In short
As cases of COVID-19 increase in adults, so do children, along with cases of a new inflammatory syndrome. Also like the adult population, Latin children have borne a disproportionate share of cases.
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At least seven California children have died of COVID-19 since the pandemic began, more than 350,000 children have tested positive for the virus and the number of children diagnosed with a rare new inflammatory syndrome continues to spread.
All of these statistics are increasing while a new highly contagious strain of the virus is worrying parents and experts and as the state is trying to reopen schools next month.
“We are at a critical juncture because the overall number of COVID cases is soaring,” said Dr. Jackie Szmuszkovicz, a pediatric cardiologist at Children’s Hospital in Los Angeles. “We are seeing more children with MIS-C in the last few weeks after this huge increase (in cases) in the community.”
MIS-C, or multisystemic inflammatory syndrome in children, is the name of a new inflammatory syndrome that affects a small number of children three to six weeks after they have experienced the coronavirus, even if they have mild symptoms or no symptoms at all.
Although children have been spared some of the worst effects of coronavirus and the high mortality rate seen among adults, young people in California are still at risk, especially due to the current increase. Children usually have mild symptoms or no symptoms of the infection, but it is what happens to a small number of them a few weeks later that worries doctors. Pediatricians are preparing for a wave of inflammatory syndrome cases three to six weeks after the current increase, especially with the new, more communicable variant, said Szmuszkovicz.
Children get sick
Although severe COVID-19 is uncommon in children, there has been a small increase in more severe cases recently, said Dr. Erica Lawson, a pediatric rheumatologist at UCSF Benioff Children’s Hospital in San Francisco.
“We are seeing more children on the other side of the curve, who are sick enough to be hospitalized,” she said. “It is because of the larger numbers in the community. If you have a prevalence in the community, the more cases you have, the more serious cases you will have. “
Dr. Behnoosh Afghani, a pediatric infectious disease specialist at UCI Health in Orange County, hopes that the spread of the vaccine will begin to decrease the number of infections in adults and therefore also contribute to fewer infections among children. Although children under 16 cannot be vaccinated, if more adults around them are vaccinated, it will increase protection for children, she said.
The California Department of Public Health reports that at least six minors have died of COVID-19 since the pandemic began. At least one more child died in Southern California, at Children’s Hospital in Los Angeles, which has not yet been counted in the state.
The state does not identify which of the children had the inflammatory syndrome and how many had COVID-19 at the time of death. Nor is it releasing information about where they lived or their ages, although there was one confirmed death in Orange County, one in Central Valley and two in Los Angeles.
A rare post-COVID syndrome is affecting children
MIS-C, the rare inflammatory syndrome, was discovered last year in children who had previously had coronavirus. Originally, it was thought to be Kawasaki’s disease, a post-infection syndrome that afflicts young children, but doctors connected the new syndrome to COVID-19. It is marked by an overwhelming inflammation in the body that sometimes affects important organs and can lead to heart failure. Children develop fever, some have abdominal pain, vomiting or diarrhea, skin rash, are severely fatigued and have red eyes.
So far, 176 children in California have been diagnosed with the inflammatory syndrome.
“These children develop a lot of inflammation in the bloodstream and can have several affected organ systems, including the heart,” said Lawson. The San Francisco hospital and its Oakland campus have treated about 20 children with the syndrome so far, but there have been no deaths, she said. Most children are Latin.
Across the state, Latino children account for 64% of COVID-19 cases among children under 18, where race and ethnicity are known, but represent only 48% of children in the state, according to the Department of Public Health of State.
Lawson argues that childhood cases reflect what is happening to adults. In California, Latinos account for 54% of cases among adults. Most of the time, they are essential workers – such as drivers, restaurant cooks and grocery workers – and sometimes live together in conditions of overcrowding with relatives or other family groups where it is difficult to isolate.
Nationally, racial and ethnic trend lines among children also reflect adults, according to the Centers for Disease Control and Prevention. Most children in the United States who have been diagnosed with the infection and the inflammatory syndrome are Latin or black.
As of January 8, there were 1,659 cases of MIS-C in the US among children and 26 deaths. The average age is 8 years and more than 70% of the cases occurred in Latin or black children, according to the federal agency.
Pediatric specialists advise parents to be aware of signs of MIS-C a few weeks after their children become ill with the virus. Some families may not realize that their children have the virus until they show signs of the syndrome, said Szmuszkovicz.
