Connection to rare inflammatory condition - Printable Version
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Connection to rare inflammatory condition - UltimateCard - 04-29-2020
I wonder what the medical professionals on this board make of this possible connection to Kawasaki Disease, reported by pediatricians in the U.K., Italy and now Stanford:
https://www.cnn.com/2020/04/29/health/rare-inflammatory-syndrome-us-covid-19/index.html
https://www.nytimes.com/aponline/2020/04/28/world/europe/ap-eu-virus-outbreak-kids-rare-syndrome.html
I have a personal interest since my younger son had it when he was 5; thankfully docs at UCSF caught it within the 5-day window for intervention and he doesn’t have lasting coronary problems. With the now first death reportedly due to a ruptured heart and many young adult victims experiencing strokes, this connection seems valid and alarming. There is no known cause for Kawasaki (and hence, no cure) but a massive infusion of immunoglobulin saved my son from permanent damage. Might that be an approach worth exploring with COVID-19 patients?
RE: Connection to rare inflammatory condition - akiddoc - 04-30-2020
(04-29-2020, 03:10 PM)UltimateCard Wrote: I wonder what the medical professionals on this board make of this possible connection to Kawasaki Disease, reported by pediatricians in the U.K., Italy and now Stanford:
https://www.cnn.com/2020/04/29/health/rare-inflammatory-syndrome-us-covid-19/index.html
https://www.nytimes.com/aponline/2020/04/28/world/europe/ap-eu-virus-outbreak-kids-rare-syndrome.html
I have a personal interest since my younger son had it when he was 5; thankfully docs at UCSF caught it within the 5-day window for intervention and he doesn’t have lasting coronary problems. With the now first death reportedly due to a ruptured heart and many young adult victims experiencing strokes, this connection seems valid and alarming. There is no known cause for Kawasaki (and hence, no cure) but a massive infusion of immunoglobulin saved my son from permanent damage. Might that be an approach worth exploring with COVID-19 patients?
I've only gotten 10 emails on this topic!
I think at this point we're calling it a Kawasaki's-like inflammatory process. I would not be surprised if it is exactly the same process, but unfortunately we don't really understand Kawasaki's disease in the first place. This virus seems to cause multiple inflammatory reactions. See also Chilblains. I saw a kid with Chilblains in late January. Still wondering if that was Covid-19.
https://www.usatoday.com/story/news/health/2020/04/27/coronavirus-doctors-learn-more-new-covid-19-symptom-covid-toes/3031743001/
By the way, one of the criteria for Kawasaki's is 5 days of high fever. You then get another 5 day window where treatment with immunoglobulin is thought to be effective. Obviously, we like to start treatment on that 5th day of fever if the patient meets the criteria for the disease or if there is a high index of suspicion. It seems that the earlier we treat the more likely we avoid longterm cardiac artery damage.
I've heard that immunoglobulin infusions were tried for Covid-19 even back in December in China. I don't think it has been helpful generally but it may help in specific situations - especially this one.
RE: Connection to rare inflammatory condition - UltimateCard - 04-30-2020
(04-30-2020, 02:37 AM)akiddoc Wrote:(04-29-2020, 03:10 PM)UltimateCard Wrote: I wonder what the medical professionals on this board make of this possible connection to Kawasaki Disease, reported by pediatricians in the U.K., Italy and now Stanford:
https://www.cnn.com/2020/04/29/health/rare-inflammatory-syndrome-us-covid-19/index.html
https://www.nytimes.com/aponline/2020/04/28/world/europe/ap-eu-virus-outbreak-kids-rare-syndrome.html
I have a personal interest since my younger son had it when he was 5; thankfully docs at UCSF caught it within the 5-day window for intervention and he doesn’t have lasting coronary problems. With the now first death reportedly due to a ruptured heart and many young adult victims experiencing strokes, this connection seems valid and alarming. There is no known cause for Kawasaki (and hence, no cure) but a massive infusion of immunoglobulin saved my son from permanent damage. Might that be an approach worth exploring with COVID-19 patients?
I've only gotten 10 emails on this topic!
I think at this point we're calling it a Kawasaki's-like inflammatory process. I would not be surprised if it is exactly the same process, but unfortunately we don't really understand Kawasaki's disease in the first place. This virus seems to cause multiple inflammatory reactions. See also Chilblains. I saw a kid with Chilblains in late January. Still wondering if that was Covid-19.
https://www.usatoday.com/story/news/health/2020/04/27/coronavirus-doctors-learn-more-new-covid-19-symptom-covid-toes/3031743001/
By the way, one of the criteria for Kawasaki's is 5 days of high fever. You then get another 5 day window where treatment with immunoglobulin is thought to be effective. Obviously, we like to start treatment on that 5th day of fever if the patient meets the criteria for the disease or if there is a high index of suspicion. It seems that the earlier we treat the more likely we avoid longterm cardiac artery damage.
