Can children get long COVID?
Dr Khan examines the mounting evidence that children are suffering from long COVID months after catching the virus.
Children have been largely overlooked during the COVID-19 pandemic; thankfully the majority of them get mild or even no symptoms if they catch the virus. Much of the discussion around the role of children in the pandemic has been about how they may spread the virus.
However, over time there has been a growing body of evidence that suggests that a proportion of children may develop long COVID, whether or not they had any symptoms when they actually contracted the virus.
Long COVID in adults is defined as signs and symptoms that develop during or following an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
So far there is no medical definition of long COVID in children but support groups and researchers say there may be up to 100 symptoms, including fatigue, “brain fog”, muscle aches, pain, gastrointestinal problems, nausea, dizziness, seizures, hallucinations and testicular pain. The cause of these symptoms is poorly understood, although findings suggest an ongoing immune reaction, after the virus has cleared, plays a part.
A study in Italy looked at 129 children aged between six and 16 years, diagnosed with COVID‐19 between March and November 2020. Some 96 of them had symptoms of COVID-19 during the acute infection phase, while 33 had no symptoms at all but tested positive. The study found that 42.6 percent of the children still had symptoms more than 60 days post-infection. Symptoms like fatigue, muscle and joint pain, headache, insomnia, respiratory problems and palpitations were particularly frequent.
A similar case study was carried out in Sweden, focusing on a smaller group of five children aged from nine to 15. All five children had fatigue, dyspnoea (laboured breathing), heart palpitations or chest pain, and four had headaches, difficulties concentrating, muscle weakness, dizziness and sore throats six to eight months after the initial infection.
A recent report from the UK’s Office for National Statistics estimates that 12.9 per cent of UK children aged two to 11, and 14.5 per cent of children aged 12 to 16, still have symptoms five weeks after their initial infection with COVID-19. Almost 500,000 UK children have tested positive for COVID-19 since March 2020.
More research is needed but as the debate around vaccinating children against COVID-19 rages, it is important to acknowledge as part of that discussion the growing body of evidence that children appear to develop symptoms beyond the initial infection and these symptoms can be debilitating.
The lack of knowledge in this area is also a source of frustration for families who are presenting children to hospitals and GP surgeries with vague and varied symptoms and being turned away without adequate treatment and support. Campaigners are urging policymakers to invest in research in this area so that these children can be managed appropriately and return to normal life.
Until now, the focus has been on COVID-19 in adults. Perhaps now is the time to think about the long-term effects it can have on children. We urgently need research into both the effects the lockdown has had on children and also the long-term effects of the coronavirus on children. Both are vital to their future health.
Progress Report: COVID-19 vaccines for children
The Pfizer-BioNTech vaccine has shown 100 percent efficacy against COVID-19 in 12-to-15-year-olds in the preliminary results of a phase 3 trial.
The phase 3 trial included 2,260 children in the US. A total of 18 cases of COVID-19 were observed in the placebo group whose members were given an alternative vaccine, while none were reported in the vaccinated group. The vaccine also elicited robust antibody responses and was well tolerated, with side effects consistent with those observed in participants aged 16 to 25.
After the success in its phase 2 trial, Pfizer applied for emergency authorisation for the vaccine in the US as well as other parts of the world, including Canada and Europe. According to the American medicines regulatory body, the Food and Drug Administration (FDA), an Emergency Use Authorization (EUA) is a mechanism to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies, such as the current COVID-19 pandemic.
Under an EUA, the regulator may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.
On May 10, the FDA authorised the Pfizer COVID-19 vaccine for children aged 12 to 15. Dr Janet Woodook, the agency’s acting commissioner, called the authorisation “a significant step in the fight against the COVID-19 pandemic”. She added: “Parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data, as we have with all of our COVID-19 vaccine emergency use authorizations”.
According to the Centers for Disease Control and Prevention (CDC), from March 1, 2020 to April 30, 2021, approximately 1.5 million COVID-19 cases in individuals aged 11 to 17 have been reported in the US.
“Having a vaccine authorised for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”
Prior to the US giving the vaccine the green light, Canada also approved its use in children over the age of 12. Supriya Sharma, chief medical adviser to Health Canada, the government’s medical agency, told reporters on May 6 that the vaccine was “safe and effective” and would allow a return to “a more normal life” amid the pandemic. She added that the most common side effects for children are mild and temporary, like “a sore arm, chills or fever”.
Europe and the UK are yet to give their approval of the Pfizer vaccine in those aged 12 to 15, but most experts agree part of the solution to this global pandemic has to be vaccinating children.
