‘MIS-C Is Rare, but Deadly’: COVID’s Worst May Hit Kids After Recovery

Kids can develop Multisystem Inflammation Syndrome 3 to 8 weeks after COVID infection.

Multisystem Inflammation Syndrome in kids: What to know

(Photo: iStock)

11-year-old Aarav is running a high fever. He only had COVID-19 a few weeks ago. His mother worries if he's now contracted another serious illness like dengue, or perhaps typhoid.

Aarav's paediatrician diagnosis him with MIS-C, a rare inflammatory condition in children that has now come to be almost exclusively associated with COVID-19.

Mounting data shows that COVID can raise a person's risk of cardiovascular issues that can last for months after recovery.

As it happens, while COVID itself is typically mild in kids, the risk of cardiovasular problems as a result of Multisystem Inflammation Syndrome after COVID also extends to kids.

To better understand this post COVID condition, FIT spoke to Dr Maninder Singh Dhaliwal, Associate Director, Paediatrics, Medanta Hospital Gurugram, and Dr Sameer Sadawarte, HOD & Sr. Consultant-Paediatric, Fortis Hospital, Mulund.

What is MIS-C?

Multisystem inflammation syndrome is a rare, but serious post COVID complication that develops as a result of a child's immune system going into overdrive.

As a result, the body's immune system itself starts damaging it.

Symptoms of MIS-C are also multisystem. "It causes a fire in the body, and it can also have a heart involvement where the heart blood vessels become dilated. There are also GI (Gastrointestinal) symptoms," says Dr Dhaliwal.

"It can be seen in age from 0 to 21. But it is most commonly seen in the 10 to 14 age group."

Inflammation can happen with other viruses too, but this word, is now pretty much exclusively attached to COVID-19.

"Maybe because it's (COVID-19) a new infection for the body, the body is reacting harshly to it."

Dr Maninder Singh Dhaliwal, Associate Director, Paediatrics, Medanta Hospital Gurugram

Dr Sadawarte explains that children usually develop either mild or asymptomatic COVID, but a history of COVID or COVID like symptoms in the family could give a doctor the clues required to diagnosing MSI-C.

"Sometimes even if the whole family has a history of Diarrhoea, cough, vomiting, or mild COVID symptoms, they don't get tested. In that case we check the antibodies of the child. And their antibody levels (if they have MSI-C) comes strongly positive."

Dr Sameer Sadawarte, HOD & Sr. Consultant-Paediatric, Fortis Hospital, Mulund

This is also why it's important to monitor any unusual symptoms in kids and consult a paediatrician as early as possible.

What Symptoms Should You Look Out For?

According to the experts we spoke to, some common tells of MIS-C are

• Rashes on the body

• Headache

• Abdomen pain

• High grade fever

• Low blood pressure

• Diarrhoea and Vomiting

• Breathlessness

Symptoms of MIS-C typically start showing up 3 to 8 weeks after COVID infection, says Dr Sadawarte.

Both Dr Sadawarte and Dr Dhaliwal explain that while there is no way to predict or prevent MIS-C, children with pre-existing comorbidities like renal issues may be more susceptible.

MIS-C and COVID Waves

MIS-C in kids has been around for as long as COVID has. In fact, says Dr Sadawarte, things were much worse in the first two waves.

"From 2020, we first noticed cases in the month of may. At the time we used to get more number of cases. In the last four to five months, the number of cases that are coming in has reduced," says Dr Sadawarte.

Dr Dhaliwal on the other hand says that while the number of cases are lower now than during the second wave, it's too soon to declare a win.

"In wave 3, COVID is yet to get over. So while we are not seeing a jump of cases, but in the next 1 or 2 weeks we'll be more clearer on the picture."

Dr Maninder Singh Dhaliwal, Associate Director, Paediatrics, Medanta Hospital Gurugram

Neonatal MIS-C

"We are not seeing more patients, but we are seeing more neonatal MISC," says Dr Sadawarte.

He goes on to talk about how babies born to women we had COVID-19 at some point during their pregnancy are more likely to develop it.

"Mother's COVID, during pregnancy in the prenatal period can actually cause neonatal MISC."

A reason why MIS-C may be missed in newborns is because it's not standard practice to check their antibodies, says Dr Sadawarte

“After they are born, they have a stormy course in the NICU, and subsequently, when we check the antibodies, they are getting strongly positive. Right now, we have 2 patients with neonatal MISC."

Dr Sameer Sadawarte, HOD & Sr. Consultant-Paediatric, Fortis Hospital, Mulund

"All the 2 cases that have now been referred to us from other hospitals because they were having issues and the patients were not getting better. And here we diagnosed them with neonatal MIS-C," he adds.

Rare, But Deadly

"The numbers of cases we are getting is still very less, compared to adults. Even if kids get affected with COVID, only one or two in thousands will get MIS-C."

Dr Sameer Sadawarte, HOD & Sr. Consultant-Paediatric, Fortis Hospital, Mulund

But, says Dr Dhaliwal, "MIS-C is a life-threatening condition. Most of the cases of MIS-C will be admitted to the ICU with low blood pressure, and high fever."

MISC is typically treated with small amounts of steroids.

Which is why it's extra important to be sure it is MIS-C before beginning treatment.

"When diagnosing MIS-C, its important to first rule out tropical infections like dengue and malaria which have similar symptoms. Because if you give steroids in those conditions, it will worsen."

Dr Maninder Singh Dhaliwal, Associate Director, Paediatrics, Medanta Hospital Gurugram

Vaccines Can Help

Vaccines, Dr Dhaliwal, says—quoting studies conducted by the US Center for Disease Control and Prevention—can help lower the risk of MIS-C in kids.

"That vaccination prevents MIS-C is a new fact," says Dr Dhaliwal.

COVID-19 Vaccines Protect against MIS-C

(Source: cdc.gov)

According to data collected by the US CDC, 2 doses of the Pfizer-BioNTech vaccine (which has been approved for children over the age of 5) was estimated to prevent MIS-C by 91 percent. The CDC also says that critically ill MIS-C case-patients requiring life support in the US, were all unvaccinated.

However, it must be noted that this data only applies to mRNA COVID vaccines, and there isn't much we know about how other vaccine platforms work against MIS-C.