Coronavirus: Italy, UK explore possible Covid-19 link to child inflammatory disease

Italian and British medical experts are investigating a possible link between the coronavirus pandemic and clusters of severe inflammatory disease among infants who are arriving in hospital with high fevers and swollen arteries.

Doctors in northern Italy, one of the world's hardest-hit areas during the pandemic, have reported extraordinarily large numbers of children aged under nine with severe cases of what appears to be Kawasaki disease, more common in parts of Asia.

In Britain, doctors have made similar observations, prompting Health Secretary Matt Hancock to tell a coronavirus news briefing on Monday that he was "very worried" and that medical authorities were looking at the issue closely.

Kawasaki disease, whose cause is unknown, often afflicts children aged under five and is associated with fever, skin rashes, swelling of glands and, in severe cases, inflammation of arteries of the heart.

England's national medical director, Stephen Powis, told the British briefing he had become aware of reports of severely ill children with Kawasaki-like symptoms in the past few days but stressed it was too early to determine a link with coronavirus.

"I've asked the national clinical director for children and young people to look into this as a matter of urgency ... We're not sure at the moment."

In Italy, paediatricians are also alarmed.

A hospital in the northern town of Bergamo has seen more than 20 cases of severe vascular inflammation in the past month, six times as many as it would expect to see in a year, said paediatric heart specialist Matteo Ciuffreda.

Ciuffreda, of the Giovanni XXIII hospital, said only a few of the infants with vascular inflammation had tested positive for the new coronavirus, but paediatric cardiologists in Madrid and Lisbon had told him they had seen similar cases.

He has called on his colleagues to document every such case to determine if there is a correlation between Kawasaki disease and Covid-19. He aims to publish the results of the Italian research in a scientific journal.

'MULTI-ORGAN INFLAMMATION'

Ciuffreda said his first case of apparent Kawasaki disease was a nine-year-old boy who came to hospital on March 21, at the peak of the coronavirus outbreak, with high fever and low blood oxygen levels. He tested negative for coronavirus.

A scan showed he had an enlarged coronary artery, a hallmark of severe cases of Kawasaki disease, he said.

"The little boy worried me a lot, with a violent multi-organ inflammation affecting both heart and the lungs," he said. "I feared he wouldn't survive but surprisingly, in the course of a few days, he took a positive turn and he got better."

Kawasaki disease was also anecdotally linked 16 years ago to another known coronavirus, though it was never proven.

The research was carried out after another, related coronavirus known as NL63 was found in a baby showing symptoms of Kawasaki disease in 2004.

Professor Ian Jones, professor of virology at the University of Reading in Britain, said the NL63 virus uses the same receptor as the new coronavirus to infect humans but also stressed that it was too early to draw conclusions.

"We just have to wait and see if this becomes a common observation," he said.

The American Academy of Pediatrics has yet to see something similar in the United States, which has the most number of coronavirus infections and deaths.

"We are not aware of any reports of this phenomenon in the United States," Dr Yvonne Maldonado, who chairs the academy's committee on infectious disease, said in an email referring to a potential link between Covid-19 and Kawasaki-type symptoms.

Meanwhile, UK Prime Minister Boris Johnson returned to work on Monday after recovering from Covid-19 and warned that it was still too dangerous to relax a stringent lockdown wreaking havoc on Britain's economy, for fear of a deadly second outbreak.

Looking healthy again after a life-threatening bout of the coronavirus, Johnson compared the disease to an invisible street criminal whom Britons were wrestling to the floor.

"If we can show the same spirit of unity and determination as we've all shown in the past six weeks then I have absolutely no doubt that we will beat it," the 55-year-old said outside his Downing Street home, a month and a day after testing positive.

"I ask you to contain your impatience because I believe we are coming now to the end of the first phase of this conflict and in spite of all the suffering we have so nearly succeeded."

With unemployment soaring, many companies crippled and a recession looming, Johnson said he understood the concerns of business and would consult with opposition parties pressing for clarity on a pathway out of lockdown.

But with Britain posting one of the world's highest death tolls - 21,092 hospital deaths and thousands more yet to be quantified in care homes - he stressed it was still a time of maximum risk.

"We simply cannot spell out now how fast or slow or even when those changes will be made, though clearly the government will be saying much more about this in the coming days," he said.

"We must also recognise the risk of a second spike, the risk of losing control of that virus and letting the reproduction rate go back over one because that would mean not only a new wave of death and disease but also an economic disaster."

EMERGENCY CREDIT

The lockdown has left Britain facing possibly the deepest recession in three centuries and the biggest debt splurge since World War Two. Johnson's government, party and scientific advisers are divided over how and when the world's fifth-largest economy should start returning to work, even in limited form.

Finance minister, Rishi Sunak, announced the latest in a series of emergency measures to try and stave off calamity, a programme of small business loans fully backed by the state.

He said the government would stand fully behind commercial loans of up to 50,000 pounds (Dh228,000) for emergency credit to small firms, which will not be required to meet repayments or pay interest for the next 12 months.

Johnson initially resisted introducing the lockdown but changed course when projections showed a quarter of a million people could die. The government is next due to review social-distancing measures on May 7.

Since the lockdown started on March 23, his government has faced criticism from opposition parties and some doctors for initially delaying measures, for limited testing capabilities, and for a lack of protective equipment for health workers.

Johnson's spokesman said the government may not know if a target of 100,000 tests per day by the end of April had been met on Thursday because of a time lag with data. Health minister Matt Hancock later said the testing system was on course to meet the target.

Johnson's spokesman added that the prime minister would meet opposition Labour Party leader Keir Starmer, who has urged the prime minister to say when and how restrictions might be eased.