Millions of children worldwide infected with the pandemic coronavirus SARS-CoV-2 showed long Covid – persistent symptoms that have lasted more than three months. It is typical that studies show that more than 25% of children affected by COVID-19 suffer from persistent symptoms – it is estimated that in the US alone up to 5.8 million children and adolescents experienced symptoms that persisted for months after the initial infection.
Now a large American study (Researching COVID to Enhance Recovery – RECOVER) involving 10 pediatric centers funded by the US National Institutes of Health (NIH) and aimed at improving the prognosis, diagnosis and treatment of long covid at young ages , offers the most detailed “x-ray” of the symptoms of… childhood long Covid.
Symptoms for more than two years
“In our clinic dealing with the recovery of pediatric long Covid cases, some patients have symptoms for about two months, but there are others whose symptoms have not stopped after two years,” said Sidhu Mohandas, co-director of the Immunocompromised Infectious Disease Program at Children’s Hospital Los Angeles (CHLA). “However, we do not yet know which patients are at risk of long-term symptoms. Until this large study was conducted, physicians seeking information relied only on small-scale surveys. Pediatricians and researchers can now use the new publication to have quick access to the latest research evidence on long COVID and the sources from which the data have come,” added Dr. Mohandas.
Sidhu Mohandas, CHLA
The risk factors
The new findings published in the scientific journal “Pediatrics” bring to light valuable information about long covid at young ages. For example, they “illuminate” the parameters associated with an increased risk of its occurrence. The researchers saw that about 45% of children who develop prolonged Covid have previously experienced symptomatic Covid-19 while only 15% have asymptomatic disease. Other factors associated with an increased risk of long covid are older age, more severe symptoms of the initial infection, the number of organs and systems initially affected, underlying diseases and greater weight.
Fatigue and “brain fog”
The most common symptoms of long Covid in children are, according to the RECOVER study, fatigue, persistent headaches, weakness, musculoskeletal pain, shortness of breath, anosmia and anorexia as well as dizziness. Up to 44% of children with long-term Covid experience problems concentrating – known as ‘brain fog’ – when exerting themselves physically or mentally. Fatigue and “brain fog” even mimic the symptoms of myalgic encephalomyelitis, commonly called chronic fatigue syndrome, and can last for at least six months, interfering with children’s functioning.
Diabetes and MIS-C
Long COVID is also associated with the onset of type 1 or type 2 diabetes in children about a month after initial infection as well as multisystem inflammatory syndrome (MIS-C) which is attributed to an exaggerated immune response of the child’s body to COVID-19 and manifests including abnormal heart rhythm and heart damage. “In most children, the symptoms of MIS-C disappear after six months, but a small percentage of children continue to have unexplained weakness with exercise and great fatigue,” noted John Woodcardiologist and researcher at CHLA, one of the authors of the study.
John Wood, CHLA
Underdiagnosis by pediatricians
Long COVID is underdiagnosed in children, Dr. Woods said. “Some pediatricians believe that children do not experience long Covid while others do not know the signs and symptoms of long Covid. I think the big ‘added value’ of the new study is that it provides some of the characteristic ‘fingerprints’ of long Covid that pediatricians can use to identify it in children.”
Exacerbation of chronic diseases and rare disorders
Long-term COVID can worsen children’s chronic respiratory diseases such as asthma. As the RECOVER researchers have seen, although evidence shows that asthma does not worsen during the initial infection, it does worsen within six months of the infection. It can also worsen fibromyalgia and rare connective tissue disorders such as Ehlers Danlos syndrome and Marfan syndrome. These types of disorders are also associated with chronic fatigue syndrome as well as dysregulation of blood pressure and heart rate, leading to dizziness when changing posture, a condition that resembles postural tachycardia syndrome (POTS).
“Our hope is that the effort to better understand long COVID in children will also lead to a deeper understanding of these rare syndromes as well as effective treatments for them. We are currently collecting information about symptoms that reappear during periods of intense stress or in case of re-infection in order to learn how to prevent the appearance of chronic diseases in adulthood as well” underlined the David Warburtonstem cell researcher and neonatologist at CHLA.
David Warburton, CHLA
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