Post-COVID symptoms in children

Dr Gopal Wasgaonkar, Consultant - Pediatric Department, Aster Aadhar Hospital, Kolhapur

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly through human populations, presenting across a continuum of severity from asymptomatic carriage to multi-organ failure and death. In comparison to adults, acute coronavirus disease (COVID-19) appears mild in children, comprising approximately 1% of admissions to hospital. However, severe acute disease has been described, and is frequently associated with co-morbidities.

In early May, 2020, in many parts of UK and Europe and the US, children were admitted in hospitals due to an unexplained multisystem inflammatory syndrome similar to Kawasaki disease and Toxic Shock Syndrome. The majority of children affected were RT-PCR negative for SARS-CoV-2 virus, but were antibody positive, indicating past infection.

Multisystem Inflammatory Syndrome in Children (MIS-C) multiple symptoms were observed like fever, myalgia, rash, joint pain and oedema with or without cardiovascular involvement. Treatment for the same however remained standard with immunoglobulin as well as steroids.

We have seen a recent case with this phenomenon and it is challenging in identifying the same amidst all the chaos and numbers of COVID infections. A 10 year boy presented with fever, joint pain and rash mostly on the upper extremities without any history of high risk contact within the family. Surprisingly, after baby was found RTPCR positive, parents did not have any signs or symptoms at that time, we investigated a little further and checked for IGG antibodies in the parents which came positive, giving us a clue that asymptomatic parents must have transmitted the disease to the child who later had symptoms. His Echo revealed 40% ejection fraction which showed us that he has minimal cardiovascular involvement, we immediately started patient on immunoglobulins and steroids and within 72 Hours patient responded very well.

For us guiding light in this case was presentation which was early and hence we think we were able to start the right treatment on time which gave us good clinical outcomes. 

In my 21 years of practice as a pediatrician this is the most challenging time as a Doctor as this is a novel disease for all of us and we continue to learn few more things every day. But in my learning of the COVID-19 virus so far, avoiding the same would be an ideal choice. However, parents specifically should abide by all the norms such as social distancing, use of masks, regular hand wash, avoiding crowds at all times. To safeguard a child means safeguarding a nation and our children deserves the safety and good health. We must not keep our guards down and picking up early symptoms of COVID-19 would ensure a better clinical outcome.