An email alert warning doctors of a possible rise in complications among children who may have Covid-19 has been widely shared online and reported by news outlets.
The message is worrying, but NHS leaders and independent experts point out that the risk of severe illness from coronavirus is very rare in children. The official advice to parents remains unchanged.
The internal email was sent to GPs and hospital doctors by North Central London Clinical Commissioning Group.
It is being shared widely online after the Paediatric Intensive Care Society charity posted the warning on Twitter.
The text urges clinical staff to urgently refer children suffering from three symptoms: abdominal pain, gastrointestinal symptoms and cardiac inflammation.
It reads: “It has been reported that, over the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.
“The cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe Covid-19 in children.”
Kawasaki disease is a rare condition that causes swelling of the blood vessels of the heart, mainly affecting children under five.
The message adds that the three symptoms listed have been seen in children who have tested positive and negative for the coronavirus with swab tests.
It ends: “There is a growing concern that a SARS-CoV-2-related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”
Why has the warning been sent?
NHS England says this kind of alert is a standard way of raising awareness quickly among clinicians about potential new illnesses and complications.
The fact that a signal like this is sent out does not mean that there is confirmed statistical evidence of a clinical trend, according to experts.
Professor Adilia Warris, Paediatric Infectious Diseases Specialist at the University of Exeter, said: “Please do consider that the absolute number of those cases are very low (a handful at the moment).
“The call to ask if other colleagues have comparable experiences over the last week is so we are able to define what is going on, and if there is reason for additional assessment into this.”
Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School, and Locum GP, said: “A new alert has been raised about a signal, a notable change, marking an increase in children being admitted to hospital with a ‘multi-system inflammatory state’.
“A clinical signal does not mean there is a new finding, it does however work as an alter to clinicians to be vigilant in case there is anything substantive behind that signal. This cannot be stressed enough.”
Advice to parents
The NHS has not changed its advice to parents who may be worried about their children becoming ill with Covid-19.
Prof Simon Kenny, NHS national clinical director for children and young people, said: “Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to Covid-19, but it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.
“The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.”
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said: “New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.
“However our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with COVID-19 but if they are concerned about their children’s health for any reason, they should seek help from a health professional.
“See here for more information: Guidance for parents on symptoms and seeking advice.”
Low overall risk to children
Evidence from around the world suggests that the absolute risk of children becoming seriously ill from Covid-19 is very low.
A major study of more than 2,000 confirmed or suspected cases of the disease among children in China found that 94 per cent were diagnosed as asymptomatic, mild or moderate.
Statistics from NHS England show that only nine out of more than 18,000 deaths reported in hospitals so far – or 0.05 per cent – have been among children and teenagers.