‘Long Covid’ in children

Or is it ‘long lockdown’?

In a prospective German study, 1,560 secondary school children were tested regularly for SARS-CoV-2 and all took part in a survey for typical ‘long Covid’ symptoms. These were present in approximately one third of the children, regardless of whether they had tested positive or negative, perhaps emphasising the impact of the pandemic restrictions themselves on the well-being and mental health of young adolescents.

To the extent that a post-viral syndrome may occur after COVID-19 infection, this is of course no different from flu and glandular fever. NICE have drawn up a rapid guideline which has defined ‘ongoing symptomatic COVID-19’ as signs and symptoms of COVID-19 from 4 to 12 weeks duration, and ‘post-COVID-19 syndrome’ where signs and symptoms developing during or after infection consistent with COVID-19 continue for more than 12 weeks and are not attributable to an alternative diagnosis. 

Children are generally much less affected by acute COVID-19, with up to 50% of those testing positive being asymptomatic, and have a much lower likelihood of hospital admission. Post-Covid symptoms may occur but at a lower frequency than for adults, and generally with a quicker recovery. In a large cohort of 258,790 school children using the Zoe-Covid-app, 1,734 had a positive SARS-CoV-2 test and of them, 77 children (4%) had symptoms beyond 4 weeks and only 25 children (1.8%) had symptoms persisting beyond 8 weeks.

An Australian study of 171 children with positive SARS-CoV-2 tests, of whom 36% were asymptomatic, found 8% with prolonged symptoms, most commonly a cough lasting 3-8 weeks or fatigue lasting for 6-8 weeks. By 8 weeks, all children had recovered fully. Also importantly, none of the children in the asymptomatic group had any delayed symptoms.

An FOI from the HART group to regional paediatric chronic fatigue services has received 4 replies to date. None have seen any increase in referrals in 2020 compared to the previous 5 years. Four services are yet to reply and have exceeded their statutory 20 working days to respond.

There is currently an intense debate over whether COVID-19 vaccines should be rolled out to 12-17 year olds. ‘Long Covid’ has been suggested by some as a reason to proceed. However, in children this appears to be a self-limiting condition. HART advises that a new vaccine with rare but potentially serious side effects and unknown long term safety, has no place in paediatric practice. 

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