Personal account: Online abuse for talking about vaccines
The last few months have been a huge test for me, as a doctor, on many levels. Working on the front line during a pandemic has been a challenge; seeing my patients get sick from COVID-19 in the numbers that they did was hard. Seeing some of them die from the virus was even more difficult and then following that up with conversations with their bereft loved ones only added to the heartbreak. I know many of my colleagues on the front line feel exhausted due to the toll the last year has taken on their mental health.
But then the COVID-19 vaccines were given the green light and a hugely successful vaccine programme was rolled out here in the UK, as well as in other countries. To encourage people to take up the vaccine, I was asked by the government to be part of vaccine advertising campaigns and, because I have mixed Pakistani and Indian heritage, much of my messaging was aimed at people from a South Asian background. I was also part of the campaign to encourage social distancing measures and testing, all of which I agreed to do because I had seen first-hand what the virus does to people.
In hindsight, I think I was naïve, because the thing I was not prepared for was the level of abuse I have sadly received online.
For encouraging the vaccine, I have been accused of being a “paid media shill” – something I had to look up because I had never heard that expression before. Essentially, it seemed that some people thought I was part of a larger organisation that operated in the shadows and had plans to inject the human race with a substance that would allow mind control!
I batted that one off as crazy. But then things became more personal, with people messaging me to tell me I would have “blood on my hands” when people died from the vaccine. Direct threats to my wellbeing were also made, and sinister letters started arriving at my surgery. I reported it to the social media sites, which did nothing. I also reported some of the direct threats to the police, who were more helpful.
However, it was not until I started reporting on research into the use of COVID-19 vaccines in children that the real abuse began.
I will be honest; I understand that the use of vaccines in children stirs up a lot of emotions for people. The majority of children get mild or no symptoms from COVID-19, so are we giving children the vaccine to protect others? Is that completely ethical?
On the flip side, a small number of children have died as a result of a coronavirus infection across the world, and, as I have reported earlier in this column, it would appear the risk of long COVID in children is real. Furthermore, to reach the level of herd immunity required in a population to reduce virus spread, vaccinating children makes sense.
I have been very careful about giving my personal opinion on this matter and have been guided by the evidence which suggests the vaccines are safe and effective in young people. When I went on UK television to simply report the findings of the Pfizer vaccine in children I was bombarded with abusive messages, which ranged from calling me a “child murderer” to some people calling me a “paedophile”. And this was simply for reporting on the study, not giving my opinion. Once again, I received messages that threatened my safety which had to be reported to the police.
I am only human; there is only so much abuse I can take before it takes a toll on my mental health. Some may say this is the price you pay for being on social media, and in some ways, they may be right – speaking to my NHS colleagues, I understand many have received abuse when sharing their stories about front-line work during the pandemic or for promoting vaccine uptake.
The easy answer is for the social media channels to police this kind of abuse more robustly, but they do not. So, it is for us to think long and hard before sending messages to people on social media, especially if they are negative ones. You may type it, send it and then forget about it, but believe me, the effect of it stays with the recipient for a long time.
And now, some good news: Woman gives birth to baby while in a coma from COVID-19
Marriam Ahmad was 29 weeks pregnant when she was admitted to hospital in Wales, UK, with symptoms of COVID-19. She had asthma and her condition deteriorated rapidly. Her breathing became more laboured. The doctors planned to perform an emergency caesarean section on Marriam while she was still conscious but, as her health became worse, she was told she would need to be put on a ventilator and into an induced coma and that she may not survive at all.
Marriam only had time to call her parents before being put on a ventilator. Marriam’s baby was born on January 18 at 8:27pm BST (19:27 GMT) while Marriam was unconscious. The baby was taken straight to neonatal intensive care. Thankfully, Marriam woke up the next day but was not able to remember a thing. She was not able to see her baby girl as they were both too unwell to be moved, but she did get to see pictures of her. Luckily, the baby, named Khadija, did not have any of the complications that can occur in pre-term babies and, after eight weeks in hospital, both mum and baby returned home.
“I am just so grateful – that she’s still alive, that I am still alive,” Marriam said of her experience.
Reader’s question: How can I prevent my child from catching COVID-19?
It is important to remember that the vast majority of children have few, if any, symptoms when they catch COVID-19. And, with mounting evidence that vaccines in adults reduce transmission rates across the board, the chances of your child getting sick from COVID-19 is small.
Saying that, it is important to stick to your local guidelines: handwashing and social distancing are still key, but experts are now focusing on another aspect of prevention: ventilation. We have learned over time that the most likely way the virus is spread is via airborne particles. These are small particles containing the virus that can linger in the air. So, if there is good airflow or ventilation then these are likely to be moved on before anyone can breathe them in. Static airflow means they stay in the air for hours, increasing the risk of spread.
So it is always worth ventilating indoor spaces and finding ways to improve your ventilation if you want to reduce the risk of spreading the virus to either adults or children.