Medical

Indiana sees 1st case of inflammatory syndrome related to COVID-19 in child

INDIANAPOLIS (WISH) — Indiana’s health commissioner Dr. Kris Box said Monday that the state has learned of its first case of multisystem inflammatory syndrome in a child.

The Indiana State Department of Health is asking doctors to report suspected cases. The CDC issued an alert Friday, which outlined the symptoms used to define cases:

  • A person 21 or younger presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological).
  • No alternative plausible diagnoses.
  • Positive for current or recent COVID-19 or antibodies, or COVID-19 exposure within the four weeks prior to the onset of symptoms.

The alert also says, “It is currently unknown if multisystem inflammatory syndrome is specific to children or if it also occurs in adults.”

Box said she did not ask which part of the state the case came from, but said such cases involving children usually are sent to children’s hospitals, most of which are in central Indiana.

In regard to reopening schools with the knowledge of a child with the syndrome, Box noted that many Indiana children have likely had the coronavirus without symptoms and without having the inflammatory syndrome, but the Department of Health will be working with the state’s top educators this week on a plan to safely reopen schools.

WISHTV.com posted a story Friday on the syndrome, which is below.

Expect more cases of strange coronavirus syndrome in kids, doctors warn

(CNN) — Parents, hospitals and clinics should expect to see more cases of a mystifying condition that seems to be affecting children after a bout with COVID-19, doctors said Wednesday.

The condition, called multisystem inflammatory syndrome in children, appears to be a post-viral syndrome, said Dr. Jeffrey Burns, a critical care specialist at Boston Children’s Hospital who has been coordinating a global group of doctors who compare notes on the condition.

Doctors by Friday were investigating cases in at least 150 children, most of them in New York. But a CNN survey finds hospitals and clinics in at least 17 states and Washington, D.C., are checking into suspected cases.

“This multisystem inflammatory syndrome is not directly caused by the virus,” Burns told CNN. “The leading hypothesis is that it is due to the immune response of the patient.”

Symptoms include persistent fever, inflammation and poor function in organs such as the kidneys or heart. Children may also show evidence of blood vessel inflammation, such as red eyes, a bright red tongue and cracked lips, said Dr. Moshe Arditi, a pediatric infectious diseases expert at Cedars-Sinai Medical Center in Los Angeles.

Dr. Ngozi Ezike, director of the Illinois Department of Public Health, said it’s a complicated disorder.

“It’s a spectrum of disorders, and so in some cases you’ll have the individual have coronary artery involvement. Sometimes they don’t,” Ezike told a news conference.

Not all of the affected children have tested positive for the coronavirus, but reports from Europe and from several cities in the United States show a link.

“There seems to be delayed responses to COVID infections in these kids,” Arditi said.

Burns believes more cases will turn up as COVID-19 affects more people. It’s a rare condition, but rare consequences of viral infections are seen more often when millions of people are infected.

“We can expect that each of the epicenters will see clusters of these emerging roughly four to six weeks later,” Burns told CNN.

“It makes sense that it emerged in New York first because New York had the largest and most severe outbreak (of COVID-19), followed by New Jersey and, unfortunately, Boston.”

Most children are not seriously affected by the syndrome, Burns said. Most don’t even need treatment in the intensive care unit, he said, although a very few have died. “We do have proven treatments that we can use and are using,” he said. They include blood thinners and immune modulators.

The Centers for Disease Control and Prevention on Friday a Health Alert Network notification to send to doctors across the country. Burns said the World Health Organization is also working to define the syndrome and alert doctors so they will know what to look for and how to treat it.

“This new entity has some similarities to Kawasaki disease,” Arditi told CNN. “But there are a lot more features that are consistent with toxic shock syndrome, such as multiorgan system involvement and severe abdominal involvement with diarrhea,” he added.

It will be important to study, because the response could help explain why children are so much less likely to be severely affected by COVID-19 than adults are, Burns said.

