The latest medical mystery surrounding the novel coronavirus’s impact on children has arrived in the District.
Kawasaki disease — which causes swollen hands and feet, a rash, red eyes, and fever — has appeared recently in two covid-19 patients at Children’s National Hospital, according to Michael Bell, the hospital’s chief of critical care medicine.
Kawasaki disease “has been an enigma for several decades, but every pediatrician sees it a few times a year, so it’s not that uncommon,” Bell said. “But what’s uncommon now is with these patients coming in after being exposed to [the coronavirus], we’re seeing a much more severe form of it where people actually have Kawasaki disease as well as additional symptoms like shock.”
In some patients suffering from Kawasaki disease, the condition can cause inflammation of coronary arteries, leading to a greater risk of blood clots, aneurysms, and other heart damage. Doctors typically only see Kawasaki disease in children, and the causes of the condition remain unknown.
The presence of Kawasaki-like symptoms among covid-19 patients has only underscored the need for more careful scrutiny of how the coronavirus is manifesting itself in children, Bell said. Earlier this month, both the Centers for Disease Control and Prevention and the American Heart Association alerted health-care providers about the condition’s possible ties to the virus.
Medical professionals initially believed the novel coronavirus did not affect children as much as older adults as the pandemic began sweeping through the United States. Statistics continue to show most children who contract the virus do not face serious harm or even present serious symptoms.
But the actual hospitalization numbers from American health facilities — including from Children’s National — suggest the virus’s impact on children could be greater than initially thought. Between March 15 and April 22, the hospital saw 105 children who were sick with covid-19. Twenty-eight required hospitalization.
The patients who arrived at Children’s National came with symptoms of the virus — but as the doctors looked closer, they saw additional red flags pointing to Kawasaki.
“The first kid that came in here was at the exact right age — around 5 years of age,” Bell said. “He had classic symptoms of a rash, [swollen] lymph nodes, cracked lips, swollen tongue. And if covid was not involved at all, we would have just said he had Kawasaki and that was it. But he tested positive for covid in his first day here.”
Unlike usual covid-19 patients, the 5-year-old was suffering from a “tremendous amount of shock,” Bell said.
“His heart was in failure when he got to us. He needed a lot of therapy to get over that. He’s doing quite well now but it took three or four days of intensive work to get him into the right state.”
Children’s National’s second patient with the condition was about 9 years old, according to Bell. Although his symptoms were less severe than the other patient’s, Bell said, “he also had the heart abnormalities and his coronary arteries were also dilated, so we’re concerned about him.”
Bell said he and other doctors at Children’s National have been keeping tabs on the condition as other cities report similar patients.
“There’s probably 20 to 30 cases abroad that have been very well-described and now cases in New York City that have been described,” he said. “Someone called in from Kentucky just this past afternoon saying they have the exact same case that we have here. So I think it’s traveling around with the virus and we’re going to see more and more of it.”
