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At the “long COVID” clinic at Schneider Children’s Medical Center in Petah Tikva, around 150 children are being treated, but several hundred more are on the waiting list. “The demand is high and the wait is over six months, as we monitor and test everything for each patient,” explains infectious disease specialist Dr Liat Ashkenazi-Hoffnung.
The clinic started operating in November, several months after similar adult clinics opened. Symptoms seen by doctors are varied, ranging from shortness of breath (the most common complaint), muscle pain, headache, fatigue, trouble sleeping, chest pain, hair loss and digestive disorders, loss of taste and smell, weight loss, difficulty concentrating, memory loss and exacerbation of tics in children who have suffered from them previously. About 60 percent report a reduction in their daily functioning due to the symptoms.
“What’s interesting is that in some children it really does appear to be a direct continuation of serious illness, but in very many children there is serious illness followed by a lull of several months and It is only then that the symptoms of long COVID begin, ”says Ashkenazi-Hoffnung.
According to her, the persistence of symptoms varies. “There are children for whom it takes six months or more. For example, we had a boy here who was a competitive swimmer and came down with a long COVID and was very anxious and in pain. After six months he returned to swimming and even broke a personal best. ”
However, she also says that there are “a few children here who, a year after illness, have not recovered, and they are exhibiting symptoms that affect their day-to-day functioning.” There are cases when it lasts longer. more than a year.
She adds that about 15 percent of children treated at the clinic do not have antibodies, even though they tested positive on the PCR test.
Underestimated
Coronavirus infection in children has been considered mild since the start of the pandemic. Less than 1% of children who have been tested have had to be hospitalized, and cases of severe illness are rare and appear mainly in those with pre-existing conditions. The assumption that children are protected is part of medical and public discourse regarding vaccinations.
However, the disease has long-term effects, known as “long-term COVID,” the extent, severity and persistence of which is not yet entirely clear.
A recently released Department of Health survey of 13,000 children who contracted COVID found that 11.2% of them suffered from at least one symptom after recovering and that 1.85 to 4, 6% still had symptoms after six months.
One of the limitations of the ministry’s investigation is that the responses were based on asking the children’s parents and remembering how their children’s symptoms were first noticed or perceived. Experts believe that there is an underdiagnosis of the phenomenon both on the part of parents and doctors.
“I think there is an underestimation,” says Ashkenazi Hoffnung, “even in research studies, because of their methods, and the numbers are higher. However, not all symptoms mean the same. The essential question is whether this affects the functioning. If, for example, a child loses the sense of taste and smell for eight months and this leads to difficult feeding, this is not necessarily clinically significant in relation to the symptoms that damage the functioning and prevent the child from functioning. to do the things he loves.
For example, there are children for whom physical activity was an important part of their life. “Fifteen percent of the kids who come to us have trained in various sports three or four hours a day, six days a week, and after the coronavirus they can’t even walk for five minutes. Their parents and sometimes doctors don’t always make the connection with the coronavirus. ”
“These kids are not spoiled or depressed – they are suffering from the physical damage that is part of the long COVID and they want to get back to their activities. I’m sure there are other kids who are suffering from the same phenomenon, but this is not. is not the case. ”I did not notice because it does not affect their routine. Some of them are sitting at home playing Fortnite and not knowing that they are unable to walk for five minutes, that they have these symptoms. ”
No clinical definition
The lengthy process of researching and understanding the phenomena of COVID is still in its infancy and even the World Health Organization does not yet have a definitive diagnostic definition.
According to Ashkenazi-Hoffnung, the lack of recognition and awareness of the syndrome among doctors in the community leads to two phenomena.
On the one hand, “the doctors tell the parents that it is psychological, or that the child is spoiled, or that they should wait and that it will pass and that they do not diagnose the symptoms,” he notes. she. But on the other hand “it leads to intensive and unnecessary testing for children. For example, a child who was dizzy came to us after a series of tests and was diagnosed with vertigo and was sent to an ear, throat doctor. Doctors fail to pinpoint the correct diagnosis and parents tend to interpret it as spoiled or something psychological. I have kids who come in with chest pain and shortness of breath and their mom whispers, “I think it’s psychological, he’s having a panic attack.
Due to the unfamiliarity with the symptoms, children often come to the clinic because of one of the symptoms, but it turns out that they are suffering from other symptoms. “A teenager walks in and says he has shortness of breath and chest pain. And it wasn’t until after I asked, “she said,” that it turns out he’s having trouble falling asleep and has tingling in his extremities. ”
Another phenomenon, which was first reported in April 2020, is multisystem inflammatory syndrome in children, of which around 100 cases have been reported in Israel. The syndrome usually appears eight to ten weeks after illness, even in children who have had mild cases. It starts with an upset stomach, rash, and fever and can progress to life-threatening heart damage. It requires hospitalization, and in most cases, heart damage persists after healing.
There is also treatment for long-term COVID in children at Ichilov Hospital in Tel Aviv (Sourasky Medical Center) and Shaare Zedek Medical Center in Jerusalem, where Professor Yechiel Schlesinger is responsible for pediatrics.
“A year ago, we opened a clinic that treated persistent symptoms in children. With the decline of the third wave it hardly worked, but in the fourth wave with the high infection rate in children it is back in action, ”he says.
While all cases “ended well,” Professor Schlesinger says there are now cases of children arriving “long after they have fallen ill, with the most common symptom being severe difficulty breathing. , damage to the nervous system and the brain, very severe pain and neurological phenomena, as well as dermatological problems such as skin rashes and problems with the digestive system. ”
Iron, physiotherapy and inhaler
“We are seeing children arriving with very significant nutritional deficits due to loss of sense of taste or incomplete return,” says Ashkenazi-Hoffnung at Schneider. “There are children who smell the smell of burning or for whom the tastes of foods that were familiar to them have completely changed. This is a common occurrence, which leads to very picky eating and weight loss. In the process, we are witnessing, among other things, an iron deficiency, which aggravates exhaustion and hair loss. ”
“We have found that many children, at least a third of them, suffer from shortness of breath and that giving them an inhaler, even if they do not have asthma, helps some of them.”
The clinics also offer physiotherapy for pain and for improving breathing techniques, as well as psychological support for children with post-trauma and anxiety and drug treatments for damage to the peripheral nervous system, as well as therapies for sleep disorders using drugs or during sleep. clinics if needed.
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