Some 500 children in the state have been hit by Multisystem-Inflammatory Syndrome (MIS-C), a post-Covid-19 complication, in the course of the first and second waves of the novel coronavirus outbreak.
Karnataka, unlike Maharashtra, has not yet designated MIS-C as a notified disease, which means that not all cases have been systematically documented by the government.
“Based on available information, there have been 500 cases so far, out of which roughly 300 cases have been reported in Bengaluru,” explained Dr Sanjay K S, director of Indira Gandhi Institute of Child Health (IGICH), where some 50 children have been treated for the condition since mid-2020.
Paediatricians across Bengaluru spoke of having encountered many more MIS-C cases in the second wave than in the first wave.
“In the last 3-4 weeks alone, we have seen eight to 10 cases. The cases can be split into two camps: mildly symptomatic and moderate to seriously symptomatic. In the former, the symptoms are fever, rash. In the latter, it is low blood pressure, shock, cardiac, liver and kidney problems,” explained Dr Yogesh Kumar Gupta, Head of Paediatric Intensive Care unit, Fortis Hospitals (Bannerghatta Road).
At the same time, the manifestation of these cases is unsurprising.
Researchers have noticed a link between the “peaking” of a Covid-19 outbreak and reports of MIS in children.
Doctors explained that this is because the process of seroconversion, which produces an antibody response to the virus, is a delayed process in children, requiring as many as two months.
While the exact cause for MIS-C is not yet known, scientists see it as an excessive immune response related to Covid-19. Dr Gupta said there could also be a genetic predilection for the syndrome among some children.
Manipal Hospitals (Old Airport Road), for example, said it had treated 16 children for MIS-C in the second wave, as opposed to 14 last year.
“The common reason for them to come to paediatric ICU was circulatory shock with poor blood circulation, some had multiorgan dysfunction with involvement of liver, kidney and brain as well,” said paediatric intensivist Dr Jahnavi Kare.
At Aster CMI Hospital, paediatrician Dr Sagar Bhattad said 24 cases of MIS-C had been seen over the last five weeks.
2-3% mortality rate
While treatment of intravenous immune globulin, glucocorticoids or interleukin-6 inhibitors are effective, Dr Sanjay specified that the mortality rate of MIS-C is roughly the same as Covid-19: 2-3%, if the child is not treated in time.
In some cases, the syndrome is camouflaged. Paediatrician Dr Yogesh Kumar Gupta of Fortis explained that he had treated a four-year-old boy recently who suffered from a persistent fever but had never been identified as having had Covid.
An antibody test also failed to detect any Covid antibodies. Doctors later came to know that his entire family had been infected a month ago.