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100 Brit kids with coronavirus-linked ‘Kawasaki disease are tip of the iceberg – as it peaks weeks after Covid’
UP to 100 children in the UK have contracted "coronavirus-linked Kawasaki disease" - but this is only the "tip of the iceberg", an expert has warned.
The youngsters - who were mostly aged between five and 16 - had become seriously unwell weeks after possibly being infected with Covid-19.
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The NHS first alerted doctors about a spike in kids being admitted to intensive care with a mysterious new life-threatening inflammatory syndrome last month.
Since then, experts have been frantically carrying out research to understand the condition - thought to have affected between 75 and 100 children in the UK, including a 14-year-old boy who has died.
Dr Liz Whittaker, a clinical lecturer in paediatric infectious diseases and immunology at Imperial College London, warned the cases seen so far may just be the tip of the iceberg.
She also said that, from data gathered in just two weeks, it appears the peak of the new syndrome is following behind the peak of Covid-19 by about two to three weeks.
Steep rise in cases of rare 'Kawasaki-like disease in kids linked to Covid-19' in Northern Italy
NORTHERN Italy has reported a 30-fold rises in cases of the Kawasaki-like disease in one of the worst-affected coronavirus regions.
A new study found ten children between February 18 and April 20 had a syndrome similar to the inflammatory disease, which causes rashes, red eyes and a red mouth, as well as a fever.
This is compared to the 19 children who had been diagnosed with the condition in that area in the five years up to the middle of February 2020.
Experts say the findings, published in The Lancet, are the "first clear evidence of a link" between the syndrome and coronavirus.
All of the children in the study survived, but those who fell ill during the pandemic had more severe symptoms.
These included heart complications and signs of toxic shock syndrome.
The average age of kids with the condition were also older - aged around seven-and-a-half rather than three.
Dr Lorenzo D’Antiga, who led the research at the Hospital Papa Giovanni XXIII in Bergamo, said: “We are starting to see case reports of children presenting at hospital with signs of Kawasaki Disease in other areas hit hard by the Covid-19 pandemic, including New York and South East England.
“Our study provides the first clear evidence of a link between SARS-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus.”
The UK’s leading child doctor, Professor Russell Viner, said the study could provide vital information about the immune response to coronavirus.
Speaking at a science media briefing, Dr Whittaker said: "The likelihood is that it’s an iceberg, where the very tip of the cohort that we see above the water is the very sick children and there might be other children below the water that we are only picking up now.
"One of the things that is quite interesting is that the peak that we’re seeing in these children is several weeks after the peak of Covid-19 across the country.
"We estimate in London that the peak of Covid-19 was around the first to the second week in April, whereas we think we saw the peak of these children last week and this week.
"The feeling amongst my colleagues is that the numbers are starting to drop down a little bit now hopefully."
Dr Whittaker said that most of the children tested negative for Covid-19, but all of them had positive antibodies to the virus.
She suggested that this could indicate that some children are having a delayed response to the virus several weeks after being infected - which is why it's not being picked up in tests.
"We’ve called it paediatric inflammatory multi-system syndrome, which is temporarily associated with SARS-CoV-2," she said.
"We’re very careful to do that because we can’t definitely say that every single child has Covid at the time they’re unwell.
"But this new phenomenon is happening in the middle of a pandemic so it seems pretty reasonable to suggest that the two things are related."
This new phenomenon is happening in the middle of a pandemic so it's reasonable to suggest that they're related
Dr Liz Whittaker
Dr Whittaker, who has personally treated children with these cases, told reporters that medics in London first started to see cases emerging at the end of April.
She said: "We saw these children who were coming in - some of whom were seriously unwell and were requiring critical care.
"We recognised a pattern in their presentation, but also in a blood test that was similar to some of the adults who were admitted with Covid.
Signs of new 'Covid-linked' paediatric inflammatory multi-system syndrome
Based on the early data available, the experts found that the children who were admitted to hospital had similar symptoms to Kawasaki disease, which include:
- A rash
- Swollen glands in the neck
- Dry, cracked lips
- Red fingers or toes
- Red eyes
Dr Liz Whittaker, of Imperial College London, who has treated some of the children noted that they also had some other symptoms.
She said: "These children are usually presenting when they’ve had high fever for a few days.
"A large proportion of them have had severe acute abdominal pain and diarrhoea and some of them have had other symptoms such as a rash and red eyes and red lips.
"A very small group of these children develop something called shock, which is where the heart is affected. Those children become very unwell they get cold hands and feet and breathe very fast.
"These are the group who need to be in intensive care and getting urgent treatment rapidly.
"Most children seem to be very unwell for four to five days, but then get better."
"We thought that it was important to determine whether it was related to Covid-19 and whether we were seeing a new phenomenon in children.
