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Rare, COVID-Related Inflammatory Disease Affecting Children The novel coronavirus still affects a


How prevalent is COVID-19 in children?

In the U.S., just 2% of confirmed cases of COVID-19 are among people under the age of 18, according to the Centers for Disease Control and Prevention.

It’s unclear if the lower number is because children are more resistant to getting the virus, or they just aren’t getting as sick with it. Without widespread testing, experts also can’t confirm how many more children may have been affected.

How does COVID-19 affect children?

New research continues to describe differences in how the virus behaves in children compared to older patients. When it comes to common respiratory viruses, like the flu, the very young (and the very old) tend to be more severely affected. But that’s not the case with SARS-CoV-2.


How often are children hospitalized for COVID-19?

Small studies during the pandemic have found between 6-20% of pediatric COVID-19 cases requiring hospitalization and 1-2% needing ICU care.

Most of the children admitted to pediatric intensive care units had other health conditions, such as cancer, obesity or diabetes, according to currently available data.

What do we know about the newly reported pediatric multi-system inflammatory disease?

Starting in late April and early May, several U.S. states and parts of Europe began reporting a possible link between an inflammatory arterial disease and COVID-19 in children.

“We are seeing reports of a small number of children, many who seemed to be otherwise healthy, experiencing significant systemic inflammation through the body that appears to be linked to COVID-19,” Lloyd says. “A lot of these children had low blood pressures, persistent fevers, red eyes and rashes.”

“We’re still learning about this condition and trying to understand why it affects certain children. We suspect that something is triggering the immune system to overreact.”

The inflammatory response shares common features with other pediatric inflammatory conditions, including Kawasaki disease and toxic shock syndromes.

What is the connection between the inflammatory disease and COVID-19?

Some children who experience the inflammatory disease are testing positive for the novel coronavirus, SARS-CoV-2. Others are testing negative for the virus but positive for coronavirus antibodies, suggesting a possible post-infectious inflammatory response even weeks after exposure to the virus or being sick, Lloyd says.

“Many of these kids are testing negative for COVID-19, which indicates that the inflammatory condition is most likely caused by an immune response and not the virus itself,” says Lloyd. “There appears to be a temporal relationship with COVID-19, but we still don’t have enough data to understand the link.”

This new condition has been described as “Kawasaki-like.” What is Kawasaki disease?

Unlike congenital heart defects present at birth, Kawasaki disease is an acquired heart condition that appears in early childhood without any previous symptoms, Owens says. The disease is rare, affecting nine to 19 per 100,000 children under age five in the U.S. It’s more frequently diagnosed in Japan and among Asian-American populations.

It causes swelling in the walls of blood vessels throughout the body. The most serious risk involves an inflammation of coronary arteries, which supply the heart with blood and nutrients, and can lead to organ failure.

Provider image"Most children who get Kawasaki disease and those who may experience symptoms of this new inflammatory disease should recover. But we don’t want to miss opportunities to diagnose these kids."Gabe Owens, M.D., Ph.D.

“Even outside of the context of COVID, there are many unknowns around Kawasaki disease,” Owens says. “The disease process for Kawasaki is not well understood but there are theories that it might be triggered by a virus or infection combined with genetic or environmental factors.”

What signs should parents and providers look for?

Symptoms include prolonged fever (four or more days), very red eyes, a rash spread across the body, reddening or peeling on palms and soles of feet, abdominal pain, vomiting or diarrhea.

SEE ALSO: Keeping Our Patients Safe During COVID-19

If children experience these symptoms, parents should call their provider to seek an evaluation immediately.

How is it treated?

The standard treatment for Kawasaki disease involves intravenous immunoglobulin, a mixture of antibodies from blood donors. Aspirin and blood thinners may also decrease the risk of coronary artery problems after the inflammatory process has occurred.

The same strategies are being used for children who experience similar symptoms from the new pediatric multi-system inflammatory disease associated with COVID-19, Owens says.

“With early and proper medical care, Kawasaki disease is treatable, and most children recover without serious problems,” Owens says. “But it is essential that we identify it early. We should consider the same approach for this new inflammatory condition related to COVID-19”.

Even under normal circumstances, it can be difficult to differentiate Kawasaki disease from other childhood diseases that cause similar symptoms, Owens says. There are no definitive blood tests but children whose symptoms match the description should be monitored for signs of inflammation in the body.

Are certain children, such as those with congenital heart disease, at higher risk?

Children with an underlying health condition or an immunodeficiency – such as those who have undergone chemotherapy – are generally at higher risk for serious illness from COVID-19.

But so far, there is little information about how or why the virus may trigger PMIS in a small number of children who are seemingly healthy, experts say.

However, since the gravest risk is heart failure, Owens says families of children with congenital heart disease should be extra vigilant for concerning symptoms.

“The most severe complication of the condition appears to be cardiovascular collapse,” he says. “We don’t have enough evidence to know how this inflammatory disease specifically affects children with existing heart conditions, but it’s possible that they may have more vulnerability to complications if they get it.”

“Any pediatric patient with a chronic condition is at increased risk for any acquired infection,” Owens adds. “We need to be very diligent about evaluating kids with new symptoms and err on the side of caution by seeing them earlier to make sure we aren’t missing anything.”

What should parents and providers do to keep children healthy?

Lloyd says parents should follow all of the standard guidance on preventing transmission and spread of coronavirus, including proper handwashing (at least 20 seconds using warm water and soap), not touching your face, nose, eyes or mouth and following aggressive social distancing (not going out unless you absolutely have to and staying six feet apart from others.)

The CDC has also recommended that community members wear cloth masks if they have to go somewhere like the grocery store.

