Thread by @elisaperego78

"In the past month we found a 30-fold increased incidence of Kawasaki-like disease. A similar outbreak of [severe] Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic"

—13 May 2020—data from Bergamo—Italy @TheLancet

#MISC

thelancet.com/journals/lance…

Some early pandemic history. This in the top @TheLancet journal from May 2020 is a first description of the severe, sometimes fatal multi-inflammatory syndrome seen in children weeks after SARS-CoV-2 infection — later known as MISC or PIMS.

"Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease."

MISC was first identified in early pandemic epicenters, like, primarily, in the hard-hit Bergamo, in the Lombardy region, Italy. In view of its clinical features, MISC was initially compared to an already known clinical entity, namely Kawasaki disease (and called Kawasaki-like)

"In this study, the clinical and biochemical features of patients with Kawasaki disease diagnosed during the COVID-19 pandemic appeared to differ from our historical cohort of patients; therefore, we have classified these patients as Kawasaki-like disease."

Make no mistake. We knew a lot of things about SARS-CoV-2 already at the beginning of the pandemic. Some vital information was published in the most prestigious medical and scientific journals on the planet.

We knew this virus was very dangerous for at least some children in early 2020 already.

An article in Italian from 28 April 2020

"Kawasaki disease: a severe increase in Bergamo. According to pediatricians there is a link to covid"

"Italy and the UK are seeing an increase in Kawasaki disease. In Bergamo there's 30-fold increase"

quotidianosanita.it/m/scienza-e-fa…

Italy's news in spring and summer 2020 were reporting quite openly on the Kawasaki like disease seen in children after (other cases were being reported in additional early hotspots like the UK). A fast Google search will suffice.

"Kawasaki syndrome: it hits blood vessels in children (and could be linked to covid)" from Italy, 28 April 2020

"Dr Ciuffreda first diagnosed one case at the emergency in Bergamo in March 2020"

"Many cases from Genova to London, Bergamo, Lisbon"

corriere.it/salute/malatti…

"Kawasaki disease is an inflammation of the blood vessels, a vasculitis."

We have been discussing so many times even on this very platform the role of vascular disease (including covid-related vasculitis) in acute and #LongCovid

MISC wasn't fully meeting the clinical case criteria for pre covid Kawasaki disease, hence names like Kawasaki like, and then MISC and PIMS, but the strong cardiovascular component of the disease remains interesting especially in terms of pandemic history and understanding covid