ANALYSIS: There are now ~100 children in the United States with an inflammatory syndrome that overlaps with Kawasaki & may be linked to #coronavirus. We know very little about these patients. When I think about a potential link between the virus & a syndrome, I ask 4 questions:
1. Is this link biologically plausible? Take a step back. Does it make sense that a respiratory virus could cause an inflammatory vasculitis? Yes. Coronavirus induces an aggressive immune response in a subset of adults (cytokine storm); this *could* be a pediatric variant.
2. Is there an alternative explanation for the phenomenon? Perhaps. There's a seasonality to Kawasaki Disease; it peaks January-March in some parts of Northern Hemisphere. Children's Hospital LA reported an uptick in Kawasaki over the past 2 years. What about the past 10 years?
3. Is the link consistent? Kawasaki is more prevalent in Japan yet we haven't heard anything from Asia. Why? Maybe it was missed. Many of the ~100 kids did not have respiratory symptoms; some test negative by PCR (but positive by serology). Perhaps doctors never made connection.
4. Does this new Kawasaki-like syndrome at least partially fulfill Koch's postulates? These criteria establish a causative relationship between a microbe & a disease. en.wikipedia.org/wiki/Koch%27s_….
Doctors must be on the look out for Kawasaki now so we can figure out if link is real.
Doctors must be on the look out for Kawasaki now so we can figure out if link is real.
