Throughout this pandemic one source of comfort to many parents has been that the coronavirus seems to be sparing children with under 18s the least affected group of the population worldwide.
This does not mean no child will get COVID-19, or have serious complications, but children are far less likely to be affected.
Professor Adilia Warris, a paediatric infectious diseases specialist from Exeter University says “Children have so far accounted for between 1% and 5% of diagnosed Covid-19 cases, have often milder disease than adults and deaths have been extremely rare." (1)
Alarm has however been growing after reports that a new and severe illness is affecting some children with COVID-19. The media is reporting that up to 20 children have needed hospital admission for a Kawasaki-like illness possibly triggered by COVID-19. (2)
Kawasaki Disease is an inflammatory condition of children usually under the age of 5. Infants present with a high temperature, a widespread rash, inflamed mouth, red eyes, enlarged lymph nodes in the neck and a characteristic redness and peeling of the skin on the hands and feet. Up to 30% of sufferers have heart and blood complications. The vast majority of patients, in the region of 99%, recover. It is not contagious.
Its cause is unknown but there may be a genetic susceptibility. It is more common in north-east Asia than anywhere else with Japan (where it was first identified) and Korea having the highest rates. It has not, to date, been shown to be caused by a viral or bacterial infection.
The disease is very rare affecting around 8 in 100,000 (or 0.01%) of UK children under the age of 5 each year. (3)
On 27 April 2020 the Paediatric Intensive Care Society (PICS) issued a statement intended for medical professionals warning that there had been an apparent increase in the number of cases of a Kawasaki type illness reported with a possible link to COVID-19. The statement began with this:
“Please note this is a statement intended for medical professionals who look after critically ill children. If you are a parent, please be assured that serious illness as a result of COVID-19 still appears to be a very rare event in children.” (4)
The concern centred round the presentation of a very small number of children with an unusual clinical picture that mimicked some, but not all, features of Kawasaki disease. Some of the children had tested positive for COVID-19, but some had also tested negative.
Kawasaki disease has been documented for 50 years but remains poorly understood. COVID-19 has been with us for just five months and our understanding of it is therefore limited but increasing rapidly.
All we can conclude at the moment it that there seems to be a very small number of children in the UK, possibly less than 20, that have presented with an illness quite like Kawasaki disease but not exactly the same. Some of those children tested positive for COVID-19 but some did not. Newspaper reports are that 12 of those children needed intensive care but there are no reports of any deaths. (The alert does not give any numbers nor any details about individual cases.)
It is still not known if these children had:
i) Unusual Kawasaki disease that was wholly unconnected to COVID-19;
ii) Unusual Kawasaki disease and COVID-19 at the same time but simply by chance;
iii) Unusual Kawasaki disease caused by COVID-19;
iv) A completely new disease unrelated to either Kawasaki or COVID-19 but being noted, at least in part, because of hyper-vigilance amongst doctors at this time.
Although the media has led with headlines such as “Children falling critically ill with new coronavirus-related syndrome” and “At least 12 UK children have needed intensive care due to illness linked to Covid-19” it is simply too soon to make these types of assertions and directly link the two illnesses. (5) (6)
The issuing of alerts such as this simply reflects that fact that due care and diligence is always taken to highlight anything unusual or of concern to doctors, however most of the time these alerts go unreported in the media. They serve to heighten awareness and increase understanding of diseases and their presentations. These alerts also prompt scientists to study very specific areas and establish causes and effects of illnesses and connections, if any, between illnesses. You can read the alert in full here.
Parents should be reassured that it remains the case that children are highly unlikely to become seriously ill as Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, emphasises in his statement:
“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.
“However our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with COVID-19 but if they are concerned about their children’s health for any reason, they should seek help from a health professional.” (1)
