What to Know
- New York state health officials are investigating around 100 children who may have been diagnosed with a recently identified illness associated with COVID-19 that some doctors are referring to as "pediatric multi-system inflammatory syndrome"
- Gov. Andrew Cuomo said Sunday two more deaths are waiting confirmation, which would bring related deaths to five
- Doctors say in some cases, kids are taking up to 6 weeks after exposure to the virus to present with symptoms of this illness
New York may have as many as 100 cases of children presenting with a new pediatric multi-system inflammatory syndrome likely linked to COVID-19. At least three children have died, and two more deaths are under investigation, Gov. Andrew Cuomo announced.
Cuomo previously confirmed the deaths of two boys in New York City and Westchester County, as well as a teenager in Suffolk County. Details on the two most recent fatalities weren't immediately available.
New York City Mayor Bill de Blasio said Wednesday the city had confirmed 82 cases of pediatric multi-system inflammatory syndrome. Some 53 of those kids tested positive for COVID-19 or antibodies.
He urged parents to be aware of the warning signs and act immediately if they spot related symptoms. The city's top doctor, Oxiris Barbot, outlined key symptoms to look for in the mayor's briefing Monday.
"If [your child has] a fever, their energy level is off, their appetite is off, they're developing a rash, their lips look extra red, their tongue is looking extra red, those are the early signs that we want parents not to discount them and say 'oh they'll be better tomorrow' but to reach out to your pediatrician, have that conversation and then do the testing if your pediatrician thinks its indicated," Barbot said.
A complication of the coronavirus the state had not even acknowledged a week ago, this new condition is now being seen across the country. It's striking newborns and teenagers alike.
"As it turns out, these children happened to have the COVID antibodies, or be positive for COVID, but those were not the symptoms they showed when they came into the hospital system," Gov. Cuomo said Saturday.
The New York State Health Department is working with the CDC to develop national criteria for the health departments and hospital systems in the 49 other states to help them identify, track and respond to help children exhibiting symptoms, Gov. Cuomo said. Doctors in the state say children are not presenting with symptoms until 4 to 6 weeks after exposure to the virus.
"This is every parent's nightmare, right?" Cuomo said, adding that the state is investigating additional child deaths and will conduct further studies to better understand the illness.
The CDC released a statement regarding the child syndrome, saying "at this time as more data are emerging, CDC is working with the Council of State and Territorial Epidemiologists and other domestic and international partners to better understand and characterize this new syndrome, its prevalence and risk factors for it; and to develop a case definition that will allow us to keep track of it."
New Jersey was said to be investigating eight possible cases of the illness in the state, though they were not yet confirmed. Connecticut Gov. Ned Lamont said Monday there were three cases at Yale New Haven Hospital.
While Lamont said the issue didn't wasn't addressed during a governor's call with the White House, President Trump fielded questions regarding the pediatric syndrome during his afternoon press conference, saying "it's been on the radar for weeks" and that officials were looking into it.
"We're studying that very closely ... we've seen this for quite a while. It's been very rare, but we're looking at it very closely," Trump said.
At Westchester Medical Center, where one of the children with the illness died, more than a dozen other children have been treated, not including the multiple cases since Monday afternoon. Dr. Michael Gewitz, the hospital's director of pediatrics, said there have been more cases as more parents are coming in to the ER since local officials put out the warning.
"We've seen a bump in both the number coming to the emergency room, a small bump, but more in terms of the number who call, and that's good," Gewitz said.
A 5-year-old boy died in New York City Thursday, the first child identified by the state to die from inflammatory syndrome brought on by COVID-19 complications.
News 4 New York's Melissa Russo interviews Dr. Steven Kernie, chief of pediatric critical care at Morgan Stanley Children's Hospital in Manhattan, on the new inflammatory illness striking kids with coronavirus.
How to Identify the Symptoms Early
So what are the symptoms of pediatric multi-system inflammatory syndrome? Health officials say children had prolonged fever, and more than half reported having rashes, abdominal pain, vomiting or diarrhea.
