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In December, doctors speaking at the Health Ministry's virtual press conferences on covid19 started using the terms MIS-C and MIS-A.
They said as of December 14, there were 20 cases of MIS-C and no cases of MIS-A in TT. In addition, of the 20 children who presented with MIS-C, four were positive for covid19 and three of them had “involvement of the heart.”
But what are MIS-C and MIS-A?
Dr Peter Chin Hong, a Trinidadian professor at the University of California San Francisco, explained that multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) were specific to covid19.
He said one of the reasons covid19 was so challenging was because there were two main phases – the infectious phase and the inflammatory phase. With covid19, the inflammation phase could be “insidious” and have effects that doctors and scientists were still trying to understand.
“Inflammation is like when you get a cut and you get that redness and swelling and pain. That’s not necessarily an infection, but your body’s immune system trying to rally the troops to stand on guard in case of infection.
“Or the infection might come in and the body is saying, ‘Okay, there is a foreign invader, let me just bring in the troops.’ And those troops can be too many and too out of control and they can damage your regular healthy organs.
"This is where MIS-C and MIS-A fall into place: where your own body is causing you to get sick, not the infection.”
With the syndromes, organs and tissues including the heart, blood vessels, lungs, kidneys, brain, eyes and skin, become severely inflamed. But Chin Hong said the most deadly was involvement of the heart.
He explained that with MIS-C the heart did not pump blood as well as it was supposed to because of inflammation of the lining or the aorta. Therefore, any organ the heart fed would not get enough blood.
If the brain was not getting enough blood, people could feel lightheaded and have similar symptoms to a stroke. Lack of blood to other organs could lead to kidney damage and failure, and affect the liver.
In addition, blood receives oxygen from the lungs and travels to the heart to be pumped to the rest of the body. So when the heart is not pumping well, it could cause a “traffic jam” in the lungs, resulting in fluid in the lungs and causing respiratory symptoms.
Other symptoms include arrhythmia (irregular heartbeat), headache, vomiting, diarrhoea, abdominal pain, enlarged lymph nodes, rash, bloodshot eyes, redness and swelling of the tongue and lips, redness or swelling of the hands or feet, and feeling unusually tired.
He said MIS-C was similar to Kawasaki disease, a childhood illness that causes inflammation of the blood vessels. No bacterium or virus has been proven to cause the disease but it is most common in children of Asian heritage under the age of five, although children of any age and race can develop it.
“We don’t really understand it very much, but maybe covid can help us understand this other illness that acts very similarly in kids. It hasn’t really been seen in adults before, but MIS-A is the case being seen in adults.”
Chin Hong said MIS-C and MIS-A were difficult to diagnose because they did not usually occur at the time of infection, but much later, even after the infection had passed. Weeks after being infected with covid19, someone may go to the doctor with “something weird” and, unless the doctor suspected it and did tests for it, many cases would go unnoticed, since the symptoms were not specific to any virus or disease.
To diagnose the syndromes, he said first medical professionals should start with a PCR test. Next there should be a test for covid19 antibodies, and blood tests to measure inflammation levels, such as the CRP or c-reactive protein test.
“However, it is very non-specific: that why you have to have multiple criteria to diagnosis this. Also, generally, you have to have two or more systems involved. Systems include the heart, the kidneys, the lungs, the gastrointestinal system, skin, and then the brain.”
Treatment would include anti-inflammation therapy, steroids, and immunoglobulins.
Asked why children seem to be more susceptible, he said, “There are more questions than answers.”
However, he had two theories. He said generally children did not get very sick from covid19, so their immune system worked overtime on something that sometimes passes unnoticed, while adults get more symptoms, so they “don’t have time” to get sick with MIS-A.
However, he believed it was more likely that adults simply went undiagnosed, as strokes, heart failure, kidney failure, and liver failure were more suspicious in children than in adults.
“For example, if an adult comes in with heart failure, they would say it’s regular heart failure, not making the connection that it might be related to covid. A younger person with heart failure is not as common, so then they might look deeper into it and get the diagnosis.”
He noted that in the US, communities of colour, especially black and Latino, were more affected by MIS-C. There was possibly some genetic predisposition for the immune system to go into overdrive when covid entered the body, which could be why MIS-C was not seen in China at the start of the pandemic.
Chin Hong also said there was concern about the long-term effects of MIS-C and MIS-A and advised people to continue taking the necessary precautions to protect themselves from covid19, even as hope is on the horizon because of the approved and forthcoming vaccines.
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