PEDIATRICS
THE MIS-C MYSTERY: PEDIATRIC
COMPLICATIONS IN THE COVID-19
PANDEMIC
AUTHOR Bethany Hodge, MD, MPH
Throughout the weeks of anticipation of a viral pandemic
coming to the US, pediatricians held on to one consolation:
the kids seemed to be doing all right. We know that
some of our population, such as premature babies and
children with special health care needs, are extremely
vulnerable to pulmonary pathogens, but overall the novel
coronavirus appeared to be sparing children. We did not
know why, but we were relieved.
For a while, my experience of the pandemic was simply tense
boredom. The census was way down across Norton Children’s
Hospital, and most meetings and lectures were canceled. I pitched
in to help my adult medicine colleagues as I could, volunteered
for the Louisville Metro Department of Public Health & Wellness
and tried to lower my personal protective equipment footprint. I
actually spent a significant amount of time reading new literature
while crocheting little button “ear-savers” for my masked colleagues.
A month later, however, we were no longer sure that the kids were
going to be all right. The first mentions of pediatric COVID-19-related
multisystem inflammatory syndrome came out of the United
Kingdom in late April 2020. In a case series describing eight patients,
children who either had PCR or antibody diagnosis of SARS-CoV-2
infection later developed unexplained new symptoms of persistent
fever with laboratory evidence of severe inflammation and multi-organ
dysfunction. This was nothing like the acute respiratory distress
syndrome killing adult patients slowly by asphyxiation, as the lungs
did not seem to be the main target. The whole immune system appeared
to be on fire, leading to every organ suffering and potentially
death by complete cardiovascular collapse.
In my role as a volunteer researcher with the Louisville Metro
Department of Public Health & Wellness, I saw the early article
from the U.K. and knew this was something that could potentially
be headed to Kentucky. In early May, I got in contact with a University
of Louisville School of Medicine graduate, Dr. Francesca
Kingery, who was now the Chief Resident of pediatrics at Columbia
University. She was working at New York-Presbyterian Hospital in
one of the hardest hit areas of New York City. We exchanged some
frantic texts on May 5. She warned me that a storm was coming.
About a week later, we had our first recognized case in Louisville.
This pediatric illness seems to come about 14 days after the peak of
adult COVID-19 cases in an area, and ours was right on time. The
first Centers for Disease Control and Prevention bulletin warning
us of this new entity came out a few days after that. By then, the
news outlets and social media were ramping up their coverage of
the mystery illness. It was so new; we didn’t really even know what
6 LOUISVILLE MEDICINE