Although the recent surge in COVID-19 cases fueled by the omicron variant has receded, Texas physicians continue to see a steady stream of patients with multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition that is associated with the virus and can be difficult to diagnose and treat.
Donald Murphey, MD, a pediatric infection disease specialist at Dell Children’s Medical Center in Austin and a member of the Texas Medical Association’s COVID-19 Task Force, treated three children with MIS-C during the last week of February alone.
“If you’re in a children’s clinic, emergency department, or hospital in Texas, then you are seeing children with MIS-C,” he said.
MIS-C causes different body parts – including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs – to become inflamed, with symptoms typically occurring two to six weeks after a COVID-19 infection, according to the Centers for Disease Control and Prevention (CDC).
As of Feb. 28, the Texas Department of State Health Services (DSHS) has confirmed 418 MIS-C cases since the onset of the COVID-19 pandemic, according to a spokesperson. DSHS last updated the number of MIS-C cases confirmed in Texas on Nov. 4, when there were 282. The spokesperson attributed the months-long gap to the time it takes to investigate and confirm MIS-C cases, adding that DSHS expects to provide updates in the future.
Dr. Murphey suspects MIS-C is underreported in Texas because it is difficult to diagnose and confirm, sometimes presenting similarly to other illnesses, including Kawasaki disease, appendicitis, and sepsis. “I would love to stop worrying and puzzling over every kid with fever, wondering, ‘Do they have MIS-C?’” he said.
Lynn Thoreson, DO, a pediatric hospitalist at Dell Children’s, echoes this concern.
“For every child that we confirm the diagnosis of MIS-C, we probably have done the evaluation workup on two or three other children at the same time,” she said, adding that such lab work and tests are taxing on families and on the health care system.
MIS-C also may be more common than the confirmed caseload indicates. A recent study published by JAMA Pediatrics found that during winter 2020-21, there was one MIS-C hospitalization among children aged 5 to 11 for every COVID-19 hospitalization.
Treating MIS-C patients can prove complicated. In the most severe cases, children develop inflammation of the heart muscle and experience precipitous drops in blood pressure, which can require lengthy hospital stays. “Your heart is suddenly not working,” Dr. Murphey said. “You’re in heart failure.”
Fortunately, most MIS-C patients make a full recovery. But Dr. Murphey warns even a mild case of COVID-19 can land a child in the intensive care unit with MIS-C and on blood pressure medication, straining an already overburdened health care system. “None of it’s good,” he said.
DSHS has reported four MIS-C deaths as of Feb. 28. “We certainly can’t tell parents that the death rate is zero,” Dr. Thoreson said, adding that this enacts a mental health toll for patients and their families, in addition to the financial toll of treatment.
Because the vast majority of MIS-C cases – 98%, according to CDC – are diagnosed in children who have tested positive for COVID-19, Dr. Murphey says the same prevention tactics used to mitigate exposure to the virus, such as masking and getting vaccinated and boosted, will help mitigate MIS-C.
A recent study published by the U.S. Department of Health and Human Services found two doses of the Pfizer vaccine were 91% effective at preventing MIS-C in children aged 12 to 18.
“What I would hope is that people are aware that there is risk of MIS-C,” Dr. Murphey said. “Kids should get fully vaccinated to prevent COVID-19 and MIS-C.”
Emma Freer
Associate Editor
(512) 370-1383