What is Kawasaki disease, and how is it related to COVID-19?
Doctors explain what you need to know about the mysterious, potentially coronavirus-related illness.
In the midst of this global coronavirus pandemic, people have plenty to worry about. Recent news of a mysterious and dangerous disease that may be linked with COVID-19 — the disease caused by the novel coronavirus — has only added to that worry. While fear of a multi-system inflammatory syndrome was first reported in the United Kingdom, the disease — which resembles another illness known as Kawasaki disease — is mounting intensely in the United States. As of May 12, 2020, at least 52 children in New York City alone were reported to have the rare but serious illness, while nearly 100 children have been diagnosed with the newly-identified syndrome across the US. On May 4, 2020, the New York City Health Department reported that 15 cases had been identified in children aged 2 to 15 in New York City hospitals, some of whom tested positive for COVID-19. Cases have also been noted in Italy, France and Spain. A nine-year-old boy in France and an eight-month-old baby in the UK have died of the puzzling inflammatory condition seemingly linked to the coronavirus, which has sickened about 230 children in Europe, and killed at least three children in the US.
While the statistics may sound scary, we spoke with a pediatrician and a virologist familiar with this disease to learn more about it, and help you replace fear with facts.
What is Kawasaki disease?
According to the Mayo Clinic, Kawasaki disease, sometimes called mucocutaneous lymph node syndrome, "causes swelling in the walls of medium-sized arteries throughout the body." While it is treatable, and most children fully recover without any lasting damage, it is considered dangerous, because "it is the leading cause of acquired heart disease in children." Dr Prashant Nagpal, a Mumbai-based paediatrician says, "Kawasaki disease is typically seen in children aged 2 to 12 years old, but is more common in children less than 5." In regards to the recently documented cases, Dr Nagpal says, "What we are seeing now in parts of Europe and the US is more than just typical Kawasaki disease, because of the very high percentage of the reported children requiring ICU admission for blood pressure support and mechanical ventilation."
What are the symptoms of Kawasaki disease?
"The first sign is a high fever and blotchy red rash, which lasts for at least five days or more. This is often accompanied by extreme fussiness or irritability," says Dr Nagpal. He went on to add, "As the disease progresses, you might see red eyes, red and cracked lips, bright strawberry like tongue, and swelling in the hands and feet." If you notice any of these symptoms, whether or not your child had a confirmed case of COVID-19 infection, Dr Nagpal recommends that you talk to your child's physician. "If parents note that their child has a fever and a significant rash, they should contact their physician by phone to further discuss the situation," he says.
How is Kawasaki disease linked with COVID-19?
According to the above-mentioned New York City Health Department report, of the 15 recent cases of a Kawasaki-like disease, four were found to be positive for the coronavirus via nasal swab testing, while the rest were negative. When the 10 negative cases were given an antibody blood test, however, six came back positive. Pune-based virologist, Dr Abhay Singh also acknowledges the link, saying, "This suggests that this is an immune-mediated reaction occurring during recovery from the virus. As a scientific community we have been stumped by Kawasaki disease for some time, but suspected that it was triggered by viruses." He added that Kawasaki disease can occur after common cold viruses, "so it's not surprising that we are seeing cases after a COVID-19 infection." Basically, it often occurs after the body recovers from a virus — meaning Kawasaki disease appearing after a bout of COVID-19 is not a new behaviour of the disease, explains Dr Singh.
What is the treatment for Kawasaki disease?
Kawasaki disease is typically treated with "IVIG, an intravenous infusion, which is basically pooled antibody from many donors," Dr Singh says. "This calms the inflammation of the small and medium blood vessels, and can prevent long-term complications from Kawasaki disease, most importantly damage to the coronary arteries that supply the heart muscle with oxygen." What's notable about these recent reports, according to Dr Singh, is the rate of ICU admission. In one study from October 2004 to October 2014, of the 1,065 patients with Kawasaki disease, only 30 were admitted to the ICU. Of the 15 cases in New York more than half required blood pressure support, and five required mechanical ventilation.
Should parents be worried about Kawasaki disease?
"Kawasaki disease is not a very common condition with an incidence of less than 25 cases for every 100,000 children," Dr Nagpal says. Dr Singh added, "The biggest and most urgent unknown is determining the lag between COVID-19 exposure and presenting with this new syndrome. If it's long we may see many more cases, but if it's shorter or more variable, we may not, and this case cluster may be occurring due to the high number of Kawasaki disease cases in certain cities." A breeding ground for coronavirus infections, New York is the worst hit city by the coronavirus with more than 3,55,000 cases, and about 28,200 deaths, as of May 17.
While the symptoms and severity of this illness are concerning, typical Kawasaki disease is a rare condition; hence, Dr Nagpal doesn't want parents to panic. "If your child already had the coronavirus, there would be a 99.9 per cent chance they do not develop this (Kawasaki disease-like) complication, and it is treatable with appropriate care," he says. As always, if you have questions or concerns about your child's health, you should speak with your child's pediatrician. We aim to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out the resources from the World Health Organization, the Ministry of Health and Family Welfare, local public health departments, and trustworthy news sources.