“Understanding the child’s immune response could be a key to vaccine development and could also be a key to therapy for adults to understand why children are able to fight (COVID-19) off so well,” Burns said.

CNN has contacted departments of health, hospitals and state officials around the country to get a sense of how many children are affected, and where.

“We don’t believe this syndrome is very common, but several cases have been reported elsewhere in association with COVID-19,” said Dr. Paul Cieslak, medical director for infectious diseases and immunizations at the Oregon Health Authority Public Health Division. “This syndrome appears to be an uncommon but serious complication of COVID-19 in children.”

Connecticut Gov. Paul Mounds said the syndrome would be trackable illness in the state. The Department of Public Health “sent this out to all the Connecticut pediatric health systems to make sure that they are reporting if these cases are occurring in their facilities, so we can be able to track it and handle it accordingly,” Mounds said Wednesday.

States reporting cases by Friday included:

  • California
  • Delaware
  • Illinois
  • Kentucky
  • Louisiana
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • New Jersey
  • New York
  • Ohio
  • Oregon
  • Pennsylvania
  • Tennessee
  • Utah
  • Washington

Coronavirus links

Indiana coronavirus timeline

With updated information from the Indiana Deaprtment of Health on May 25, this timeline reflects updated tallies of deaths and positive tests by date.

  • March 6: Indiana State Department of Health (ISDH) confirms the first case in Indiana. Officials say the Marion County resident had recently traveled to Boston to attend a BioGen conference as a contractor.
  • March 8: ISDH confirms a second case. An adult in Hendricks County who had also traveled to the BioGen conference was placed in isolation. Noblesville Schools say a parent and that parent’s children will be self-quarantining after attending an out-of-state event where someone else tested positive.
  • March 9: Avon Community School Corp. says a student on March 8 tested positive.
  • March 10: ISDH launches an online tracker. Ball State University basketball fans learn the Mid-American Conference tourney will have no fans in the stands. Three businesses operating nursing homes in Indiana announce they will no longer allow visitors.
  • March 11: The Indianapolis-based NCAA announces the Final Four basketball tournaments will be conducted with essential staff and limited family attendance. The Big Ten announces all sports events, including the men’s basketball tournament at Bankers Life Fieldhouse, will have no fans starting March 12. Ball State University suspends in-person classes the rest of the spring semester. NBA suspends all games, including the Indiana Pacers, until further notice. Butler University and the University of Indianapolis extend spring break, after which they will have virtual classes.
  • March 12: Gov. Eric Holcomb announces new protections that led to extended public school closings and the cancellation of large events across the state. The NCAA cancels its basketball tournaments. The Big Ten suspends all sporting events through the winter and spring seasons. The league including the Indy Fuel hockey team suspends its season. Indy Eleven says it will reschedule four matches. Indianapolis’ annual St. Patrick’s Day Parade is canceled. 
  • March 13: Indiana’s total of positive cases rises to 15. The Indiana High School Athletic Association postpones the boys basketball tournament. Wayzata Home Products, a Connersville cabinet maker, shuts down and lays off its entire workforce due to market uncertainty. Gov. Holcomb announces actions including the elimination of Medicaid co-pays for COVID-19 testing and the lifting of limits on the number of work hours per day for drivers of commercial vehicles. Franklin College says it will begin online classes March 18 and empty residence halls of students in two days. The Children’s Museum of Indianapolis closes indefinitely. The Indianapolis Public Library joins other libraries across Indiana and closes all facilities indefinitely.
  • March 14: The Indiana Gaming Commission says all licensed gaming and racing operations will close in two days for an indefinite period.