Other symptoms include change in skin color; parents have reported their kids turning pale, patchy or blue. Racing heart, decreased urination, lethargy irritability and confusion are also possible. And according to New York state health officials, some infants have also exhibited difficulty feeding.
While it has been considered a direct symptom of COVID-19, less than half of the pediatric patients in the city displayed any shortness of breath.
"I want to keep reminding parents and family members to look out for these symptoms and act quickly," NYC Mayor BIll de Blasio said.
Any child that shows symptoms relating to Kawasaki disease or toxic shock syndrome should be seen by a doctor as soon as possible, as the health department said early recognition and a pediatrician's referral to a specialist are essential, including admission to critical care units if necessary. Beginning treatment quickly can help prevent end-organ damage and other long-term problems, Demetre Daskalakis, the Deputy Commissioner of Disease Control with the New York City Health Department, said in the city's medical alert.
Dr. Newburger suggests that any parent who finds their child to have a high fever and "seems unwell" should call their pediatrician and seek medical attention.
Mount Sinai Hospital previously confirmed reports by NBC New York that they are seeing the new and unusual COVID-19 related illness in several pediatric patients, up from just two on April 28. The hospital’s chief of pediatric critical care issued a warning to parents to be on the lookout for certain symptoms.
In a statement, Dr. George Ofori, Pediatric Critical Care Director at Mount Sinai Kravis Children’s Hospital said, "Some of the cases that we are currently treating entered our care presenting with symptoms such as abdominal pain, vomiting, diarrhea, and a low-grade fever. Others presented first with a rash, conjunctivitis, and/or cracked lips.”
Dr. Ofori said some patients have developed heart problems and low blood pressure that led to shock. He explained that some had been diagnosed with COVID-19 2-3 weeks before these symptoms developed.
"Whether the underlying condition is COVID-19 or the body’s response to COVID-19 is not known at this time. While it is too early to definitively say what is causing this we believe it is important to alert the public as to what we are seeing," he said.
A different source told NBC New York some of these children had no previous underlying health conditions.
The Mount Sinai statement came two days after Dr. Ofori’s counterpart at Cohen Children’s Hospital on Long Island told the I-Team in an interview they’ve seen about a dozen critically ill pediatric patients in the past weeks with similar inflammatory symptoms.
“We now have at least about 12 patients in our hospital that are presenting in a similar fashion, that we think have some relation to a [COVID-19] infection,” said Dr. James Schneider, Director of Pediatric Critical Care at Cohen Children’s Hospital in Nassau. “It’s something we’re starting to see around the country.”
The state issued an advisory on the syndrome and its potential association with COVID-19 in children May 6. It was sent to all healthcare facilities, clinical labs and local health departments in the state to inform providers of the condition as well as to provide testing and reporting guidance. Any suspected cases of pediatric multi-system inflammatory syndrome in people under the age of 21 must be reported to the State Department of Health.
As the advisory stated, "Though most children who get COVID-19 experience only mild symptoms, in the United Kingdom, a possible link has also been reported between pediatric COVID-19 and serious inflammatory disease. The inflammatory syndrome has features which overlap with Kawasaki disease and toxic shock syndrome and may occur days to weeks after acute COVID-19 illness. It can include persistent fever, abdominal symptoms, rash, and even cardiovascular symptoms requiring intensive care. Early recognition by pediatricians and referral to a specialist including to critical care is essential."
New cases are now showing up in New Jersey as well, with doctors there telling NBC New York that they're are seeing a significant jump in cases with some similarities to the sickness.
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New York City issued its own health alert earlier last week after identifying more than a dozen children in city hospitals who have the rare illness. At least one expert believes there are sure to be more kids affected.
The syndrome has been observed in 15 children who were hospitalized from April 17 to May 1 in the city, according to Daskalakis. While the full spectrum of the illness is not yet known, Daskalakis said, features of Kawasaki disease and toxic shock have been seen in patients between the ages of 2 and 15.
