Don't Wait: Get Unwell Children Seen in Pandemic
Updated: Nov 14, 2020
Tagan Ja’Nae Marie Drone, 5, died hours after testing positive for COVID-19.
Distraught parents of a kindergartener, who died hours after testing positive for COVID-19, told their story of grief in an effort to spare others the same heartache.
Five-year-old Tagan Ja’Nae Marie Drone did not have the common symptoms of fever and coughing. On Tuesday, her mother, Latassija White, noticed that something was not right when her child began experiencing exhaustion.
“She was just sleeping, sleeping, sleeping,” White told local KAMR news audiences in Amarillo, Texas and national audiences on CNN. “That went on Tuesday and Wednesday. She was still eating and drinking, and then Wednesday night, she started throwing up. So, that Thursday, I decided to take her to the ER (hospital emergency room).”
Tagan tested positive for the new coronavirus.
The little girl’s mother said that doctors assured her that her daughter would be fine and that the virus mainly affected older adults. So, they returned home. The following morning, White found her daughter unresponsive – but still breathing – in bed. Tagan died later that day on Friday, October 30, after her parents called the emergency telephone number, 911, for help.
“My daughter was perfectly healthy. Perfectly healthy. There’s no way that should have happened,” said her mother.
Her father, Quincy Drone, said that he and Tagan’s mother felt that “she could have been saved.”
The cause of Tagan’s death is unclear.
The majority of children dying from COVID-19 in the United States are Latino, Black or Native American, according to National Public Radio (September 16).
Tagan was African American.
Relatively few cases of children confirmed to have COVID-19 have been reported, and those who are infected have experienced mild illness. Also, robust evidence associating underlying conditions with severe illness in children is still lacking, according to the World Health Organization (September 15, 2020).
However, there is a rare and dangerous childhood disease associated with COVID-19: multisystem inflammatory syndrome or hyperinflammatory shock, according to EClinicalMedicine, The Lancet (September 4).
“With prompt recognition and medical attention, most children will survive,” said The Lancet.
In May, New York health officials urged parents to seek immediate care if a child has prolonged fever; difficulty drinking fluids; severe abdominal pain; diarrhea or vomiting; change in skin color (becoming pale, patchy and/or blue); trouble breathing or is breathing too quickly; racing heart or chest pain; decreased amount of frequency of urinating, and lethargy, irritability or confusion.
Children have been treated with anti-inflammatory treatment, including immunoglobulin and steroids, according to the World Health Organization.
In the United States, nearly 100 children had been diagnosed with this condition, according to NBC News on May 8. In New York State, three children had died, including a 5-year-old and a teenager), and 93 cases were under suspicion.
New York Governor Andrew Cuomo said that the condition, now called pediatric multisystem inflammatory syndrome in the United States, is rare but that parents should be vigilant.
The disease had been discovered in children and teenagers in the United Kingdom, Spain, Italy, France and Belgium, according to El Correo on April 28. The New York Times reported its appearance in the United States on May 11.
On May 6, The Lancet published a Commentary called “Hyperinflammatory shock in children during COVID-19 pandemic”. One patient out of 8 died from the condition. He was 14 years old.
“South Thames Retrieval Service in London, U.K., provides paediatric intensive care support and retrieval to 2 million children in South East England. During a period of 10 days in mid-April, 2020, we noted an unprecedented cluster of eight children with hyperinflammatory shock, showing features similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome (typical number is one or two children per week). This case cluster formed the basis of a national alert,” The Lancet reported.
“All children were previously fit and well. Six of the eight children were of Afro-Caribbean descent (one was of Asian and the other of Middle Eastern descent), and five of the children were boys. All children except one were well above the 75th centile for weight.”
The children, ages 6 to 14, had “unrelenting fever (38-40 C), variable rash, conjunctivitis, peripheral oedema (dropsy), and generalised extremity pain with significant gastrointestinal symptoms. All progressed to warm, vasoplegic shock, refractory to volume resuscitation and eventually requiring noradrenaline and milrinone (used especially for congestive heart failure) for haemodynamic support. Most of the children had no respiratory involvement, although seven of the children required mechanical ventilation for cardiovascular stabilisation.
“Other notable features (besides persistent fever and rash) included development of small pleural, pericardial and ascetic effusions, suggestive of a diffuse inflammatory process.
“All children tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on broncho-alveolar lavage or nasopharyngeal aspirates. Despite being critically unwell, with laboratory evidence of infection or inflammation including elevated concentrations of C-reactive protein, procalcitonin, ferritin, triglycerides, and D-dimers, no pathological organism was identified in seven (of the eight) children.
