In April of 2020, healthcare |
But there are established |
“ We needed to adapt,” |
Dr. Jone.“ That’ s not |
systems around the world |
courses of treatment. As in |
says Dr. Jone. |
good. Some will get a kidney |
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faced a steep and urgent learning curve: COVID-19 was spreading rapidly, and much about it remained unknown.
Some of the most pressing questions in pediatrics revolved around MIS-C, a severe complication that, while rare, came with some familiar hallmarks— at least to those who knew what to look for.
“ Rash, red eyes, red lips, diarrhea, common things we see in Kawasaki disease,” says Dr. Jone.“ Both are a hyperimmune response to trying to fight infection.”
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Kawasaki disease, patients with MIS-C responded to intravenous immunoglobin, or IVIG, a blood product containing thousands of antibodies. Drs. Jone and Dominguez, who’ d run a Children’ s Colorado Kawasaki Clinic together since 2011, started doing MIS-C rounds in spring of 2020, bringing together the infectious disease and cardiology teams to talk through each case every day at 9 a. m.
In many cases, they found, IVIG wasn’ t enough.
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CATCHING IT EARLY
By fall of 2020, it was clear that, when it came to MIS-C, time was of the essence.
“ Patients with MIS-C have higher levels of systemic inflammation and more often decompensate,” says Christina Osborne, MD,“ which puts them at risk for requiring admission to intensive care.”
“ They can get myocarditis and very low blood pressure. The heart function goes down, the coronary arteries dilate,” adds
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or liver disorder, their blood pressure gets so low. Some go into shock.”
Dr. Osborne, a former fellow in pediatric infectious disease and current fellow in critical care with a research interest in coronaviruses, took on the task of creating a protocol for identifying MIS-C early, with input from infectious disease, hospital medicine, critical care, cardiology, rheumatology and emergency medicine. The protocol combined recommendations from the Centers for Disease Control
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