28 May 2021 Long COVID and children

As you will see, this emerging topic is quite controversial, it comes with rather few data, but a lot of emotion.  Because it is about our children?

Ep 144-1 Altman Imperial College on 15 March in BMJ suggests that the caseload of infections in children may have been underestimated, that they probably play a similar role in COVID as in Flu (relatively low severe disease, but significant spread) and that in UK there are 79,000 cases of long COVID in children with fatigue, shortness of breath, joint pain, rashes, and headaches.

Ep 144-2 is a series of nice slides on “awareness of long-COVID in children” updated on 23 May, accessed via a link https://www.longcovidkids.org/  in the Altman’s view.  It contains some examples of children with long COVID and official statistics, but has also a clear “advocacy and fundraising” side. The cofounders of this website are Sammie Mcfarland (a well being coach and entrepreneur, suffering from long COVID, a “long hauler”) and Frances Simpson (lecturer of psychology at Conventry University and also suffering from long COVID).

Ep 144-3  returning to “sound science”, I found this interesting recent study in Nat Med. It is a prospective cohort of over 4000 SARS-CoV-2 (+) adult individuals compared with a control group.

The % of people who reported symptoms was 13 after 4 weeks, 4.5 after 8  weeks 4.5 and 2.3 after 12 weeks.  The most frequent symptoms were fatigue, headache, dyspnea and anosmia. The associations were: increasing age, higher BMI and female sex. The main predictor for “long COVID” was  experiencing more than five symptoms during the first week of illness.

Ep 144-4: A recent systematic review on COVID-19, mainly focusing on adults in Front Med, summarizing 145 publications.

The most common reported symptoms after COVID-19 are  

• abnormal lung functions with persistent dyspnea,
• general neurological decay: problems with concentration, memory loss and confusion:
• smell and taste disturbances,
• and chronic fatigue

These symptoms can be present after mild-moderate COVID, but are more prevalent and outspoken after severe disease.

In critical-to-severe COVID-19 patients’ supplementary longterm symptoms are lung fibrotic-like changes up to 6 months after infection and a high reduction in diffusing capacity that frequently required oxygen uses.

In < 60 years old, women have twice the risk on long COVID as compared to men, but at higher ages, this difference disappears.

Unfortunately, I did not find many nice prospective and controlled study in children.  This is what I can offer from literature in chronological order:

Ep 144-5: Ludvigson (Nov 2020) from Karolinska reports in Acta Paediatrica on 5 Swedish children (9-15 yrs; 4 girls) all with fatigue, dyspnoea, heart palpitations or chest pain, and four had headaches, difficulties concentrating, muscle weakness, dizziness and sore throats 6-8 months after mild COVID. None was able to return to school. At that time, the author could not find other reports on long COVID in children.

Ep 144-6: Smane (Dec 2020) in a retrospective study on 30 pediatric COVID cases, finds 9 nchidren, who after on average 100 days had at least one symptom: 2 had prolonged fever, while headache, joint pain, anosmia, ageusia and microhematuria occurred in 1 child each.  

Ep 144-7: Isoldi (Feb 2021) reports on a prospective study in La Sapienza (Rome) on 300 children admitted for suspected COVID.  Only 17 were positive and only 15 were included.  None developed long COVID.

Ep 144-8: Lopez (March 2021) from La Paz in Madrid reports on 4 boys and 4 girls of a similar age with a similar syndrome as described by Ludvigson, but less well documented.

Ep 144-9:  Buensenso (April 2021) from Gemelli hospital in Rome describes a cohort of 129 children with COVID diagnosis, a quarter of whom were followed up during more than 2 months.  From the complicated table, the authors conclude that many children had lasting symptoms, including Insomnia (18.6%), respiratory symptoms (including pain and chest tightness) (14.7%), nasal congestion (12.4%), fatigue (10.8%), muscle (10.1%) and joint pain (6.9%), and concentration difficulties (10.1%), irrespective of whether they had been symptomatic or not during the acute phase.  The study is, however, difficult to interpret in the absence of a control group.

My preliminary conclusion: published data provide evidence that children can have prolonged symptoms, but they seem generally less common and less severe than in adults.  Clearly, much better controlled studies are needed to see what is the real prevalence and specificity of these symptoms….

It is a bit strange that there is so much fuzz about long COVID in UK and so few published data.  Nevertheless, there is a lively debate going on:   

• Dr. Psych Frances Simpson calls for attention. See Ep 144-10 (The Elephant and the blind men) and Ep 144-11(The perspective of parents and children needs to be heard)
• Dr Sunil Bhopal and Michael Absoud  write Ep 144-12 under the title “More caution is needed in interpreting current epidemiological data”

To be followed up….

Have a nice WE

Guido