Long COVID in children: Less frequent and ‘much more poorly understood’
Experts are learning about long COVID, a mysterious syndrome that the CDC describes as “new, returning, or ongoing health problems” that occur 4 or more weeks after a person is initially infected with SARS-CoV-2.
Like multisystem inflammatory syndrome, a rare but serious condition that also develops as a result of SARS-CoV-2 infection, a lot remains unknown about long COVID. Unlike multisystem inflammatory syndrome —which is called MIS-C when it occurs in children — long COVID is less common among children than adults.
“Is long COVID also present in people who are younger than 18 years old? The answer is yes,” Ziyad Al-Aly, MD, FASN, director of the Clinical Epidemiology Center and chief of the research and development service at the Veterans Affairs Saint Louis Health Care System, told Healio.
Al-Aly studies long COVID and was the lead author on a large study that found the syndrome can affect nearly every organ system in the body.
“Even in adults, we don't really know the true incidence and true prevalence of long COVID-19 yet,” he said. “In kids and adolescents, we don't really know the extent of the problem. It is much, much, much, much less frequent than what you see in adults.”
According to the CDC, new or ongoing symptoms of long COVID may include difficulty breathing or shortness of breath, tiredness or fatigue, difficulty thinking or concentrating, cough, chest and/or stomach pain, headache, heart palpitations, joint and/or muscle pain, pins and needles, diarrhea, sleep problems, fever, dizziness, rash, mood changes, change in smell and/or taste and changes in the menstrual cycle.
Al-Aly said long COVID is “generally more expressed in people who are older and people who have poor baseline health, but that doesn’t mean there aren’t young folks out there who are suffering from it.”
Gastrointestinal manifestations of long COVID are less common in children than adults, and the metabolic consequences that have been reported in adults have not been described in children, Al-Aly said.
“It doesn't mean it doesn't exist. It’s that we have not seen a ton of studies that tell us this really exists,” he said.
Some symptoms go away over time, but there are no specific treatments for long COVID, said Aaron E. Glatt, MD, chairman of the department of medicine and chief of infectious diseases at Mount Sinai South Nassau in Oceanside, New York.
“Besides the very well publicized MIS-C and heart inflammation, there are numerous other complications that adults and children can get post COVID-19,” Glatt told Healio. “Many of them are neurological, which is of great concern in children. Almost all organs are impacted.”
“We do palliative treatments, which should not be confused with hospice, or end of life care,” he said. “What we do is we try to get patients through their symptoms, to palliate the difficulties.”
Glatt explained that if a patient presents with fatigue, clinicians try to figure out a way to minimize it. It is not a cure, but a way to help the patient deal with the issue.
“We don't have a pill that we can take, we don't have any magical monoclonal antibody or anything like that that we know would be effective,” Glatt said. “Long COVID is a poorly understood thing in adults. So, it's going to be that much more poorly understood in children.”
Both Al-Aly and Glatt said the easiest way to protect against long COVID is to get vaccinated.
“I tell people the best and only way to prevent long COVID-19 is to not get COVID-19 in the first place,” Glatt said.
CDC. COVID-19. Post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html. Accessed July 21, 2021.