"We’ve seen more than 15 … We’re seeing them every day that have required ICU admission every day," said Dr. Steven Kernie, professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons and chief of Critical Care Medicine at New York Presbyterian Morgan Stanley Children's Hospital. He said they are seeing one or two children every day with similar symptoms.
"What we’re seeing is children who have had high fever -- over 102 or 103 -- for three to four days," Kernie added. "They tend to have a rash anywhere on their body, including the palms of their hands and soles of their feet. They may have abdominal distress. Their eyes may be very red. They look ill."
He believes this is not a primary infection but the child's immune response to exposures that took place weeks prior.
Dr. Jennifer Owensby runs the pediatric ICU at the Bristol-Meyers Squibb Children's Hospital in New Brunswick, and says her unit has treated five children for the illness in the past three or four weeks — where normally the ICU sees one child with Kawaski syndrome admitted every three or fours years. All five children showed signs of heart failure, and all five tested positive for COVID-19 or the virus' antibodies.
"They were all previously ... normal, healthy kids who become critically ill," Owensby said. She did note that all were improving, however.
"As terrifying as this illness is, children do recover and it's important to know that," she said.
A Near-Tragic Case
Cohen is one of several local hospitals where pediatricians say they’re concerned about recent hospitalizations of previously healthy children who have become critically ill with the same features, resembling Toxic Shock Syndrome and Kawasaki disease, an autoimmune sickness that can be triggered by a viral infection and if not treated quickly, can cause life-threatening damage to the arteries and the heart.
One child who had gone to Cohen Children's Hospital is 8-year-old Jayden Hardowar, who was seemingly healthy before he suddenly went into cardiac arrest one evening.
In late April, Jayden started having a fever and bouts of diarrhea. His parents took him to his pediatrician, and soon after he appeared to be responding well to Tylenol. Mother Navita Hardowar said that his temperature broke after a few days, and he never showed any shortness of breath. Although Jayden's father Roup said his son's strength hadn't really come back, they weren't overly worried as they believed it may be due to diarrhea.
His mother said she noticed something was very wrong when she was sitting in bed with the child, and saw her son's head and hands twisted in an unorthodox position backward.
"I quickly looked over at his face and his lips were all blue at that point, so right away I knew something was not right here with Jayden," Navita Hardowar said. She started yelling his name, but he was not responding. The boy's brother and father performed CPR, and soon he was rushed to Jamaica Hospital before being rushed to Cohen Children's Hospital in Nassau County.
In Jayden's case, it took just five days for an overall healthy boy to go from playing games and singing to requiring a machine to help him breathe for several days, unable to speak to his parents who tried to video chat with him from his hospital bed. His parents said he has inflammation and suffered from cardiac arrest and heart failure.
Dad Roup still isn't sure how how his son could've contracted the virus. "None of us — six of us in the home: two adults, four kids — none of us had been sick. We've all been very strong and practicing our social distancing very diligently ... we thought we were safe," he said.
Thankfully Jayden was finally well enough to be taken off the ventilator in early May, three days after he was rushed to the hospital. Two weeks after he was initially admitted into the ICU, Jayden finally got to go home — receiving a hero's welcome from NYPD officers and FDNY firefighters following his terrifying ordeal.
Coronavirus Pandemic Coverage
“It just goes to show that COVID does not spare any age group and can lead to very serious illness, even in kids,” said Dr. Schneider.
Scott Gotlieb, former head of the FDA and a New York City emergency room physician, echoed those sentiments during an appearance on CNBC, saying the new cases appear to disprove the previous notion that coronavirus "wasn't really affecting kids."
"We certainly know that there are children who've been hospitalized, who have gotten very sick, but now it appears that there are some unusual phenomena that are affecting children — not in high numbers, these still appear to be small reports in the medical literature — but there are some unusual syndromes that children are developing, perhaps as a result of coronavirus," Gottlieb said on CNBC.
