During the COVID-19 pandemic, an unprecedented cluster of eight children with hyperinflammatory shock was observed at the South Thames Retrieval Service in London, UK. These children presented with features similar to atypical Kawasaki disease and Kawasaki disease shock syndrome.

Michigan State University

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For the patients between 3-13 month: 8 patients (80%) had fever, 6(60%) had cough, 4 (40%) had sore throat, 3 (30%) had stuffy nose, and 2(20%) had sneezing and rhinorrhea. None of the patients had diarrhea or dyspnea during the course of illness.
Fever resolved 24 h after fever onset with the peak of fever ranging from 37.7 °C to 39.2 °C.

Children's Symptomatic COVID-19 Infection

Riphagen, S., Gomez, X., Gonzalez-Martinez, C., Wilkinson, N., & Theocharis, P. (2020). Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet, 395(10237), 1607-1608. https://doi.org/10.1016/s0140-6736(20)31094-1

Hyperinflammatory shock in children during the COVID-19 pandemic

MIS-C "is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. This rampant inflammation has been recorded in multiple organ systems; yet, clinical research into the pathogenesis of the disease is insufficient. However, we know that many children with MIS-C were exposed or infected with SARS-CoV-2. Currently, the lack of a universal case definition of MIS-C has limited the number of cases that are accurately diagnosed and hampered with proper treatment of the disease. Further research into the clinical, epidemiological and immunological nature of MIS-C is desperately needed. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care."

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19

"Combined data from both PCR instruments show that viral loads of at least 250,000 copies, a threshold we previously established for the isolation of infectious virus in cell culture at more than 5% probability, were present across the study period in 29.0% of kindergarten-aged patients 0-6 years old (n=38), 37.3% of those aged 0-19 (n=150), and in 51.4% of those aged 20 and above (n=3153). The differences in these fractions may also be due to differences in test utilization. We conclude that a considerable percentage of infected people in all age groups, including those who are pre- or mild-symptomatic, carry viral loads likely to represent infectivity. Based on these results and
uncertainty about the remaining incidence, we recommend caution and careful monitoring during gradual lifting of non-pharmaceutical interventions. In particular, there is little evidence from the present study to support suggestions that children may not be as infectious as adults."

Abstract for An analysis of SARS-CoV-2 viral load by patient age

- Working Papers
- Journal of American Medical Association (JAMA)

References for Children's Symptomatic COVID-19 Infection by Journal/Source

This cross-sectional study included children positive for COVID-19 admitted to 46 North American PICUs between March 14 and April 3, 2020 with follow-up to April 10, 2020. The main outcomes and measures analyzed were prehospital characteristics, clinical trajectory, and hospital outcomes of children admitted to PICUs with confirmed COVID-19 infection.

Prehospital comorbidities appear to be an important factor in children. 

Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

Cluster of Hyperinflammatory Shock in Children in London

- Eight children with the recent onset hyperinflammatory shock were chosen for the study (symptoms similar to Kawasaki disease)
- 4 children came from families with exposure to COVID-19
- 7 children presented with inflammation in both lungs
- All of the children tested negative for the virus
- 1 of the children was secluded due to having adenovirus and enterovirus
- 1 child had a coronary aneurysm
- Another child had an irregular heartbeat and faced a refractory shock; the child eventually died due to a stroke
- During the first day of the study, the children were intravenously given immunoglobulin and antibiotics
- 6 children were given aspirin
- After 4-6 days, all the children were discharged
- After discharge, two children tested positive for COVID-19, one of them being the child that died (post-mortem report) 
- Overall, 7/8 children survived


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