Only after New York City passed its current coronavirus peak did pediatricians notice a striking, new pattern: Dozens of kids who had been exposed to COVID-19 were coming in sick, but they weren’t coughing. They didn’t have severe respiratory distress. Instead, they had sky-high inflammation and some combination of fever, rashes on their hands and feet, diarrhea, vomiting, and very low blood pressure. When ICU doctors around the world gathered for a weekly online COVID-19 call on May 2, doctors elsewhere began sharing similar observations. “The tenor of the meeting completely changed,” says Steven Kernie, the chief of critical-care medicine at New York–Presbyterian Morgan Stanley Children’s Hospital, who was on the call.
Until then, the news about children and COVID-19, the disease caused by the novel coronavirus, had been largely good: Kids can get seriously sick, but they rarely do. They can spread the disease, but they do it less than adults. Study after study—in China, Iceland, Australia, Italy, and the Netherlands—has found that children get less sick and are less contagious.
But a very small number of children seem to have a delayed reaction to the novel coronavirus—one that takes many weeks to manifest. What pediatricians first saw in Europe and New York is now named “pediatric multi-system inflammatory syndrome” (PMIS) or, per the Centers for Disease Control and Prevention, “multisystem inflammatory syndrome in children.” Since the New York City Health Department issued an alert on May 4, 82 such cases have been confirmed in the city. Most patients have recovered or are recovering, but one child has died. Across the country, doctors are finding similar cases. PMIS does seem to be a phenomenon unique to kids.