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no short answer when it comes to long covid in kids
jan 22 2022
4 minute read
children who contract covid-19 are unlikely to have serious symptoms. but experts say not enough is known yet about the long-term effects on their health.
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recently, i read an op-ed by professors on the issue of vaccinating children against covid-19. they did their best to communicate accurately. but as we so often see in any covid conversation, we always end up with what i call “the swiss cheese phenomenon.”
the point is simple: there are glaring gaps and holes which may not impact the taste of the cheese, but a gap there is — unlike other solid pieces of cheese.
one such gap is that the authors of the op-ed failed to mention that we do not vaccinate children to prevent death. the risk for a child to die from covid is low; very low. it appears to be less than one per cent. most agree around 0.025 per cent. but if they survive an infection, then what is the risk for long covid? after all, whenever we discuss covid-19, is it not ultimately about risks; about reducing risks, about taking risks when we ignore facts and focus instead on feelings, our own “research” and whatever we believe our individual rights to be?
by the way, one reason science has gotten a bad rap since 2020 is that initially brilliant minds lacked the humility to say, “we simply do not know.” instead, the idea was to communicate dogmatically and with supreme confidence — probably to instill trust and comfort in laypeople. thankfully, even the venerable dr. fauci, the u.s. director of the national institute of allergy and infectious diseases, recently, has become more comfortable in saying “we don’t know.”
here is a brief summary of what we know about long covid today. (it may be vastly different in future as we cycle through seemingly endless loops of variants, all being unknowns at the start in terms of how bad it is going to be this time around.) currently, there are no definitive papers that differentiate between long-term covid from the original sars-cov-2 infection to the delta variant to the current omicron rascal. who knows if there may be future mutations which will target kids specifically and make them more prone to long-term covid — despite being vaccinated and even boosted.
one of the pioneers in the study of long covid in children is dr. danilo buonsense, based out of gemelli university hospital in rome. in the early stages of this pandemic, italy led the world in the number of infections.
in the middle of 2020, the recognition and diagnostic criteria of long covid did not exist. according to dr. buonsenso, some children, four months after their initial infection, experienced symptoms such as insomnia, fatigue, muscle pain, persistent cold-like symptoms, headaches, troubles concentrating, a loss of smell and a lingering cough.
dr. buonsenso’s ongoing research suggests the incidence of true long covid may be somewhere between five and 10 per cent. other experts on this topic disagree. jakob armann, a pediatrician at dresden university in germany suggests the number to be lower. he pegs the number between one and 10 per cent. his argument is that symptoms such as fatigue, headache, difficulty concentrating and insomnia can also be related to stressors such as school closures, the trauma of seeing family members sick or dying and other psychosocial factors.
in a letter published in the journal lancet recently, british researcher sammie mcfarland, who is involved with the long covid kids and friends organization, lamented the flawed methodology of studying these children. (see www.longcovidkids.org) mcfarland notes: “patients with long covid experience a wide range of changing symptoms, including asymptomatic periods.” thus, the true prevalence may be underestimated.
not so long ago, the american academy of pediatrics held a virtual town hall meeting to address the issue of long covid. experts included not only infectious disease doctors but also cardiologists and neurologists. many of these experts are guided by data collected via the national institute of health (see https://www.caring4kidswithcovid.nih.gov)
at the meeting, a panel came up with another term for long covid: pasc, which stands for post-acute sequelae of covid-19. it was noted that too many doctors tend to brush off long covid because the condition is poorly understood, or some doctors may remain unaware or skeptical.
some long covid patients are diagnosed to have postural orthostatic tachycardia syndrome(pots) this is a condition where the body’s automatic nervous system malfunctions. it can lead to a major disruption in the daily quality of living. in medical jargon, we refer to it as a dysfunction of the autonomic nervous system.
as a result of better awareness of long covid, many pediatricians now inquire about these symptoms. what makes it interesting is that children who initially may have had mild symptoms during acute infection are not free from the risk of developing long covid later.
the bottom line is that we are hoping that vaccinating children will prevent the incidence of long covid. however, as we are currently discovering, even fully vaccinated humans suffer breakthrough infections.
dr. nieman is a community-based pediatrician. he is the author of moving forward and 101 finish lines. he recently completed his 133rd marathon. see www.drnieman.com
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