A message from NHS England that has been cascaded to GPs and shared on social media by the Paediatric Intensive Care Society reads: 'Over the past three weeks there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK.
'The cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children.
'Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation. This has been observed in children with confirmed PCR positive SARS-CoV-2 infection as well as children who are PCR negative.
'Serological evidence of possible preceding SARS-CoV-2 infection has also been observed. There is a growing concern that a SARS-CoV-2 related inflammatory syndrome emerging in children in the UK or that there may be another as yet unidentified infectious pathogen associated with these cases.'
The message was shared nationally on 25 April with an instruction to flag the concerns to frontline staff.
GPs in CCG areas across north-west London received an alert marked 'urgent' on the morning of 27 April - highlighting a 'significant alert for paediatrics'.
Advice for GPs from CCG leaders says 'the prevalent presenting symptoms are abdominal pain and diarrhoea and rapid progress to a shock-like picture' - but emphasises that 'the cases are rare'.
The email sent to GPs adds: 'Our understanding of the pathophysiology is currently incomplete. Whether this is COVID-associated or something else is not clear at the moment.'
The north-west London advice urges GPs to 'be alert to children who are unwell and refer sick children urgently to A&E', adding that most children are likely to 'present with non-COVID problems but still may be very unwell'.
*Urgent alert*— PICSUK (@PICSociety) April 26, 2020
Rising no of cases presenting to #PedsICU with multi-system hyperinflammatory state, overlapping features of toxic shock syndrome & atypical Kawasaki disease, bloods consistent with severe #COVID19 - seen in both #SARSCoV2 PCR +ve AND -ve
Please share widely pic.twitter.com/Bj6YHLJ8zi
Prof Simon Kenny, NHS national clinical director for children and young people, said: 'Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to Covid-19, but it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.
'The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.'