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Dr Louis P Coates
19 hrs ·
Coronavirus Update 5/11/2020 - BTHO COVID-19

So today at the time of this writing there are 20,329 new cases today with 750 deaths. Cases and deaths have dramatically decreased over the weekend. Today the mortality rate is way down to 3.69%. We also have 16,514 in critical condition still high so the fatality numbers will likely stay high a while longer. So the overall mortality rate dropped a little to 5.91%.

We also have now had 256,336 people recovered from this virus and should now be considered immune from this horrific disease.

Locally, in Texas we are still plateaued and we are waiting for the downside of the curve. We had 842 new cases and 28 new deaths with a slightly rising mortality rate of 2.8%.

Because antibody testing is being added to the numbers we are monitoring active cases. So we have 17,142 down from 22,790 active cases in Texas. The number of active cases dropped over the weekend. In addition we have 21.022 recovered now. Yes we are trending down at this time but could be less reported over the weekend. We are still many times under both the number of hospital beds and ICU beds needed.

Today in Dallas county 251 new cases and no new deaths. Harris county with 75 new cases and 4 new deaths. Collin county with 31 new cases and 1 new death. Denton county with 12 new cases and no new deaths. Tarrant county with 83 new cases and 6 new deaths. Brazos county with 9 new cases and no new deaths. Travis county with 32 new cases and 0 new deaths. Fort Bend county with 13 new cases and no new deaths. Also Bexar county with no new cases and 2 new deaths.

For the newbies we are predicting an overall fatality rate somewhere in the 0.3 to 0.7 range when we finally correct the denominator. The real question is just how much of the population is already infected 2%, 5%, 10% etc.

Why are some children getting Kawaskai’s Disease from Covid-19?

Well first we need to know what Kawasaki’s Disease actually is? It is a vasculitis which means your own antibodies are attacking the blood vessels in your body. It is diagnosed by 5 of the following symptoms.

1) fever persisting for 5 days or more
2) bilateral conjunctival congestion (pink eye)
3) changes in the lips and oral cavity: strawberry tongue, reddening of the lips and diffuse infection of the oral mucosa (sore throat)
4) polymorphous exanthema (rash)
5) changes in the peripheral extremities: initial stage = reddening of the palms and soles, and indurative edema, convalescent stage = membranous desquamation from the fingertips (rash or peeling of hands and feet)
6) cervical lymphadenopathy (big lymph nodes in neck)

It is usually in kids under 5 years of age and is believed to be caused by a virus that affects the respiratory or GI tracts. This causes the immune system to make plasma cells that produce IgA antibodies which attack blood vessels. So this is essentially a cytokine mediated process activated by a virus. Sound familiar?

Absolutely it does! We know from all the articles I have previously written that Covid-19 is an immune mediated process from a virus. So while this is very unfortunate it is not completely unexpected. The biggest difference seems to be age as this is affecting children age 2-17 not under 5. Also most are having very severe gastrointestinal symptoms and only half had any respiratory symptoms at all. Also it seems to be more frequently attacking the heart as many are having elevated cardiac markers much more than typical Kawasaki’s. Frequently going into cardiogenic shock and needing ICU even ventilator support.

With Covid-19 this is likely a late immune response usually 3-4 wks after exposure to the virus which is causing some type of cytokine storm aimed at the blood vessels of the heart. A big concern at this point is trying to identify why some kids are being affected. We don’t know what the risk factors are for some kids having this type of complication. Luckily it is very rare and I attached a statement from the American Heart Association stating such to give parents some reassurance.

The process likely comes from the same as other endothelium damage in adults. The imbalance of free radicals along with an increased immune response. So much more research is needed. Luckily with all the attention on it now much more research and information should become available soon.

Kawasaki’s disease is always a difficult diagnosis so it is not uncommon to be missed for quite some time until more symptoms develop. So any child with persistent fever for over 4-5 days and significant gastrointestinal symptoms should be elevated in a pediatric emergency room where blood tests can be done.