[akiddoc]

https://www.nytimes.com/2020/05/05/nyreg...virus.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.

---

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/ra...index.html
https://www.nytimes.com/aponline/2020/04...drome.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/heal...031743001/

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...-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.

[akiddoc]

https://www.nytimes.com/2020/05/05/nyreg...virus.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.

---

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/ra...index.html
https://www.nytimes.com/aponline/2020/04...drome.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/heal...031743001/

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...-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.