Some kids with coronavirus suffer second illness. Fresno-area hospital sees its first case

Valley Children’s Hospital has one young person in its intensive care unit displaying symptoms of a rare disease that experts around the world suspect may be linked to COVID-19, a hospital administrator said.

Citing privacy concerns, doctors on Thursday did not disclose the patient’s age, gender or hometown.

Dr. Mohammad Nael Mhaissen, medical director of pediatric infectious diseases at Valley Children’s, said the patient tested positive for the COVID-19 antibody test, which suggests they were previously infected with the coronavirus. The virus is not what landed the patient in the ICU, however.

Mhaissen said the patient has Kawasaki Disease-like symptoms. In Kawasaki Disease, the body’s immune system goes overboard and starts attacking the body’s own blood vessels after an infection is gone.

The New York State Department of Health is investigating 102 similar pediatric cases, linked to three deaths. Los Angeles has reported four cases. Several dozen cases have cropped up around the world, notably in England and Italy.

Common features of the disease include abdominal pain, gastrointestinal symptoms and cardiac inflammation, according to a health alert from the Los Angeles Health Department. Many, but not all, children across the globe tested positive for COVID-19. The link to COVID-19 is still under investigation.

As a leading children’s hospital for the Central Valley, Nael Mhaissen said VCH sees dozens of Kawasaki cases each year. He believes the hospital is seeing more cases this year, but did not have data available Thursday.

Spring is the most common time for Kawasaki, he said, as the disease tends to hit after an infection like the common cold is gone. But things look different this time around.

First, while the disease normally hits infants between ages 2 and 5, patients experiencing symptoms this year are older, with a median age of 8.

“The other aspect is, it seems like these patients are much sicker than the typical Kawasaki. Their heart is so severely inflamed it cannot pump blood to the rest of the body. So they are coming with toxic shock syndrome, or cardiac shock,” he said.

Of more than 10 cases at Valley Children’s since January, this patient was the only one “acting sicker than normal,” he explained.

He said the other patients have not been tested for antibodies because the test is not very reliable.

However, doctors said the young patient lives with someone who had a severe case of COVID-19 in April.

Unlike COVID-19, there are clear guidelines from the American Pediatric Association on how to treat Kawasaki. Most patients recover completely, although some develop lifelong heart complications.

“Many general pediatricians are comfortable treating Kawaski on their own without even needing to do a consultation with a heart doctor,” he said.

COVID-19 and children

The elderly and immuno-compromised remain top concerns for Fresno health officials when it comes to COVID-19. But kids are not as safe as was initially assumed.

“In the pediatric world, we were relatively reassured we had dodged the bullet,” Nael Mhaissen said. “But now we’re recognizing it’s not about the acute infection.”

For the moment, causation has not yet been established between COVID-19 and the Kawasaki-like disease. Fresno County Interim Health Officer Dr. Rais Vohra said he is awaiting more scientific evidence about the pediatric disease.

“Because obviously this would be a much more serious outcome than what we typically think of with COVID-19 affecting children,” he said.

Valley Children’s has tested upwards of 1,000 kids for COVID-19, with 14 positive cases, all of which were considered minor infections.

“Honestly, none of them were sick,” Nael Mhaissen said. Only one patient stayed after an initial ER visit because of a separate surgical procedure.

Overall, Fresno County has seen 71 positive cases of coronavirus among children 17 and younger. Madera County’s coronavirus report shows 13 positive cases among ages under 20.

Merced County announced Wednesday the first case of COVID-19 in an infant. The 5-month-old is doing well and recovering at home, according to a county news release. There are 12 cases of COVID-19 among children in Merced, representing a four-fold increase in the last two weeks.

Nael Mhaissen said Valley Children’s was bracing for more Kawasaki-like cases.

“We are all expecting more and more of these cases. Even as the rate of the (COVID-19) infection is going away, we will likely see more of these infectious complications,” he said.

He said the disease should be taken into consideration before reopening schools. While kids may not get too sick from the coronavirus, “they can get really sick with the immune response.”

This story was originally published May 14, 2020 at 4:26 PM.