Connecting clues, doctors treat COVID-linked illness in children

David Vargas loves to draw fellow New Yorkers.

He lives in the Bronx, and uses public transport to visit parks in Brooklyn and Manhattan. He draws people on the subway, and gets lost in the details, like their shoes.

New Yorkers who ride the subway wear so many different shoes, they hold their feet in so many different positions, and sketching shoes is far less awkward than staring a stranger in the face as the train rolls from station to station.

Does he ever miss a stop in order to finish a portrait? Vargas reflects, but then quickly starts laughing, “yes, all the time”, he says.

When Vargas got the coronavirus, the illness was swift and mild. He is 17, and thought nothing of it. A few days later, he felt terrible.

“I’ve never felt anything like it,” he says.

In the evenings, pain started in his chest, but he could not say whether it was coming from his skin, his bones, or his heart. “I didn’t know what was happening to me.” After keeping quiet about it for two days, he told his parents, who took him to the emergency room.

Vargas was one of the first young New Yorkers to experience a rare new illness that appears in children weeks after COVID-19 cases peak in the vicinity, which doctors are calling paediatric multisystem inflammatory syndrome, or PMIS (but other variations of the name include MIS-C, or simply MIS).

The condition – which affects children, from toddlers to teenagers – is defined by a serious inflammatory syndrome affecting multiple organs, and a proven connection between the patient and the virus that causes COVID-19: SARS-CoV-2.

But PMIS is not COVID-19 – it is something that seems to follow it.

A clue in the dark

In New York, where almost 400,000 people have been infected by the coronavirus, just more than 200 PMIS cases have been observed since late April. Scientists are beginning to understand its features and search for its causes.

At first, Vargas did not know what he had, but after spending one night at a local hospital, he was moved to Mount Sinai Kravis Children’s Hospital in Manhattan.

Dr George Ofori-Amanfo, a cardiologist and intensive care physician, leads the paediatric ICU at Mount Sinai. When PMIS children began arriving, he and his team set two goals: treat them, and understand what they were suffering from. In the beginning, all they knew was that the cases were serious.

“It’s an exaggerated, uncontrolled immune response to COVID exposure. By that definition, it could affect any organ of the body, including the heart,” Dr Ofori-Amanfo says.

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