There is very little understanding of what triggers this MIS—indeed, as is the case with Covid-19 and its pathogen, SARS-CoV-2—and, hence, guarding against it could prove quite tricky.
Till a few weeks back, it was believed that children and adolescents had been spared the worst manifestations of Covid-19—indeed, in May, the WHO, in a scientific brief, had spoken about limited data indicating this. But, in the same brief, it had also spoken up a few cases where the disease turned serious in children, and in an even smaller number, manifested as a Kawasaki-disease-like multisystem inflammatory syndrome (MIS). Kawasaki disease is a condition usually noted in children aged five years and below, in which the patient suffers from blood vessels developing inflammation brought about by, as is generally believed, an infection triggering an immune system hyperdrive. The disease is marked by symptoms like persistent high fever, rashes, red eyes, etc—symptoms common to other diseases like scarlet fever and juvenile rheumatoid arthritis. Indian Express recently reported cases of MIS in Mumbai. It has been reported in May, by hospitals in Europe and the US. While, in the majority of the cases in Europe and North America, laboratory tests had shown positive serology for Covid-19, in the Mumbai cases talked about in Indian Express, the children had tested negative for the virus. Given Kawasaki is believed to be triggered by an immunological kamikaze as a reaction to an infection, some experts believe that the viral load could have fallen to an extent where it doesn’t get detected in a test even as the inflammatory syndrome becomes apparent. Indeed, a 2005 study published in the Journal of Infectious Diseases had found a strong association between Kawasaki disease and another coronavirus, the New Haven Human Coronavirus (HcoV-NH).
There is very little understanding of what triggers this MIS—indeed, as is the case with Covid-19 and its pathogen, SARS-CoV-2—and, hence, guarding against it could prove quite tricky. The WHO says treatment lines involving parenteral immunoglobulin and steroids have helped. But, to understand MIS, and indeed both Covid-19/SARS-CoV-2 and Kawasaki disease, there needs to be rigorous mapping of the syndrome and risk factors, which could then inform treatment and disease management better. With there being very little clarity on many factors—for instance, one observational study published in the BMJ talks about a high proportion of the affected children in Paris considered for the study having African ancestry—the need for standardised data on “clinical presentations, severity, outcomes and epidemiology” urgently needs to be collected.
In the meanwhile, it will be important to institute important safeguards for children and young adults—even though MIS seems to be quite rare at the moment, the SARS-CoV-2 seems to be presenting a wide range of pathologies—more so, given experts have voiced serious concerns about lasting coronary damage from inflammation in blood vessels. Against such a backdrop, India needs to collect targeted patient data—and this will mean more aggressive detection of infections—and collaborate with global research efforts. A lot of future decisions—on opening schools, parks & playgrounds, home isolation with infected family members, even on disease prevention in shelter homes and orphanages—could depend on what the risks are for children in the country.