As Omicron cases fall, doctors anxiously await possible surge of dangerous child
MIS-C can follow Covid-19 even some weeks after infection. It can cause parts of the body to become inflamed, and it can affect major organs including the kidneys, brain, lungs and heart.
With the Omicron variant causing so many illnesses, it wasn’t clear exactly how many MIS-C cases hospitals could expect or how serious they would be. Research is still underway, but health care providers at many major children’s hospitals describe the outcomes as “a mixed bag.”
The US Centers for Disease Control and Prevention tracks MIS-C cases but updates the numbers on its website only once a month. There have been 6,851 cases reported during the pandemic, with 59 deaths, as of January 31.
That’s a tiny fraction of child Covid cases. More than 12.3 million children have been sick with Covid since the start of the pandemic, according to the American Academy of Pediatrics’ analysis of data from the states that report cases, hospitalizations and deaths by age.
The more contagious Omicron variant brought a flood of cases: Almost 4.5 million children have had Covid just since the beginning of January.
Different regions of the country are still at different points in the Omicron wave, and it will take some time before scientists have a clearer picture of what the variant has meant for MIS-C cases overall.
Most MIS-C cases have not been fatal, but just last week, the Wisconsin Department of Health Services reported that a 10-year-old from the southeast part of the state died within the past month from MIS-C.
Tom Haupt, a respiratory disease epidemiologist with the department, said Friday that the state puts a priority on having doctors report even suspected cases of MIS-C so state officials can then report them to the CDC as quickly as possible.
“We want to share this information with the CDC with hopes that we can ultimately find out what’s causing this and what we could do to further prevent MIS-C,” Haupt said.
There are several MIS-C studies underway across the country. Scientists are still trying to figure out why some kids get it and others don’t. They’re also trying to understand the long-term consequences and the best way to treat it.
One thing is certain about MIS-C: “It always follows the same pattern,” said Dr. Roberta DeBiasi, Infectious Disease Division chief at Children’s National Hospital in Washington, DC. “It’s always two to six weeks after we see the spike from whatever variant it is, and then we’re on the lookout for MIS-C. And then, sure enough, it comes.”
DeBiasi is one of several scientists still enrolling participants in MIS-C studies. From her work with kids and Covid-19 so far, MIS-C still seems rare, relative to the number of Covid-19 cases that doctors at Children’s National have treated.
A study published Monday found that during the winter of 2020-21, there was one MIS-C hospitalization for every Covid-19 hospitalization for children 5 to 11 years old. The period studied was long before the Omicron wave hit, but the researchers note “that MIS-C may not be as rare … as previously thought.”
In Washington, DeBiasi said, her hospital has had 30 Omicron-related MIS-C cases. But each wave has brought with it fewer cases. With the first wave, DeBiasi said, they treated about 100 kids with MIS-C, and with Delta, it was about 60.
It’s unclear exactly why there have been fewer cases, but she theorizes that vaccines — now authorized for children 5 and older — may have helped.
“The older kids are much less represented among the MIS-C cases now, and that makes sense because they’re vaccinated, and there are plenty of studies now showing that vaccination reduces the risk of MIS-C cases just like it reduces the risk of hospitalization and severe disease,” she said.
For example, CDC research released in January showed that the Pfizer/BioNTech Covid-19 vaccine reduced the likelihood of MIS-C by 91% in children 12 to 18 years old during a period when the Delta variant was predominant.
Another study, published Tuesday, found that MIS-C happened in only 1 per million vaccinated children, a number “substantially lower” than previous estimates of 200 cases per million in unvaccinated people who caught Covid, the researchers said.
At Children’s Hospital of Colorado, workers are seeing about two or three cases of MIS-C a week, despite what Dr. Pei-Ni Jone described as “a ton” of Covid-19 cases. She said some of the MIS-C patients have been vaccinated, but the vast majority are not.
“The MIS-C children, we thought we may see an uptick with Omicron, but we haven’t. It’s very similar for us with the Delta surge,” the cardiology specialist said. “It’s really unknown what’s driving the MIS-C cases.”
At the University of Pittsburgh Medical Center, Dr. Marian Michaels watched the many-fold increase in Covid infections and hospitalizations in her area with deep concern, but the spike in MIS-C cases hasn’t come. “Luckily, in our area we are not seeing a surge,” she said. “I’m very grateful.”
Michaels said she regularly talks…
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