Is reopening schools safe? Doctors warn of new ‘paradigm shift’ in COVID-19’s impact on children

COVID-19 cases continue to surge in the U.S., and leaders across the country are grappling with how to best handle a rapidly approaching school year. As this debate rages on, doctors are now warning of an “alarming” syndrome appearing in some children with the disease.

In a new study published Thursday, Boston Children’s Hospital and Harvard Medical School researchers asserted that COVID-19 is “far more than just a respiratory illness” in pediatric patients. They pointed to a condition related to the novel virus known as multisystem inflammatory syndrome or MIS-C, which can inflict “catastrophic” multiorgan damage, including liver and kidney injuries, and brain damage.

After reviewing the chest images of 20 pediatric patients with MIS-C, the authors noted three main findings, including heart failure, acute respiratory distress syndrome and pulmonary embolus. Most recover with treatment, but the condition can be fatal, Abbey J. Winant, MD, a radiologist at the Boston-based institutions, and colleagues reported.

“… Emerging new evidence suggests that COVID-19 infection in children and adolescents is associated with a multisystem inflammatory syndrome, with features similar to Kawasaki disease and toxic shock syndrome, frequently requiring intensive care unit admissions,” Winant et al. wrote in Radiology: Cardiothoracic Imaging. “This signals an important paradigm shift in our understanding of pediatric COVID-19 infection: from a primarily respiratory illness to multi-organ system disease,” they added later.

The imaging takeaways and the clinical features of this hyperinflammatory condition also resemble late-stage severe infection in adults with the coronavirus, the authors noted, possibly due to cytokine storms.

The team reiterated that the scientific evidence and knowledge surrounding imaging findings of MIS-C-associated COVID-19 continues to evolve, and that future studies are required to illuminate this disorder—one “unique to the pediatric population.”

More concerning MIS-C evidence

The American Journal of Roentgenology released a similar study Wednesday, which found cardiovascular abnormalities in 16 pediatric patients with MIS-C.

Among the cohort, nearly two-thirds developed hypotension or shock, with another two-thirds showing heart injuries. Additionally, the most common thoracic imaging abnormalities proved to be cardiomegaly, congestive heart failure or pulmonary edema, and pleural effusions.

Abdominal imaging most often showed ascites, hepatomegaly and echogenic kidneys, first author Einat Blumfield, MD, with Montefiore Medical Center children’s hospital, and colleagues reported.

Just as Winant et al. mentioned, Blumfield and co-authors noted that while most patients with MIS-C are severely ill and require immediate care, a majority will recover with a timely diagnosis and prompt treatment.

There are still many unknowns regarding this syndrome, the authors reiterated, but imaging should undoubtedly play a major role going forward.

“Pediatric radiologists should be aware of the constellation of these imaging findings, which although nonspecific, when combined with the clinical presentation and with history of exposure to SARS- CoV-2, should suggest the diagnosis of MIS-C associated with COVID-19, as patients may rapidly deteriorate,” Blumfield et al. concluded. “Nevertheless, the long-term outcome of MIS-C is yet to be determined.”