Introduction This review follows specific guidelines provided by the Publons team to secure rapid critical appraisals of papers related to the COVID-19 outbreak. My assessment scrutinizes this paper for sound scientific practices, in the hope that this will help researchers working on the COVID-19 outbreak.

Reviewer type I am currently working directly on COVID-19 response

COVID-19 Topic Epidemiology

Author/s’ experience The authors are affiliated with the New York State Department of Health and the Center for Disease Control.

Brief overview of the paper and its main findings This article provides a fascinating insight into COVID-19 in the pediatric population, particularly when presenting with the multisystem inflammatory syndrome. MIS-C conferred a significantly higher risk of death (2%) when compared to all pediatric COVID-19 cases reported to the NYSDOH (0.1%).

One of the most perceptive statements that the authors make is that children with COVID-19 often present with mild symptoms, and thus this underwhelming presentation may lead to a lower likelihood of being tested for COVID-19. However, given the more profound clinical implications of COVID-19 associated MIS-C, a high index of suspicion for COVID-19 must be made if MIS-C in noted in a pediatric patient during the ongoing pandemic, particularly in areas of high disease burden, where inadvertent exposure to a contagious person in the community may be more likely.

Major and minor points

The methodology was appropriate since the authors were essentially sharing characteristics of the pediatric population suffering from COVID-19 associated MIS-C. It is important to note that the authors used a broad definition to be able to include PCR negative patients who had a clinical presentation highly suspicious for COVID-19. However, such cases constitute only 4 our of 99 MIS-C cases described.

Research integrity No concerns noted.

Conflicts of interest None

Overall categorizationPromising. As best as you can assess, this paper appears possibly significant and presents a breakthrough in COVID-19 research or the promise of one.