I've heard that immunoglobulin infusions were tried for Covid-19 even back in December in China. I don't think it has been helpful generally but it may help in specific situations - especially this one.
Yes, we were very fortunate to hit that treatment window and our kid avoided that artery damage.
Here’s another piece that posits a further connection to serum ACE-2: https://healthykidshappykids.com/2020/04/29/kawasaki-ace2-covid-19/
Though I was a Hum Bio major, I didn’t focus on health so I don’t know how sound this argument is (the self-promotional tone makes me a bit skeptical).
RE: Connection to rare inflammatory condition - BostonCard - 05-05-2020
https://www.nytimes.com/2020/05/05/nyregion/children-Kawasaki-syndrome-coronavirus.html
Fifteen children in the NY area have been diagnosed with a Kawasaki-like syndrome, possibly linked to COVID-19. Annual incidence of Kawasaki disease in the US is 20/100,000, which would translate to about 1700 cases a year in a city the size of New York, or about 140 a month. Thus 15 cases doesn't strike me as all that unusual, though the fifteen only represent severe cases, so there are probably many more out there.
BC
RE: Connection to rare inflammatory condition - akiddoc - 05-05-2020
(05-05-2020, 08:41 AM)BostonCard Wrote: https://www.nytimes.com/2020/05/05/nyregion/children-Kawasaki-syndrome-coronavirus.html
Fifteen children in the NY area have been diagnosed with a Kawasaki-like syndrome, possibly linked to COVID-19. Annual incidence of Kawasaki disease in the US is 20/100,000, which would translate to about 1700 cases a year in a city the size of New York, or about 140 a month. Thus 15 cases doesn't strike me as all that unusual, though the fifteen only represent severe cases, so there are probably many more out there.
BC
Actually, there are about 20 cases per 100,000 children under 5 years of age. That translates to 3,000 to 4,000 cases in the USA per year. Practically every case of Kawasaki's disease occurs in kids under 5.
There are about 430,000 children under the age of 5 in NYC. That would translate into 7 cases of Kawasaki's disease per month, 84 cases per year in NYC. I absolutely guarantee you that there are not 140 cases per month in NYC. I've only had 4 cases in my career. And I know Pediatricians who have never seen a case outside of residency. It is rare.
The other issue is that these kids are much sicker than the usual kid with Kawasaki's. Usually, we give them immunoglobulin, the fever is gone in 24-48 hours, we send them home on low dose ASA, and they are fine. Once in a while a patient gets readmitted with recurrent symptoms. They are followed in Cardiology for a while and they cannot get live virus vaccines for 11 months. Multi-organ failure almost never happens. This set of kids is very unusual.
(04-30-2020, 08:26 AM)UltimateCard Wrote:(04-30-2020, 02:37 AM)akiddoc Wrote:(04-29-2020, 03:10 PM)UltimateCard Wrote: I wonder what the medical professionals on this board make of this possible connection to Kawasaki Disease, reported by pediatricians in the U.K., Italy and now Stanford:
https://www.cnn.com/2020/04/29/health/rare-inflammatory-syndrome-us-covid-19/index.html
https://www.nytimes.com/aponline/2020/04/28/world/europe/ap-eu-virus-outbreak-kids-rare-syndrome.html
I have a personal interest since my younger son had it when he was 5; thankfully docs at UCSF caught it within the 5-day window for intervention and he doesn’t have lasting coronary problems. With the now first death reportedly due to a ruptured heart and many young adult victims experiencing strokes, this connection seems valid and alarming. There is no known cause for Kawasaki (and hence, no cure) but a massive infusion of immunoglobulin saved my son from permanent damage. Might that be an approach worth exploring with COVID-19 patients?
I've only gotten 10 emails on this topic!
I think at this point we're calling it a Kawasaki's-like inflammatory process. I would not be surprised if it is exactly the same process, but unfortunately we don't really understand Kawasaki's disease in the first place. This virus seems to cause multiple inflammatory reactions. See also Chilblains. I saw a kid with Chilblains in late January. Still wondering if that was Covid-19.
https://www.usatoday.com/story/news/health/2020/04/27/coronavirus-doctors-learn-more-new-covid-19-symptom-covid-toes/3031743001/
By the way, one of the criteria for Kawasaki's is 5 days of high fever. You then get another 5 day window where treatment with immunoglobulin is thought to be effective. Obviously, we like to start treatment on that 5th day of fever if the patient meets the criteria for the disease or if there is a high index of suspicion. It seems that the earlier we treat the more likely we avoid longterm cardiac artery damage.
