Long Covid symptoms differ between children and adults: study

Rachel Gross wants to clear up misconceptions about children and Covid-19. As a pediatrician and public health researcher, she remembers a time four years ago when people didn’t think children could even contract the disease. When people accepted children’s vulnerability to the virus, it was thought that only adults could suffer from the myriad symptoms that persist or emerge after the infection, collectively known as long Covid.

Now that it is clear that children can also develop Covid for a long time, Gross wants to correct the assumption that the condition looks the same in adults as it does in children, regardless of their age. In new research published Wednesday in JAMAGross and the RECOVER-Pediatrics Consortium report that school-age children and adolescents experience similarly long Covid symptoms across multiple organ systems, but these symptoms cluster in ways that vary depending on their age, while deviating to some extent from the pattern seen in adults observed.

As part of the federally funded RECOVER initiative that focuses on post-acute sequelae of SARS-Cov-2, or PASC for short, the study found that school-aged children (6 to 11 years old) with long-lasting symptoms were more likely than uninfected children. experiencing headaches (57%); problems with memory, focusing and sleeping (44%); and abdominal pain (43%) at least four weeks after Covid. Infected adolescents (12 to 17 years old) were more likely to experience daytime fatigue, sleepiness, and low energy (80%); body, muscle or joint pain (55%); and problems with memory and focus (47%) after infection than uninfected peers.

Adults are also primarily plagued by fatigue, dizziness, brain fog, gastrointestinal problems, and loss of taste and smell, symptoms that overlap with those experienced by some adolescents.

“This whole idea of ​​whether PASC represents one unified condition or whether it reflects a group of unique phenotypes is very important because these phenotypic stratifications have many implications for research into the pathophysiological processes that actually underlie long Covid,” Alicia Johnston, an infectious disease doctor at Boston Children’s Hospital, told STAT about the long characteristics of Covid. She was not involved in the investigation. “That will help define future clinical trial designs to understand these.”

Gross told STAT that the goal of the study was to learn how to identify children with long Covid-19 and how these symptoms change over time. “Then we will be able to better understand the question we really want to know: why is this happening?”

The data for the JAMA article came from electronic health records and provider reports from March 2022 through December 2023 for 5,376 children at 60 sites across the United States who participated in RECOVER-Pediatrics. Overall, the RECOVER initiative has been criticized for its slow pace and limited answers about causes, risks and treatments. But after some of the JAMA study’s results were presented at the Pediatric Academic Societies 2024 Meeting in May, the pediatric arm of the massive effort won praise from a parent group.

“There is no other study like RECOVER for pediatrics in the world,” Megan Carmilani, a patient representative and founder of Long Covid Families, told Betsy Ladyzhets, a STAT employee, praising the pediatric researchers for being more responsive to feedback from patient representatives like them. than those leading the adult cohort.

“We work very closely with families, caregivers and patient advocates in pediatric research,” said Gross, an associate professor at New York University’s Grossman School of Medicine. “We hear from them how challenging it is for families and children experiencing these debilitating symptoms, and that this research cannot come soon enough to really help them.”

Johnston sees that need every day in her practice at Boston Children’s.

“Four years have passed and there is a lot we still don’t know about the long Covid-19 crisis. I mean, we still don’t have clinical trials of effective therapies in children, and not many in adults either,” she said, listing unknowns about the effects of reinfection, how physiological or psychological stress can influence the disease. the waxing and waning symptoms of long Covid, the role of Covid vaccination in preventing long Covid, and the risk of long Covid associated with different types of Covid.

Wednesday’s JAMA paper was not intended to determine the incidence of long Covid in children, but other research estimates that up to 5.8 million children in the US could have a long Covid-19 crisis. If 2% to 5% of children in the US live with long Covid-19, that would still amount to millions of children, making it not a rare disease. Although the study was aimed at laying a foundation for further research and not at creating tools for current practice, Johnston sees additional value in the long term for diagnosing long Covid patients.

“That’s extremely important to get this diagnosis right because Covid has long been recognized as a disability” by the American Disabilities Act, she said. “Having this diagnosis can ensure that affected individuals receive certain protections and accommodations. It will be very important.”

When asked why children feel differently depending on their age due to Covid, Gross said answering that question is one of the next research goals. “Children at these different ages are growing, their brains are developing, there are a lot of changes,” she said. “It could be changes related to their immune system. They could be changes related to the onset of puberty and hormonal changes.”

An immediate next step will look at what happens in the youngest children, from birth to 5 years old, to decipher mechanisms and tailor treatments.

Johnston and Gross expressed concern about adolescents approaching adulthood. “We know that having adverse experiences and experiencing a chronic illness in childhood can impact children as they grow and mature. This is truly a public health crisis,” Gross said. “It will really impact the health of generations to come for decades to come. And that’s why it’s so crucial to remember that we really need this research for children.”

STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg Philanthropies. Us financial supporters are not involved in decisions about our journalism.