If COVID is a four letter curse word, Long COVID is a drunken sailor’s mouth which torments adults after COVID and includes a few children as well. Thankfully, studies like today’s focus article indicate that children are affected less often than adults. Still, parents want to know the chances and be prepared if their child happens to be one of those affected. This study in the Journal of the American Medical Association (JAMA) sought to answer the question of how often children get Long COVID and what risk factors predict it.
Many are likely getting as fed up with Long COVID as with COVID itself. The acute illness causes enough disruption not only in individuals, but in families with children, affecting family member after family member until it runs its course through the house. Then for weeks one or two of the family members just don’t bounce back and end up struggling at work or in school. Adults can sometimes push through it, but we hate seeing our children struggling with ongoing symptoms.
The study tracked the course of 1884 COVID positive pediatric patients presenting to emergency rooms across several countries and compared it to a large group of COVID negative children at 90 days post ER visit. While prior studies had suggested a much higher rate of post COVID symptoms in children, their study methods had limitations which made the 50% prevalence rate questionable. This study approached the question more systematically and proactively, eliminating some of the reporting bias and limitations. They also compared the rates of these symptoms to children whose tests were negative to see if the COVID affected children had higher rates.
Ultimately, they report a 9.8% rate of post COVID symptoms (by their definition) in children who had been hospitalized for COVID and a 4.6% rate of symptoms if they had just visited the emergency room. These numbers were clearly increased from the 5% rate of the same symptoms at 90 days for children hospitalized without COVID and 2.7% for children who only visited the emergency room. Respiratory symptoms were the most common group of symptoms reported at 2% including coughing and shortness of breath. The most common single symptom reported was fatigue.
Besides the risk factor of hospitalization, age over 14 years was another risk factor that increased the rate of post COVID symptoms. Prior studies by other groups also suggest being female, having other underlying allergic disease or chronic diseases as risk factors.
While the paper does consider limitations to its method of study and the reasons why other studies resulted in different rates, it does not address a few questions I want to raise. First, can we truly trust the test for COVID? From clinical experience, we have seen multiple family members in one house ill with the same symptoms, with some testing negative and some testing positive. Regardless of how you look at it, either some tests were false positive, or some were false negative. In other cases, patients were sick for days, testing negative for the first 2 to 3 days and then testing positive later on. Clearly the test has significant limitations which might affect the outcomes of this study.
Second, this study only reports on children who presented to a hospital emergency room. Children who were not sick enough to go to the ER, either only visiting a clinic or just staying home were not evaluated. The overall rate of Post COVID in children is likely much, much lower.
Third, other than the treatment of hospitalization, we have no description of how these children were treated. This is more of a natural progression study and even the treatment of hospitalization reflects the severity and not the medical response. Parents would love to know if they can do something to change their child’s risk of Post COVID.
Fourth and finally, no information on health factors such as vitamin D level, general diet, or other potentially modifying factors was given. I would love to know if any nutritional factors before infection played a role in which children developed the longer term symptoms.
All in all, this should encourage parents to be aware of Post COVID symptoms in their child but be aware that the risk for their children is much lower than for they themselves. Beyond that, we can continue to encourage lifestyle practices that will likely lower both the risk of severe acute COVID and the risk of Long COVID. Helping our patients and the public live healthier more abundant lives as we wait for more studies means moving forward with what we already know works
Anna L. Funk, Nathan Kuppermann, Todd A. Florin, Daniel J. Tancredi, Jianling Xie, Kelly Kim, Yaron Finkelstein, Mark I. Neuman, Marina I. Salvadori, Adriana Yock-Corrales, Kristen A. Breslin, Lilliam Ambroggio, Pradip P. Chaudhari, Kelly R. Bergmann, Michael A. Gardiner, Jasmine R. Nebhrajani, Carmen Campos, Fahd A. Ahmad, Laura F. Sartori, Nidhya Navanandan, Nirupama Kannikeswaran, Kerry Caperell, Claudia R. Morris, Santiago Mintegi, Iker Gangoiti, Vikram J. Sabhaney, Amy C. Plint, Terry P. Klassen, Usha R. Avva, Nipam P. Shah, Andrew C. Dixon, Maren M. Lunoe, Sarah M. Becker, Alexander J. Rogers, Viviana Pavlicich, Stuart R. Dalziel, Daniel C. Payne, Richard Malley, Meredith L. Borland, Andrea K. Morrison, Maala Bhatt, Pedro B. Rino, Isabel Beneyto Ferre, Michelle Eckerle, April J. Kam, Shu-Ling Chong, Laura Palumbo, Maria Y. Kwok, Jonathan C. Cherry, Naveen Poonai, Muhammad Wassem, Norma-Jean Simon, Stephen B. Freedman, Jessica Gómez-Vargas, Bethany Lerman, James Chamberlain, Adebola Owolabi, Camilla Schanche-Perret Gentil, Sofie Ringold, Jocy Perez, Heidi Vander Velden, Tyrus Crawford, Steven E Schultz, Kimberly Ross, Kathy Monroe, Karly Stillwell, Jillian Benedetti, Sharon O’Brien, Kyle Pimenta, Amia Andrade, Adam Isacoff, Kendra Sikes, Nina Gold, Kathleen Reichard, Maureen Nemetski, Pavani Avva, Rakesh Mistry, Shanon Young, Marlena Cook, Virginia Gómez Barrena, Sandra Castejón Ramírez, María T García Castellanos, Emma Patterson, Anicka Samuel, Redjana Carciurmaru, Eleanor Fitzpatrick, Megan Bonisch, Bruce Wright, Mithra Sivakumar, Patricia Candelaria, Vincent Cervantes, Shaminy Manoranjithan, Nabeel Khan, Toni Harbour, Usha Sethuraman, Priya Spencer, Neha Gupta, Amira Kamboj, Gael Muanamputu, Guillermo Kohn Loncarica, Eugenia Hernández, Ana Dragovetzky, Angelats Carlos Miguel, Sylvia Torres, Joseph Zorc, Rebecca Haber, Ren Mee Hiong, Dianna Sri Dewi, Gary Joubert, Kamary Coriolano Dasilva, Julie Ochs, Alberto Arrighini, Camilla Dallavilla, Andrea Kachelmeyer, Daisy Marty Placencia. Post–COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Network Open, 2022; 5 (7): e2223253 DOI: 10.1001/jamanetworkopen.2022.23253
Thanks to Science Daily:
University of Calgary. “International study identifies risks for long COVID in children: Study finds age, hospitalization and number of symptoms are key factors.” ScienceDaily. ScienceDaily, 22 July 2022. <www.sciencedaily.com/releases/2022/07/220722123318.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.