Doctors in England have been warned to look out for symptoms in children that have not previously been associated with coronavirus but that might suggest they have contracted the disease.
The Paediatric Intensive Care Society told its members on Monday it had received an email alert from NHS England “highlighting a small rise in the number of cases of critically ill children presenting with an unusual clinical picture”. Many of the children had tested positive for Covid-19, it said.
The alert said if children had toxic shock syndrome or “atypical Kawasaki disease” — a general inflammation of blood vessels — “then please discuss this case early with paediatric infectious disease or paediatric critical care teams”.
Abdominal pain and gastrointestinal symptoms had also been “a common feature as has cardiac inflammation”, it said.
The society said it was “important to highlight that, both in the UK and in other countries, there have still been very few cases of critically unwell children with Covid-19 admitted to paediatric intensive care units”.
However, PICS was “aware of a small number of children nationally who appear to fit the clinical picture described in the NHS England alert”, it said, without giving any specifics.
NHS England national medical director Stephen Powis told the daily Downing Street briefing: “We have become aware in the last few days of reports of severe illness in children which might be a Kawasaki-like disease.
“Both Chris [Whitty, the chief medical officer] and I are aware of that, and we have asked our experts, I have asked the national clinical director for children and young people to look into this as a matter of urgency.
“We're not sure at the moment — it is really too early to say whether there is a link.”
Prof Whitty told the briefing a link was “certainly plausible”.
“This is a very rare situation but I think it is entirely plausible that this is caused by this virus, at least in some cases,” he said. “Because we know that in adults who of course have much more disease than children do, big problems are caused by an inflammatory process and this looks rather like an inflammatory process, a rather different one.
“Therefore, given that we have got a new presentation of this at a time with a new disease, the possibility — it is not a definite, we need to look for other causes as well — but the possibility that there is a link is certainly plausible.”
Russell Viner, president of the Royal College of Paediatrics and Child Health, said it was already known that a very small number of children could become severely ill with Covid-19 but emphasised this was very rare.
Prof Viner added: “New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.
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“However our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with Covid-19 but if they are concerned about their children's health for any reason, they should seek help from a health professional.”
James Gill, honorary clinical lecturer at Warwick Medical School and a locum GP, cautioned that “a clinical signal does not mean there is a new finding, it does however work as an alert to clinicians to be vigilant in case there is anything substantive behind that signal”.
While it was easy to draw conclusions suggestive of a connection with Covid-19, “there is not sufficient evidence to substantiate that the signal has any clinical significance”, he said.
Matt Hancock, health secretary, said he was “very worried” about reports of the possible emergence of a corona-related syndrome affecting children.
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