'Immune response gone haywire' in at least two SC kids who had COVID

July 14, 2020
Boy lying on sofa
Children who don't even know they were infected with the coronavirus can develop a rare condition now showing up in South Carolina.

At least two and possibly four kids in South Carolina have developed multisystem inflammatory syndrome in children, also known as MIS-C, a rare condition associated with COVID-19. The two confirmed cases were diagnosed in Columbia and Charleston. So were the two possible cases.

Elizabeth Mack, M.D., a pediatric critical care specialist at MUSC Children’s Health and spokeswoman for the American Academy of Pediatrics, described the condition. “It seems to be an immune response to this virus, in particular, gone haywire,” she said. “They can be tired, have a fever, have a variety of organ systems involved. Then, typically a couple of days in, they develop a rash that looks very similar to the Kawasaki rash.”

All four of the children in South Carolina with MIS-C symptoms have fully recovered, but the condition’s arrival is the latest sign of the virus’ speedy spread. South Carolina ranks in the top five states with the highest COVID-19 growth per capita.

Dr. Elizabeth Mack 
Dr. Elizabeth Mack

“Our colleagues around us had been telling us for a couple of weeks before we saw anything that they’d seen huge numbers of MIS-C — for example, in Georgia and North Carolina — so we knew it was coming,” Mack said.

They also knew it was a rare but serious illness. “This is something that would lead a child to be admitted to the hospital.”

Mack said some kids who develop MIS-C never even knew they’d been infected with the coronavirus. “It isn’t like ‘Oh, they were diagnosed in the clinic and then they got sicker a couple of weeks down the road.’ This is typically like, ‘We found they had antibodies to the virus’” after they were diagnosed with MIS-C.

Mack said treatment for MIS-C is similar to how doctors care for children with Kawasaki disease. “We use various treatments that are specifically targeted at the immune system to treat these children. We also have to look out for coronary artery aneurysms, basically weakening or widening of areas in the blood vessels that supply oxygen and flow to the heart. You can get severe abnormalities that can be fatal if untreated. We checked a variety of inflammatory markers in children that are suspected to have this and we follow those markers to be sure the immune system is responding accordingly.”

Prevention is in adults’ hands, Mack said. “Getting rid of this virus, getting back into schools, getting our lives back to normal — which I think will be a new normal —  all of that depends on our adult behavior. Whether we are willing to physically distance, wear masks, wash our hands aggressively, use hand sanitizer, clean all the high-touch surfaces wherever we go. Certainly, being thoughtful about gatherings. All of those things. It’s all adult behavior.”

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