A British breakthrough is made in treating a dangerous Covid-related children’s illness called PIMS-TS.

17 June 2020 By Paul Martin

The patients are now recovering within three to five days, a senior consultant has told correspondent.world.

Great Ormond Street Hospital for Children has dealt with a large proportion of the cases found in Britain. These were first reported in March, when eight children, six of them of Afro-Carribean origin, were rushed to the Evelina London Children’s Hospital. One of those, a 14-year-old, died.

They had high fevers, rashes, red eyes, swelling and general pain.

“These patients respond extremely well to treatment within 3 to 5 days,” said Dr Karyn Moshal, a senior consultant in Paediatric Infectious Diseases at Great Ormond Street Hospital, the world-renowned hospital in central London. 

“At the Great Ormond Street Hospital we have treated between 50 and 60 children with Paediatric Inflammatory Multi-System Syndrome (PIMS-TS), which is a tiny proportion of all Covid cases in children,” she told correspondent.world. There had been around 200 PIMS-TS cases across the UK.

A small number of children, who have evidence of having had COVID-19, present with a hyperinflammatory syndrome. This is a disordered immune response to infection, which results in severe illness and sometimes shock, Dr Moshal said.  

“This contrasts with most cases we have seen of Covid-19 in children, where it is usually very mild. In a very small number of cases where children have, or have had, Covid-19, children experience a ‘disordered over-reaction’ of their immune systems which results in severe disease.”

 To find a way to treat PIMS-TS, paediatric intensive care doctors and paediatric infectious diseases specialists at Great Ormond Street Hospital adapted their experience of treating similar disease processes, Dr Moshal said. This had been done in collaboration with colleagues at two other large London paediatric centres, Evelina and St. Mary’s.

“In the beginning we didn’t know exactly what we were dealing with, or how to deal with it,” Dr Moshal told correspondent.world.

The suddden illness showed some similarities with the extremely rare toxic shock syndrome, and with Kawasaki disease — a condition that affects around one in 10,000 children under the age of five.  Kawasaki patients have a rash and swollen glands in the neck, as well as dry and cracked lips.

But PIMS-TS syndrome strikes at older children, from ages 7 up to the age of 16. “We’ve seen [disproportionately] more cases in children from BAME backgrounds, and high body mass indexes have been common. We’re not sure why at the moment. We don’t know if it’s a reflection of the areas these children live having a high prevalence of COVID-19 infection in the month before these young people started to present to us, or if there is a particular vulnerability in this group which makes them more at risk. We are currently looking closely at this.” Dr Moshal explained.

“It was a brand-new phenomenon and we had to make quick decisions in the absence of evidence. A multi-disciplinary, multi-hospital team designed a treatment plan using drugs which we have evidence work well in both toxic shock syndrome and Kawasaki disease.

“We used Intravenous Immunoglobulin together with Methylprednisolone, a similar steroid preparation to the drug that Oxford was testing (Dexamethasone). Then for those who were illest, or were taking a little longer to respond, we added an immune modulatory therapy. 

“Individual treatment plans were discussed and agreed by this group, and response to treatment monitored. It’s this combination that has proved successful.”

Only two of around 200 PIMS-TS patients in Britain has died, and it is not clear whether there were other causes linked to these children’s deaths, she said.

The disease is no longer expected to be fatal.

Britain has been the world leader in recognising and treating PIMS-TS.

“We noticed a pattern of clinical symptoms and signs in a number of patients over a short period of time, which seemed to indicate a new disease syndrome, distinct from Kawasaki Disease and Toxic Shock Syndrome and sent out alerts worldwide.

“Hospitals then started to report that they had seen a similar phenomenon but had not recognised it as a distinct and new syndrome, initially,” Dr Moshal said.

The treatment and the origins of the disease “are now being studied more closely”, she added. 

Many parents who may have been  panicked by “sensationalised” reporting of this very rare phenomenon should now feel reassured, said Dr Moshal. “They can focus rather on the real risks and the balance we need to strike.”

thought ‘maybe we are [one of these cases]’.”

