NJ hospitals report 13 cases of children's inflammatory disease linked to coronavirus
At least 13 children in New Jersey have been hospitalized with a rare inflammatory illness believed to be linked to the coronavirus, a worrisome new development in the pandemic that has also been noted in New York and Europe.
Five children have been treated at Hackensack University Medical Center, five at Rutgers Robert Wood Johnson University Hospital in New Brunswick, two at St. Joseph's University Medical Center in Paterson and one at Morristown Medical Center, hospital officials said Thursday. All were patients at the children's hospitals associated with those institutions.
The children ranged in age from 3 to 14, and all have survived, according to pediatric specialists who treated them. Three remain in intensive care at Rutgers, while two were hospitalized at St. Joseph's and Morristown as of Thursday. The others have been discharged.
“They are coming in with symptoms of cardiac failure, with shortness of breath [and] fatigue," said Dr. Jennifer Owensby, medical director of the pediatric intensive care unit at the Bristol-Myers Squibb Children’s Hospital in New Brunswick. Some also had fevers, she said.
The New Jersey Health Department is seeking guidance from the federal Centers for Disease Control and Prevention about the syndrome and criteria for defining a case, said Donna Leusner, a department spokeswoman.
"This is a very rare disease," Dr. Ed Lifshitz, director of the department's Communicable Disease Service, said Thursday. "We’re still learning a whole lot more about how it's associated with COVID-19," the illness caused by coronavirus infection.
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Generally, children exposed to the coronavirus have mild or asymptomatic infections. No one younger than 18 is known to have died of the infection in New Jersey. Of those with confirmed diagnoses of COVID-19, only 2 percent are younger than 18 — meaning that most haven't been sick enough to be tested. And of those children confirmed to have the disease, only 6 percent have been hospitalized.
Nevertheless, Lifshitz said pediatricians should be aware that the newly reported inflammatory syndrome "is something that can happen and should be acted on. It's rare, but it needs to be kept in mind."
New Jersey children with the syndrome have arrived at hospitals extremely ill, with symptoms that included kidney and liver failure and inflammation of the heart. Most arrived in shock, with low blood pressure and rapid heart rates.
Intensive care
They have been treated in pediatric intensive care units, with stays of one to two weeks on average.
The first case at Hackensack's Joseph M. Sanzari Children's Hospital was identified in March, with the last discharged this week, said Dr. Aryeh Baer, a pediatric infectious disease specialist there. The children arrived at the Hackensack emergency department or were referred from Hackensack Meridian Health's Pascack Valley Medical Center in Westwood or Palisades Medical Center in North Bergen.
All of the children were previously healthy.
At St. Joseph's Children's Hospital in Paterson, one 8-year-old boy was admitted on Saturday and has been discharged, said Dr. David Goldberg, chief of pediatric infectious diseases. A girl was admitted Tuesday night and is being monitored.
"We weren't really looking for it," Baer said of the initial cases. But the unusual illnesses matched descriptions of a pediatric syndrome that had been reported in areas of Europe hard hit by the pandemic and in New York City.
None of the children treated at Hackensack showed signs of active infection with coronavirus when tested with a nasal-pharyngeal swab, he said. That suggests that the illness resulted from the immune system's delayed and overactive response, Baer said. The timing of the cases, with most occurring in April, also is consistent with a delayed response to an infection that occurred during the peak period for the virus in North Jersey.
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One of the children tested positive for antibodies to COVID-19 and another's antibody test was negative, but Baer noted that there is uncertainty about the reliability of current antibody tests for the virus. Some of the children had family members who were diagnosed with COVID, and one had no known exposure, he said.
In contrast, all five children treated in New Brunswick tested positive for the coronavirus, after nasal swab tests or an antibody test, The first case at St. Joseph's also had a positive swab test, and developed respiratory symptoms after he was admitted, Goldberg said.
"The first cases we saw were just kids with low blood pressure and acting like [they had] sepsis," or an infection of the blood, Baer said.
Laboratory tests of their blood, however, showed unusually high levels of a marker for inflammation, as well as low levels of platelets, the blood cells that aid clotting. "Our feeling was, if this is happening, it’s probably somehow related to the pandemic," Baer said.
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While the new illness is similar to a rare childhood inflammatory disease known as Kawasaki disease, it has some key differences. Kawasaki is rarely identified in children over age 8, and it does not cause low platelet counts. Although the cause of Kawasaki disease is not known, it is believed to be triggered by a virus.
Symptoms of Kawasaki include red eyes, rash throughout the body, high fevers, and deep red tongues with white spots known as strawberry tongue. Any combination of such symptoms should cause concern and lead parents to have their children evaluated, Owensby said.
Parents should also seek care immediately if their child has difficulty breathing or getting out of bed, is confused and doesn't recognize people, and shows signs of extreme sickness.
Baer referred to the cases he'd seen as Kawasaki-shock syndrome, due to symptoms of shock the children exhibited from low blood pressure and rapid heart rates.
They received treatment in the pediatric intensive care unit to boost their pressure and make sure the blood supply to the brain and other organs was sufficient. Most were in intensive care for one to two weeks, Baer said.
Morristown toddler
At Morristown Medical, a toddler with COVID-19 was admitted last week showing “clinical manifestations consistent with Kawasaki disease” said Dr. Cecilia Di Pentima, director of pediatric infectious diseases at the Atlantic Health System.
The child remains at the hospital and “is doing really well,” Di Pentima said, after recieving a standard treatment for Kawasaki as well as the antiviral medication known as Remdesivir.
Di Pentima said a medical team at Atlantic Health including infection specialists and cardiologists are working to address the problem. They are consulting with experts from the U.S., London and Geneva on the illness and its treatment.
She said she participated in a call with more than 100 pediatricians on Thursday to help them understand the health risk among young patients and advised parents to contact a pediatrician if their child developed fever. Di Pentima “absolutely” expects to see more of these cases.
“We still have transmission in the community,” she said. “As the country starts to open up, I think the number of cases are going to continue to increase and that the number of pediatric patients that we see is going to be higher.”
64 cases in New York
New York may have 64 potential cases of children coming down with the condition. On Wednesday, the New York state Department of Health issued an advisory to health care providers about the inflammatory disease affecting children.
New York City initially reported 15 cases among children aged 2 to 15. Patients had a fever with more than half of them reporting a rash, abdominal pain, vomiting or diarrhea.
No deaths have been reported in New York due to the illness, but New York City said many of the patients required blood pressure support and five required mechanical ventilation.
The United Kingdom Pediatric Intensive Care Society sent an alert late last month about a "severe COVID-19 related illness in children." The group said 100 cases had been identified in five countries, including the U.S., France, Italy, Spain, and Switzerland.
Staff Writer Joseph Spector contributed to this article.
Check back for more details in this developing story.
Monsy Alvarado is the immigration reporter for NorthJersey.com. To get unlimited access to the latest news about one of the hottest issues in our state and country, please subscribe or activate your digital account today.
Email: alvarado@northjersey.com Twitter: @monsyalvarado