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Long-term COVID: Not just adults

Post-COVID-19 illness (PCC) consistent with so-called prolonged COVID, lasting 3 months for many children seeking urgent care due to acute illness, according to an international pediatric hospital network study.

Among 1,884 children with 90-day follow-up who were diagnosed with COVID-19 infection, 5.8% reported PCC with COVID-19 in an emergency department or hospital visit, The most common are fatigue or weakness, cough, shortness of breath, and other respiratory symptoms.

This rate was higher among hospitalized children, with 9.8% reporting Stephen Freedman, MD, MD, of PCC Calgary Alberta Hospital Research Institute, and JAMA Network Open.

A matched analysis comparison showed that 5.0% of hospitalized children not infected with SARS-CoV-2 had similar symptoms infection and 2.7% of non-hospitalized children did not have SARS-CoV-2 infection.

Although the long-term COVID incidence in their study was lower than previously reported in adults, the findings of risk factors matched the researchers’ recommendation that previous studies of PCC in adult patients showed that children face similar obstacles.

Children with four or more symptoms at the emergency department visit were more likely to report PCC due to 48 hours or more, or 14 years and older.

PCC is more common in patients with more symptoms in emergency department visits, 4.7% higher than in hospitalized patients 1 to 3 in hospitalized patients with 7 or more symptoms Symptoms were reported in 22.7% and 1.5% to 11.2% of non-hospitalized patients, respectively.

“Unfortunately, there is no known cure for long-term COVID in children, and more research is needed in this area,” said Todd Florin, MD, MSCEf Chicago Lurie Children’s Hospital, in a press release. “However, if symptoms are severe, symptomatic treatment is paramount. If symptoms affect quality of life, multidisciplinary care is required.”

Pediatric PCC findings are inconsistent, the group said , and is still “poorly described”. “Early reports estimate that 25 to 58 percent of children experience PCC months after acute illness, independent of disease severity,” Friedman and co-authors wrote. “However, a subsequent study that included mainly SARS-CoV-2-positive children who were not hospitalized reported that only 4% of children developed symptoms 28 days after testing and 2% developed symptoms 56 days after testing.”

They added, “The lower prevalence of PCC in our study may reflect a higher follow-up rate, which reduces the risk of bias and our use of different methods to induce PCC.”

Regardless of the exact prevalence, they concluded that it was higher than the prevalence in uninfected children.

Their data were drawn from 39 different pediatric emergency departments within the Pediatric Emergency Research Network and spanned from March 7, 2020 to January 20, 2021. Children from eight different countries, including the United States, Italy, Paraguay, Singapore, Argentina, Canada, Costa Rica and Spain, participated with the consent of their guardians.

The mean age of the patients was 3 years, and 52.8% of this group were male.

The association with age “may reflect that younger, less verbal children are less likely to report specific symptoms than verbal adolescents,” the researchers wrote. These findings are also “consistent with adult studies showing that the presence of five or more symptoms during acute illness is associated with PCC.”

Limitations include that causal conclusions cannot be drawn, so these associations may be Not specific to SARS-CoV-2 infection, and “may reflect the association of infection with symptom perception.” Furthermore, there are no follow-up antibody tests, and these findings predate emerging SARS-CoV-2 variants and may not apply to children who do not seek emergency department care.


This study was supported by the Canadian Institutes of Health Research, Alberta Health Services-University of Calgary-Clinical Research Grant, Alberta The Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) funded the UC Davis program and the Cincinnati Children’s Hospital Medical Center Emergency Medicine Small Grants Program.

Freedman reports on relationships with Canadian Institutes of Health Research, Alberta Health Services – University of Calgary, Alberta Children’s Hospital Research Institute and Alberta Children’s Hospital Foundation. Florin reports on its relationship with the Cincinnati Children’s Hospital Medical Center’s Department of Emergency Medicine Small Grants Program. Other co-authors report on relationships with International Flavors & Fragrances and Pfizer, as well as patent pending treatments for coronavirus treatments.



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