Long-term effects of COVID-19 in children

The 2019 coronavirus disease pandemic (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While many SARS-CoV-2 infections are asymptomatic or cause mild illness, some become serious or even critical.

Study: Long-term effects of COVID-19 on physical, mental and social health in the pediatric population: a review of the scope. Image Credit: Ann Rodchua / Shutterstock

In addition, the persistence of adverse effects in adults after serological recovery, lasting for months, is a worrying aspect of COVID-19. The low prevalence of COVID-19 in children has led to an equally low number of studies in this population. A recent prepublication on medRxiv* the server discusses the incidence and significance of long-term COVID-19, often referred to as long-term COVID, in children.

A pre-printed version of the study is available on the medRxiv * server while the article is peer reviewed.

Background

In the United States, children make up 22% of the population, but only 15.5% of the total COVID-19 cases reported to the Center for Disease Control and Prevention (CDC) are pediatric cases.

Pediatric studies on the long COVID are few. The number of infections in children is certainly a gross underestimate due to a general reluctance of parents to have their children tested after contact with someone positive for COVID-19. Another important factor in this trend is the low rate of symptomatic infection in children.

Hospitalizations in children are much less common than in adults due to the milder pediatric COVID-19 phenotype. A few children develop serious illness, although very few have died. Some children develop a rare multisystem inflammatory syndrome (MIS-C) similar to Kawasaki disease, even after an asymptomatic infection.

Effects of COVID-19

Acute symptoms of COVID-19 include fever, cough, shortness of breath, muscle aches and chills, sore throat, and anosmia / ageusia. While adults most often complain of continued fatigue and shortness of breath during their recovery, which lasts for months, the majority recover within two weeks.

Like the long COVID-19 in adults, children can also have persistent joint pain, insomnia, headaches, and trouble breathing. Previous research is based on reports from a center in Rome which had a small number of pediatric COVID-19 patients despite being the largest hospital in Rome.

Besides the physiological impact of the viral illness, COVID-19 has caused profound changes in the environment in which children grow up. Isolation from friends, family and school, and the loss of educational opportunities, may all have worsened the current emotional, mental and behavioral profile of children today.

What did the study show?

Review shows most children reported to have more than acute illness following SARS-CoV-2 infection experience chronic fatigue, inattention or brain fog , insomnia and other sleep disorders, and persistent taste and / or smell problems.

Much of the studies in children have focused on identifying any significant differences in the clinical features of the disease compared to adult COVID-19. Fortunately, these are insignificant, and the diagnosis of pediatric COVID-19 follows the same path as in adults.

MIS-C patients present with shock, fatigue, fever, and inflammation, along with myocarditis and other cardiovascular signs. Long-term effects in children with mild infection include fatigue, joint pain, myalgia, headache, breathing problems, problems concentrating, and disturbances in sensory function.
Long-term viral shedding has been reported in a few pediatric COVID-19 studies.

Children’s mental health issues linked to the pandemic include anxiety and depression, primarily related to their restriction to the family environment. A study in the United States showed that children from Chinese-American families suffered from a sense of racial discrimination during the pandemic.

A reduction in positive mood seemed to accompany less physical activity in children, with studies also showing symptoms of depression, marked anxiety, and other mental and social problems. Some children showed symptoms of insecurity, clinging to their parents, avoiding questions about the pandemic and distraction.

Others were more affectionate or more agitated or frustrated. The behavior changes reported by parents were mostly negative. Deterioration in peer relationships, anger, sleep disturbances and an overall decline in quality of life have been identified in

What are the implications?

Researchers found that few studies addressed long-term COVID-19 in children. A study of around 130 children found that more than half had a persistent symptom. This corroborates an earlier review that found little data on long-haul trips among children with COVID-19.

The reason for the long symptoms of COVID in children may be due to an aberrant immune or inflammatory response in certain tissues that have high expression of the viral receptor, the angiotensin-converting enzyme 2 (ACE2).

The presence of the virus in the central nervous system could also be responsible for anxiety, depression and other mental health problems. Still, more studies are needed to understand how it works. Physical symptoms can also make mental problems worse, especially if the child has suffered from MIS-C.

Further research will expand the body of knowledge on the effects of the virus on the human body of the child, both acute and chronic, mental, emotional and physical.

*Important Notice

medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.