Scientists urge caution after NHS warning of coronavirus-related syndrome emerging in children
Scientists have said more evidence is needed before we can draw any conclusions from reports that a coronavirus-related syndrome could be emerging in children that leaves them in intensive care.
An “urgent warning” from a paediatric intensive care charity and NHS Trust warned doctors to be aware of the condition.
NHS England is reported to have sent the letter warning of an “apparent rise” in admissions of children to intensive care as a result of the condition.
According to the Paediatric Intensive Care Society (PICS), the letter says: “In the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK.”
It adds: “There is a growing concern that a [COVID-19-] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”
PICS shared the statement on Twitter and asked its followers to “please share widely”.
*Urgent alert*
Rising no of cases presenting to #PedsICU with multi-system hyperinflammatory state, overlapping features of toxic shock syndrome & atypical Kawasaki disease, bloods consistent with severe #COVID19 - seen in both #SARSCoV2 PCR +ve AND -ve
Please share widely pic.twitter.com/Bj6YHLJ8zi— PICSUK (@PICSociety) April 26, 2020
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Little is known so far about the condition, or how widespread it has been, but the number of children affected is thought to be very small.
But in a statement prepared for Yahoo News UK, Professor Simon Kenny, NHS national clinical director for children and young people, said: “Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to COVID-19, but it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.
“The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.”
The NHS England statement was also reported by the Health Service Journal (HSJ), which reported on Monday morning that the North Central London NHS Trust had issued the same statement to its frontline doctors.
The journal said the syndrome has the characteristics of serious COVID-19, and that there have otherwise been “relatively few cases of serious effects or deaths from coronavirus in children”.
Many more adults than children have suffered serious illness as a result of coronavirus, but the letter was still considered worthy of “urgent action” by the trust.
According to the HSJ, it said: “Please refer children presenting with these symptoms as a matter of urgency.”
The statement also added: “The cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki Disease with blood parameters consistent with severe COVID-19 in children.
“Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation.
“This has been observed in children with confirmed PCR positive SARS-CoV-2 infection as well as children who are PCR negative. Serological evidence of possible preceding SARS-CoV-2 infection has also been observed.”
The warning was reiterated by Jeremy Farrar, director of the Wellcome Trust and a member of the Sage scientific advisory board that is providing advice to government decision-makers during the pandemic.
He called the alert “really important” and asked his 36,000 followers to share the news.
A really important alert from @PICSociety in UK - can @ProMED_mail share widely?
— Jeremy Farrar (@JeremyFarrar) April 27, 2020
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, said: "We already know that a very small number of children can become severely ill with COVID-19 but this is very rare – evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection.
"New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.
"Please do consider that the absolute number of those cases are very low (a handful at the moment). The call to ask if other colleagues have comparable experiences over the last week is so we are able to define what is going on, and if there is reason for additional assessment into this.”
Dr James Gill, honorary clinical lecturer at Warwick Medical School and a locum GP, said on Monday: “A new alert has been raised about a signal, a notable change, marking an increase in children being admitted to hospital with a ‘multi-system inflammatory state’.
“A clinical signal does not mean there is a new finding, it does however work as an alter to clinicians to be vigilant in case there is anything substantive behind that signal. This cannot be stressed enough.
“Regardless of source, multi-system inflammatory diseases are exceptionally serious for children and already stretched intensive care teams, so keeping an extra eye out for new symptoms arising in the patients we see if always a good thing.
“Whilst it is easy to draw conclusions suggestive of a connection with COVID1-9 there is not sufficient evidence to substantiate that the signal has any clinical significance.”
News of the syndrome comes as Boris Johnson warned of a “huge loss of life” if lockdown is lifted too soon, in his first public appearance since recovering from coronavirus.
Children are believed to be generally at very low risk from the effects of COVID-19. Education secretary Gavin Williamson has refused to say when schools will be reopened – some ministers had suggested opening by mid-May but it is now expected that restrictions on all but essential movement will still be in place for several weeks.
In Scotland, Nicola Sturgeon has suggested that people could meet small “bubbles” of friends during lockdown but Johnson has urged Britons to continue observing lockdown measures after many breached the rules at the weekend and travelled to beauty spots to enjoy the sunshine.
