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The Link Between SARS-CoV-2 and MIS-C in Children

By: Sai Srihaas Potu

The world is presently grappling with a global pandemic known as COVID-19. At the time of this writing, 39 million confirmed cases and over 1.1 million deaths due to COVID-19 have been reported globally. Although most individuals infected with COVID-19 present minimal symptoms, 15–20% of those who contract the disease experience severe symptoms that require medical intervention and hospitalizations.


The pandemic has affected the world in a deep and far-reaching manner across nearly every level of analysis, ranging from personal to economic to social. The psychological and lifestyle adjustment needed to cope with COVID-19 has offered a significant obstacle for many families and individuals. Governments around the world, including state and local constituents, are attempting to respond to the pandemic via various measures, ranging from the implementation of social distancing protocols to the initiation of efforts to rapidly develop an efficacious COVID-19 vaccine.


Researchers have been working around the clock in order to learn more about the origin, impact, and adaptability of the virus. In a recent study, researchers were able to find out the biological, more specifically the cardiological, impacts of COVID-19. Researchers were able to find out the connection between COVID-19 and multisystem inflammatory syndrome (MIS-C). More specifically, they learned that multisystem inflammatory syndrome in children, a Kawasaki-like disease that appears to result from COVID-19 infections, damages the heart to such an extent that children will need lifelong monitoring and interventions.


A team of researchers led by Dr. Alvaro Moreira, a neonatologist and an assistant professor of pediatrics at the University of Texas Joe R. and Teresa Lozano Long School of Medicine, reviewed 662 MIS-C cases reported worldwide between Jan. 1 and July 25. Case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections.


The results showed that 71% of the children who were dealing with MIS-C were admitted to the intensive care unit (ICU), 100% had a fever, 73.7% had abdominal pain or diarrhea, 68.3% suffered vomiting, 22.2% of the children required mechanical ventilation, 4.4% required extracorporeal membrane oxygenation (ECMO), and 11 children died.


MIS-C is a new childhood disease that is believed to be associated with SARS-CoV-2. It can be lethal because it affects multiple organ systems. Whether it be the heart and the lungs, the gastrointestinal system, or the neurologic system, it has so many different faces that initially it was challenging for clinicians to understand how MIS-C actually impacts the body.


The amount of inflammation in MIS-C surpasses two similar pediatric conditions, Kawasaki disease, and toxic shock syndrome. The researchers believe that the saving grace is that treating these patients with therapies commonly used for Kawasaki, immunoglobulin and glucocorticosteroids, can be effective.


Most of the 662 children suffered cardiac involvement as indicated by markers such as troponin, which is used with great accuracy in adults to diagnose heart attacks. Almost 90% of the children (581) underwent an echocardiogram because they had such a significant cardiac manifestation of the disease.


MIS-C caused significant damage to the cardiovascular system which included dilation of coronary blood vessels, depressed ejection fraction, indicating a reduced ability for the heart to pump oxygenated blood to the tissues of the body, and an aneurysm of a coronary vessel.


Children with an aneurysm are at the most risk of a future event. These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives.


The researchers also found out that almost half of the patients who had MIS-C had an underlying medical condition, and of those, half of the individuals were obese or overweight. Generally, in both adults and children, they saw that patients who were obese were at a greater risk for cardiovascular damage.


When compared to the initial COVID-19 infection, inflammatory markers in MIS-C were far more abnormal. For instance, troponin, the marker used in adults to diagnose heart attacks, was 50 times its normal level in children with MIS-C.


Evidence suggests that children with MIS-C have immense inflammation and potential tissue injury to the heart, and the researchers believe they will need to follow these children closely to understand what implications they may have in the long term.


Over the past 2 decades, coronaviruses (CoVs) have been associated with significant disease outbreaks in East Asia and the Middle East. The severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) began to emerge in 2002 and 2012, respectively. However, the recent coronavirus outbreak has had a greater impact and has left researchers clueless as they try to understand the links between SARS-CoV-2 and other psychological and biological disorders.


Thanks to ongoing studies, researchers have been able to decipher the SARS-CoV-2 virus code which has led to many breakthroughs such as the discovery that multisystem inflammatory syndrome is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C and SARS-CoV-2 can be lethal to a child’s cardiovascular health without prompt recognition and medical attention.


The public health impact of COVID-19 on our psychological, biological, and physical characteristics is substantial and ongoing. There is a need for financial and social investment in research to better understand how COVID-19 affects the onset, maintenance, and relapse potential for some of the most common, costly, and chronic behavioral health conditions in the general population.


References:

1. Alvaro Moreira, Mubbasheer Ahmed, Shalesh Advani, Axel Moreira, Sarah Zoretic, John Martinez, Kevin Chorath. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020.

2. Daniella S. Battagello, Guilherme Dragunas, Marianne O. Klein, Ana L.P. Ayub, Fernando J. Velloso, Ricardo G. Correa. Unpuzzling COVID-19: tissue-related signaling pathways associated with SARS-CoV-2 infection and transmission. Clinical Science. 2020.

3. Daolin Tang, Paul Comish, Rui Kang. The hallmarks of COVID-19 disease. PLOS Pathogens. 2020.

4. Michael J. Zvolensky, Lorra Garey, Andrew H. Rogers, Norman B. Schmidt, Anka A. Vujanovic. Psychological, addictive, and health behavior implications of the COVID-19 pandemic. Behaviour Research and Therapy. 2020.

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