overly sleepy
We know that this level of uncertainty is frustrating. We feel it too. Just know that we will work through this together.