Doctors watch for rare COVID-19 condition in children now that cases have peaked in Alberta

A Calgary pediatrician says more children are turning up in hospital with a rare but serious condition associated with COVID-19 now that coronavirus cases have peaked in the community.

Multisystem inflammatory syndrome in children (MIS-C) can be triggered by COVID-19, causing severe inflammation in organs such as the heart and kidneys weeks after an infection. 

"[We] really did have quite a high number of children infected [with COVID-19] during our third wave — a much higher percentage of kids were part of that third wave. And as expected, we're really seeing that increase in MIS-C cases," said Dr. Michelle Bailey, a pediatrician at Alberta Children's Hospital and section president for pediatrics with the Alberta Medical Association.

Symptoms of MIS-C can include fever, rash, red eyes, abdominal pain, vomiting and diarrhea.

And while rare, cases are expected to peak about four to six weeks after a surge of COVID-19 in the community, said Bailey.

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"I think we're around that time that we should be seeing the peak of the MIS-C rate. But we can anticipate for the next several weeks that we still may be seeing … more cases than we did in January or December, perhaps," she said.

According to Alberta Health, 23 cases of MIS-C have been confirmed in Alberta since the start of the pandemic, an increase of three since April 1.

But there can be a lag time with provincial reporting due to requirements for official paperwork and the need to review each case.

Dr. Joan Robinson, an Edmonton pediatric infectious disease specialist, is studying the prevalence of MIS-C and has tracked at least 51 cases in Alberta to date, including 33 in Calgary and 18 in Edmonton. Those numbers, she cautioned, are up to date as of about two weeks ago.

"Certainly we expect to see MIS-C cases well into June and even July related to the current infections," she said.

It is difficult to know for sure just how many cases are out there, according to Robinson, because there is no definitive diagnostic test for MIS-C. Doctors combine a number of lab tests with the clinical picture to make the diagnosis. 

"It's often not possible to prove for certain that they do or do not have it because it certainly can look like many other medical problems, including many viral infections."

There are no deaths related to this condition reported in the province. 

Robinson said the condition can lead to dilation of blood vessels triggering shock. But it is treatable. 

Children can be given corticosteroids and intravenous immunoglobulin (IVIG), a blood product that contains antibodies to reduce inflammation.

"About half of these kids in Alberta have gone to the ICU. And almost always by the next day, they are dramatically better and they end up being able to go to the ward and typically go home within about six or seven days."

Both physicians are urging parents to keep an eye on their kids over the next few weeks.

"MIS-C is quite a serious disorder and those children do need to come into hospital to have treatment and management of that condition so it doesn't worsen at home," said Bailey.

"We would encourage families, if their child has more than a few days of fever, that having that checked out is really important."