Thanks to everyone who was able to attend our COVID-19 pediatric research panel on November 10. If you were unable to attend, we have posted the questions and answers posed to the panel here. The panelists who fielded questions were Stephanie Schwartz, MD and Zachary Willis, MD, MPH.
Do we have a reliable estimate of COVID rates of infection in NC by ethnicity? Do we see more MIS-C in POC because they have a larger burden of COVID in their communities?
Zachary Willis: There is far more burden in Black and Latinx communities, although in recent months it has evened out significantly. NC has data at https://covid19.ncdhhs.gov/dashboard/cases. Durham County has a great racial/ethnic data at https://covid19.ncdhhs.gov/dashboard/cases.
The definition of Multisystem Inflammatory Syndrome in Children (MISC-C) is still quite broad. How has your understanding of the difference between COVID-19 disease directly since it is often associated with myocarditis and the MIS-C evolved over time?
Zachary Willis: It’s often a challenge, and we are deciding whether to do remdesivir/dexamethasone vs high dose steroids and IVIG. I find the lgG to be very helpful, and increasingly children are more likely to have a known positive test than they were earlier in the pandemic.
Stephanie Schwartz: It’s a great question. The OVERCOMING COVID group is submitting a paper looking at phenotypes. One phenotype certainly appears to overlap with acute COVID. More data on this is needed.
Zachary Willis: I agree.
It seems like whatever we do, patients all benefit from some forms of immunosuppression. It would be interesting to see head to head trial of remdesivir/dexamethasone and IVIG/steroids.
Zachary Willis: I think if they have an IgG they probably don’t have replicating virus. The steroid doses that work for MIS-C are high.
If MIS-C is a post infectious phenomenon, do we expect similar risk post vaccine?
Zachary Willis: This is theoretically possible. Probably unlikely, but hard to know until we figure out MIS-C immunopathogenesis. Post-infectious immune-driven phenomena are generally far less common after vaccination than natural infection (e.g., Guillian-Barre syndrome after influenza).
Does severity of an individual’s acute COVID illness seem to hold any correlation to development of MIS-C?
Stephanie Schwartz: Most of the MIS-C patients we have cared for have not been hospitalized with acute COVID implying their course is not severe. Many were asymptomatic or had a mild illness which was believed to be acute COVID.