Virus can have severe effect on kids
Cases are rare but state sees growing number as pandemic deepens.
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By Yamil Berard
yamil.berard@ajc.com

AJC TOP LOCAL STORY CORONAVIRUS OUTBREAK

Austin Carney was sure he had wiped out COVID-19, back in August.

The 12-year-old Gainesville boy caught it alongside his parents and his 3-year-old sister just as school kicked off. He suffered a bad headache, fatigue and other lesser symptoms. By day five, though, he was back in school, on his PlayStation and shooting hoops with friends.


Then, Dec. 7, something unexpected happened. “I felt a stabbing pain in my stomach,” he said. That same afternoon, a very sick Austin went home early from school.

By 4 p.m., his fever had climbed to 104.5 F, said his mother, Jessica Carney. Two hours later, he was in an examination room at Children’s Healthcare of Atlanta Scottish Rite Hospital, hooked up to two IV drips, a heart monitor and other medical equipment.

X-rays, blood work and ultrasounds of the heart and abdomen ruled out serious conditions, including meningitis, blood clots and respiratory abnormalities. It was COVID-19 a second time, his mother said.

“I did not like the sound of that,’’ the sixth-grader said.

Serious complications are rare among children with COVID-19. In Georgia, children represent only 9.7% of total known COVID-19 infections and less than 2% of total hospitalizations.

However, the Centers for Disease Control and Prevention says that hospitalization rates are increasing among children, and there are new concerns for the health and safety of Georgia’s children as clinicians see more cases of youngsters, like Austin, who must be hospitalized in order to recover.

“We have seen our numbers going up, as cases have gone up in the area, of those children who are otherwise healthy children with no significant past medical history,’’ Dr. Preeti Jaggi, a pediatric infectious disease specialist at Children’s Healthcare of Atlanta, told the Atlanta Journal-Constitution.

In recent weeks, rates of infection among Georgia children have more than doubled, with the greatest spike among those ages 10 to 17. In the first two weeks of December, the seven-day average jumped to 432 cases, from 166 cases on Dec. 1 for that age group, state data show.

As of Dec. 21, Georgia had a total of 581 children ages 17 and under requiring hospitalization due to the virus, state data shows. Nationwide, according to the CDC, about one in three children hospitalized with COVID-19 were admitted to intensive care units — similar to the rate among adults.

Children with severe COVID-19 can develop serious problems such as diabetic ketoacidosis and intestinal blockage. Weeks after being infected, children also can develop multisystem inflammatory disease, or MIS- C, which causes persistent fever, as well as complications of vital organs, including the heart and lungs.

CHOA has treated more than 100 young sufferers of MIS-C. With record-breaking rates of infection throughout the state, “we imagine that number will go up,’’ Jaggi said.

“We have never encountered this illness before this year,” she said. “The majority of children require intensive care, many of them require blood pressure support. It is a really serious illness, requiring for the most part a week in the hospital.”

‘Scary situation’

At CHOA, as early as March pediatric infectious disease specialists and epidemiologists began seeing symptoms of chronic fever and organ failure among children, Jaggi said. Those very early cases were thought to be Kawasaki’s disease or toxic shock syndrome, both of which can cause chronic fever and multiorgan failure.

Similar cases were noticed by clinicians in the United Kingdom and in New York City, where 15 children were hospitalized from April 16 through May 4, many in intensive care units. By May 12, New York health officials identified 102 patients with the illness, all of whom had been infected by COVID-19.

Triggered by the increasing reports, on May 14 the CDC issued a health advisory.

It recognized the illness as multisystem inflammatory syndrome in children, Jaggi said.

As of mid-December, a total of 1,288 children in the U.S. had been confirmed with MIS-C, according to the CDC.

Georgia reported a total of 97 cases, state Department of Public Health spokeswoman Nancy Nydam said last week.

But that number often lags, Jaggi said, because of the time it takes for the state health department to conduct its investigation based on data provided by clinicians at CHOA.

Most cases affect children and adolescents ages 1 to 14, with an average age of 8 years. More than 75% of reported cases have occurred in children who are Hispanic or Latino or black. About 56% of the youngsters were male, according to the CDC.

“It is a scary situation,” said Dr. Zachary Hoy, a pediatric infectious disease specialist at Nashville Pediatric Infectious Disease in Tennessee.

Since August, Hoy has witnessed four cases of MIS-C among previously health children, he said. One of the worst cases involved a 16-year-old football player who was gearing up for his fall season. Another was an energetic 10-year-old who loved to ride horses and tractors on her family farm.

“Her family knew something was wrong when she didn’t want to ride four-wheelers anymore,’’ he said.

While dangerous, the disease is still rare among children who catch COVID-19.

In Georgia’s southeast coastal region, Dr. Stephen Thacker, a pediatric infectious disease specialist at Memorial Health Dwaine & Cynthia Willett Children’s Hospital of Savannah, has seen few children with symptoms of MIS-C.

But he expects to see more as Georgia posts record-breaking rates of infection.

‘Symptoms lined up’

While the CDC has issued a case definition of MIS-C, Jaggi, the pediatric infectious disease specialist, said a diagnosis can be tricky, For example, the acute respiratory distress associated with the coronavirus also is observed in MIS-C patients.

“Since this is a new illness, the definition is sort of purposefully general,’’ she said.

“I think later on we will go back and try to understand a little bit more about it.

“We have to really look at the full clinical picture to decide if they are MIS-C,” she said. “It can be a bit of a challenge because there can be a bit of subjectivity potentially. But, as times goes on, we are going to be doing more analysis to try to figure out some more of the patterns.”

CHOA officials declined to discuss details of Austin Carney’s medical history, diagnosis or treatment as federal law prohibits disclosures of protected health information to the public.

Jessica Carney suspected that her son had MIS-C but doctors at CHOA told her that early lab work had ruled it out. “I asked doctors repeatedly,’’ she said. “All the symptoms lined up with it.”

When Austin arrived at the hospital, an electrocardiogram showed he had an elevated heartbeat. He broke out in unusual rashes, kept vomiting and had to be put on oxygen. His previous bout with the virus was still another potential indicator of MIS-C.

Doctors told family members that they were able to get a handle on his fever, which tends to persist in cases of MIS-C, she said. In addition, many children who develop the condition must take steroids and cardiac medication to ease inflammation and elevated blood pressure.

Austin did not require those treatments.

Still, Jessica Carney urged doctors to conduct another test before her son, who suffers from a condition that causes excess fluid in his brain, was discharged from Scottish Rite on Dec. 11.

“The inflammatory markers came back good,’’ she said. “But I’m still a little uncertain about it because of all the symptoms and how hard it hit him.”

Federal records show a spike in the number of COVID-19 hospitalizations in recent weeks at CHOA campuses.

As of Dec. 11, Scottish Rite Hospital reported a seven-day average of 24 confirmed or suspected COVID- 19 pediatric patients. Egleston Hospital reported an average of 16, federal data shows.

So far, there are no drugs specifically approved by the Food and Drug Administration to treat COVID-19 in children, and no vaccines are yet available for those under age 16.