Coronavirus Cases Are Down, But More Kids Are Having Severe Complications
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MICHAEL BELL: Tiffany, how much oxygen are you on?
UNIDENTIFIED PERSON: Sixty percent.
BELL: You can probably come down substantially.
UNIDENTIFIED PERSON: Potassium 3.4, calcium 1.25.
LULU GARCIA-NAVARRO, HOST:
Dr. Michael Bell is on a walkie-talkie advising a group of medical staff treating a young girl in the pediatric intensive care unit at Children's National Hospital here in Washington, D.C.
BELL: The kid came in at 2 o'clock in the morning. She had a rash. And she has the skin findings. And her blood pressure was terrible. Her heart function was bad. So we worked on her from 7 o'clock this morning till 10:20. And she's on cardiac bypass.
GARCIA-NAVARRO: Her small body is attached to a machine called an ECMO, basically a type of life support that's only used on the very sickest patients. It's a last resort, especially for children.
BELL: So the cardiac surgeons will cut into the blood vessels of the neck, into the jugular vein and the carotid artery, take the blood out of the jugular vein, put it through a circuit to give oxygen, push it back into the arterial side to fully support the heart and lungs because the kid's heart and lungs were failing, and she was going to die.
GARCIA-NAVARRO: Basically, the machine acts like an external heart and set of lungs, pumping the blood out of the body and adding oxygen to it before putting it back in. Sitting in the room with the sick girl is her mother, who is weeping. Dr. Bell believes the girl has a very rare condition called multisystem inflammatory syndrome in children, and it's also known as M-I-S-C or MIS-C. Tara Floyd, the head nurse in the pediatric ICU, says MIS-C normally happens weeks after a COVID-19 infection, when a child appears to have recovered.
TARA FLOYD: Especially in these cases where you have a child go from previously healthy to something like what you see here, that's terrifying for people.
GARCIA-NAVARRO: The last time we met Dr. Bell and Tara Floyd was in May last year, when MIS-C was new. They were still trying to figure out what it was and how to treat it. Now they know it is post-viral, meaning it happens after a COVID infection. And it causes inflammations in the heart, lungs, brain and other organs of affected children. There have only been around 2,060 cases in the United States so far and around 30 deaths, according to the Centers for Disease Control and Prevention. No one has died of it at Children's National. But even though they've seen more cases than most hospitals, something surprising is happening now that has caught everyone's attention at Children's National. They're seeing an unprecedented surge in the pediatric ICU of patients with MIS-C in both the number of cases overall and how sick those children are when they arrive.
BELL: This is probably our busiest we've been in the ICU. I think we're into the thirties of kids just since the first of the year. They're coming in sicker. We don't know why that's true. But before, about half the kids who come to us would need MIS-C, and now it's about 90% coming to us.
GARCIA-NAVARRO: Dr. Roberta DeBiasi is the head of the infectious disease division at Children's.
ROBERTA DEBIASI: And what you have here are - these are only MIS-C cases. And blue bars are kids that went to the intensive care unit. And red are those that did not need intensive care.
GARCIA-NAVARRO: Dr. DeBiasi is showing us a chart that tracks all the MIS-C cases that have come into the hospital since the beginning of the pandemic.
DEBIASI: Now, look at this January. Whew, just in one month, we had 25 or 30 cases, but they were almost all in the ICU.
GARCIA-NAVARRO: And why that's happening right now is a mystery, which has the hospital worried.
DEBIASI: We looked at, is there anything different about anything, like, the virus, the kids, the type of background, the racial or ethnic, you know? And there really is no difference between that first wave and this other than we're just seeing that a higher percentage of them are needing critical care.
GARCIA-NAVARRO: At the moment, there are no spare pediatric ICU beds. And doctors are trying to understand what is happening. Dr. DeBiasi says it may be a new variant.
DEBIASI: We know that we have these variants in the U.S. We think they're at a very low level compared to the vast majority of circulation. But we also know that we are not sequencing huge amounts of virus in the U.S. to be absolutely sure that there's not a lot of variants. So one possibility would be, oh, it's just a different virus.
DEBIASI: It's possible that these kids are having multiple exposures to virus. So it could be they were exposed in March, and they get reexposed again in the late fall. And then with each exposure, perhaps the inflammatory response - if they're the right kid that has this rare propensity to develop this - it's just that maybe these additional exposures are causing a higher amount of inflammation.
GARCIA-NAVARRO: Or maybe in the earlier wave of children, those that were less ill were simply sick with a similar disease, like Kawasaki, which also affects children with inflammation, though it is totally unrelated to COVID - many possibilities but so far, few answers. This is, after all, a very new illness from a very new virus. And there is still a fundamental mystery to do with the syndrome. Who gets it, and why? They now know that unlike COVID-19, the kids that get MIS-C tend to have no other conditions like obesity or asthma.
DEBIASI: So these are generally normal kids. They are not kids with underlying diagnoses.
GARCIA-NAVARRO: So why are they susceptible? One glaring clue - almost all the kids who come in with the illness here are either Black or Latino.
DEBIASI: That's about 90, 92% of all the MIS-C. And, in fact, I think we've had either none or maybe one Caucasian MIS-C patient. So it's really striking.
