Hanna Saltzman: Concerns for children’s health won’t expire with the mask mandate

Dozens of children have been hospitalized in Utah with life-threatening inflammatory syndrome

(Francisco Kjolseth | The Salt Lake Tribune) Houses sign up to participate in the SugarHood Halloween treat giving or a visual scavenger hunt as participants agree to abide by CDC Covid safety standards as they encourage children to touch only what is taken, keep their distance from others and wear masks while trick or treading on Saturday, Oct. 31, 2020.

Our 4-year-old patient screams with every touch, a red rash ripping down his swollen body. A tangle of tubes connects him to the medications and fluids that are saving his life. This young child, J., has a rare but dangerous consequence of COVID-19 infection: multisystem inflammatory syndrome in children (MIS-C). His parents, who permitted my sharing his story, are among dozens of families here in Utah whose children have been hospitalized with this life-threatening illness.

It’s a common misconception that kids don’t get sick from COVID-19. It’s true that healthy children like J. tend to have minimal or no symptoms when infected — often parents, including J.’s, have no idea that their children have had the virus. But rarely, for some children the immune system stays revved up afterward. Several weeks after an unknown COVID-19 infection, J.’s immune system started to throw a temper tantrum of inflammation. But instead of fighting off the virus, now his immune system was attacking his own body. That’s MIS-C.

As a pediatric resident physician, I have taken care of many of these patients. With the mask mandate set to expire April 10, the threat of MIS-C adds one crucial reason to keep wearing yours.

When J. first got sick, it seemed like he might have an ear infection. Then, after a couple days of fever, he suddenly got worse. His fever rose and didn’t respond to Tylenol. He developed projectile vomiting, diarrhea, swelling and a head-to-toe red rash. By the time he got to the emergency department, his blood pressure was dropping. We admitted him to the intensive care unit.

In MIS-C, inflammation can cause arteries to widen and leak, which can lead to dangerously low blood pressures. In the intensive care unit, J. was exhausted. “He looked like a lifeless body,” his father said. Hooked up to monitors and tubes, he needed a slew of medications, fluids, blood draws and imaging tests. For many patients, including J., inflammation can attack the heart. Sometimes, this can harm the heart’s ability to pump blood.

With intensive medical treatment, J. slowly started to improve. After almost a week in the hospital, he finally wanted to play with his toys again. Fortunately, almost all children hospitalized with MIS-C survive. But the treatments, including immune-suppressing medications, come with their own risks and costs.

After leaving the hospital, these children often continue to feel exhausted. They need lab monitoring and follow-up appointments with heart and immune system doctors. The long-term effects of MIS-C are not yet known. J.’s parents are particularly worried about the risk for future heart problems.

“Going home is the first step, but it’s not the end of this nightmare,” his mother said.

With warm weather rolling in and the mask mandate set to expire next week, it’s tempting to think of the pandemic as over. But it’s not.

As adults, we often have the power to choose the risks we take. Kids don’t have that privilege.

“This 4-year-old has gone through more in the past week than I’ve ever gone through,” J.’s mom said as she watched her still-recovering child tentatively take a bite of grilled cheese.

As state and local restrictions loosen, I urge you to keep wearing your mask, get vaccinated, and stay vigilant. If not for yourself, please, do it for kids like J.

Hanna Saltzman

Hanna Saltzman, M.D., is a pediatric resident physician in Salt Lake City. She can be reached on twitter @hannasaltzman.

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