On May 5, Mayor Bill de Blasio warned New Yorkers on Twitter that if their children were experiencing persistent fever, rash, abdominal pain or vomiting, to call a doctor right away. The previous day, City health officials had issued a bulletin to New York City health care providers instructing them to immediately report any patients under 21 who displayed these symptoms.

 

In the bulletin, the officials also wrote that 15 patients aged between two and 15 years of age had been hospitalized in the City between Apr. 17 and May 1 with an illness possibly linked to COVID-19. “We haven’t seen any fatalities yet but we are very concerned by what we’re seeing,” the Mayor wrote on May 5.

 

A New York State health department advisory notice followed on May 6 which detailed that 64 children across the State, including at least 15 in New York City, were suspected of having contracted a specific, inflammatory syndrome potentially linked to COVID-19.

 

On May 7, Gov. Andrew Cuomo announced on Twitter that this number had risen to 73, and that a 5-year-old boy had died, apparently from complications related to COVID-19. “DOH is investigating,” he wrote. In its coverage of the governor’s announcement, Eyewitness News ABC7  reported that the 5 year-old-boy in question died in New York City.

 

During a May 9 press conference, the governor said that two more young people had died from complications related to COVID-19, and that all three children who have died had either tested positive for the virus, or they had antibodies in their system which showed that they had already had the virus. Cuomo added that none of the three displayed COVID-19 symptoms when they entered the hospital system.

 

If your child is experiencing a persistent fever, rash, abdominal pain or vomiting, call your doctor right away.@nycHealthy has instructed all New York City health care providers to report any patients under 21 years old with these symptoms IMMEDIATELY.

— Mayor Bill de Blasio (@NYCMayor) May 5, 2020

 

On May 7, in response to an enquiry from Norwood News, a representative from The Children’s Hospital at Montefiore confirmed that the hospital is caring for children with this multi-system inflammatory syndrome. When asked how many cases of the syndrome the hospital had, and whether the impacted children had any underlying health complications like asthma, the representative said, “I’m sorry – I don’t have that level of detail”.

 

On May 8, following the governor’s tweet about the death of the 5-year-old boy, Norwood News asked the Children’s hospital if there had been any deaths at the hospital involving children who were being treated for the syndrome. We have not received a response as of the time of publication. We also reached out to other hospitals in the Bronx on the matter, and to date, have not received any information.

 

The New York Times subsequently reported on May 8 that the death of the 5-year-old boy, the first of the three children to die, occurred at Mount Sinai Kravis Children’s Hospital in Manhattan, where the child was being treated, and that the hospital did not release any further information about the victim.

 

Some information about the two additional victims was subsequently released by the governor on May 10. One was a 7-year-old who died in Westchester County, and the other, a teenager who died in Suffolk County.

 

According to State officials, COVID-19 is potentially linked to a particular pediatric condition called, ‘Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19’. Cases of the syndrome had already been reported at the end of April in the UK and later in Europe, and experts were advising that early detection could prove vital.

 

The State health department wrote in the advisory notice that the syndrome has some features which overlap with Kawasaki Disease and Toxic Shock Syndrome, whereby inflammation may be elevated, and fever, rash and abdominal symptoms may be present in the patient.

 

According to the Mayo clinic, doctors can treat Kawasaki Disease if they detect it early, and most children recover from the disease without serious problems. It usually occurs in three stages and a lasting fever is normally the first sign. The condition most often affects children under five. The Mayo clinic writes that Toxic Shock Syndrome can affect anyone, can progress rapidly and can be fatal.

 

During his press conference on May 9, Cuomo made reference to these two conditions, as he did in his tweet dated May 7. “Toddler and elementary school children are presenting with symptoms similar to Kawasaki disease or toxic shock-like syndrome,” he said. “Now, these are children who come in and don’t present with the symptoms that we normally are familiar with, with COVID. They’re not in respiratory distress. It’s more an inflammation of the blood vessels which can then cause problems with their heart.”

 

There have been 73 reported cases in NY of children getting severely ill with symptoms similar to Kawasaki disease and toxic shock-like syndrome.

On Thursday, a 5-year-old boy passed away from these complications, believed to be caused by COVID-19.

DOH is investigating.

— Andrew Cuomo (@NYGovCuomo) May 8, 2020

Cuomo said that this may be one of the reasons why the syndrome is only being identified at this stage of the pandemic.

 

The State health department wrote in the advisory dated May 6 that while older adults are clearly at risk for severe COVID-19 illness, children can still get sick with it too, though they wrote that children most often present with mild symptoms of COVID-19, and rarely become severely ill.

 

State health officials also wrote that myocarditis, and other cardiovascular changes may also be seen in this recently identified pediatric syndrome. According to the Mayo Clinic, myocarditis is usually caused by a viral infection.

 

Symptoms include chest pain, rapid or abnormal heart rhythms, shortness of breath at rest or during physical activity, fluid retention with swelling of the legs, ankles and feet, fatigue, and other signs and symptoms of a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea.

 

State health officials wrote that the purpose of the health advisory was two-fold. One was to ensure health care providers were aware of the syndrome, while another was to provide guidance on how to report any identified cases to the State’s health department, as well as providing guidance on how to test patients who present with it.

 

New York hospitals were instructed to immediately report identified cases of the syndrome in patients under 21 to the State’s health department. Hospitals must also test impacted patients for COVID-19, or corresponding antibodies.

 

The advisory notice outlined that, based on information gathered to date, the majority of patients who have presented with the syndrome have tested positive for COVID-19 or corresponding antibodies, though some have not. State health officials wrote that the inflammatory syndrome may occur days to weeks after a patient has had acute COVID-19 illness, though, again, not all patients with the syndrome tested positive for COVID-19.

 

The advisory included examples of some of the other conditions which were found in patients diagnosed with the syndrome, though it was not clear where those patients were based in the world. Some had developed cardiogenic or vasogenic shock and had required intensive care.

 

According to the National Heart, Lung and Blood Institute, cardiogenic shock is a condition in which the heart suddenly can’t pump enough blood to meet the body’s needs. Vasogenic shock is caused by the widening of the blood vessels, usually from medication. Symptoms include dizziness and loss of consciousness.

 

When the syndrome was reported in the UK’s Independent newspaper on Apr. 27, Professor Russell Viner, president of the Royal College of Pediatrics and Child Health, sought to reassure parents that children were unlikely to become seriously ill with COVID-19.

 

He said,”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”.

 

Viner added, “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”.

 

Meanwhile, the New York State health department wrote that clinicians should not delay seeking expert advice while waiting for results of investigations [into the syndrome], and that early recognition by pediatricians, and prompt referral to an in-patient specialist, including to critical care was essential.

 

Though, relative to the population as a whole, cases of this syndrome are rare, parents are advised to seek immediate care if a child has:

 

• Prolonged fever (more than five days)
• Difficulty feeding (infants) or is too sick to drink fluids
• Sever abdominal pain, diarrhea or vomiting
• Change in skin color – becoming pale, patchy and/or blue
• Trouble breathing or is breathing very quickly
• Racing heart or chest pain
• Decreased amount of frequency in urine
• Lethargy, irritability or confusion

 

“We still have a lot to learn about this virus,” the governor said on May 9, adding that research is already underway to determine if there is perhaps a genetic reason as to why the syndrome manifested in the 73 impacted children. He also said that New York State is working with the CDC to assist other states on how best to deal with this new pediatric condition. “Every day is another eye-opening situation,” he said.