The ongoing coronavirus 2019 (COVID-19) pandemic has caused over one hundred million reported infections, with over 2.23 million deaths worldwide. While most cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are asymptomatic or mild, some patients report long-haul symptoms, often severely debilitating in nature. However, it is unclear how many children are affected similarly. A new preprint research paper posted to the medRxiv* server recently reports early findings in this area.
The persistence of COVID-19 symptoms beyond a few weeks was first described in Italy as 'Long COVID.' Since then many studies have reported on 'Long COVID' among adults. For instance, over three-fourths of 1,700 patients from Wuhan in one study still had symptoms six months after the initial diagnosis.
Long COVID's impact on children is also likely to be significant. The mental ill-health induced by the restrictions on social interactions and even on moving out of the house during some phases of the pandemic has been widely reported. Besides this, the educational losses allegedly suffered by children, particularly those from underprivileged or minority subgroups, have received attention.
Children with COVID-19 have also been reported, in rare cases, to develop a systemic illness, including the Multisystem Inflammatory Syndrome (MIS). Here, many parts of the body, including the heart, lungs, brain, kidneys, skin, eyes, and gut, become inflamed, typically following mild COVID-19. While death is uncommon, about 70% may require intensive care.
The research analyzed children aged 18 years or less who had received a microbiological diagnosis of COVID-19 at a single center. The study did not include those with severe disabling symptoms. The children's health data came from the caregivers and was captured on a questionnaire created by the Long COVID ISARIC study group.
The interviews all took place between September 1st and January 1st. They were classified into symptomatic and asymptomatic (based on the acute phase of infection), and further according to their requirement for hospitalization. A final categorization was made based on the time from the COVID-19 diagnosis to the time of the interview.
The children in the study numbered 129, all diagnosed between March and November 2020, with a mean age of 11 years. The number of males and females were roughly equivalent. Immediate complications included MIS in three of the children, while two had myocarditis.
Persistence of symptoms
The average period from diagnosis to evaluation was ~163 days. Of the group, ~42% had a complete recovery. Within the group, 53% of children were reported to have one or more symptom 120 or more days after diagnosis, fitting the diagnosis of Long COVID. Strikingly, 36% of them had one or two symptoms at the time of evaluation, and 23% three or more symptoms.
When assessed by severity, insomnia was reported in about a fifth of them, while 15% complained of respiratory symptoms. These included chest tightness and pain. About 12% complained of nasal congestion, while ~10% each had tiredness, difficulty concentrating, and muscle pain. About 7% were said to have joint pain. Headaches and palpitations were also frequent.
Such symptoms were more frequent in children who had symptomatic illness or were required to be hospitalized with COVID-19. Interestingly, however, they were also found in children who had had an asymptomatic illness.
What are the implications?
This pioneering study lays bare the existence of Long COVID in children as well as in adults. The caregivers for over half the children said their charges had persistent symptoms at 120 days or more from infection, and in the 68 children in this group, fully 43% had symptoms severe enough to distress them or impair their daily activities.
The study was carried out at a single center, with only a few pediatric cases. However, the investigators plan to continue their assessments until 24 months from the diagnosis. They also intend to include controls from the household of the participating children, both with and without a history of COVID-19.
The lesson to be taken away from this study is that though children have a mild or asymptomatic infection with SARS-CoV-2, the illness's impact may still be significant.
"The evidence that COVID-19 can have a long-term impact on children as well, including those with asymptomatic/paucisymptomatic COVID-19, highlight the need for pediatricians, mental health experts and policymakers to implement measures to reduce the impact of the pandemic on child's health."
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.