Saturday, September 19, 2020
St. Luke’s Doctors Treat First Idaho Child with Multisystem Inflammatory Syndrome
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Life appeared blissful on the Big Wood River near St. Luke’s Wood River Tuesday afternoon. But Idaho parents are cautioned to monitor their children’s health for Multisystem Inflammatory Syndrome after an 8-year-old was treated in the Treasure Valley.
   
Wednesday, August 19, 2020
 

STORY AND PHOTOS BY KAREN BOSSICK

COVID GRAPHS BY PAUL RIES

St. Luke’s Children’s Hospital Pediatric has successfully treated what is believed to be the first case of a child with Multisystem Inflammatory Syndrome in Children in Idaho.

MIS-C, referred to in its early days as Kawasaki Disease, is known to make children profoundly ill.

 
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Dr. Kenny Bramwell said that he expects to see more cases of Multisystem Inflammatory Syndrome among youngsters because of the prevalence of COVID in parts of Idaho.
 

The 7-year-old—from the Treasure Valley—was admitted to Children’s Hospital in Boise late Wednesday. She improved enough that she was transferred to a main hospital floor on Sunday and released to go home on Monday.

“So, it’s a great success story,” Dr. Kenny Bramwell, system medical director for St. Luke’s Children’s told 22 reporters via a conference call Tuesday morning. “We were very fortunate to have the resources here to treat it, and I’m very pleased the doctors here recognized the illness.”

Bramwell said the child had no known prior health conditions. She appeared to come down with MIS-C symptoms about two weeks after exposure to someone with COVID.

Bramwell said Treasure Valley doctors had been expecting a case of MIS-C for the past two months because of the prevalence of coronavirus in Boise, Nampa and Caldwell. Idaho had just 2,803 cases of coronavirus and was seeing between two and three dozen new cases a day as June debuted. Now it has 28,000 cases, often recording more than 500 or 600 cases a day. And the Treasure Valley has led the way.

 
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Idaho reported lower numbers for the third day in a row Tuesday with just 384 new cases for 28,326 total. But the state gained 9 new deaths for a total of 282 deaths. Five deaths occurred in Canyon and Ada counties; the rest, in Shoshone, Payette and Kootenai counties.
 

St. Luke’s Children’s Hospital has treated 11 patients with COVID since the pandemic began—this is the first with MIS-C.

“It happens in one of every 1,000 COVID patients,” said Bramwell, specifying he was referring to all of those diagnosed with COVID, not just children. “And I do expect we’ll have a handful more as the prevalence continues locally.”

The illness was defined just four months ago. About 570 children through age 21 have been treated for MIS-C, according to the Centers for Disease Control. Ten have died, making the mortality rate just under 2 percent.

At least 93 of those cases were confirmed in New York, New Jersey and Massachusetts, with 64 percent of those ending up in the ICU. The median age is 8 but six patients under 1 year of age have been diagnosed with MIS-C. The majority of patients are boys; 73 percent have been black or Hispanic.

 
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Blaine County continued its march toward 600 cases Tuesday, adding four new cases for a total of 590.
 

Parents should watch for persistent or worsening fatigue or listlessness. Other systems include a sunburn-like rash, bloodshot eyes, swollen hands and feet, cracked lips, enlarged lymph node and a swollen tongue that resembles a strawberry.

Toxic shock-like symptoms include severe flu-like symptoms, high fever, low blood pressure, very high heart rate, diarrhea and vomiting.

The criteria for being diagnosed with MIS-C includes a high fever of more than 24 hours, having multi-systems or organs involved, a positive COVID exposure, signs of inflammation detected by lab tests and being sick enough to be admitted to a hospital.

Some patients’ blood vessels, including the coronary arteries, enlarge or form aneurysms. Some have impaired cardiac function, kidney damage, neurologic symptoms or gastrointestinal symptoms.

The symptoms progress quickly so families should be ready to seek medical care—first from a pediatrician or family doctor and, if necessary, from a hospital where the child can be closely observed and treated by a variety of specialists, including cardiologists.

“Given the severity of the patient here and the severity of the cases I’ve heard about in Salt Lake City and Portland, I have difficulty believing it could be treated at home,” said Bramwell. “These are profoundly ill patients.”

There is not a treatment specifically designed for MIS-C. Instead, doctors offer supportive care using treatments used for other illnesses. Those include rehydration, electrolyte therapy, anti-inflammatory infusions to tamp down the patient’s over-vigorous response, blood thinning medications, IV fluids, and antibiotic and antiviral therapy.

The disease appears to be a delayed complication of the coronavirus infection. Some of those treated for MIS-C test first display symptoms about four weeks after they’ve tested positive for COVID.  The MIS-C symptoms follow after they’ve dealt with respiratory problems of COVID.

In other cases, MIS-C is the first manifestation of illness.

That’s the case with St. Luke’s patient. She didn’t have any COVID symptoms the first two weeks after exposure.

Bramwell said he doesn’t believe age has any correlation with severity and mortality of the disease. He also doesn’t believe that a youngster with MIS-C can infect another child with it. Rather, it’s a matter of how the body responds to COVID.

Doctors do not know how contagious children with MIS-C are. But St. Luke’s doctors treated their patient with the full precautions of isolation, assuming she was contagious.

“We assume these patients are shedding the virus particles throughout,” Bramwell said.

Bramwell said it’s too soon to know what the long-term effects of MIS-C might be, if any. But he expects doctors will learn more in the next few months.

The best way to prevent COVID--and MIS-C--remains vigilance, he said: “Continuing to wear masks, watch distances, wash your hands is the best way to prevent COVID.”

ST. LUKE’S CONSIDERS A CLINIC FOR LONG HAULERS

St. Luke’s doctors are examining the possibility of setting up a clinic for those with long-term effects of COVID, Dr. Kenny Bramwell said Tuesday. The clinic could address patients who are struggling weeks after the onset of COVID with such symptoms as difficulty sleeping and muscle aches.

MULDOON FIRE UPDATE

Seventy-seven firefighters continue to work the Muldoon Fire 20 miles southwest of Mackay. The fire is making short crown runs in timber with crowning and group torching. Red Flag warnings continue from noon until 6 today with winds gusting to 25 miles per hour, which could cause increased fire activity.

The fire is 35 percent contained.

Some smoke to the north of Ketchum on Tuesday emanated in northern California.

 

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