Hospitals prepare for increase in children suffering rare disease triggered by Covid

Covid-19 triggers inflammatory response in very small minority of children, most of whom will not be seriously affected

Hospitals across the country are preparing for a significant increase in children needing treatment for a rare disease triggered by coronavirus.

Paediatric departments across the NHS are recalling children’s nurses who have been redeployed to help care for adult patients as well as freeing up specialist intensive care beds to be ready for more cases of the rare condition first identified after the first wave last year.

Because of how widespread Covid-19 infections have become in the last month, with the numbers of patients in hospital peaking at almost 40,000, experts believe they will see a larger number of children affected by the disease called Paediatric Multisystem Inflammatory Syndrome (PIMS).

Modelling by London’s Evelina Children’s Hospital, which treated around 110 children with PIMS during the first wave of the virus, suggested for every 200 adults admitted to hospital across London, there was one child admitted with PIMS at the Evelina.

This modelling cannot be used to predict admissions across the country, but paediatric experts believe they will begin to see a larger number of children with the condition with a peak expected in the next three weeks.

It is thought Covid-19 triggers an inflammatory response among a very small minority of children – of all children infected with Covid-19, less than half of one per cent went on to develop PIMS.

Those that do suffer severe inflammation in their blood vessels and can have damage to their heart. Symptoms of PIMS include a rash, fever and abdominal pain.

London and the southeast is likely to be the worst affected areas but cases of PIMS will be seen across the UK.

During the first wave the Evelina hospital, which looks after children from across London, Kent, Surrey and Sussex, saw six children admitted with PIMS on one day at its peak.

Experts said paediatric departments across the UK were now more prepared for PIMS cases than last year and emphasised the condition affects a very small number of children, most of whom should make a full recovery.

Sara Hanna, medical director at the Evelina hospital, told The Independent: “We have halved the number of adults in our intensive care beds this week from 24 to 12, in order to free up nurses on our paediatric intensive care ward.

“We are doing the right things and reducing adult numbers in a sensible fashion. Hospitals do need to be thinking about this now.”

She said the Evelina was at the forefront of PIMS cases last year and they were already seeing cases now.

“We have seen an increase in the numbers but at this point it is still quite small and they are not as sick as we saw in the first wave. I think part of the reason for that is around early recognition and management now we know what we’re looking for.”

She said hospitals were ready: “We are planning to manage this in a networked way. All the hospitals have been educated on PIMS and we have daily meetings.”

James Fraser, president of the Paediatric Critical Care Society, told The Independent: “For several weeks children’s hospitals have had adult patients in them and it’s not just paediatric ICU, it’s also children’s wards which have adults in them. That has been the case up and down the country for the last month.

“Since before Christmas paediatric ICU nurses have been helping out on adult wards and looking after adult patients. That has happened much more in the second wave than in the first wave and reflects the huge pressure and increase in adult patients in the latest surge.  

“This is an unprecedented situation in the 20 years I have been a consultant. Staff are exhausted and we need to get our paediatric nurses back as soon as is possible. However, I am immensely proud of everyone who has had to work in such challenging situations.”

He added: “Because there are so many infected adult patients and the virus has been so prevalent in the community, we do expect to see more children with PIMS three to four weeks after the peak of the adult surge.

“We expect that peak in children within the next two to three weeks.

“After the first wave last year, most parts of the country saw some cases. We have started to see more now with an uptick around seven to 10 days ago in areas affected worst by infections, particularly in London.

“Around half of PIMS cases come to paediatric ICU, the rest are seen in HDU or on wards. This still represents a small number of our total patients. Some of them can be sick but most tend to turn around very quickly. Mortality is very, rare with PIMS.”

NHS England is modelling the expected uptick in PIMS cases to account for extra pressure on beds and Dr Fraser said the UK’s 28 paediatric critical care units were experienced in transferring patients within regions if needed should any one unit become overwhelmed.

Dr Liz Whittaker, infectious disease lead at the Royal College of Paediatrics and Child Health said the rise in cases of Covid-19 had led to an increase in PIMS cases in the last two weeks.

The college has produced online advice for parents on what to look out for among children.

Dr Whittaker added said: “We expect the numbers  to continue to rise until around the middle of February. This is because the incidence of PIMS cases seems to be around 3-5 weeks behind the rise in adult Covid cases.

“Most children are recovering quickly and are being treated in normal paediatric wards but with some in high dependency units. A minority will need to be treated in paediatric intensive care units.

“Some PICU facilities are currently being used for adult care because of the surge in adult cases, but we certainly don’t anticipate there not being enough intensive care beds for children with PIMS or any other illnesses.”

NHS England said it had plans in place to manage any significant pressure with hospitals able to provide aid to each other where needed.

It said paediatric intensive care capacity was being reviewed daily at a national and regional level.