Additionally, families should make sure they are keeping up with regular pediatric care and immunizations as best they can and not wait to call their doctor if they notice any concerning symptoms.

“Routine pediatric health care has really been affected by COVID,” Lloyd says. “Parents should work with primary care providers to make sure their children are still getting important routine care and that health concerns are being addressed in a safe environment.” 


More information on Vaping

Leading The News
Vitamin E Acetate Is A “Very Strong Culprit” In Vaping-Related Illnesses, CDC Report Says
The New York Times (11/8) reported an analysis of lung fluid samples taken from 29 patients with vaping-related illness, “including two who died,” suggests that vitamin E acetate is a “very strong culprit” in causing the lung injuries. The article says that the samples were taken from patients across the US, so the findings could have implications nationwide. Dr. Anne Schuchat, the principal deputy director of the CDC, said, “For the first time, we have detected a potential toxin of concern, vitamin E acetate, from biological samples from patients.” Dr. Schuchat added that the analysis “provided evidence of vitamin E acetate at the primary site of injury in the lungs.”

The Washington Post (11/8) reported the CDC found vitamin E acetate in all 29 samples, and THC in 23 samples, including from three patients who said they had not vaped products containing THC. The CDC also found nicotine in 16 samples.

The AP (11/8) reported that vitamin E acetate was already a suspected compound, because it “was previously found in liquid from electronic cigarettes and other vaping devices used by many of those who got sick.” The article adds that more than 2,000 people have been affected by vaping-related lung injuries, and at least 40 have died.

On its website, CNN (11/8) reported that during a press briefing, Dr. James Pirkle of the CDC said that vitamin E acetate is “enormously sticky” in the lungs, so it “does hang around.” Dr. Pirkle also said that the presence of THC in so many of the samples was “noteworthy,” because that chemical tends to leave the lungs quickly


Before grabbing a grapefruit, understand its power

By American Heart Association News

This story is part of Eat It or Leave It?, a series that provides a closer look at the pros and cons associated with certain foods and drinks – and cooking options if you decide to eat them.

Grapefruit looks sweet and friendly, but you might have heard it possesses powers far beyond those of ordinary produce.

Some of that reputation is fact, and some is myth.

Facts first: According to the U.S. Department of Agriculture, half a medium grapefruit has only 41 calories and nearly half a day's recommended supply of vitamin C.

"In addition, it's a reasonable source of potassium," which is important for maintaining healthy blood pressure, said Karen Collins, a registered dietitian in western New York who specializes in cancer prevention and heart health.

Grapefruit also is laden with natural plant compounds called phytochemicals, specifically flavonoids, which studies show can help fight stroke and heart disease. Pink and red grapefruit are good sources of beta carotene (a source of vitamin A) and lycopene, an antioxidant "cousin" to beta carotene that has been linked to lower stroke risk. One cup of red or pink grapefruit sections has as much lycopene as a medium 4-ounce tomato.

That's all good. But grapefruit's reputation for interfering with some medications is well-deserved.

It particularly affects certain anti-cholesterol statin drugs, as well as some medicines used to treat high blood pressure, irregular heartbeats and even allergies. Grapefruit and grapefruit juice can cause too much or too little of a drug to stay in the body. Too much drug increases the risk of side effects; too little means the drug may not work as well.

If you enjoy grapefruit or grapefruit juice and take such medications, there's no need to panic, Collins said. But talk with your pharmacist or health care provider to clarify what's safe. They might be able to switch your prescription to something unaffected by grapefruit, or even advise you to simply watch the timing of when you eat it.

In the past, grapefruit has been the very symbol of a "diet" food. Here's where its reputation drifts into the realm of fable.

"The things that are not true are that grapefruit has some kind of magical power, or contains some kind of fat-burning enzyme, that you're going to eat it and burn calories while you're sleeping," Collins said. Studies have found grapefruit provides no special boost to weight loss.

Even so, grapefruit's tartness encourages people not to gulp it in a rush but to slow down, letting them feel full with relatively few calories, "and that is exactly an approach that research does support as the kind of eating pattern that helps people reach and maintain a healthy weight," Collins said.

The classic way to enjoy grapefruit – splitting it and eating with a spoon – is OK, she said. (Be sure to rinse it before you cut: Otherwise, the knife might push bacteria on the skin through the entire fruit.)

But if you peel it like an orange and eat it by the section, you get added benefits from the membranes.

"Those membranes are rich in a type of dietary fiber called pectin, which is what we would call a viscous fiber," Collins said. "And that is the type of fiber that can help lower (bad) LDL cholesterol and seems to be what they call a prebiotic that helps to nurture the healthy bacteria in our gut."

For the best flavor, don't chill it.

"It's actually recommended that if you're going to be eating grapefruit within the week to just store it at room temperature," she said. It can keep for several weeks in the refrigerator, but it will taste better if you let it return to room temperature before serving.

She recommends trying it in a salsa, with chopped bell peppers and cilantro. "That adds a really nice, very crisp and refreshing kind of flavor like, say, on fish." She also thinks the sections work great on a green salad. "You can combine it with avocado, and that's kind of a classic."

And if you're in the habit of taking it with a sprinkling of salt or sugar?

First, she suggests, try it plain. "The grapefruit of today is really not necessarily the grapefruit of 30 years ago, and many of them don't have as bitter a taste."

Although most Americans already consume too much sodium and sugar, a tiny sprinkle of salt on half a grapefruit or a bit of brown sugar on a slice you stick under the broiler is "a drop in the bucket" compared with other choices you could make, Collins said.

"If you're saying a quarter of a teaspoon of sugar makes it so you enjoy that grapefruit compared to a doughnut that has eight teaspoons of sugar in it, I would take the grapefruit."

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