“Adenovirus and enterovirus were isolated in one child. Baseline electrocardiograms were non-specific; however, a common echocardiographic finding was echo-bright coronary vessels, which progressed to giant coronary aneurysm in one patient within a week of discharge from paediatric intensive care. One child developed arrhythmia with refractory shock, requiring extracorporeal life support, and died from a large cerebrovascular infarct. The myocardial involvement in this syndrome is evidenced by very elevated cardiac enzymes during the course of illness.
“All children were given intravenous immunoglobulin (2 g/kg) in the first 24 hours, and antibiotic cover including ceftriaxone and clindamycin.
“Subsequently, six children have been given 50 mg/kg aspirin. All of the (eight) children were discharged from PICU (pediatric intensive care) after 4-6 days. Since discharge, two of the children have tested positive for SARS-COV-2 (including the child who died, in whom SARS-CoV-2 was detected postmortem).
“All (eight) children are receiving ongoing surveillance for coronary abnormalities.”
Four of the eight patients were exposed to COVID-19 from family members. On hospital admittance, none of the children tested positive for COVID-19.
“As this Correspondence goes to press, one week after the initial submission, the Evelina London Children’s Hospital paediatric intensive care unit has managed more than 20 children with similar clinical presentation, the first ten of whom tested positive for antibody (including the original eight children in the cohort described above.”
The Spanish Society of Pediatrics (SEP) also launched an alert to its associates about the accumulation of cases of pediatric shock, according to El Correo on April 28.
Parents reacted frantically on What’s App. The Spanish Society of Pediatrics spokeswoman, pediatrician Cristina Calvo, explained that this condition is extremely rare and has a known treatment. SEP called for calm. Calvo said that the condition has been associated with the coronavirus epidemic but it is not completely clear whether it has a causal relationship.
The pediatric shock syndrome was not unknown in Italy, reported La Repubblica on April 28. The Italian Society of Pediatrics wrote a letter to 11,000 pediatricians to be alert for the symptoms, noting that it was not clear whether the new coronavirus was directly related to the pediatric condition. Nevertheless, the high incidence of this condition in areas with a high incidence of new coronavirus infection (Lombardy, Piedmont and Liguria) and the association of positive swab and blood tests suggest that the association is not accidental.
“It is essential to characterize this syndrome and its risk factors, to understand causality, and describe treatment interventions,” said the World Health Organization. “It is not yet clear the full spectrum of disease, and whether the geographical distribution in Europe and North America reflects a true pattern, or if the condition has simply not been recognized elsewhere.”
The Lancet wrote in May:
“The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management.”
In the United States, researchers found more than 390,000 coronavirus cases and 121 deaths of those under the age of 21 between February 12 and July 31 out of a total of 190,000, according to the Centers for Disease Control (CDC) (September 16).
National Public Radio (September 16) said:
“Researchers also found a staggering racial disparity. Of the children who died, 78 percent were children of color: 45% were Hispanic, 29% were Black and 4% were non-Hispanic American Indian or Alaska Native.”
It should be noted that there was no mention of multisystem inflammatory syndrome in the National Public Radio piece.
The disproportionate number of deaths among children reflects the disparities among adults of color compared with other adults. The death toll from COVID-19 is twice as high among people of color under the age of 65 than among other adults.
Underlying conditions that put adults at higher risk for severe illness and death from COVID-19 are also a risk factor for children.
“Three-quarters of the children who died had an underlying condition that made them more vulnerable to complications from the coronavirus,” according to the CDC. “The most common underlying conditions were asthma, obesity and cardiac issues.
“Seventy percent of those who died were between the ages of 10 and 20. Only 10% were infants younger than 1.
“While the majority of deaths occurred after the children were admitted to the hospital, 39 (out of 121) children died at home or in the emergency room, which prompts a lot of questions,” said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan.
“What we really need to understand is why each of these 121 children died,” said Malani. “We need to really dig into that and come up with ways to make sure this doesn’t happen.”
The doctor advised parents:
“If your child is sick, and you don’t think they are doing well, don’t wait,” she said.
“Make sure your child can be seen by a doctor or taken to the hospital. “If you can’t take your child to the hospital yourself, make a plan for somebody else in your social circle that can help you.”
Researchers at Karolinska Institutet and Science for Life Laboratory in Sweden and Tor Vergata University of Rome in Italy have added another piece to the puzzle of multisystem inflammatory syndrome (MIS-C) by mapping the immune response in children affected by it, according to Karolinska Institutet (September 7).
“Our results show that MIS-C is truly a distinct inflammatory condition from Kawasaki disease, despite having some shared features,” said Peter Brodin, pediatrician and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet. “The hyperinflammation and cytokine storm detected in children with MIS-C is also different from that seen in adult patients with severe acute COVID-19.”
The researchers are looking now into genetic risk factors for developing MIS-C.
“Better knowledge of the pathogenesis is important for development of optimal treatments that can dampen the cytokine storm and, hopefully, save lives,” said Brodin.