Reports dominated the news channels tonight about a “new” complication from COVID-19 infection in children — Kawasaki disease. Dramatic pictures of children on ventilators were displayed across the screen with warnings from grieving parents. Since Kawasaki disease is a suspected complication of many viral infections, I wondered what the evidence of this disease was in COVID?
Kawasaki disease is a type of vasculitis (inflammation of the blood vessels). It occurs in children, is usually self-limited, but has a potential serious complication of inflammation caused aneurysms (ballooning) of the arteries that feed the heart. Some physicians believe infections cause this disease, including toxic shock syndrome (which may not be identical).
The disease is uncommon, The incidence of the disease in children under the age of 5 is estimated at 8.1 / 100,000 in the United Kingdom, 17.1 / 100,000 in the United States, but is more common in Japan, where it was first identified 112/100,000 (Kawasaki Foundation). It is also thought that Kawasaki is triggered by many types of viral infections, and it has some seasonal occurrence that would support that theory.
While less than 4% of COVID cases are in children and almost all are mild, it still might be possible that the patients contracting COVID-19 develop Kawasaki disease. So, it is worthwhile to examine the data behind this concern. This story seemed to start with unverified reports in the U.K., that were mentioned in passing by The WHO a few days ago.
Today, reports in Forbes Magazine and “The CUT,” focused on the European reports that 12 children have required medical care due to symptoms that were felt to be “linked to the coronavirus.” “Several” of these children were confirmed to have Kawasaki disease. These articles also suggested there were cases in Italy, Spain, Switzerland, Belgium, and France, but the reference for this was a report in today’s New York Times of 15 cases in NYC resembling toxic shock syndrome and/or Kawasaki disease.
After these three stories were published today, the lead was picked up by all major news outlets on the Web and television, and the same claims and quotes were repeated.
The Times article also referred to a bulletin from the state health department stating none of the children died, but most required ICU care and five needed ventilators. The Times also reported “many” of these children also tested positive for COVID-19 virus or antibodies. Overall, only 20 children in the U.S. with COVID-19 have died and most had predisposing illnesses.
So how strong is the medical evidence supporting this association? There is a total of one case report of Kawasaki disease associated with COVID-19.
The Forbes article notes that, “Even though the relationship of this syndrome to COVID-19 is not yet defined, and not all of these cases have tested positive for COVID-19 by either DNA test or serology, New York City’s health commissioner Oxiris Barbot, MD, has asked doctors ‘to report any suspected cases.’ ” In the Times article, which was appropriately titled “15 Children Are Hospitalized With Mysterious Illness Possibly Tied to Covid-19,” New York State health commissioner Howard Zucker said that, “we are following it very closely.” Therefore, the actual association is still under investigation.
In the UK, where this story began, the Kawasaki Disease Foundation released a statement Wednesday, saying that many children with the disease tested negative for COVID-19 and, “there is no current evidence of any increased incidence or greater susceptibility to COVID-19 infection for children who had Kawasaki Disease in the past.” Dr. Liz Whittaker, a member of the Royal College of Pediatrics and Child Health’s allergy, immunology and infectious diseases committee, told the Guardian, “this is not something people should be panicking about.”
Someone should have told the journalists.