GARCIA-NAVARRO: Dr. DeBiasi acknowledges that there are large Black and Latino populations in D.C., and those groups are the most impacted by COVID. But...
DEBIASI: That's out of proportion to our mixture of patients that come to our ER, to our hospital in general for African American, Hispanic.
GARCIA-NAVARRO: So she suspects that the cause of MIS-C could be genetic, but they don't yet know, which is why studies are being launched or are underway already to understand the mysterious illness. One of them at Children's National is looking at the possible long-term impacts of MIS-C on the hearts of kids who have recovered.
How have you been feeling all these many months?
KYREE MCBRIDE: Good.
GARCIA-NAVARRO: Last May, we also spoke with nine-year-old Kyree McBride. He was diagnosed with MIS-C after developing a fever and stomach pains. Once admitted, they found his heart was inflamed. He was given a heart monitor because he had an irregular heartbeat. Now, months later, he is part of this national study. When I called him this past week, he told me he's back to playing outside. And he rides his dirt bike.
I ask him - and it feels the same, feels cool? You don't get out of breath or anything like that?
TAMMIE HAIRSTON: You do?
HAIRSTON: You don't tell me that.
GARCIA-NAVARRO: Tammie Hairston is his mom. She says he's been doing pretty well. But she's worried.
HAIRSTON: For the most part, he felt pretty good. I just keep an eye on him just because of what he went through. But I haven't had any scares.
GARCIA-NAVARRO: How have you been feeling? I mean, it was a big scare last time I spoke to you. You were - it was pretty frightening, what happened. How's it been for you in the months following?
HAIRSTON: I mean, I feel pretty good. But I'm - always have my antennas up, just hoping that he doesn't turn back around and go through that again.
GARCIA-NAVARRO: I call those mom-tennas (ph).
HAIRSTON: Yes. Well, sometimes, when he come in the house, he'll say, Mommy, my heart is beating fast. And then I'll instantly feel his heart because I know how fast his heart was beating when he was sick. It was a real heavy thump in his heart. So as long as I don't feel that, I'm OK. I know what to look for because of what he experienced at first.
GARCIA-NAVARRO: She says all his doctors' appointments have shown recently his heart is back to normal. But joining the study is important.
HAIRSTON: If I can help someone else, I'm all for it, to help in any kind of way.
GARCIA-NAVARRO: And it will be a help. The kids who have recovered seem to have no serious problems. But they have been very sick.
ANITA KRISHNAN: So this is an echocardiogram of one of the children with MIS-C who is hospitalized here. So if you look, these are the four chambers of the heart. And this is the ventricle, which is the muscle that squeezes the blood out. And so we look at the strength of its squeeze. And this is an 8-year-old who had decreased heart function, so his heart isn't squeezing as well as normal.
GARCIA-NAVARRO: Dr. Anita Krishnan is the primary investigator for Children's National in the National Institutes of Health study that will follow 600 kids, including Kyree, for five years.
KRISHNAN: So MIS-C can cause shock in kids. It can affect the coronary arteries. And it can cause rhythm disturbances in kids, so the heart can beat too fast or too slow. And we know that happens in the acute phase when they first come into the hospital. But we don't yet know what happens, you know, six months, a year or five years later.
GARCIA-NAVARRO: Dr. Krishnan says kids have a lot of life ahead of them. So understanding the aftermath of MIS-C, especially now that the numbers are rising, is vital.
KRISHNAN: When can they go back to sports safely? Are they 100% back to normal, able to go back to school? Are their moods back to normal?
GARCIA-NAVARRO: And that's the worry with this pandemic and its many health tentacles. There are still so many questions and things doctors do not understand.
Again, Dr. Roberta DeBiasi, the head of the Infectious Disease Division at Children's National.
DEBIASI: I think what most of us have learned is this is a very surprising virus. It can cause so many different manifestations. And just when you kind of get comfortable with, OK, I get this, and I know how to handle this, something new comes out, and then we have to readjust. And it's really important for the clinicians to have an open mind when patients come in with something unusual - because it is a new disease - to say, huh, I wonder if this could be some new thing we have to worry about with COVID.
GARCIA-NAVARRO: She says the sooner everyone can get vaccinated, the better to stop the spread of COVID-19. This past week, Dr. Anthony Fauci said children as young as 6 could begin to get vaccinated in the fall.
Back at the pediatric ICU, another long day looms for Dr. Michael Bell, the head of critical care medicine, and Tara Floyd, the executive director of neonatal and pediatric intensive care nursing. They're both exhausted. Bell hasn't been able to see his family in Pennsylvania since October. And Tara Floyd - she's working on her birthday.
FLOYD: Forty-four years ago, I was in a hospital being treated by people like me. So I always feel it's really fitting to work on my birthday. I don't mind it at all.
GARCIA-NAVARRO: Really? You were in the NICU. Why?
FLOYD: I'm an identical twin. So we were born prematurely. We were 32-weekers 44 years ago today.
GARCIA-NAVARRO: Happy birthday.
FLOYD: Thank you (laughter).
GARCIA-NAVARRO: It's a brief, bright spot. Over the next two days, four more children with MIS-C will be admitted to the pediatric intensive care unit at Children's National as the surge of patients with this syndrome continues.
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