"We know that there was an alert on April 27, that came out in response to those initial eight children in South London and another about 10 in North London who were similarly affected."
Rare condition
Initially, doctors reported children were reporting with a Kawasaki-like disease - a very rare inflammatory condition typically affecting those under five.
Dr Whittaker said most of them had similar symptoms such as rashes, red eyes and a red mouth, as well as a fever.
But they were slightly older than children who typically present with Kawasaki disease - aged between five and 16.
They also didn't have any underlying conditions.
She added: "These children are usually presenting when they’ve had high fever for a few days.
"A large proportion of them have had severe acute abdominal pain and diarrhoea and some of them have had other symptoms such as a rash and red eyes and red lips.
"A very small group of these children develop something called shock, which is where the heart is affected. Those children become very unwell they get cold hands and feet and breathe very fast.
"These are the group who need to be in intensive care and getting urgent treatment rapidly.
"Most children seem to be very unwell for four to five days, but then get better."
Covid-link
Based on the limited data available, experts believe that the syndrome is linked to the coronavirus pandemic, rather than being a coincidence.
Michael Levin, a professor of paediatrics and international child health at Imperial College London, told the briefing: "The problem is clearly linked to the Covid pandemic because it's emerged as the numbers of cases of Covid increased.
"But we only started seeing these children about a month or six weeks after the cases of acute Covid, which suggests it had a different mechanism.
"The second reason to think it had a different mechanism is that most of the children were negative for the detection of the virus but positive detection of antibodies.
"We really think that the biology of the disease involves an unusual immune response to the virus."
Prof Levin added: "We seem to be seeing a spectrum ranging from critically ill children who have been admitted to intensive care units - which can be seen as perhaps the tip of the iceberg.
"Then there are children with what looks very similar to the Kawasaki disease we've known about for many years.
"Then there are a large group of children who have only some of the features of Kawasaki disease but have high fever and inflammation in their blood."
We seem to be seeing a spectrum ranging from critically ill children who have been admitted to intensive care units - which can be seen as perhaps the tip of the iceberg
Professor Michael Levin
He said that experts are desperately trying to understand more about the condition so that clinicians know the best way to treat these children.
"From the point of view of doctors trying to decide how a new disease should be diagnosed, treated and managed, we have a vast amount to learn," he said.
"I cannot think of a situation more in need of proper science than trying to work out what we should do for children who are coming into our hospitals with this condition - which we have only known about in the last two or three weeks."
Boy, 14, only known death from 'Covid-linked Kawasaki disease' in UK
A 14-year-old boy with no underlying health conditions is the only known death from the Kawasaki-like disease linked to coronavirus, an expert has said.
Dr Liz Whittaker said the teenager died after undergoing treatment on a extracorporeal membrane oxygenation (ECMO) machine for the mysterious new syndrome.
It is one of the most aggressive forms of life support and is always seen as a last resort in respiratory aid as it involves removing blood from the body.
She said that the boy suffered a fatal stroke and died.
Doctors who uncovered the disease at Evelina London Children's Hospital saw the first eight cases involving kids aged four to 14.
Two tested positive for coronavirus, including the 14-year-old who died, and four of the eight were from homes with a family member suspected or confirmed to have had the virus.
The hospital has now treated more than 40 children for the "hyper inflammatory" disease, after a "cluster" of cases was detected in south east London.
Rapid research is underway, with early data expected to be published next week.
In the meantime, doctors have urged parents to seek medical help immediately if they notice any of the symptoms.
Prof Simon Kenny, national clinical director for children and young people at NHS England, said: "The NHS has the capacity and families should be reassured that paediatricians have a widespread awareness of it."
And the country's top children's doctor has said that while parents should be aware of the illness, they do not need to be "too concerned".
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, told BBC Radio 4's Today programme: "We can count the number of children that have died with coronavirus on the fingers of two hands, compared to over 30,000 in adults. And that tells us most of what we need to know.
"This is a new syndrome. It appears to be happening mostly after coronavirus infection, we believe it's where the body's immune system overreacts to coronavirus."
He said there were "very few cases, 75 to 100 across the country", adding: "The important thing to say is most are being treated well, many are going home, most haven't gone to intensive care units."
MORE ON CORONAVIRUS
In recent weeks, parents have shared their experience after claiming their children had battled the new hyper-inflammatory syndrome.
Mum Hayley Grix told how her some Marley became very unwell with a "roaring temperature" bright red hands and feet, swollen glands and bloodshot eyes.
And another mum said her three-year-old son was reduced to a "lifeless zombie" while battling terrifying Kawasaki disease symptoms.
Chloe Knight, 22, from Edinburgh shared little Freddie Merrylees' story as the NHS issued a warning about the mysterious new "coronavirus-related" condition.
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