I've heard that immunoglobulin infusions were tried for Covid-19 even back in December in China. I don't think it has been helpful generally but it may help in specific situations - especially this one.
Yes, we were very fortunate to hit that treatment window and our kid avoided that artery damage.
Here’s another piece that posits a further connection to serum ACE-2: https://healthykidshappykids.com/2020/04/29/kawasaki-ace2-covid-19/
Though I was a Hum Bio major, I didn’t focus on health so I don’t know how sound this argument is (the self-promotional tone makes me a bit skeptical).
There is a ton of conjecture in that blog not backed up by research. This may follow some of the theoretical thought up at UCSF (She did her Residency at UCSF.), but we've already seen plenty of theories go up in smoke over the past few months. I would NOT take this as scientific fact. Some of it might be true, some may not.
Song is a big self promoter here in the Bay Area. She promotes herself as a holistic Pediatrician and promotes the use of a ton of supplements and vitamins. Let's remember that there is no medical evidence that supplements, including vitamins, extend human life. There are no studies that such therapies can "boost" your immune system anymore than just eating a healthy diet.
RE: Connection to rare inflammatory condition - BostonCard - 05-05-2020
(05-05-2020, 03:38 PM)akiddoc Wrote:(05-05-2020, 08:41 AM)BostonCard Wrote: https://www.nytimes.com/2020/05/05/nyregion/children-Kawasaki-syndrome-coronavirus.html
Fifteen children in the NY area have been diagnosed with a Kawasaki-like syndrome, possibly linked to COVID-19. Annual incidence of Kawasaki disease in the US is 20/100,000, which would translate to about 1700 cases a year in a city the size of New York, or about 140 a month. Thus 15 cases doesn't strike me as all that unusual, though the fifteen only represent severe cases, so there are probably many more out there.
BC
Actually, there are about 20 cases per 100,000 children under 5 years of age. That translates to 3,000 to 4,000 cases in the USA per year. Practically every case of Kawasaki's disease occurs in kids under 5.
There are about 430,000 children under the age of 5 in NYC. That would translate into 7 cases of Kawasaki's disease per month, 84 cases per year in NYC. I absolutely guarantee you that there are not 140 cases per month in NYC. I've only had 4 cases in my career. And I know Pediatricians who have never seen a case outside of residency. It is rare.
The other issue is that these kids are much sicker than the usual kid with Kawasaki's. Usually, we give them immunoglobulin, the fever is gone in 24-48 hours, we send them home on low dose ASA, and they are fine. Once in a while a patient gets readmitted with recurrent symptoms. They are followed in Cardiology for a while and they cannot get live virus vaccines for 11 months. Multi-organ failure almost never happens. This set of kids is very unusual.
Thank you for the correction. That makes a lot more sense.
BC
RE: Connection to rare inflammatory condition - akiddoc - 05-06-2020
https://www.jwatch.org/fw116617/2020/05/06/covid-19-multisystem-inflammatory-syndrome-risk-factors
100 kids in USA, 200 world wide now identified with this syndrome.
RE: Connection to rare inflammatory condition - akiddoc - 05-07-2020
(05-06-2020, 04:53 PM)akiddoc Wrote: https://www.jwatch.org/fw116617/2020/05/06/covid-19-multisystem-inflammatory-syndrome-risk-factors
100 kids in USA, 200 world wide now identified with this syndrome.
Now 64 identified in NYC. This doesn't really seem to be Kawasaki's, even though the press has that idea and is pushing it.
https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/
RE: Connection to rare inflammatory condition - UltimateCard - 05-07-2020
(05-07-2020, 12:10 PM)akiddoc Wrote:(05-06-2020, 04:53 PM)akiddoc Wrote: https://www.jwatch.org/fw116617/2020/05/06/covid-19-multisystem-inflammatory-syndrome-risk-factors
100 kids in USA, 200 world wide now identified with this syndrome.
Now 64 identified in NYC. This doesn't really seem to be Kawasaki's, even though the press has that idea and is pushing it.
https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/
This NPR story says it's now called Pediatric Multi-System Inflammatory Syndrome
https://www.npr.org/sections/health-shots/2020/05/07/851725443/mystery-inflammatory-syndrome-in-kids-and-teens-likely-linked-to-covid-19
RE: Connection to rare inflammatory condition - akiddoc - 05-07-2020
(05-07-2020, 07:43 PM)UltimateCard Wrote:(05-07-2020, 12:10 PM)akiddoc Wrote:(05-06-2020, 04:53 PM)akiddoc Wrote: https://www.jwatch.org/fw116617/2020/05/06/covid-19-multisystem-inflammatory-syndrome-risk-factors
100 kids in USA, 200 world wide now identified with this syndrome.
