COVID and Kids

This week's guest columnist is Dr. Mai Vu, a Family Practice resident at the University Hospital and Clinics here in Lafayette. A 16 year-old boy came in with three days of fever, vomiting, and diarrhea. He didn't have anything left to throw up- he could only dry heave; but he still managed six bouts of diarrhea that morning. His blood pressure was down and he looked beat. You'd think he had dehydration with a bad bout of stomach virus, except his eyeballs were red? Could this be COVID? After his first liter of IV fluid, he perked up.  He sat up, smiled, and even his lips were less cracked. An hour later he was back down, pale, tired, with borderline blood pressure. Despite receiving two more liters, he quit rallying. While his COVID PCR came back negative, his antibody test was positive. This means he wasn't shedding Coronavirus now, but had antibodies to previous infection. Mom confirmed that after Christmas he was with cousins who tested positive. He hadn't had symptoms like fever back then, but many kids don't with their initial infection. He was our first case of Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is a rare complication of Coronavirus. Many elderly and sickly adults get rampant inflammation from their infections- in their lungs, hearts, kidneys, and just about any other organ. They have respiratory failure, heart attacks, and spend weeks in ICU. Kids don't have these problems, except a rare few like our boy. Something about COVID irritates the immune system after the main infection, and while you've recovered from the initial bout, your immunity goes haywire against your own body. Besides his eyeballs, our patient had heart inflammation, called myocarditis, which  affected it's ability to pump blood.  Hence his low blood pressure. It also attacked his GI system, causing all that vomiting and diarrhea. MIS-C is diagnosed when the child has fever, looks really sick, and inflammation in two or more organ systems; our patient's inflammation blood tests were sky high. He spent 3 days in the ICU for blood pressure support, immunoglobin therapy, steroids, and more fluids, and eventually got better. A 14 year-old female came in last week after feeling tired for 2 days. She had fever, headache, and cough. Though she denied sick contacts, she had been in school and out shopping. She had also attended a family reunion. Given all those exposures, we weren't surprised when her COVID test came back positive. Dad wasn't happy she caught Coronavirus, but since he had also attended the reunion, he had no moral high ground to stand on! Though few kids get severe disease like our 16 year-old boy from above, they can still get sick and pass the virus to others, including older loved ones. As of February, the CDC reported only 204 deaths in ages 0-17 years. Those above 50 years-old make up 95% of deaths. COVID is now the leading cause of death in the US; heart disease second, cancer third. Other bad things about Coronavirus: our 16 year-old from above had myocarditis. A competitive athlete, his weakened heart put him out of sports for at least 6 months. Though he was likely to regain his strength, that wasn't guaranteed. Also, kids with "regular" COVID like our 14 year-old are out of school and sports for two weeks. Those restrictions were terribly disheartening for our two patients. A second problem is delayed procedures for positive patients. This affects adults who need diagnostic and therapeutic interventions for heart disease and cancer. It also impacted a teenager with lymphoma- he had swollen lymph glands, night sweats, and terrible pain. He needed chemotherapy to shrink his cancer and relieve the pain.  However, he couldn't start chemo without a biopsy to identify the cancer and choose the best regimen. And he couldn't have the biopsy because he was COVID positive, and anesthesia would expose the OR team to his virus. He was finally admitted to the hospital when his pain couldn't be controlled at home, and eventually got his biopsy. Though states, parishes, and towns are easing restrictions, don't you and your family!  Continue mask-wearing and distancing, particularly with the advent of more highly contagious variants. No teens going on spring break! The end of the Pandemic is near, if we can all hang in there a little longer.