May 15, 2020

COVID-19: US case count rises by more than 20,000; CDC issues advisory on multisystem inflammatory syndrome in children associated with COVID-19

According to CDC's update as of May 14, the case count of COVID-19 in the US stands at 1,384,930* cases, including 83,947* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. This represents an additional 20,869 cases and 1,701 deaths compared to the day before.

Twenty-eight jurisdictions reported more than 10,000 cases, 9 jurisdictions reported 5,001 to 10,000 cases, 10 jurisdictions reported 1,001 to 5,000 cases and 8 jurisdictions reported 1 to 1,000 cases of COVID-19.

* As of April 14, 2020, CDC case counts and death counts include both confirmed and probable cases and deaths. This change was made to reflect an interim COVID-19 position statement issued by the Council for State and Territorial Epidemiologists on April 5, 2020. The position statement included a case definition and made COVID-19 a nationally notifiable disease.

A confirmed case or death is defined by meeting confirmatory laboratory evidence for COVID-19.

A probable case or death is defined by one of the following:

  • Meeting clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19
  • Meeting presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence
  • Meeting vital records criteria with no confirmatory laboratory testing performed for COVID19

The 20 jurisdictions with the highest case counts, and their daily additional confirmed cases and deaths (in brackets) over the week are compiled as follows.

 

State
Additional Cases (Deaths)
Total Cases
(Deaths)
as of May 14
May 11May 12May 13May 14
New York1,660
(162)
1,430
(205)
2,176
(168)
2,390
(157)
343,051
(22,170)
New Jersey1,413
(55)
798
(198)
817
(194)
1,144
(244)
142,704
(9,946)
Illinois1,266
(53)
4,014
(142)
1,677
(191)
3,239
(136)
87,937
(3,928)
Massachusetts669
(129)
870
(33)
1,165
(174)
1,685
(167)
82,182
(5,482)
California1,259
(25)
1,443
(77)
1,759
(87)
2,023
(98)
73,164
(3,032)
Pennsylvania543
(24)
837
(75)
707
(137)
938
(275)
59,636
(4,218)
Michigan414
(33)
469
(90)
370
(40)
1,191
(73)
49,582
(4,787)
Texas1,000
(12)
1,179
(33)
1,355
(25)
1,448
(58)
43,851
(1,216)
Florida386
(14)
941
(44)
479
(48)
808
(48)
43,210
(1,875)
Georgia169
(39)
846
(50)
579
(23)
550
(27)
35,977
(1,544)
Maryland786
(35)
688
(70)
751
(51)
1,091
(54)
35,903
(1,748)
Connecticut211
(41)
568
(33)
522
(84)
609
(94)
35,464
(3,219)
Louisiana215
(29)
235
(39)
612
(34)
827
(36)
33,489
(2,351)
Virginia989
(11)
730
(41)
946
(36)
1,067
(28)
27,813
(955)
Ohio696
(16)
473
(79)
471
(47)
636
(51)
26,357
(1,534)
Indiana501
(32)
500
(33)
346
(38)
580
(26)
26,053
(1,508)
Colorado176
(16)
278
(22)
318
(53)
363
(29)
20,838
(1,091)
Washington231
(14)
208
(17)
182
(13)
261
(8)
17,773
(983)
Tennessee559
(8)
566
(13)
260
(9)
329
(14)
16,699
(287)
North Carolina281
(3)
301
(27)
470
(20)
691
(18)
16,507
(615)

 

CDC issues health advisory on multisystem inflammatory syndrome in children associated with COVID-19

CDC has issued a health advisory on May 14, providing background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 and a case definition for this syndrome. 

According to the health advisory, clinicians in the United Kingdom (UK) recognized increased reports of previously healthy children presenting with a severe inflammatory syndrome with Kawasaki disease-like features. The cases occurred in children testing positive for current or recent infection by SARS-CoV-2, the novel coronavirus that causes COVID-19, based on reverse-transcriptase polymerase chain reaction (RT-PCR) or serologic assay, or who had an epidemiologic link to a COVID-19 case. Patients presented with a persistent fever and a constellation of symptoms including hypotension, multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic) involvement, and elevated inflammatory markers. Respiratory symptoms were not present in all cases.

CDC noted that cases of COVID-19 rapidly increased in New York City and New York State during March and April. In early May 2020, the New York City Department of Health and Mental Hygiene received reports of children with multisystem inflammatory syndrome. From April 16 through May 4, 2020, 15 patients aged 2-15 years were hospitalized, many requiring admission to the intensive care unit. As of May 12, 2020, the New York State Department of Health identified 102 patients (including patients from New York City) with similar presentations, many of whom tested positive for SARS-CoV-2 infection by RT-PCR or serologic assay. New York State and New York City continue to receive additional reports of suspected cases.

According to CDC, reports of children presenting with severe inflammatory syndrome with a laboratory-confirmed case of COVID-19 or an epidemiological link to a COVID-19 case have been reported by authorities in other countries.

“It is currently unknown if multisystem inflammatory syndrome is specific to children or if it also occurs in adults”, said CDC. “There is limited information currently available about risk factors, pathogenesis, clinical course, and treatment for MIS-C. CDC is requesting healthcare providers report suspected cases to public health authorities to better characterize this newly recognized condition in the pediatric population.”

The CDC provided the following case definition for MIS-C:

  • An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
  • No alternative plausible diagnoses; AND
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

* Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours.

**Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin.

The CDC added that some individuals may fulfill full or partial criteria for Kawasaki disease but these cases should be reported if they meet the case definition for MIS-C and that healthcare providers should consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.

“Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to their local, state, or territorial health department”, the CDC recommended. 

SOURCE: CDC; State Health Agencies