Now 64 identified in NYC. This doesn't really seem to be Kawasaki's, even though the press has that idea and is pushing it.
https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/
This NPR story says it's now called Pediatric Multi-System Inflammatory Syndrome
https://www.npr.org/sections/health-shots/2020/05/07/851725443/mystery-inflammatory-syndrome-in-kids-and-teens-likely-linked-to-covid-19
There are now 3 cases at CHLA (Children's Hospital of Los Angeles). No cases at UCSF CHO (Children's Hospital Oakland). I don't know about UCSF CHSF or Packard Children's Hospital (Stanford). I don't know about the Kaiser system either.
RE: Connection to rare inflammatory condition - UltimateCard - 05-08-2020
(05-07-2020, 07:59 PM)akiddoc Wrote:(05-07-2020, 07:43 PM)UltimateCard Wrote:(05-07-2020, 12:10 PM)akiddoc Wrote:(05-06-2020, 04:53 PM)akiddoc Wrote: https://www.jwatch.org/fw116617/2020/05/06/covid-19-multisystem-inflammatory-syndrome-risk-factors
100 kids in USA, 200 world wide now identified with this syndrome.
Now 64 identified in NYC. This doesn't really seem to be Kawasaki's, even though the press has that idea and is pushing it.
https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/
This NPR story says it's now called Pediatric Multi-System Inflammatory Syndrome
https://www.npr.org/sections/health-shots/2020/05/07/851725443/mystery-inflammatory-syndrome-in-kids-and-teens-likely-linked-to-covid-19
There are now 3 cases at CHLA (Children's Hospital of Los Angeles). No cases at UCSF CHO (Children's Hospital Oakland). I don't know about UCSF CHSF or Packard Children's Hospital (Stanford). I don't know about the Kaiser system either.
And now the death of a 5-year old in NYC: https://www.nytimes.com/2020/05/08/nyregion/child-dead-new-virus-kawasaki.html?referringSource=articleShare
RE: Connection to rare inflammatory condition - OutsiderFan - 05-08-2020
So this could put a monkey wrench in the plan to re-open schools? Or once Kindergarten age, this inflammatory condition isn't an issue?
RE: Connection to rare inflammatory condition - dabigv13 - 05-08-2020
School age children are definitely at risk of this. From the article, ages 2 through 15 were identified. The prevalence does seem low; New York has identified 70 cases.
If we do some back of the envelope math, NYS estimates 20% exposure by serology studies. They have 20 million people, 20% of whom are under age 18. So 4 million minors. Assuming 20% of them have been exposed, you get 800k. So roughly 1 in 10,000 kids may get this severe syndrome if they catch covid.
RE: Connection to rare inflammatory condition - UltimateCard - 05-12-2020
Children Gravely Ill with Covid Often Had Other Medical Conditions
https://www.nytimes.com/2020/05/11/health/coronavirus-children-icu.html?referringSource=articleShare
Cuomo reported today there are now ~100 cases in New York. The separate update noted there are few such cases in Asia so this may be associated more with the European strain that’s infected NY.
RE: Connection to rare inflammatory condition - akiddoc - 05-12-2020
(05-08-2020, 02:48 PM)OutsiderFan Wrote: So this could put a monkey wrench in the plan to re-open schools? Or once Kindergarten age, this inflammatory condition isn't an issue?
The risk is still very low. If we go by the science, this should not keep schools closed. It is a question of how much the virus will spread to older people if kids go to school. If we accept the risk of children dying from Influenza and don't close schools, than closing them for this alone makes no sense.
RE: Connection to rare inflammatory condition - BostonCard - 05-12-2020
Agree. Even with the rare development of a systemic inflammatory syndrome in kids, the small mercy of this virus is that it generally spares kids. The concern is not that kids will die due to the virus, but rather that schools will be petri dishes that will spread the virus, and that kids will bring it home to their susceptible parents and grandparents.
BC
RE: Connection to rare inflammatory condition - UltimateCard - 05-14-2020
JAMA article posted Monday affirms relatively small number of cases, many of which had underlying conditions. Still, one has to wonder about long-term effects on these kids. Guess time will tell.
RE: Connection to rare inflammatory condition - UltimateCard - 05-21-2020
Immunoglobulin, which is used to treat Kawasaki's, seems to help in pediatric COVID-19 cases by dampening overstimulated immune system
https://www.yahoo.com/lifestyle/doctors-say-cdc-backed-treatment-for-kids-with-inflammatory-syndrome-linked-to-coronavirus-is-highly-effective-161540741.html