Wait! What? This article is filled with assumptions stated as facts and scientific inaccuracies. Those who have received the DNA and mRNA versions of the COVID shots are MORE likely to transmit the virus (one study showed that their noses were 251 times richer in the virus than the noses of the unvaccinated and other studies have shown similar results), not less. Masks may be politically and emotionally satisfying, but there is no science behind their use in the prevention of transmission. If SARS-COV2 persists in the gut of the exposed, does it persist in the guts of the inoculated more or less or the same as in the guts of the uninoculated? What evidence is there that receiving the inoculations reduces the incidence of MIS-C and how does that compare with the otherwise unexpected myocarditis, coronary infarctions, strokes, clots and other cataclysmic responses to the inoculations in healthy, very low risk people, including children? This is not scientific information or science reporting. It is advertising and meets, in my opinion, the standard for shameless propaganda. The same issue of this newsletter contains numerous other pieces of the same low quality. I look to this publication for information, not sales pitches and propaganda. Sincerely, Rima E. Laibow, MD Medical Director Natural Solutions Foundation
— Raising awareness of this condition, especially among the parents of our patients, is key
Babies are placed on their backs to sleep, children wear seat belts and bike helmets, and young kids are vaccinated against rare but potentially serious diseases. A pediatrician’s day is filled with offering guidance to families to protect children from uncommon but potentially serious events. The same should be true with COVID-19, yet we still struggle against the misconception created early in the pandemic that children were “spared” from serious COVID-19. It is now clear that some children can and do develop severe and life-threatening complications — we need to protect them.
It is true that most children experience only minimal symptoms or are asymptomatic, thankfully. But tens of thousands of children have developed severe COVID-19 requiring hospitalization, and some (nearly 6,000 to date) develop the post-COVID-19 hyperinflammatory illness, multisystem inflammatory syndrome in children (MIS-C). Over 700 children have died from COVID-19 or MIS-C. These numbers are not trivial. We need to protect our children.
Although most people are aware of the pulmonary symptoms of COVID-19, and pediatricians and COVID-19 researchers are very familiar with the disease entity of MIS-C, many families are not. A recurring comment from parents who have children with MIS-C is that they had never heard of MIS-C before their child got sick.
As our understanding of MIS-C continues to evolve, it is critically important to raise awareness of this condition, especially among parents.
What Do We Know About MIS-C?
MIS-C occurs weeks to months after a child has been infected with SARS-CoV-2. The initial illness may have been mild or even asymptomatic and the family may not be aware that the child had COVID-19. Most kids with MIS-C are between the ages of 5 to 13 years, but MIS-C can occur in a child of any age. People older than 21 years can also develop a post-COVID-19 multisystem inflammatory syndrome in adults called MIS-A, which presents similarly to MIS-C, although the incidence is not yet well defined. Although some children with certain underlying immune defects may be more predisposed to MIS-C, the majority of the children who develop MIS-C were previously healthy.
Children with MIS-C present with high fever, gastrointestinal symptoms (abdominal pain, poor appetite, nausea, vomiting, or diarrhea), and possible rash or conjunctivitis. Blood tests show high markers of inflammation. The major concern is that these children can develop life-threatening myocarditis, coronary aneurysms, or ventricular failure. Many children will require admission to the ICU; some have died from MIS-C. Since the first cases of MIS-C were reported in spring 2020, researchers and doctors have been racing to understand what causes MIS-C, how we can best treat MIS-C, and what we can do to prevent this severe illness in children. While many questions remain, we’ve made significant strides in our understanding of MIS-C.
We now know that following COVID-19, SARS-CoV-2 can exist in the gut for weeks to months after the upper respiratory infection is cleared. This ongoing presence of SARS-CoV-2 in the gut can irritate the gastrointestinal mucosal barrier, resulting in the release of zonulin, a key regulator of barrier integrity. When zonulin is released, the lining of the gut can become leaky on a microscopic level, and in MIS-C, SARS-CoV-2 viral particles begin to leak into the blood stream.
The spike proteins, which have been suggested to have superantigen-like features, and the immune complexes stimulate a potent and hyperactive immune response that results in high fever, systemic inflammation, and in many children with MIS-C, damage to the heart. We have a clinical trial currently underway testing the therapeutic use of larazotide acetate, a zonulin “blocker,” to reduce symptoms and severity in MIS-C. However, any widespread use of the therapeutic application of this compassionate use drug is years away. Current treatments include supportive care, often in the ICU, intravenous immunoglobulin (IVIG), and prolonged courses of steroids.
While COVID-19 is mostly mild in children, we cannot predict who will develop severe COVID-19, MIS-C, long COVID-19, or other complications following infection with SARS-CoV-2.
Why Is MIS-C Awareness So Important?
Growing awareness of the potential life-threatening complications of COVID-19 in kids is an essential part of protecting children and battling this virus. Public officials and government leadership must acknowledge these severe outcomes in children. This means doubling down on safety measures to protect children, including requiring mask use indoors, especially if there are unvaccinated children around, and enforcing other CDC-recommended safety precautions. This also means encouraging the vaccination of all children against COVID-19 as soon as each age group becomes eligible. With the emergence of the Omicron variant and its unknowns, protective measures are only becoming increasingly important.
Not only are vaccinated individuals less likely to transmit the virus — making it an essential component of ending the pandemic — but vaccinated children, just like adults, also directly benefit from protection against COVID-19. Vaccination, which is highly protective against severe disease, will likely protect against MIS-C. By growing understanding of the connection between COVID-19 and MIS-C, families may be more likely to take the appropriate precautions and will have a better understanding of the situation if their child does end up with MIS-C.
I’m concerned that — as we’ve seen far too often with adults — vaccine hesitancy and lack of awareness will prevent many children from receiving the necessary protection that the COVID-19 vaccine can provide. This will undoubtedly result in ongoing cases of MIS-C and unnecessary pediatric deaths from a now preventable illness. This is absolutely heartbreaking to any pediatrician. As doctors, as leaders, as parents, let’s keep our children safe from this vaccine-preventable illness.
Lael Yonker, MD, is a pediatric pulmonologist at Massachusetts General Hospital (MGH) in Boston and an assistant professor at Harvard Medical School. She is the director of the MGH Cystic Fibrosis Center and has been leading the Pediatric COVID-19 Biorepository at MGH since the outset of the COVID-19 pandemic.