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Governor Andrew M. Cuomo today directed hospitals statewide to prioritize COVID-19 testing for children displaying symptoms similar to an atypical Kawasaki disease and toxic shock-like syndrome. The State is currently investigating approximately 100 reported cases in New York where children - predominantly school-aged - are experiencing these symptoms possibly due to COVID-19. The illness has taken the lives of three young New Yorkers, including a 5-year old in New York City, a 7-year old in Westchester County and a teenager in Suffolk County.

"We have been behind this virus every step of the way and even as we are now beginning to see the numbers on the decline, the virus is still surprising us," Cuomo said. "Initially we thought COVID-19 didn't affect children, and now we're dealing with a disturbing issue where we have about 100 cases of an inflammatory disease in children that seems to be created by the virus. New York is leading the investigation of this situation and we are advising all hospitals and medical providers to prioritize diagnostic testing for any children that are displaying symptoms of this illness."

New Yorkers should seek immediate care if a child has:

• Prolonged fever (more than five days)
• Difficulty feeding (infants) or is too sick to drink fluids
• Severe abdominal pain, diarrhea or vomiting
• Change in skin color - becoming pale, patchy and/or blue
• Trouble breathing or is breathing very quickly
• Racing heart or chest pain
• Decreased amount of frequency in urine
• Lethargy, irritability or confusion

At the request of the CDC, the state is helping to develop the national criteria for identifying and responding to COVID-related illness. The State Department of Health is also partnering with the NY Genome Center and Rockefeller University to conduct a genome and RNA sequencing study to better understand COVID-related illnesses in children and the possible genetic basis of this syndrome. New York State is also notifying 49 other states across the country of emerging cases of COVID-related illness in children.

At the direction of Cuomo, the State Department of Health has issued an advisory about this serious inflammatory disease, called "Pediatric Multi-System Inflammatory Syndrome Associated with COVID-19," to inform healthcare providers of the condition, as well as to provide guidance for testing and reporting. Health care providers, including hospitals, are required to report to the Department of Health all cases of pediatric multisystem inflammatory syndrome potentially associated with COVID-19 in those under 21 years of age.

Though most children who get COVID-19 experience only mild symptoms, in the United Kingdom, a possible link has also been reported between pediatric COVID-19 and serious inflammatory disease. The inflammatory syndrome has features which overlap with Kawasaki disease and toxic shock syndrome and may occur days to weeks after acute COVID-19 illness. It can include persistent fever, abdominal symptoms, rash, and even cardiovascular symptoms requiring intensive care.

Early recognition by pediatricians and referral to a specialist including to critical care is essential. Molecular and serological testing for COVID-19 in children exhibiting the above symptoms is recommended. The majority of patients have tested positive for COVID-19, some on molecular testing for SARS-COV-2, others on serological testing.

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