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The Complexities and Growing Threats of SARS-CoV-2

"We will not comment on decisions made by other jurisdictions."
"We will remain very attentive to the situation and if public health recommends us to postpone the opening of schools, we will not hesitate for a single instant to do so."
"You have to trust Dr.[Horacio] Arruda [Quebec's director of public health] and his team."
"They are the experts."
Francis Bouchard, press attache, Quebec Education Minister Jean-Francois Roberge

Saint Justine Hospital in Montreal

Several months ago a rare and mysterious illness began surfacing in Europe where children were admitted to hospital with peculiar symptoms of swollen blood vessels which on occasion led to respiratory distress and on rare occasions seeing those children placed in respirators in emergency care. Contrary to early reports, no children impacted by these strange symptoms have died. The symptoms, however, are now being linked to the transmission of COVID-19.

The symptoms, collectively described as "multi-system inflammatory syndrome" vary depending on which organ system is affected, including a persistent fever, rash, abdominal pain, vomiting or diarrhea. Mechanical ventilation was required for five children in perplexing cases in New York City. What began in Europe spread to cities along the American east coast. And now it is being seen in clusters in Montreal.

New York City's health department issued an alert, reporting on 14 cases of children between the ages of two to fifteen having presented at city hospitals with "multi-system inflammatory syndrome". Noses swabbed for active COVID-19 infections revealed that four children tested positive, and ten negative. But when blood was sampled, six of the 'negatives' had antibodies to the virus, suggesting that at some time in the near past they had been exposed to COVID.

An alert issued by British health officials, similar to the NYC bulletin, arrived just as Quebec is preparing to reopen its elementary schools and daycare centres in mid-May. Ontario plans to reopen schools and daycares toward the end of May. "Educaton as we know it" likely won't return until September in British Columbia, according to Premier John Horgan. And schools in Alberta "as a general rule" are to remain closed for the rest of the academic year.


New Jersey Governor Phil Murphy has announced that schools there would remain closed until the fall "to protect the health of our children". Quebec remains steadfast,that its gradual, non-mandatory return to school schedule, endorsed by Quebec Public Health will proceed as planned, with elementary classes limited to 15 students, children seated two metres apart.

Doctors at Montreal's Sainte-Justine Hospital are examining the 15 to 20 cases of children developing what appears to be similar hyper-inflammatory illnesses as those reported in children in New York, as well as children in Italy, the U.K., France and Spain. Overlapping symptoms with toxic shock syndromes and Kawasaki-like disease distinguish these cases. Inflammation and swelling in blood vessels throughout the body including coronary arteries characterize Kawasaki.

When diagnosed and treated early, the vast majority of children with Kawasaki have good outcomes, though when late diagnoses occur, children can be at risk of coronary artery aneurysms, a dilation of the blood vessels providing oxygen to the heart. "In every case we failed to detect" the virus that causes COVID-19, Dr. Elie Haddad, head of pediatric immunology at Sainte-Justine stated, in the Montreal cluster.

Then came reports out of Europe, where children with the same mystery disease were seen with antibodies against SARS-CoV-2. Now, Dr. Haddad feels it is logical to consider the pandemic virus could cause a delayed, post-viral infection in some children. While Kawasaki is thought of as an inflammatory response, the body mounts a response to a virus, an exaggerated response, targeting some of the body's own blood vessels.

Should that be the case for the COVID-19 virus, "we want to understand why. How does it work?" To the present, no definitive link has appeared, though it seems possible children had been infected with COVID, recovered, and then developed the inflammatory syndrome from another pathogen completely. "We are learning every day with this virus", said Dr. Haddad.

The symptoms include redness inside the moth, conjunctivitis (pink eye), pain in the hands and feet, fatigue and fussiness -- "they re not happy in the arms of their mothers", explained Dr.Haddad. A situation that seems quite at odds with expectations of how COVID affects children, given that early reports were that children rarely had severe complications. Children in Canada under 19 account for roughly five percent of confirmed cases overall.

Doctors at Sainte-Justine Hospital did not detect any traces of COVID-19 in the Montreal cluster of children with the mystery inflammatory syndrome. Dario Ayala/Postmedia/File