Mystery Illness

You have probably been hearing or reading about a “mystery illness” in children lately. It seems to have some similarities to Kawasaki disease or toxic shock syndrome and is possibly connected to Covid-19 infections. 

What is going on? I thought kids were pretty much spared from Covid-19? Doctors have been seeing kids coming into the ER with fever, skin rashes, lymph node enlargement and abdominal pain. It resembles Kawasaki disease because of these presenting symptoms. Some of these kids have tested positive for COVID-19 using the nasal swab test. Some have tested positive for antibodies to COVID-19 which is why they think there is a possible connection. New York has had the most cases so far, but it has been seen in other states and other countries as well. It may be a post-infectious syndrome, meaning it appears in someone who had the virus infection days or weeks earlier and then they present with fever and other signs of inflammation in multiple systems of the body. One of the key messages to parents is to get your kids to the doctor early if they develop fever, rash, bloodshot eyes, abdominal pain, enlarged lymph nodes and irritation inside the mouth. It is treatable if diagnosed early before the inflammation affects the heart. Kawasaki disease has been known to affect the arteries of the heart with inflammation and possible long term injury. This is still considered a rare occurrence but one to be aware of in case you see it in your kids or grandkids.

In other COVID-19 news: Have you struggled to understand why this virus has been so difficult to understand? And so weird in how many ways it presents? First it was thought to be mostly affecting the lungs with pneumonia and respiratory distress syndrome. Then we started seeing other organ system failure and neurologic symptoms. Then there was an increased incidence of blood clots in large and small blood vessels. One reason is that it is a “novel” virus. We humans have never been exposed to anything like this. Yes, we have been exposed to coronaviruses like the common cold, or SARS1 or MERS, but COVID-19 has a unique genetic make up and we have no previous exposure or immunity to it. And because it is so new, health care professionals are still learning about what this virus does and how it attacks the cells and causes symptoms. It is amazing to me how much the scientists in the world have learned about this virus in such a short period of time. And it is encouraging that there is global cooperation in research to find treatment options that are effective. It is not clear whether there will ever be an effective, safe vaccine for COVID-19. We still do not have one for HIV and some other viruses. But there is also the more likely scenario of finding drugs that may work in combination to treat the virus and studies like this are underway. I doubt that there is going to be one miracle drug, but more likely a combination of two or three agents.

I read an article by F. Perry Wilson, MD on Medscape that helped my understanding of why this virus is so scary for health care professionals (HCPs). He also writes a blog at www.methodsman.com. One of his article talked about variance when it comes to looking at disease and risk of death. For example, when someone has severe cardiovascular disease and advanced age, there is low variance. Those who die would probably die soon anyway. But when young people who have no health issues die, that is high variance. A JAMA Network Open letter reported on 168 patients who died from COVID-19 in China-30% had no co-morbidities at all. It feels like Russian Roulette. It is extremely hard to predict which patients will get hit hard with COVID-19. Is there a genetic predisposition of some sort? Obviously the older population and those with obesity, diabetes, hypertension and respiratory illnesses are at much higher risk. But it is not just this group. And that is what makes the virus so scary to HCPs who are taking care of those critically ill from COVID-19. There are so many questions that we do not have answers for yet. 

I will leave you with a quote from Claude Bernard (1813-1878) He was a French physiologist and one of the founders of experimental medicine. He said this: “ The terrain is everything; the germ is nothing.” Maybe focusing on the health of our immune system and our body will make a difference in how we individually deal with COVID-19 exposure.

Disclaimer: This blog is meant for educational purposes only and is not medical advice.