COVID Complications: MIS-C & Myocarditis
We continue to learn more about the effects of COVID-19 on children. For most children, the infection results in asymptomatic to mild to moderate symptoms. Children, mostly with underlying conditions, have been hospitalized for care. As the virus infected children world-wide in larger numbers, we started to see post infectious complications in some children and adolescents. The two prevalent conditions are Multi-System Inflammatory Syndrome in Children (MIS-C) and myocarditis. Both are considered serious complications.
Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Many children with MIS-C had COVID-19 or had been around someone with COVID-19 within the past 4 weeks.
Children with MIS-C have a fever and various symptoms, including severe stomach pain, vomiting, diarrhea, rash, oral mucosa changes, bloodshot eyes, swelling to extremities, headache, mental status changes, bruising, or feeling extra tired. In extreme cases, children will present to the hospital in cardiac shock. If your child has any combination of those symptoms, please call our office immediately for assistance and guidance.
We do not yet know what causes MIS-C. We do not know why some children have gotten sick with MIS-C and others have not. We also do not know if children with certain health conditions are more likely to get MIS-C. Based on what we know now about MIS-C, the best way you can protect your child is by taking every precaution to prevent your child and your entire household from getting COVID-19 virus.
There have been high-profile cases recently in the news of athletes that had contracted COVID-19 and subsequently developed myocarditis. Demi Washington, a Vanderbilt basketball player was found to have cardiac damage on MRI discovered in the Vanderbilt COVID Return to Play Protocol, Boston Red Sox pitcher Eduardo Rodriguez missed the entire 2020 MLB season due to myocarditis, and other athletes such as Buffalo Bills tight end Tommy Sweeney and University of Miami cornerback Al Blades Jr developed myocarditis due to COVID-19.
Myocarditis is inflammation and damage of the heart muscle. This damage can lead to life-threatening cardiac arrhythmias. Myocarditis develops after viral illnesses, but it is most concerning after a COVID-19 infection. There is the possibility of acute cardiac death in physically active athletes with myocarditis. The baseline risk of sudden cardiac arrest is very low in pediatric and young adult populations but when they occur, 25 to 75% of these events occur during sports. There are still many questions the medical community have regarding myocarditis and COVID.
The concern for myocarditis in children and adolescents has led to the development of the Return to Play Protocol. There are different protocols based on American Academy of Pediatrics recommendations. We are using the protocol created by the Yale Pediatric Cardiology Return to Play Team. This protocol applies to children 6 to 18 years of age with no known significant cardiac disease. It is imperative that you meet with us via a Telemed appointment after a diagnosis of COVID. We will review your child’s individual risk factors and depending on their symptoms, they may need to see the Pediatric Cardiologist at Yale.
- MIS-C, CDC
- Yale New Haven Children’s Hospital MIS-C, clinical pathway
- Yale New Haven Children’s Hospital: Return to Play in Pediatric Patients with a History of COVID-19 Infection Algorithm
- Community Pediatrician Q&A Conference 1/18/21 and 2/1/21 with Yale Pediatric Cardiology/Return to Play Team
- For This College Athlete, Covid-19 Was Just the Start of a Nightmare, New York Times