  • March 15: Indiana had its first death. St. Vincent Hospital in Indianapolis announces it will suspend all elective, non-urgent surgeries.
  • March 16: Indiana had its second death. Gov. Holcomb announced the first Hoosier death. He closes bars, restaurants and nightclubs to in-person patrons, but maintains carryout and delivery services.
  • March 17: Indiana had its third and fourth deaths. ISDH announces Indiana’s second death. Indiana’s Catholic bishops cancel masses indefinitely. Gov. Holcomb activates the National Guard. Purdue, Butler and Indiana State universities cancel May commencement ceremonies.
  • March 18: Indiana had its fifth death. Eli Lilly and Co. says it will use its labs to speed up testing in Indiana. The 500 Festival announces suspends all events. Simon Property Group closes all malls and retail properties.
  • March 19: Gov. Holcomb extends Indiana’s state of emergency into May. Holcomb says he’ll close all K-12 public and nonpublic schools. Standardized testing was canceled. The state’s income-tax and corporate-tax payment deadline was extended to July 15. Holcomb says the state will waive job search requirements for people applying for Temporary Assistance to Needy Families. The IHSAA Boys Basketball State Tournament was canceled. The Marion County Emergency Operations Center upgrades to Level 1 status.
  • March 20: Indiana’s death toll rose to 9. ISDH announces Indiana’s third death. Gov. Holcomb moves the state’s primary election to June 2. Indiana University says it is postponing May commencement ceremonies on all campuses.
  • March 21: Indiana’s death toll rises to 14. ISDH announces Indiana’s fourth death. Indiana National Guard says it and the Department of Transportation are distributing medical supplies to hospitals.
  • March 22: Indiana’s death toll rises to 19. ISDH announces seven deaths.
  • March 23: Indiana’s death toll rises to 24. Holcomb orders Hoosiers deemed nonessential to “stay at home” from March 24-April 7. Eli Lilly & Co. begins drive-thru testing for the coronavirus for health care workers with a doctor’s order. Ball State University cancels the May commencement.
  • March 24: Indiana’s death toll rises to 29. Fred Payne of Indiana Workforce Development says any Hoosiers out of work, including temporary layoffs, are eligible to apply for unemployment benefits.
  • March 25: Indiana’s death toll rises to 35. Indianapolis Motor Speedway announces the Indianapolis 500 is moved to Aug. 23. IndyGo suspends fares and changes its ride schedules.
  • March 26: Indiana’s death toll rises to 44.
  • March 27: Indiana’s death toll rises to 47.
  • March 28: Indiana’s death toll rises to 58.
  • March 29: Indiana’s death toll rises to 76. President Donald Trump announces in a press conference that the national social distancing recommendation will be extended by 30 days.
  • March 30: Indiana’s death toll rises to 91. Indiana health commissioner Dr. Kristina Box predicts the arrival of the surge in cases and deaths could come in mid-April to late April, but could be as late as mid-May, “but we don’t know.”
  • March 31: Indiana’s death toll rises above 100, to 113. Gov. Holcomb extends the limits of bars and restaurants to offer only “to go” and “carryout” through April 6. Health commissioner Box, asked about when Indiana will be in a surge of COVID-19 cases, says she thinks the surge is starting.
  • April 1: Officials extend Marion County’s “stay at home” order through May 1. Marion County health officials say they will start COVID-19 testing services for front-line employees. Gov. Holcomb announces the #InThisTogether campaign.
  • April 2: The state announces K-12 schools will be closed for the rest of the school year. The Indiana High School Athletic Association cancels spring sports seasons.
  • April 3: Gov. Holcomb extends the “stay at home” order through April 20. The state receives a federal Major Disaster Declaration for all 92 counties. The Indiana National Guard says it, the Army Corps of Engineers and state health officials will begin to assess sites for alternate health care facilities.
  • April 4: Indiana’s death toll rises above 200.
  • April 6: The state reports a Madison County nursing home has had 11 deaths. Gov. Holcomb extends the “stay at home” order through April 20. He also limits additional businesses to carry-out only.
