An Open Letter to Michigan Healthcare Professionals and Families from Michigan’s Children’s Hospitals Clinical Leadership Collaborative and the MHA

MIS-C most likely to Appear 2-5 Weeks after COVID-19 Surge

The 2021 COVID-19 spring surge in Michigan may be receding, which is welcome news for our state’s citizens. As children’s hospital leaders, we urge continued caution and use of public health measures: wear a mask appropriately (covering nose and mouth) per Centers for Disease Control and Prevention (CDC) guidelines, and practice good social distancing and hand hygiene always. Healthcare workers are stressed and exhausted. Every effort to avoid infection reduces the incidence of COVID-19 and helps keeps our families, friends and community members out of the hospital.

While we’re pleased to see the surge receding, an illness secondary to COVID-19 – multisystem inflammatory syndrome in children (MIS-C) – could become more prevalent as COVID-19 cases decline, and we want clinicians and families to be aware and prepared.

“It is important that parents and pediatricians are aware that the rare, but serious, MIS-C associated with COVID-19 could likely present in children between two and five weeks after the peak of Michigan’s recent surge of COVID-19,” said Dr. Matthew Hornik, president of the Michigan Chapter of the American Academy of Pediatrics. “This is based on analysis recently published in JAMA Pediatrics.”

Parents should be aware of MIS-C if their child was exposed to COVID-19 and later develops a fever without other explanation, and gastrointestinal symptoms (abdominal pain, vomiting, and/or diarrhea); rash or red eyes; and less commonly respiratory symptoms (cough, shortness of breath or chest pain/discomfort). Parents should seek emergency care right away if their child experiences any of the following warning signs:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
  • Severe abdominal pain

MIS-C results from a delayed immune response to COVID-19. According to Dr. Rudolph Valentini, chief medical officer at Children’s Hospital of Michigan, “A child infected with COVID-19 may not exhibit any symptoms of the virus, then later present with MIS-C. Symptoms include fever, general inflammation, and dysfunction of major organs including the heart, gastrointestinal system and kidneys.”

Pediatricians should refer to interim guidance from the American Academy of Pediatrics for recognizing symptoms and providing care for MIS-C. Because most children are ineligible to currently receive the COVID-19 vaccine, it is imperative that individuals who are 16 years and older make every effort to get the vaccine to allow us to achieve herd immunity and help protect our vulnerable children from getting COVID-19 and potentially MIS-C.

“Many pediatric patients who develop MIS-C will need treatment in the hospital including frequent admission to a pediatric intensive care unit,” said Dr. Matthew Denenberg, vice president of medical affairs at Helen DeVos Children’s Hospital. “With the number of COVID-19 cases Michigan experienced in the past six weeks, we must be prepared that some number of children will present with MIS-C. If your child isn’t doing well, don’t delay getting care. Hospitals are safe and ready to help.”

Please contact your healthcare provider if you have questions or concerns regarding MIS-C. For more information about MIS-C in children, please refer to the CDC website on MIS-C.