NEW YORK — City leaders raised alarms Tuesday about a rare illness among children that is potentially associated with coronavirus, after fifteen kids were admitted to New York City’s pediatric intensive care units showing symptoms.
“We’ve put out a health alert letting health care providers know that if they see incidents of this new condition that we want to make sure it’s reported immediately to our health department so that we can identify what’s going on, how extensive it is and deal with it,” Mayor Bill de Blasio told reporters Tuesday morning.
The city health department issued guidance on the condition Monday night.
The kids, ages 2 to 15, reported illnesses compatible with multi-system inflammatory syndrome — which have also been reported in young people in the U.K. and some European countries. The symptoms are in line with Kawasaki disease, a rare disorder that inflames the blood vessels and could cause swelling in the hands and feet, among other issues.
The city’s guidance comes after assurances from city officials that the coronavirus does not have as harsh an effect on children as adults. Doctors have begun to report the new cases in recent weeks and acknowledge it’s a mystery.
“What we’re seeing in the last few weeks, as the total number of cases grow, people are starting to see the manifestations of the disease,” Dr. Adam Ratner, director of NYU Langone’s Division of Pediatric Infectious Diseases, told POLITICO. “We’re getting to that point now, particularly in pediatrics, which has a wide spectrum of disease, that’s just starting to be described.”
The association between Kawasaki disease and Covid-19 is “something we see in pediatrics and we don’t have a handle on,” he added.
Hassenfeld Children’s Hospital at NYU Langone has a “small handful” of cases, as does Mount Sinai, where NBC New York first reported the uptick in cases on Saturday. Northwell Health said it did not have any cases.
“All patients had subjective or measured fever and more than half reported rash, abdominal pain, vomiting or diarrhea,” wrote Dr. Demetre Daskalakis, deputy commissioner for the city health department’s Division of Disease Control, in the Monday night guidance.
A third of the 15 kids required ventilation, and no deaths have been reported, according to the city health department.
Some of the children and teens who have been admitted for the inflammatory symptoms between April 17 and May 1 tested positive for Covid-19, though not all — a vexing detail for epidemiologists and doctors.
“That speaks to this being one of a variety of triggers [for Kawasaki disease],” Ratner said of Covid-19. “We don’t understand the ways the disease presents in children.”
Health Commissioner Oxiris Barbot said she herself has treated Kawasaki disease as a pediatrician.
“Generally children present with prolonged high fevers — several days of very high fevers,” she said Tuesday. “They can also have very red eyes, very brightly colored lips, and then one of the hallmarks that we see is what we call a strawberry tongue, which means their tongue is very bright and red.”
Barbot said pediatricians may not have been immediately connecting the outbreak to the coronavirus.
“When you have a syndrome that’s not very common in the context of a worldwide pandemic there are situations where pediatricians may not be thinking, ‘Oh this could be an atypical manifestation of what’s going on,” she said. “When we got the question from [NBC reporter Melissa Russo] I directed my staff to reach out to all of the pediatric providers to say are you seeing these types of symptoms coming in in children.”
When some responded they were, the city decided to issue the guidance.
Typically, Kawasaki disease can be effectively treated, Barbot said. Left untreated, she warned it could have “long-term consequences most commonly related to ongoing heart problems.”
Barbot also pressed doctors to report any suspected instances of the disease to the health department immediately.
“In public health oftentimes we say that outbreaks are made or broken by astute clinicians that are paying attention in clinical settings,” she said. “We’re still learning everyday about how Covid-19 behaves.”