  • April 7: Indiana’s death toll rises above 300. Indiana health commissioner Box says four long-term care facilities have 22 deaths that appear to be related to COVID-19.
  • April 10: ISDH said 24 residents of a long-term care facility in Madison County have died from COVID-related illness.
  • April 11: Indiana’s death toll rises above 400.
  • April 14: Indiana’s death toll rises above 500.
  • April 16: Tests ID more than 10,000 Hoosiers with coronavirus. The governor says he expects Indiana to experience a reopening in early May.
  • April 17: Indiana’s death toll rises above 600. The governor says that he will extend the “stay at home” order through May 1.
  • April 20: Indiana’s death toll rises above 700. Gov. Holcomb extends the “stay at home” order to May 1. The governor also says, if the medical supply chain is in good shape, other elective medical procedures can resume April 27.
  • April 22: Indiana’s death toll rises above 800. The Tyson facility in Logansport voluntarily closes so 2,200 employees can be tested for COVID-19.
  • April 24: Indiana’s death toll rises above 900. The Indianapolis City-County Council approves $25 million to help small businesses. Fishers City Council creates a city health department with a plan to test every resident.
  • April 25: ISDH says it will launch an antibody testing study for Hoosiers; thousands of residents were randomly selected to participate in the study.
  • April 27: Indiana’s death toll rises above 1,000.
  • April 28: Indiana officials say they will open COVID-19 testing to more Hoosiers, with expanded criteria and new testing services at 20 sites around the state.
  • April 29: The state says it will spent $43 million on contact tracing.
  • April 30: Indianapolis extends its stay-at-home order through May 15.
  • May 1: Gov. Holcomb announces a phased reopening plan for the state of Indiana. He also extends the stay-at-home order to May 4.
  • May 3: Tests ID more than 20,000 Hoosiers with coronavirus.
  • May 4: Indiana enters Stage 2 of its Back on Track plan, which excludes Cass County until May 18, and Lake and Marion counties until May 11.
  • May 6:The state begins testing for all Hoosiers at 20 sites, with plans to expand the number of sites to 50 in a week. Ivy Tech Community College says it will continue virtual classes when summer courses begin in June. 
  • May 8: Cris Johnston, director of the Office of Budget and Management, says the state missed out on nearly $1 billion in anticipated April revenues; all state agencies will be given budget-cutting goals. Purdue University OKs plans to reopen for the fall semester with social distancing and other safety measures.
  • May 11: Indiana’s death toll rises above 1,500.
  • May 13: The first phase of a state-sponsored study of the coronavirus estimated about 186,000 Hoosiers had COVID-19 or the antibodies for the novel virus by May 1. Indianapolis Mayor Joe Hogsett announced plans for limited reopenings of worship services, retail establishments, libraries and restaurants.
  • May 14: Indiana’s death toll rises above 1,600.
  • May 17: Indiana’s death toll rises above 1,700. Marion County’s death toll rises above 500.
  • May 18: Indiana reports its first case of multisystem inflammatory syndrome in a child. The Farbest Foods turkey-processing plant in Huntingburg is closed for three days; 91 people have tested positive there.
  • May 21: Indiana’s death toll rises above 1,800.
  • May 22: Indiana advances to Stage 3 of the Back on Track reopening plan. Indianapolis closes portions of five streets to allow restaurants to reopen with outdoor dining only.
  • May 27: The U.S. death toll rises above 100,000. Indiana University says the fall semester will have in-person and online courses, plus an adjusted calendar through May 2021. Ball State University says the fall semester will be 13 straight weeks of in-person classes with no day off on Labor Day and no fall break.
  • May 28: Indiana’s death toll rises above 1,900.
  • May 29: Places of worship in Marion County can begin holding indoor services at 50% capacity with proper social distancing.
  • June 1: Marion County restaurants can begin serving customers indoors and outdoors with 50% capacity. Marion County salons, tattoo parlors can reopen by appointment only. Marion County gyms, fitness centers and pools can open with 50% capacity and no contact sports.

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