Coronavirus Chronicles — MIS-C or PMIS? Two Names, One Mystery

Every day, reports continue to come out about COVID-19. Some confirm previous beliefs, and others add new knowledge. It now seems very, and dishearteningly, clear that people are flagrantly contagious before they show any symptoms (if indeed they ever do). While some people never even realize they are afflicted with an illness, others feel bad for a really long time.

There are sub-categories of victims with their own special problems and needs. A very recent study from a children’s hospital in New York made four generalizations about pediatric patients:

Children hospitalized with COVID-19 commonly had comorbidities, infants had less severe disease, those with obesity were likely to receive mechanical ventilation, and elevated markers of inflammation at admission and during hospitalization were associated with severe disease.

It became clear pretty early on that obese children are more likely to contract the illness and to have a more difficult time; and that children from America’s black and Hispanic minority groups, with a greater susceptibility to the disease in the first place, are likely to have the most miserable experience of all. But wait, it gets even worse.

Inflammation can go right off the charts into a territory known as Multisystem-Inflammatory Syndrome in Children, or MIS-C, a rare and miserable condition that doctors don’t even know what to think about. They have not even agreed on a name for it yet, with some calling it Pediatric Multi-system Inflammatory Syndrome, or PMIS.

But what is MIS-C or PMIS?

Is it just part of a very bad case of COVID-19, or a separate yet related entity that sets in after the acute viral stage is over? Why the doubt? Because, maddeningly, most of the kids who have it do not even test positive for the coronavirus. Yet they have the antibodies that indicate recovery from it. (Another question: Why do there seem to be no cases of it in China, or even on the West Coast of the U.S.?)

According to one theory, a child might have developed antibodies during an active case that she or he recovered from the first time around, without even appearing sick. But with additional exposure to the virus, which is still quite present in the community, the body gets exasperated and says, “Hey, I thought we did this already,” and throws up a really emphatic defense that ends up wreaking more damage than the disease itself.

Untreated, MIS-C can do ridiculous things like give a six-year-old a heart attack. Yet despite its severe nature, doctors are said to be reluctant to name that diagnosis because the treatment for it is very rough on tender young humans. And no matter what course the rampant inflammation takes, the long-term outlook for the recovered child is not good.

Parents must remain obsessively, intrusively, annoyingly vigilant. One unsavory possibility is that, reluctant to face another hospital admission, the child might hide any health detail that would betray a recurrence of MIS-C.

Your responses and feedback are welcome!

Source: “Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York,” JAMANetwork.com, 06/03/20
Source: “Doctors Race For Answers As Kids Fight Rare Inflammatory Syndrome Tied To Coronavirus,” NPR.org, 06/07/20
Image by Iforce/Flickr

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources