As Illinois continues with Phase 3 of reopening after the 10-week, state-wide COVID-19 shutdown, Barrington pediatrician, Dr. Mary Collins is voicing new concerns and sharing advice about continuing to protect our kids in the weeks ahead. Phase 3 of Illinois’ reopening means some restaurants with outdoor seating and other businesses reopened as of Friday, May 29th. Dr. Collins says new data from Lurie Children’s Hospital and the start of summer break indicate now is not the time to throw caution to the wind when it comes to the health of our children.
What have you learned from Lurie that has your attention?
Lurie Childrens Hospital has provided their data regarding COVID patients at that hospital. The breakdown by age groups shows that 18% of the COVID patients were in the first year of life, 19% were one to four, 30% were five to twelve, 24% were thirteen to seventeen and 8% were eighteen to twenty. That data reflects that the majority of children who contract COVID-19 are older than four years of age. While most healthy children have completely recovered from the classic coronavirus infection, the increase in cases of Multisystem Inflammatory Syndrome (MIS-C) in children is new cause for concern.
Has Lurie reported any patients with Multisystem Inflammatory Syndrome (MIS-C) in Children?
MIS-C is a very rare and unusual pediatric problem and, in fact, Lurie has not seen one child with it so far. Comer Children’s Hospital, another major pediatric hospital in Chicago, has had only three patients with MIS-C.
MIS-C occurs after the child has had COVID-19 and appears to recover from it. The children then develop a very high fever, a body rash, redness of the normally white portion of the eyes, red and cracked lips, as well as discolored fingers and toes. This serious illness is very acute and is readily recognized by parents. MIS-C is a vasculitis which means that it is an inflammatory disease which impacts multiple blood vessels in the body. Of most concern with MIS-C is the potential for it to impact the heart which contains many blood vessels. Due to this concern, children with MIS-C are being admitted to Intensive Care Units and placed on ventilators, not as treatment for their lungs, but to support their hearts.
To what degree are you concerned about this new risk for children?
Most children who develop MIS-C recover but there is a concern that children can experience prolonged cardiac issues and it is unknown at this point whether there could be permanent cardiac injury. Due to the development of MIS-C in children as well as the risk of COVID-19 itself, we will need to be very cautious in resuming sports, opening swimming pools and opening summer camps because it is next to impossible to get children to social distance. Moreover, some sports require close contact among participants. While we initially thought that COVID-19 was not going to impact children in any significant way, time has proven otherwise.
Pediatric infectious disease experts are studying those children impacted with MIS-C in an effort to determine whether they have developed Kawasaki Disease, as the symptoms are similar to it, or whether this is an inflammatory phenomenon unique to COVID-19 in which the virus causes the immune system to overreact.
I think we have to be patient as we wait and see in the next month or so what happens with the numbers. New York got hit really hard. It may be heading here if infections increase as restrictions are lifted and parents loosen the rules about social distancing. I think we have to take a deep breath and wait for this syndrome to be better understood so people aren’t committing to summer things just because they’re available in other states. For a lot of reasons, we still have to be really cautious.
How does that impact your recommendations about socializing and summer plans here at home?
We have to start letting go a little bit in safe ways because it’s time and we’ve learned a lot about how to minimize our risk of exposure. Getting together with close family and friends who have been healthy and following safeguards is reasonable. It’s time to start letting small groups of people into your circle because isolation can have negative effects. Larger gatherings and groups, which may include strangers, are more risky and should be avoided since we do not want to cause an increase in infections.
My dream is that by adhering to reasonable precautions now, schools will be able to open in the fall. It may require children to wear masks, use hand sanitizers and to wash their hands thoroughly multiple times a day. Now is a good time for parents to instill those habits in their children which means children should being doing these things now. Precautions may also require children to change clothes when getting home from school if we are fortunate enough in the fall to have our children attending school instead of learning remotely.
What are you telling parents weighing the risk of things like summer camp and the return of team sports like baseball?
I had a mom call me yesterday saying that her son’s travel baseball team cannot have any games in Illinois so they’re telling the parents that all of the games are going to be in Wisconsin. That can present a risk as the populations in Wisconsin have not undergone as stringent a quarantine as we have in Illinois. In addition, players can in great part follow social distancing on the baseball field but that is not possible in the dugout. Are those players going to be wearing masks when playing and is that even practical when playing baseball in the summer heat? In my opinion, we are not ready to do this.
With regard to summer camps, especially if they’re out of state, there should be a lot of concern and thoughtfulness about what your child is getting exposed to after all we’ve done to stay healthy.
We have made progress against COVID-19 but we need time to see if our control of this pandemic in Illinois will continue and the summer months will be a critical time to assess that.
What would you say to those who feel this is advice is overly cautious?
Above all else, these kids need to get back to school in the fall. I am very concerned about summer choices that might jeopardize our chances of that happening.
This summer, kids need to stay healthy. They need to start practicing learning to wear masks and how to breathe out of them. I’m recommending cloth, not paper, with the piece at the top you can press down over the nose for a better fit. But kids are going to have big problems getting used to this, especially those with sensory issues. If we have them practice putting the mask on for an hour a day over the summer, it’ll help them adjust to life now and changes coming in the new school year.
I understand June is here, distance learning is over and everyone is ready to get out of the house and be social again. I’m feeling that sense of “now what” from many of my patients’ parents. It’s scary and it’s good to question everything, but we have to proceed with great caution. A big risk right now is making plans elsewhere in states like Wisconsin where they are acting like COVID hasn’t been a big deal at all. Now kids and families from all over the place are heading there. They’re not quarantining and there’s little to no social distancing. It’s just not a comfortable situation for the summer, especially in light of growing concern and so many unknowns about MIS-C in children.
Dr. Mary received her B.A. in Biology, graduating Summa Cum Laude from Loyola University. Going on to the School of Medicine of the University of Illinois for her M.D, she completed her residency at Children’s Memorial Hospital. A fellow of the American Academy of Pediatrics, she is board certified in pediatrics and licensed in Illinois by the American Board of Pediatrics. In 2009, Advocate Good Shepherd Hospital awarded Dr. Mary for her compassionate care going above and beyond the norm.
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