Une mère témoigne de son angoisse, son fils est atteint de la maladie de Kawasaki
Marley Grix is now recovering at home from a mystery disease that may have been Kawasaki, or possibly PIMS. Media reports of children like this getting mystery diseases “panicked” many parents into a false belief that Covid was causing serious illness among many children. Credit: Hayley Grix

“The vast majority of children infected with Covid-19 have asymptomatic or mild disease and recover completely from their illness. However, we urge all parents to seek medical attention if they feel their children are unwell and they are very concerned. GP surgeries and paediatric A&Es are open for all children who are in need of their care, and are safe to attend.”

Dr Moshal, 55, originally from Durban, South Africa, has practised medicine in the UK for thirty years.   

A STORY BASED ON THE EXCLUSIVE REPORT BY CORRESPONDENT.WORLD APPEARED IN THE SUNDAY TELEGRAPH AND ON TELEGRAPH.CO.UK on June 21 and June 20 2020

Mysterious Covid-linked disease ‘no longer expected to be fatal’ in children after treatment breakthrough

Dr Karyn Moshal, from Great Ormond Street Hospital, says children are recovering within three to five days

By Paul Martin 20 June 2020 • 5:00pm [Headline amended]

A breakthrough in treatment means that a mysterious Covid-linked children’s inflammatory syndrome is “no longer expected to be fatal”, a top paediatrician has said. 

Dr Karyn Moshal, a senior consultant in paediatric infectious diseases at Great Ormond Street Hospital (Gosh) in London, said that youngsters who show symptoms are now recovering within three to five days. 

In April, Matt Hancock, the Health Secretary, ordered an urgent investigation into a reported rise in children needing intensive care after contracting Covid-19 after the NHS issued an alert to GPs. It led to calls for schools to stay closed, and panic among parents.

But Dr Moshal said that condition is now “no longer expected to be fatal”, after a combination of treatments were rapidly developed by doctors.

“It was a brand-new phenomenon and we had to make quick decisions in the absence of evidence,” Dr Moshal said. 

“A multi-disciplinary, multi-hospital team designed a treatment plan using drugs which we have evidence works well in both toxic shock syndrome and Kawasaki disease.

“We used Intravenous Immunoglobulin together with Methylprednisolone, a similar steroid preparation to the drug that Oxford was testing (Dexamethasone). Then for those who were most ill, or were taking a little longer to respond, we added an immune modulatory therapy.

“Individual treatment plans were discussed and agreed by this group, and response to treatment monitored. It’s this combination that has proved successful.”

Gosh, the country’s leading children’s hospital, has dealt with between 50 and 60 children with Paediatric Inflammatory Multi-System Syndrome (PIMS-TS), which is a large proportion of the cases found in Britain. 

These were first reported in March, when eight children, six of them of African-Carribean origin, were rushed to the Evelina London Children’s Hospital. One of those, a 14-year-old, died. They had high fevers, rashes, red eyes, swelling and general pain.

 The sudden illness showed some similarities with the extremely rare toxic shock syndrome, and with Kawasaki disease, a condition that affects around one in 10,000 children under the age of five.  Kawasaki patients have a rash and swollen glands in the neck, as well as dry and cracked lips.

But PIMS-TS syndrome strikes at older children, from ages seven up to the age of 16.   

A small number of children who had coronavirus symptoms develop a hyperinflammatory syndrome. This is a disordered immune response to infection, which results in severe illness and sometimes shock, Dr Moshal said.  

“This contrasts with most cases we have seen of Covid-19 in children, where it is usually very mild. In a very small number of cases where children have, or have had, Covid-19, children experience a ‘disordered over-reaction’ of their immune systems which results in severe disease,” she told The Telegraph. 

To find a way to treat PIMS-TS, paediatric intensive care doctors and paediatric infectious diseases specialists at Great Ormond Street Hospital adapted their experience of treating similar disease processes, Dr Moshal said. This had been done in collaboration with colleagues at two other large London paediatric centres, Evelina and St. Mary’s.

Britain has been the world leader in recognising and treating PIMS-TS, Dr Moshal said. 

“We noticed a pattern of clinical symptoms and signs in a number of patients over a short period of time, which seemed to indicate a new disease syndrome, distinct from Kawasaki Disease and Toxic Shock Syndrome and sent out alerts worldwide,” she explained. 

“Hospitals then started to report that they had seen a similar phenomenon but had not recognised it as a distinct and new syndrome, initially.”  

Paul Martin is editor of correspondent.world

Pages: 1 2