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Long Covid in children would be much more common than we thought

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The stubborn belief that children are less exposed to long-term Covid turns out to be fallacious, according to a recent survey. This potentially dangerous myth could threaten millions of children across the globe. In reality, they appear more vulnerable, with a prevalence of long Covid of 10 to 20%, which could partially shed light on post-pandemic behavioral and learning difficulties.

Long Covid is characterized by disabling symptoms that persist well after initial infection with SARS-CoV-2, lasting for weeks, months, or even years. It is estimated that 65 million people worldwide are affected by this condition.

In 2023, a study claimed that the rate of long-term Covid in children was only 0.4%, a result which received widespread media coverage. However, this study was refuted by other researchers earlier this year, who published a
letter pointing out obvious errors that the peer review process should have caught.

The authors of this study had claimed to rely on the WHO criteria, but had failed to consider the possibility of reinfection or recurrence of symptoms, as mentioned by the organization. They therefore assumed that a child without recurrent symptoms four weeks after infection did not suffer from long Covid. The authors later retracted their study, simply admitting an underestimate of the cases of affected children.

A detailed investigation in the review JAMA confirms a higher rate of long-term Covid in children than previously assumed. Rachel Gross of the NYU Grossman School of Medicine, lead author of the study, said in a press release : « Our study is one of the first to characterize the symptoms of long Covid in children of various ages and to develop a tool to identify those most likely to suffer from it. This is very important, because the idea that pediatric long-term Covid is rare persists, and this research can raise awareness of its impact on children ».

Symptoms potentially responsible for recent learning difficulties

The survey, which includes 5,367 children and adolescents aged 6 to 17, reveals that long Covid could affect up to 5.8 million children in the United States. Symptoms vary depending on age: in 6-11 year olds, memory and attention problems are common, followed by body pain and headaches. Unusual behaviors, such as irrational fears and refusal to go to school, were also observed. In 12-17 year olds, the predominant symptoms include loss of taste and smell, fatigue and cognitive deficits.

The study highlights that these symptoms affect almost all organ systems, causing cardiovascular, neurological and immunological damage, and increasing the risk of pediatric diabetes. Murdoch suspects they could be linked to learning difficulties noted in recent years. Reports indicate a rise in attention and emotional regulation problems among children, while academic performance among adolescents is among the lowest in decades.

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Studies in adults have shown that COVID-19 can lead to persistent brain sequelae, such as neuroinflammation and atrophy, correlated with cognitive deficits measured by IQ tests. “ Considering that 10-20% of infected children may have long-term symptoms, that the majority of symptoms affect cognition, and that children are periodically reinfected, there is scientific justification to partially explain the behavioral and commonly reported learning problems in children », estimates the expert.

However, it is worrying to note that even public health organizations seem to minimize the impact of long Covid on children. The Canadian Pediatric Society, for example, does not recognize this form of illness in children, attributing recent learning difficulties to lockdowns and the temporary cessation of classes. A study funded by the Bezos Foundation also suggested that cortical thinning seen in some children after the pandemic is linked to lockdowns, although these findings have been disputed by neurologists.

To protect children from long Covid and avoid reinfection, Murdoch recommends seasonal vaccination, isolation of sick children and normalization of mask wearing. It also proposes new air quality standards in schools, the costs of which would be lower than pediatric health costs if children remained constantly exposed to risks.

Source : JAMA

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