A 14-year-old boy with no underlying health conditions has died from a Kawasaki-like disease linked to coronavirus.
The teenager was part of a cluster of eight cases treated at the Evelina London Children’s Hospital over a 10-day period in April.
As of Tuesday, the hospital had seen around 50 children with the illness, according to medical director Sara Hanna, with around half since discharged.
Health Secretary Matt Hancock said last month that experts are investigating the new syndrome in children “with great urgency” but has stressed it is rare.
The condition is said to be similar to Kawasaki disease, which mainly affects children under the age of five, with symptoms including a high temperature, rashes, swelling and a toxic shock style response.
The 14-year-old spent six days in intensive care at the Evelina and tested positive for Covid-19 following his death, according to a report by his medical team published in The Lancet journal.
His main symptoms on being admitted to the hospital were a temperature over 40C, diarrhoea, abdominal pain and headache.
Dr Hanna, who is a consultant in children’s intensive care, said those with the illness have a “reasonably long stay in hospital”, with some admitted for up to two or three weeks.
“The majority are in high dependency, so not the highest level of intensive care,” she told the PA news agency.
“We have got a handful of children in intensive care but they are not currently requiring the highest levels of support, which is good as some of the children we have had prior to this have been much sicker.”
All of the children have survived apart from the 14-year-old, she said.
The main symptoms are a high and persistent fever, red eyes, a rash and swollen feet and hands.
Most of those with the illness are of school age, while there have been a small number under the age of five, and the majority are fit and well with no underlying health problems.
A “small number” have tested positive for coronavirus, she said, but this is the minority.
Antibody testing in collaboration with Great Ormond Street Hospital, where cases have also been reported, found evidence that those who are ill have previously had Covid-19.
Dr Hanna said there is “circumstantial evidence” that the two illnesses are related, but added: “I think most people believe that they are, because it is so temporally associated.”
Patients are being given general treatment, specifically anti-inflammatory agents – ranging from aspirin to specialist therapies – steroids and immunoglobulin infusions, while some are receiving more advanced drugs.
“They are a group of children that do require expert multi-speciality input,” she said.
“We’ve formed a team that consists of infectious diseases, rheumatology, cardiology, as an expert specialist team, supported by paediatricians and intensive care that look after them 24 hours a day.
“It’s a very small number of children in terms of the population, but it is a large number of children related to our hospital.”
Research led by Imperial College London is looking at the characteristics of those who have been admitted to hospital, while information regarding the illness is being shared across the international community.
Dr Hanna highlighted the importance of hand-washing, particularly before eating and after going outside, and said anyone with concerns should attend an emergency department.
The youngest child in the cluster of eight cases at the Evelina was four, and two others were six, according to the report in The Lancet.
Two of the children in the cluster, including the boy who died, were obese.
The report said: “All children were previously fit and well. Six of the children were of Afro-Caribbean descent, and five of the children were boys.”
Medics said all the children had similar symptoms when they were admitted, including “unrelenting fever”, variable rash, conjunctivitis, swelling, pain and significant gastrointestinal symptoms.
Most of the children had no significant respiratory symptoms during their time in hospital, although seven were put on a ventilator to stabilise their cardiovascular systems.
The medics wrote: “We suggest that this clinical picture represents a new phenomenon affecting previously asymptomatic children with Sars-CoV-2 (Covid-19) infection manifesting as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome.”
Dr Liz Whittaker, clinical lecturer in paediatric infectious diseases and immunology, at Imperial College London, said the fact that the syndrome is occurring in the middle of a pandemic, suggests it reasonable to think the two are related.
She added: “You’ve got the Covid-19 peak, and then three or four weeks later we’re seeing a peak in this new phenomenon which makes us think that it’s a post-infectious phenomenon, and that it’s more likely to be something maybe either antibody mediated or something that we call an immune complex.”
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, said the majority of children who have had the condition have been well treated, responded to treatment and are getting better and starting to go home.
Michael Levin, professor of paediatrics and international child health at Imperial, explained that most of the children tested negative for coronavirus, but positive for detection of antibodies.
“So we really think that the biology of the disease, somehow involves an unusual immune response to the virus,” he said.
Although much of the conversation has been around children having the syndrome, the experts say it cannot yet be ruled out in adults.
Dr Whittaker said: “It may not be specific to children.
“One of the things that the study is going to look at is the adult data to see if perhaps some of the adults who are being admitted, and just being called Covid-19, may actually be presenting like this – particularly some of the younger adults.
“I think that we can’t for definite say this is just a paediatric phenomenon.”
