rare post-covid disease sending children to hospitals
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when stephanie peillon’s daughter started having headaches and neck pain in early march, peillon first thought she had spent too much time on her ipad.
as her back started aching soon after, peillon bought her a new mattress to see if it would help. but when her fever climbed over 103, followed by an outbreak of rashes, peillon knew something wasn’t right.
peillon rushed her daughter to the emergency room, where she collapsed. after two nights in intensive care, rebecca, 12, would spend the following five weeks in hospital.
though she has never tested positive for covid-19, doctors believe she’s most likely suffering from a rare, post-covid syndrome seen in children called multisystem inflammatory syndrome in children (mis-c).
“parents need to be aware of this, not frightened but aware that it can happen,” peillon, 42, said in an interview. “had i known what this was i would have acted the first day, but now (rebecca) is in this situation because she was assessed so late.”
specialists first started detecting the inflammatory syndrome in children shortly after the pandemic began. though still very rare, montreal hospitals are seeing more and more suspected cases of the illness as the pandemic stretches into its second year.
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montreal’s ste-justine hospital has treated around 60 cases of the syndrome since the first wave, and the montreal children’s hospital has seen another 50 or so.
both hospitals believe cases of the new syndrome could continue to increase during the third wave, as the coronavirus variants spread among schools and daycares in the city.
“usually, there’s a delay of about four or five weeks after the peak of covid in the population and then we see the cases at the hospital,” said dr. marie-paule morin, a pediatric rheumatologist at ste-justine hospital.
morin said some of the children the hospital has treated have presented symptoms of kawasaki disease, a rare illness that leads to inflammation and swelling in blood vessels, while others have experienced symptoms associated with toxic shock.
in canada and the united kingdom, the illness can be called pediatric inflammatory multisystem syndrome, or pims, a diagnosis that requires a temporal association with covid-19 instead of proof through testing or close contact.
symptoms of the syndrome can include intense abdominal pains, persistent fever, rash and red eyes. in more severe cases, those can progress to inflammation issues with the heart or other organs.
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“we think it’s an immune reaction to covid-19, that the immune system gets very overactive,” morin said. “we still don’t know exactly why, but that’s the hypothesis.”
dr. rosie scuccimarri, a pediatric rheumatologist at montreal children’s hospital, said the hospital has seen a “significant” increase in children presenting kawasaki-like symptoms, but the link to covid-19 has not been made in all of them.
in previous years, scuccimarri said, the hospital would treat about 30 to 40 cases of kawasaki disease per year, compared to the more than 50 similar cases seen in the last 10 months alone.
scuccimarri said the increase is concerning, especially since covid-19 infection does not appear to be letting up in the province and it’s known the variants are spreading among school-age children.
“it’s still a rare disease,” she said, stressing most children also recover fully after treatment, “but it has important consequences if not picked up in time because it can be life-threatening.”
to make a link to covid-19, doctors treating the children with symptoms will look to see if they’ve tested positive for the disease in the past or know of a close family member who had been infected. they can also conduct blood tests to see if they’re positive for antibodies.
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but making the connection covid-19 isn’t always possible, such as in peillon’s case.
peillon, rebecca and her other daughter all underwent blood tests for antibodies, but none came back positive. her older daughter did present what’s known as covid toes in january, however, when her toes became swollen and purplish.
“so what does that mean? it’s really difficult to understand. is it covid or not? we don’t know yet,” scuccimarri said. “medicine is not always black or white, there’s a grey zone and right now what this patient is presenting is a grey zone.”
after five weeks in the hospital, rebecca was discharged on sunday. she will remain on antibiotics and corticosteroids for the near future, but her health is improving.
peillon said dealing with so many unknowns has been especially difficult. she’s connected with other parents from around the world online, in part for support but also to share what they’re learning as their children recover.
she believes rebecca must have contracted the coronavirus at some point, but that for whatever reason, the testing done has not picked it up.
though she understands it’s only a small percentage of children that will develop the syndrome after contracting covid-19, she feels the provincial government needs to consider it when deciding on public health measures.
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she was shocked when quebec decided to send older high schools students back to school full-time in march, and relieved when the government reversed its decision.
“my daughter is strong, thank god, and has a good immune system,” peillon said. “but even with a healthy child — she plays a lot of sports, she’s super active — it can still happen.”
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