As cases of COVID-19 increase, Utah doctors expect to see more children in hospital with associated inflammatory syndrome

SALT LAKE CITY – It all started with a headache. Madeline Dayton, 12, was a healthy and active child with no health issues.

That all changed when she woke up on an October morning with a headache that worsened with fever the next day.

By the third day, it looked like she had turned into a corner and was feeling better. But things went down very fast when she screamed to her mother after a few days that she could not move.

“I couldn’t walk at all,” she said. “I was just stuck.”

Her mother, Marilyn Dayton, packed her in a car and left her for three hours at the Primary Children’s Hospital in Salt Lake City from her small Wyoming town, Cokeville.

Merlin Dayton said, “When I knew I needed to get her somewhere fast, and I never had any doubt in my mind where to reach me.”

When the pair arrived at the emergency room, a doctor asked Merlin where Maddy was brought from, mistakenly taking the young girl to the hospital via helicopter – thinking Maddy’s condition had become critical.

“It was quite serious when we got there, but I know we were being watched and we were extremely blessed,” Merlin said.

Maddy was later diagnosed with multisystem inflammatory syndrome or MIS-C in children, a rare complication that develops mainly in children following a severe Covidi-19 infection. It can cause inflammation to various parts of the body, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

Maddy and Merlin were shocked to find this diagnosis, as Maddy was never infected with the novel coronavirus – or so he thought.

Through an antibody test, doctors discovered that Maddy had COVID-19 antibodies, meaning he was infected without ever developing symptoms. To date, the family still does not know where it is contracted from or if another member of the family has disproportionately placed COVID-19.

After spending about four days in the intensive care unit and then another two days in the hospital, Maddy was discharged and is now being closely observed in outpatient care.

“I am very grateful to the primary children, to these doctors who have worked on that and to the knowledge that they have,” Merlin Day said. “I know without a doubt that she wouldn’t be sitting near me today if it wasn’t for her intervention and caring for them and I’m very appreciative of it.”

Dayton joins doctors who helped to treat Maddy at a Monday conference to inform others to share her story and warns that COVID-19 may have serious implications for children Can.

Since late April, the hospital has seen 17 MIS-C cases, which are over-admitted over the weekend, bringing the total to about 20, said pediatric infectious disease Dr. Jason Lake. With an increase of COVID-19 cases occurring in Utah and nationwide, doctors are expecting to see an increase in MIS-C cases in the coming weeks.

Since the onset of the epidemic, it has been reported that healthy children are at lower risk for developing severe symptoms of COVID-19 and are instead seen as a vector for transmission. While this is mostly true, Lake said that people need to know that any child is at risk of developing serious COVID-19 complications, including MIS-C.

The emotional, educational, and social effects of the epidemic on children have been widely discussed, with Lake finding that the very real health implications are largely avoided by interactions.

“This is due to a very fortunate circumstance that children usually have mild diseases but this does not mean that a portion of these children do not go on to develop very severe infections,” he said.

It usually takes four to six weeks after COVID-19 infection to develop MIS-C, and symptoms are not what the case of COVID-19 looks like, doctors said. Symptoms include abdominal pain, vomiting, diarrhea, neck pain, rashes, bleeding in the eyes and feeling tired.

These symptoms are common in many other diseases, even appendicitis. With COVID-19 cases on the rise, Pediatric Rheumatology Dr. Hirin Tremorkey’s hospitals will need to initiate an MIS-C examination whenever a patient exhibits these symptoms.

12-year-old Maddy Dayton is usually an active child. She is now recovering from MIS-C, which is unable to play for several months. (Photo: courtesy of Merlin Dayton)

Much is still unknown about the syndrome, especially its long-term effects. Doctors have continued outpatient treatment and observation on MIS-C patients for three to six months to allow the organs to heal and observe long-term health issues associated with the disease.

During that time, children are unable to participate in strenuous activity like sports.

Since her release from the hospital, Maddy has not attended school or is not able to play basketball, as she usually does this time of year. Doctors said her heart, which was most affected during her bout with MIS-C, needed time to recover.

Pediatric Cardiology Dr. Dongan Trong said he is still not sure why Maddy could not walk that morning, but added that he experienced a lot of muscle pain during his stay in the hospital, more research to fully understand the condition is required.

The syndrome is similar to a rare disease often seen in young children – Kawasaki disease. Treatment plans for both include reduced inflammation as well as using immunosuppressant medications to take steroids. The degree is the same for observing Kawasaki disease and MIS-C. It is also not currently known whether children who previously suffered from Kawasaki disease are at greater risk of developing MIS-C.

Despite being extremely rare, there have been adults presenting similar symptoms to MIS-C patients, the Centers for Disease Control and Prevention reported. Trussong said the MIS-C cases are mimicking an unfortunate and common trend seen during the epidemic, with more patients in the Hispanic and African American populations.

At this point, Truong said that it is unclear why, while doctors do not know if there is a genetic component, or if there are other socio-economic factors that may follow the trend of COVID-19. Either way, more data is needed, she said. Several studies are currently underway to better understand MIS-C, including the National Heart, Lung, and Blood Institute.

MIS-C is a new diagnosis first seen in the UK according to Terameki and later in Italy and New York in the early months of the epidemic. Tremkeri said the incident is not new, as doctors have previously treated hyperinflammatory syndrome after other infections.

“But what we’re seeing with MIS-C, you know, I think that’s more in proportion to what we’ve seen before.”

To diagnose the condition, a patient must meet at least one of three criteria – a positive PCR COVID-19 test, a positive COVID-19 antibody or a known exposure to the virus.

Most commonly, like Maddy, patients with MIS-C are testing positive for antibodies.

Now recovering at home, Maddy and her mom are warning others to take the epidemic seriously – even if you think you’re not affected by it.

With a population of less than 1,000, Merlin Dayton thought that he and his family were by default a social mess in their small town. After seeing her daughter ill in the ICU for a few days, she now has a renewed commitment to step up her game when it comes to health guidelines and safety precautions.

As people across the country continue to reduce the severity of the epidemic and oppose health guidelines, such as wearing masks, Merlin Dayton is urging the public to join them in doing a better job.

I couldn’t walk at all … I was just stuck.

-12 year old Madilyn Dayton, recovering from MIS-C.

“We’ve lived the experience. And a lot of opinions don’t matter to me anymore,” she said. “We need to take care to win COVID. We need to keep in mind what our actions are doing for others.”

Before Maddy fell ill with MIS-C, Merlin Dayton said she did not know that COVID-19 could affect healthy children in such a serious way, thinking it was only the condition of at-risk children.

“I had no idea that the children would be affected and as sick as she was,” Merlin Dayton said. “And the way it progressed was so fast. That knocked me out.”

Asymptomatic spread is such a lethal part of the virus, she said, that her family inadvertently passed it on to others, leading to severe symptoms or the risk of developing MIS-C.

“We only need to take care – even if we’re not in that high-risk category – how can we care to win COVID?” Merlin Dayton said.

In order to gather people indoors due to the upcoming winter conditions and holidays, doctors are worried that the already stressful health care system will deteriorate.

“Many of us in the health community are very concerned about what is going to happen in the coming months,” Lake said. “It may be that our ability to necessarily provide health care is in turmoil.”

The record-breaking height for COVID-19 patients hospitalized on Monday in Utah was recorded at 503.

As many health officials have done over the past several months, Lake again appealed to the public to work on his behalf – wear masks, find alternative ways to celebrate holidays and social distance.

“None of us are safe until we are all safe,” he said.

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