Five-year-old Israel Shippy doesn’t remember much about having COVID-19 – or the unusual auto-immune disease it triggered – other than being groggy and uncomfortable for a bunch of days. He’d rather talk about cartoons or the ideas for inventions that constantly pop into his head.

“Hold your horses, I think I know what I’m gonna make,” he said, holding up a finger in the middle of a conversation. “I’m gonna make something that lights up and attaches to things with glue, so if you don’t have a flashlight, you can just use it.”

Israel is friendly and energetic, but he’s also really good at sitting still. During a recent checkup at Children’s Hospital at Montefiore, he had no complaints about all the stickers a health aide attached to him for an EKG. When Dr. Marc Foca, an infectious disease specialist, came by to listen to his heartbeat and chest and prod his abdomen, Israel seemed to barely notice.

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There were still some tests pending, but from the outside, Foca said, “Israel looks like a totally healthy five-year-old.”

“Stay safe!” Israel said, as Foca left. It’s his new sign-off, instead of good-bye. His mother, Janelle Moholland, explained Israel came up with it himself.

And after a harrowing couple weeks in early May, Moholland is hoping Israel will stay safe.

In New York, about 200 kids like Israel have been struck with the illness the Centers for Disease Control and Prevention dubbed Multisystem Inflammatory Syndrome in Children, or MIS-C. And though it’s relatively rare, and it apparently responds well to treatment, MIS-C is new enough — and mysterious enough — that doctors here want to make sure the children who recover don’t experience health complications in the future.

“We've seen these kids get really sick and get better and recover and go home, yet we don't know what the long-term outcomes are,” said Dr. Nadine Choueiter, a pediatric cardiologist at Montefiore. “So that’s why we will be seeing them.”

Janelle Moholland and her son Israel Shippy, both smiling for the camera

Janelle Moholland and her son Israel Shippy

Janelle Moholland and her son Israel Shippy
Fred Mogul / WNYC

Israel got sick about six weeks ago, but his illness didn’t exactly look like COVID-19. He had a persistent fever — but no problems breathing. He wasn’t eating. He was barely drinking. He wasn’t using the bathroom. He had abdominal pains. His eyes were red.

They went to the emergency room a couple times, but the doctors sent them home without a coronavirus test. Moholland, 29, said she felt powerless. 

“There was nothing I could do but make him comfortable,” she recalled. “I literally had to just trust in a higher power and just hope that He would come through for us. It taught me a lot about patience and faith.”

As Israel grew sicker, Moholland grew frustrated. When we spoke, we discussed how COVID-19 has disproportionately affected the African-American community, due to a combination of underlying health conditions and access to good health care. I asked her if she felt she was a victim of those disparities.

“Yes, I do,” she said. “It affects me, personally, because I am African-American, but you just never know. It's hard. We’re living in uncertain times — very uncertain times.”

Finally, Children’s Hospital at Montefiore admitted Israel — and the test she’d been trying to get for days confirmed he had the virus. 

“I was literally in tears, like begging them not to discharge me because I knew he was not fine,” she said.

Israel was in shock, and by the time he got to the hospital, doctors were on the lookout from MIS-C, so they recognized his symptoms — which were distinct from most people with COVID-19.

Doctors gave Israel fluids and intravenous immuno-globulin, a substance pooled from human plasma that helps prevent the immune system from attacking his arteries.

Choueiter (whose name is pronounced SHWAY-ter) says MISC appears to be caused by the immune system overreacting to the coronavirus  

“The immune system starts attacking the body itself, including the arteries of the heart,” she said.

In some MIS-C cases – though not Israel’s – the immune system attacks the coronary arteries, inflaming and dilating them. That also happens in a different but more familiar syndrome affecting children, Kawasaki disease. About 5% of Kawasaki disease patients experience aneurysms — which can fatally rupture blood vessels — after the initial condition subsides.

Choueiter and her colleagues want to make sure MIS-C patients don’t face similar risks. So far, they’re cautiously optimistic.

“We have not seen any new decrease in heart function or any new coronary artery dilations,” she said. “When we check their blood, their inflammatory markers are back to normal. For the parents, the child is back to baseline, and it's as if this illness is a nightmare that’s long gone.”

Janelle Moholland has been reading up on Kawasaki Disease, so before Israel’s first follow-up appointment, a month ago, she wrote down a bunch of questions  

“Does it affect his heart? Does it affect the function of his organs? Will the swelling come back?” she wants to know. “He had swelling internally, and that was so scary.”

Fred Mogul / WNYC

The medical team at Montefiore doesn’t have definitive answers, which is why they are tracking the children who have been discharged — three dozen and counting. Dr. Choueiter said with kids showing few symptoms in the immediate aftermath, she is hoping the MIS-C trajectory will parallel Kawasaki Disease. 

“Usually children who have had coronary artery dilations [from Kawasaki dDisease] that have resolved within the first six weeks of the illness do well long-term,” said Choueiter, who runs the Kawasaki dDisease program at Montefiore. “These kids have been followed for years and years down the road, and it hasn't seemed to affect their exercise ability or their ability to function in everyday life.”

The Montefiore team is asking families to come back one week after discharge, then after one month, three months, six months and a year, for evaluations by pediatric cardiologists, hematologists, rheumatologists and infectious disease specialists. The hospital has set up a dedicated outpatient clinic, on Tuesdays, just for these visits.

Montefiore and other children’s hospitals around the country are pooling information. Choueiter wants to establish an even longer-term monitoring program, comparable to registries that exist for other diseases. 

Moholland is glad the hospital is being vigilant.

“The uncertainty of not knowing whether it could come back in his future is a little unsettling,” she said. “But I am hopeful.”