Doctors find mysterious cases of rare dysfunction in Covid-19-recovered children

Experts say Bengaluru schools should not be reopened

Paediatric doctors in the city have been startled by the discovery of the first cases of Multisystem Inflammatory Syndrome (MIS) in several children who have recovered from Covid-19. The condition is a rare complication of the novel coronavirus infection.

According to a paper by the American College of Rheumatology (ACR), the MIS in children is a condition characterised by fever, inflammation, and multiorgan dysfunction that manifests late in the course of the SARS-CoV-2 virus.

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Doctors said that the discovery had complicated the management of child health and should prompt the government to reconsider school reopenings, which they said would potentially expose more children to Covid-19, resulting in some of them developing MIS.

Dr Gnanam R and Dr Jahnavi Kare, paediatric doctors at Manipal Hospitals, who discovered three children with the condition over the last fortnight, said that the condition had potentially affected eight to 15% of children who had recovered from Covid-19, but that further studies were required.

“All of the children are aged seven but from different families who live in different parts of the city,” Dr Gnanam explained.

“The children presented a rash, fever, redness of the eyes and other symptoms which we suspect as being that of MIS, having been versed in literature on the matter coming from the West and even from Mumbai and Chennai,” said Dr Jahnavi.

Epidemiological mystery

The doctors said that isolated MIS cases had been reported in a few other Bengaluru hospitals conducting follow-up checks on children who had recovered from Covid-19. They termed the discoveries as "surprising" and "troubling".

“Epidemiological studies in other countries and even Mumbai have shown the emergence of MIS cases coming only after a peak in cases have been reached. We are not sure why we are seeing these cases because Bengaluru has not reached its Covid-19 peak yet,” the doctors said.

Dr Giridhar Babu, a noted epidemiologist, said that the discovery of these cases revealed that certain areas in the city had peaked in the number of Covid-19 cases, but cautioned that Bengaluru was still a long way away from peaking in general.

“These first known cases represent the tip of the iceberg,” he said.

He added that MIS had been primarily seen among the worst Covid-19-hit countries such as the United States and Spain. It was also seen in Israel after the government reopened schools early, which contributed to a second wave of cases in that country.

According to the ACR paper, children with MIS “encompass a broader age range, have more prominent gastrointestinal and neurologic symptoms, present more frequently in shock, and are more likely to display cardiac dysfunction (arrhythmias and ventricular dysfunction) than children with Kawasaki Disease,” another rare inflammatory disease that causes blood vessels to become inflamed or swollen throughout the body.

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In a worst-case scenario, MIS shows a predilection for forming blood clots in children that can travel to the heart as the child grows older.

“In the three cases, however, such clotting has not been found,” said Dr Gnanam.

The doctors said that early diagnosis was helpful and stressed that parents should not panic over the first signs of these MIS symptoms.