COVID-19’s Effects on Kids Are Even Stranger Than We Thought

Doctors have found a concerning link between the rare pediatric complication known as MIS-C and a syndrome related to tampon use.

The U.S. fell short of its goal of giving at least one dose of the COVID-19 vaccine to 70 percent of adults by July 4, but not by much. About two-thirds of everyone above the age of 18 had gotten a shot when the holiday arrived, with coverage among seniors surpassing even that benchmark. That leaves kids—mostly unvaccinated—as the Americans most exposed to the pandemic this summer, while the Delta variant spreads. It’s said that COVID-19 may soon be a disease of the young. If that’s what’s coming, then its effects on children must be better understood.

This month, The New England Journal of Medicine published new treatment guidelines for the occasionally fatal, COVID-related condition known as multisystem inflammatory syndrome in children (MIS-C). When kids first started showing signs of MIS-C in early 2020—rash or conjunctivitis; low blood pressure; diarrhea or vomiting; etc.—doctors guessed it was an inflammatory disease that occurs most often in toddlers called Kawasaki disease. Now most experts believe it’s a separate condition, affecting kids at an average age of 8. No more than a few hundred children in the U.S. have died from COVID-19 during the pandemic—compared with more than half a million deaths overall—but more than 4,000 have developed MIS-C, and we still don’t have foolproof ways to cure it. But a handful of scientists think they’ve found important clues about what drives MIS-C. The disease, they say, may have something to do with a dangerous condition most commonly associated with tampon use.

That condition, called toxic shock syndrome, was also quite mysterious when it first appeared, in a group of kids in the late 1970s. Within a few years, it was clear that women who used high-absorbency tampons were also falling ill, with symptoms very much like those now seen in MIS-C: They had kidney failure, diarrhea, and skin rashes; a few went into shock and died. (Indeed, one of the early sufferers, like the early MIS-C patients, was initially and incorrectly thought to have Kawasaki disease.) Doctors soon realized that the tampon-induced sickness was caused by a buildup of toxins from certain strains of Staphylococcus or Streptococcus bacteria. In people who do not yet have immunity to those strains, the toxins somehow bypass the immune system’s usual processes for developing a targeted response to a pathogen. That sets off a widespread, confused, nonspecific immune reaction.

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