Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May

A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. 

The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. 

Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication.

“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,” the authors of The Lancet piece wrote.

Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. 

World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access

Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations.

The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. 

The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests.

Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response.

The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies.

WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced

WHO has been monitoring reports of the  ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. 

“To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. 

But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past.

Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases.

Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. 

Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms.

US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb

As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. 

Trump is briefed on COVID-19 at the White House

US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. 

This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening.

““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said.

He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. 

The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. 

“The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.”

The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April.

Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly.

Rising Cases In Africa and Southeast Asia Raise Alarm

But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon.

However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday.

And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.”

“It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove.

Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic.

Total number of cases in each WHO Region as of Tuesday night.

Gauri Saxena contributed to this story

Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO.