Central Valley doctors brace for a ‘surge’ in a rare condition among kids exposed to COVID

This story is part of the Central Valley News Collaborative — a bilingual, community journalism project funded by the Central Valley Community Foundation and with technology and training support from Microsoft Corp. The collaboration includes The Fresno Bee, Valley Public Radio, Vida en el Valle, Radio Bilingüe and the Institute for Media & Public Trust at Fresno State.

In late January, Bryce Moore’s parents noticed something was wrong with their 5-year-old son. Their eldest child — typically energetic, silly and talkative — suddenly became quiet and sullen.

He complained of a piercing headache, severe neck pain and abdominal pain, said his mother, Jennifer Moore. He had bloodshot eyes and developed a patchy, red rash. As his health deteriorated over the course of several days, Moore and her husband rushed Bryce to Valley Children’s Hospital in Madera.

“They couldn’t figure out what was wrong with him,” she said. “It was quite difficult to see him go through that.”

Doctors eventually diagnosed Bryce with Multisystem Inflammatory Syndrome, or MIS-C, a rare but serious condition caused by COVID-19 in children.

COVID-19 cases, fueled by the highly infectious delta variant, have surged in the Central Valley this summer and overwhelmed the region’s hospitals. While hospitalizations among children have slightly increased in the last few months, doctors at Valley Children’s say they expect those numbers to significantly rise in the coming weeks. That’s because MIS-C, which causes severe inflammation and swelling of the internal organs, can appear in children anywhere between two to eight weeks after the initial exposure to the virus, said Dr. Reshma Patel, a pediatric rheumatologist at Valley Children’s Hospital.

“We are seeing a big surge in the delta variant and rising COVID-19 infection cases, especially in unvaccinated populations, so we are bracing ourselves for a MIS-C surge soon to follow,” she said in a Sept. 2 interview.

Patel is especially concerned about kids’ health now. The risk for developing MIS-C could be high in the Central Valley, where low vaccination rates and the delta variant have fueled the summer spike in cases. Students have returned to the classroom amid the surge, even though kids younger than 12 still aren’t eligible for vaccination.

“We are seeing a lot more COVID-19 active infections in children... which really has been a game changer,” she said. “(MIS-C) is not a disease or syndrome itself, it is essentially what I like to call a tornado or cascade of events that’s happening when the immune system is on overdrive.”

MIS-C disproportionately impacting Black and Hispanic males

MIS-C is a serious condition caused by COVID-19 in children ages of 0 to 21. It causes vital organs, including the heart, lungs, kidneys, brain, skin and eyes, to become inflamed and swollen.

Medical professionals do not yet know what causes the condition, though the children who have developed it have either had COVID-19 or were exposed to individuals with COVID-19, according to the Centers for Disease Control and Prevention. An estimated 99% of MIS-C patients had tested positive for COVID-19, while the remaining 1% had close contact with someone with COVID-19, according to the CDC.

The condition can occur many weeks after a child is initially exposed to the virus. Clear signs of the condition include a high fever and one or more symptoms including abdominal pain, bloodshot eyes, chest tightness or pain, difficulty breathing, diarrhea, fatigue, headache, low blood pressure, neck pain, rash or vomiting.

While death from the condition is extremely rare, certain factors and underlying conditions such as obesity, asthma and developmental problems increase the potential for the condition to be fatal, according to a 2020 study in Pediatrics, the journal of the American Academy of Pediatrics. Most children, however, recover with supervised medical care.

National trends show that the condition disproportionately affects Black and Hispanic males between the ages of 5 and 13 years old. Of the 4,661 children diagnosed with MIS-C nationwide, 61% were Black and Hispanic, while 60% were male, the CDC reported as of Aug. 27.

California’s MIS-C rates among Black and Latino children are no different. There were an estimated 596 reported cases statewide as of Aug. 27, according to the CDC. Latinos represented 34% of all MIS-C cases and Blacks represented 29% of all cases, or 63% of the total case count, according to an August estimate from the California Department of Public Health.

It’s challenging to determine how many kids countywide have developed the syndrome and whether the disparities persist locally. In response to questions about the number of MIS-C cases in Fresno County, the Fresno County Department of Public Health referred The Bee to Valley Children’s Hospital, which said it is still determining the current case count.

“MIS-C number is being tallied, but it requires work by the department to review cases and ensure (those cases) meet the criteria,” Patel said in a Sept. 15 email.

The disproportionate impact of MIS-C on communities of color could be attributed to the same social and economic factors that make them overrepresented in the total number of COVID-19 infections, said Dr. Erik Fernandez y Garcia, associate professor of clinical pediatrics at UC Davis.

Latinos and Blacks are more likely to live in large, multi-generational households and work in essential, frontline jobs, which could make them more susceptible to contracting and spreading the virus, Fernandez y Garcia said. That’s why MIS-C could pose a serious risk to the Central Valley’s impoverished communities, which includes its immigrant, Black, and Latino families who have already been disproportionately affected by the pandemic and lack access to critical healthcare resources, he added.

“We can’t neglect the fact that Black and Latinx children have less access to care than others,” he said. “Access to education about this illness, access to masks, access to vaccines, access to doctors is all worse for Latinx people and Black folks. There are some barriers there that other communities don’t have to deal with.”

Fresno child diagnosed with MIS-C weeks after COVID exposure

Still, health and medical professionals say families can take preventative measures to keep their children safe from COVID-19 exposure, which in rare cases could lead to MIS-C.

CDC guidelines recommend eligible kids, teens, and adults get vaccinated and take safety measures to reduce the risk of COVID-19 in children, including maintaining social distance, limiting close contact with other children and adults who are vulnerable, masking, washing hands often, utilizing proper air ventilation indoors and sanitizing frequently touched surfaces.

“It is so very important for our community, the Latinx community, to really work on trying to reduce that exposure,” said Fernandez y Garcia of UC Davis. “This is not the time for loosening our vigilance.”

Because little is still known about MIS-C, its symptoms can be misdiagnosed as a different condition. That was the case for Bryce, who doctors first believed had developed meningitis or Kawasaki’s disease, a condition that causes inflammation of the blood vessels throughout the body, Jennifer Moore said.

Jennifer Moore watched helplessly as doctors performed various tests on her son, struggling to stabilize him. By the time he was admitted into the intensive care unit, he was so dehydrated that they couldn’t find a vein to put in an IV. In the emergency room, his blood pressure was 64 over 35, a dangerously low level indicating that the body could be deprived of oxygen.

They finally discovered what was wrong once doctors asked if Bryce had been exposed to COVID-19. In fact, his mother and father had tested positive for COVID-19 in November. Bryce, meanwhile, tested negative at the time and didn’t show any symptoms. His strange set of symptoms only appeared weeks later.

Still, Jennifer Moore said she was relieved her son was treated at a time when doctors are more capable of recognizing the symptoms of the condition.

“They said if we would have come a year before, they would have had no idea how to treat it and there would have been a high likelihood he may not have survived,” she said.

Today, Bryce is still having regular checkups with a cardiologist and rheumatologist to monitor the effects MIS-C has had on his heart, Jennifer Moore said. But he’s made significant progress and has recently received the go-ahead to resume playing sports.

“He started soccer practice and he’ll have his first game, which we’re so excited about,” she said. “We’re just extremely grateful.”

This story was originally published September 17, 2021 at 5:00 AM.