Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children

​Since the start of global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at least four waves have occurred as mutations and variant strains have developed. During the first waves, adults were the primary target, but the highly infectious delta variant has been infecting children and unvaccinated adults with a vengeance.On this go-round, the delta variant is predominately infecting children. I am seeing reports of high school football games being canceled, schools deciding to go virtual, and occasional reports of teachers dying of COVID. I have never seen anything like this pandemic and the associated disease presentations in my more than 40 years of medicine.Practice in the pediatric ED has changed dramatically. Our once happy-go-lucky, maskless interactions with febrile children are no more. Current pediatric emergency department volumes are high, as is angst about the looming winter season and its onslaught of viruses.Even though we have been inundated with information about COVID-19, we are still learning about presentations unique to pediatric patients. The breadth of the COVID-19 illness spectrum in children is intriguing and spans from fever, myalgias, conjunctivitis, and upper respiratory tract infection signs and symptoms to severe COVID-19 illness involving cardiac and pulmonary systems. This disease even has the audacity to masquerade as asthma exacerbations, croup, or bronchiolitis. And then occasional surprises materialize,...
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