Recently, Ladders reported on cases of Kawasaki disease appearing in an increasing number of young COVID-19 patients in the United Kingdom.

The condition, alternatively known as mucocutaneous lymph node syndrome, primarily affects infants aged five and under. At its mildest, the illness induces a fever that exceeds 102.2 F (39 C) and persists for more than three days, extremely red eyes, dry, cracked lips, and an extremely red, swollen tongue.

Of course, disease outcomes are infamously hard to forecast, as are our adaptive immune system responds to them.

The Center for Disease Control and Prevention reports that a notable portion of Kawasaki disease diagnoses linked to SARS-CoV-2 infection has resulted in inflammation of the heart and blood vessels, swollen lymph glands in the neck, irritation, and inflammation of the mouth, lips, and throat, in the young carriers involved in the preliminary analysis.

As cases begin to appear with greater frequency in more diverse populations, including affected communities within the US, medical experts are reconciling with the fact that Kawasaki disease displays a range of symptoms as ambiguous as the pathogen currently headlining our pandemic.

“Of the cases that have been verified, 47% of the kids involved tested positive for the coronavirus at that point; of those who tested negative, 8% had the antibodies,” New York Mayor, Bill de Blasio said in a press release. “Suffice it to say that, for the past 10 weeks, all day, every day, we’ve all been talking about the coronavirus nonstop and looking at so many different elements around it, and this particular challenge around kids came up literally days ago.”

Surveillance and contact tracing remain the privileged countermeasures. Kawasaki disease symptoms can sometimes mimic those associated with the flu; with joint and stomach pain occurring alongside fever and irregular bowel movements.

In heightened cases, prolonged inflammation leads to gastrointestinal discomfort and soreness.

As of the time of this writing, Kawasaki disease has infected 85 children in New York and three have succumbed.

“I think, probably, the most important thing that the federal government can do in this situation is, really help us maximize the number of people who are getting tested,” City Health Commissioner Oxiris Barbot commented. “This response has been hampered by a universal lack of access to testing. I think that is one additional way in which that is being manifested.”

These developments have arrived in chorus with a new study out of Rutgers University that determined children, teens, and young adults to be at a much greater risk for severe COVID-19 manifestations than previously anticipated—this is especially true for young carriers affected by comorbidities.

“The recent and ongoing coronavirus disease (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units,” the authors wrote in the Journal of Pediatrics. “This early report describes the burden of COVID-19 infection in North American PICUs and confirms that severe illness in children is significant but far less frequent than in adults. Prehospital comorbidities appear to be an important factor in children. These preliminary observations provide an important platform for larger and more extensive studies of children with COVID-19 infection.”

It should be noted that even with all the findings motioned above taken into account, COVID-19’s mortality rate is much lower among younger populations, even if it is, in fact, higher than initial reports. Moreover, pre-existing conditions compound coronavirus outcomes, irrespective of the impacted demographic.

“The idea that COVID-19 is sparing of young people is just false,” said study co-author Lawrence C. Kleinman, professor and vice-chair for academic development and chief of the Department of Pediatrics’ Division of Population Health, Quality and Implementation Science at Rutgers Robert Wood Johnson Medical School. “While children are more likely to get very sick if they have other chronic conditions, including obesity, it is important to note that children without chronic illness are also at risk. Parents need to continue to take the virus seriously.”

Of the 48 children and young adults infected by SARS-CoV-2 involved in the report, 18 became critically ill and required invasive ventilation, two have succumbed, three still require mechanical ventilation, seven have discontinued mechanical ventilation but remain hospitalized, and sic have been discharged from the hospital.

On balance, the case fatality rate in this cross-sectional study was calculated at 4.2%. This estimate will be subject to change in the coming weeks.

The patients who died were aged 12 and 17 years; both had preexisting comorbidities and developed multisystem organ failure by reason of coronavirus infection, and one had gram-negative sepsis prior to developing COVID-19.

Fifteen children (31%) were still hospitalized, including five in critical condition with one still receiving ECMO. For those patients with completed pediatric intensive care unit (PICU) and hospital admissions (they either died or were discharged), the median PICU and hospital lengths of stay were five (three to nine) days and seven (four to 13) days, respectively.

More broadly, clinical relief efforts are currently being developed and remdesivir has already demonstrated some promising results.

Remdesivir is a direct-acting antiviral trial drug that facilitates viral RNA synthesis. The agent has been previously studied to inhibit activity in cell culture and animal models against SARS-CoV, MERS-CoV, and SARS-CoV-2.

De Blasio, recently challenged the limited number of available doses of remdesivir to mitigate COVID-19 fatalities in a media release. The federal government has obtained roughly 500,000 doses of remdesivir collectively and New York City has received about 4,000 doses.

CW Headley is a reporter for the Ladders and can be reached at cheadley@theladders.com

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