“We really want to encourage people not to delay care because we are seeing that early treatment leads to the best results,” she said. “In some cases, the syndrome can, in its most severe form, affect cardiac function and cause coronary aneurysm.”
Los Angeles Children’s Hospital cares for the largest group of affected children – at least 51 so far – aged 4 to 17 years. Two children died, one in December and one in January, according to the hospital. The hospital did not release any other information about the children due to the patient’s privacy.
Treatment for MIS-C appears to work well if given early, she said. Most children receive IV fluids and others also need medications such as steroids and intravenous immunoglobulin, while some will need respiratory support, oxygen to a ventilator.
“In some cases, the syndrome can, in its most severe form, affect cardiac function and cause coronary aneurysm.”
Dr. Jackie Szmuszkovicz, pediatric cardiologist at Children’s Hospital Los Angeles
In Los Angeles, Alexis Winter has an eye on her two daughters. Her entire family, including her 3-year-old, 14-month-old son, had COVID-19 last month.
“It’s scary and I try not to be obsessed with it,” said Winter, noting that her children have been almost a month old since the infection.
She said she does not know how the family got the infection and that they were very careful not to interact with other people because Winters is at high risk.
It all started with her husband and then Winter and the children got sick. Her daughter, 3, vomited in bed and did not feel well the next day. So, her baby was super agitated and had a hoarse voice. None of the girls had a fever, she said.
“For children, complications do not outweigh the risk,” she said. “If I could go back in time and find out what happened, I would do it. Because it is scary to know that they had the virus and were exposed to it. “
Is the new variant more dangerous for children?
As more children catch the virus, pediatricians carefully look for the new, more communicable variant found for the first time in the UK. The variant, known as B117, arrived in California last month and a study suggests it is more contagious and affects younger people. But Imperial College officials who published the study said more research was needed.
Meanwhile, a second variant, this one from Denmark, has also been found responsible for an outbreak in the bay area in recent days. There is little information about the Danish variant and children.
Pediatric doctors say that even though the new UK variant does not affect children in the same way that it affects adults, they expect more children to become ill.
“If it’s more contagious in general, then more kids will get it too,” said Lawson. “Children get COVID – they just don’t get too sick. If the new strain is more transmissible in humans, it is highly likely that more children will contract it. “
And that means more cases of inflammatory syndrome in a few weeks, said Szmuszkovicz.
“We have to be open-minded and very vigilant and be ready for everything that comes,” she said.
The UK variant appeared at the Golden State just as Governor Gavin Newsom announced incentives to bring elementary students back to campus in February.
“Children get COVID, but they don’t get too sick. If the new strain is more transmissible in humans, it is highly likely that more children will contract it. “
Dr. Erica Lawson, pediatric rheumatologist at UCSF Benioff Children’s Hospital in San Francisco
Is it time for the school to reopen?
Afghani, from UCI Health, said that returning to school is essential for children’s health, but “at the same time, we must be cautious until we see a marked decrease in the incidence of the disease.”
Lawson said the school is important and points to schools that have remained open or reopened with security procedures in place.
“Children are really suffering at home and families are suffering without the possibility for children to go to school,” she said. “I think that for the health of our communities, the mental health of our children and the priorities of parents, it can be done and it must be done safely.”
But, she acknowledged that if the new strain causes outbreaks among children, then things need to change again.
When the state determines that children can go back to school, said Szmuszkovicz, everyone must follow the rules.
“We all want kids back together with other kids and learning at school,” said Dr. Jackie. “To get to that point safely, each of us individually will do what we can to prevent the spread of COVID in the community.”
Gian Schwehr, a mother from Los Angeles, said she is not sure if she would send her 10-year-old son back to school, even though the family had COVID-19 for Christmas. Her symptoms lasted about 24 hours.
Schwehr said that while her son already has the virus, she doesn’t want to put him in a situation where he can be around other people who have it, especially if the new variant makes it easier for children to catch it.
“I would have to think about it,” she said. “If he hadn’t, I wouldn’t have sent him. There is definitely no easy choice. “
An earlier version of this story incorrectly stated the timing of some of the deaths at Children’s Hospital in Los Angeles.
CalMatters’ coverage of early childhood issues is supported by grants from First 5 Los Angeles and The Ralph M. Parsons Foundation.