Doctors are investigating the case of a Winnipeg toddler with symptoms suggesting a rare, inflammatory illness potentially linked to COVID-19, the girl’s mother says.
And the child is fighting to recover, even after she no longer tested positive for the disease.
The mother says health-care providers treating her daughter are concerned the girl may have developed Kawasaki disease, or multi-system inflammatory syndrome in children, also called MIS-C.
The inflammatory syndromes can result from the body’s reaction to new viruses — not just the new coronavirus. But doctors in Canada, and scientists around the world, are investigating cases for a link to COVID-19.
Public health officials in Manitoba say no cases of the conditions connected with COVID-19 have been confirmed in the province so far.
“Honestly, it’s just terrifying. I don’t have the answers. Doctors don’t have the answers,” said the girl’s mother, who CBC is not naming due to concern about stigma.
“We’re just trying to do anything we can.”
It’s been more than a month since the one-year-old girl tested positive for COVID-19 in late April, the mother said. She believes her daughter was infected after her husband was exposed to a co-worker who later tested positive.
At first, her parents didn’t know what to make of the little girl’s symptoms. She had a red, puffy rash, vomiting and diarrhea, a tender abdomen and a recurring fever that spiked to 102 F.
“She refused to eat, barely had anything to drink,” said her mother.
Before they knew about her husband’s COVID-19 exposure, pediatricians contacted via Zoom were cautious about sending the child to a hospital, and told the mother to try Tylenol, thinking the girl had a flu.
WATCH | Toronto doctor answers questions about inflammatory syndrome following COVID-19
Dr. Samir Gupta said some children are showing symptoms of a rare disease that resembles Kawasaki syndrome, but it’s not certain that’s what they have. 5:53
The family learned of the workplace exposure on April 28, two days after the symptoms arose, and went for testing immediately. Blood work done at the Children’s Hospital at the Health Sciences Centre confirmed the toddler had COVID-19.
At that point, Manitoba had fewer than 25 active cases of the disease caused by the new coronavirus. The province was already announcing plans for reopening.
“It was absolutely devastating,” the mother said.
“You see your child kind of deteriorating, and you kind of think, it could be something different,” she said. “How could it possibly be COVID … with the cases being so low?”
Wish to take the pain away
Hospitals in Ontario, Quebec, B.C. and Alberta are examining possible cases of MIS-C. Experts say the illness is difficult to diagnose and many cases remain ill-defined.
“There are way more unknowns than knowns,” said Dr. Rae Yeung, a professor of pediatrics, immunology and medical sciences at the University of Toronto, and staff pediatrician and rheumatologist at the Hospital for Sick Children.
“Right now, the big challenge is that there is not one diagnostic test … that can actually tell us whether a child has MIS-C or Kawasaki disease, [which are] all one hyper-inflammatory syndrome,” said Yeung, who is also a senior scientist in cell biology research.
“As we’re learning, the one common denominator is that they have massive immune activation. But many things can cause massive immune activation.”
When she’s not sick, the Winnipeg 21-month-old is “very chatty. She’s energetic, running around,” said her mother. “She’s your typical toddler. She is always happy — except for when she’s teething, of course.”
COVID-19 sucked that energy away.
“She started sleeping more and more, to the point where she was only awake approximately three hours in a 24-hour period,” her mother said.
After she tested positive, doctors admitted the toddler to the hospital and put her on IV fluids and antibiotics. Medical staff did X-rays, ultrasounds, urinalysis and blood work, trying to rule out anything else that may have been making her sicker.
Initially, doctors hoped her body could fight off the disease on its own, her mother said. But the family has been in and out of the hospital for weeks as her condition remained serious.
Last week, the toddler’s condition took a turn for the worse. Her mother said it was like being “back to Square 1” — but when she brought her back to the hospital, on May 28, tests showed her daughter is now negative for COVID-19, and fighting a new medical battle.
That was the day doctors first raised the possibility of MIS-C or Kawasaki, the mother said. The toddler was also diagnosed with sepsis and a severe urinary tract infection, and prescribed a strong antibiotic — but on Thursday, one week into a 10-day prescription, there was little improvement.
Now, the mother said doctors will begin further tests to help understand exactly what is making her daughter so ill.
“You just kind of feel helpless because you can’t make [your children] feel better — and that’s kind of your job as a mother,” she said.
“You don’t want to see them sick, especially with something so serious as a pandemic. You just wish you could take their pain away.”
The syndrome with many names
Yeung calls MIS-C “the syndrome with many different names,” because depending on where you are in the world, it might be called different things.
“I think this is part of the reason why it’s led to some confusion and a lot of anxiety, in fact, among not only families, but also caregivers and health-care professionals,” she said.
Much of what’s known so far about the disease remains hypothetical, she said, and research is needed to understand more. At its core, the syndrome — and Kawasaki disease, which is part and parcel of the same family of illnesses — can be characterized by inflammation, especially in blood vessels, caused by a hyperactivation of the immune system.
“What we’re seeing in all of these syndromes is hyper inflammation — just an overactive immune system that’s gone into overdrive, affecting multiple organs in the body,” she said.
The illnesses in that family are triggered by a “tickle” to the immune system, Yeung said, which can be anything from strep throat to the novel coronavirus. Canada documents roughly 100 to 150 cases of Kawasaki disease a year, for example, she said.
But epidemiology in Europe, the U.S. and Canada has suggested a pattern, as cases of inflammatory syndromes in children emerge roughly four to six weeks following the peak coronavirus outbreak in each population.
Many, even most, of the children diagnosed with these illnesses don’t initially test positive when swabbed for COVID-19, Yeung said, but bloodwork often shows the children had the disease previously.
It’s still not clear exactly how many cases of the inflammatory illness there are in Canada, Yeung said. At the Sick Kids hospital in Toronto, where she works, she said they’re seeing roughly three to four times the volume of these illnesses over normal years.
She’s helping lead research, in partnership with the Canadian Paediatric Society and the Public Health Agency of Canada, to work with doctors across the country to determine where cases are and help understand them better.
“I think sharing knowledge and alerting the public is a very important component of this, so that people are alert and aren’t afraid to come to the hospital,” Yeung said. “I don’t want people to avoid coming to the hospital if their child is sick and has prolonged fever. They need to seek appropriate medical attention.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
