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New Study Seeks To Understand Inflammatory COVID-19 Complication In Children


MIS-C - Multisystem Inflammatory Syndrome in children - it's a rare and serious illness affecting young people who have contracted the coronavirus but may have never experienced the symptoms of COVID-19. MIS-C, also called M-I-S-C, emerges weeks after the initial infection and can particularly affect the heart. A new study on MIS-C conducted by the Centers for Disease Control and Prevention has just been published in the Journal of the American Medical Association.

And we're turning now to Dr. Roberta DeBiasi to learn more about it. She's chief of infectious diseases at Children's National Hospital here in Washington, D.C., and someone we visited twice now as we reported on MIS-C. Dr. DeBiasi, welcome back to the program.


GARCIA-NAVARRO: You are kind of our in-house expert on MIS-C, so before we get to the news of the study, let's talk about where we are in treating it. Again, this is very rare, but do we still not know why MIS-C occurs? What are the reasons why a child might get it?

DEBIASI: We don't know exactly why any one particular child gets it and another doesn't. But as more and more of these studies come out, we get more and more hints that then can guide us into where exactly we need to do more research. But it's very clear now - this information from the Centers for Disease Control with the data across the country showing, clearly, this temporal relationship where you have a surge of virus circulation in a particular community, and then, sure enough, you know, two to six weeks later, you get a surge of this inflammatory disorder.

GARCIA-NAVARRO: One of the things that struck me in this study is it really does cement the idea that the kids who get MIS-C will not have shown that they were infected. They will have been asymptomatic.

DEBIASI: Yeah. I think it's - but, you know, we've known all along, in both children and adults, that there's a large percentage of people that just don't have symptoms. And I think what has, you know, concerned us - and this is now solidified in this study - is that just because you don't have symptoms doesn't mean that you are now protected from getting a post-infectious complication like MIS-C. And, in fact, in this study, there were a higher proportion of the kids that actually did not have recognized symptoms that had the complication.

Now, that does not mean that, you know, every child with asymptomatic disease is going to get MIS-C. We don't want parents to be overly concerned. This is still an incredibly rare complication. And the vast majority of kids, whether they have symptoms or not - and, in fact, 97% of them are not going to be hospitalized or have severe disease.

GARCIA-NAVARRO: Just remind our listeners briefly what to look for if a parent or guardian suspects MIS-C in a child.

DEBIASI: The most common symptoms are high fever, severe abdominal pain, rash, and what we call conjunctival injection, which means the white parts of the eyes get very red and inflamed-looking.

GARCIA-NAVARRO: What else jumped out at you from the study?

DEBIASI: So they did a really nice detailed analysis amongst different-aged children. And instead of saying, you know, there are 50% of children that end up in the intensive care unit and have shock, which has been shown in pretty much every center, they actually then could break it out because of the large numbers that they have and compare, you know, the young - the very young children versus the middle-aged children versus the older children.

And so it showed that, you know, even though overall 50% percent of the children end up in the ICU and have problems with their blood pressure and shock, it's actually the older group that is more likely for that to happen to, and the younger kids, it's less likely to happen to. So it is definitely a severe disease, but this helps us discern a little bit who is at the highest risk for the most severe disease.

GARCIA-NAVARRO: And it also does confirm what you had told us previously, that MIS-C disproportionately affects Black and Hispanic children.

DEBIASI: Absolutely. So that has been a uniform message at - in almost any center's data. But now, you know, when you take it all across the United States, it really is true. So it's about equal if you look at Hispanic versus non-Hispanic Black. They're both each about 35%. But together, that group is 70% of all the cases.

GARCIA-NAVARRO: What do you think the public should take away from what we now know about MIS-C?

DEBIASI: I think the most important thing - and I try to always temper, particularly for parents - we don't want people to panic and think that every child will have this horrible complication of COVID infection. But at the same time, we don't want to diminish its importance and severity so much that it - that people don't think about it, and particularly parents and physicians that see their child with symptoms that are possibly compatible with MIS-C, that they say, well, it just can't be because it just doesn't happen because clearly it does happen. We have, you know, almost 2,000 children here in this report across the country.

And, you know, the really - the most important thing is we need to try to prevent the transmission of COVID in our community because that is what precedes these episodes of and surges of MIS-C in our children. And the very best way we can prevent transmission of COVID in our community is to keep getting vaccinated and get us up to the herd immunity we need so that we don't have large amounts of circulation in any community.

GARCIA-NAVARRO: Because, indeed, children are not eligible yet for the vaccine.

DEBIASI: Absolutely.

GARCIA-NAVARRO: Dr. Roberta DeBiasi, chief of infectious diseases at Children's National Hospital in Washington, D.C., thank you so much.

DEBIASI: Thank you, Lulu. Transcript provided by NPR, Copyright NPR.