Children are less likely to develop long COVID than adults and far less likely than health officials had previously thought to have lingering symptoms after infection, according to one of the most comprehensive studies so far on the topic.
Children’s Hospital Colorado recently completed a review of electronic medical records for nearly 660,000 kids around the country who were tested for the coronavirus, an attempt to zero in on the symptoms associated with long COVID.
Of those children, 9% had tested positive for the virus. Researchers compared their symptoms — from hair loss to kidney trouble — with health issues noted in the medical records of children who had tested negative for COVID. The point was to figure out which symptoms were actually linked to a COVID infection and which were related to other illnesses or stresses of living through a global pandemic.
Children who had a coronavirus infection were more likely than kids who had not to have loss of smell and taste, hair loss, skin rashes and diarrhea, as well as more serious complications including irregular heart rhythm, abnormal liver enzymes and kidney problems.
On the positive side, the study found that children were not only less likely than adults to develop long COVID but also that some of the symptoms attributed to long COVID earlier in the pandemic were likely not related to the coronavirus.
Long COVID was defined as symptoms that lasted 28 days or longer from diagnosis.
Dr. Suchitra Rao, an infectious disease specialist at Children’s, used electronic health records from 659,286 children who had COVID tests from March 2020 through October 2021, including 59,893 children who tested positive. She documented symptoms reported from one month to six months beyond diagnosis.
Of those who had tested positive for COVID, about 42% were experiencing at least one symptom in that five-month period that seemed related to the coronavirus. However, among those kids who tested negative, nearly 38% were experiencing at least one symptom, too.
“That’s why you have to have this comparison group,” Rao said. “Some of these early reports were saying that up to 30% of kids would have long COVID, but then they didn’t have a frame of reference to compare to. That’s why our study is pretty unique in that sense, because we had a large control group.”
Put another way, the study, which was recently published in JAMA Pediatrics, found that among kids who had COVID, 4% more of them had lingering symptoms compared with kids who tested negative.
“When you compare the two groups, the relative difference was low,” Rao said. “It’s not as super high as we might be originally thinking.”
The rate among adults is between 10% and 30%, according to various research so far.
An important point, though: The study is looking at electronic medical records, which means it’s only including people who went to a clinic or hospital for treatment of their symptoms. It does not capture those who had long COVID and never saw a doctor.
While some of the symptoms of long COVID were the same in children as in adults, including loss of taste and smell and hair loss, other symptoms flagged in the research appeared more prevalent in children.
Skin rashes and myocarditis, which is a heart inflammation, were the big two. Researchers also noticed higher occurrences of abdominal problems, including pain and diarrhea. The most serious symptoms among children also included multisystem inflammatory syndrome, abnormal liver enzymes and kidney trouble.
Children who had long COVID also had higher levels of anxiety compared to other children, despite that all of them went through pandemic isolation, online school and the stress in general of the pandemic.
“That’s the perfect example of why we need a comparison group because we know how mental health was such a big component for really everybody,” Rao said. “It may show that there’s potentially something that’s happening from the infection itself.”
The youngest children, those under age 5, were more likely to have long COVID symptoms, as were children with other medical issues and those who spent time in the intensive care unit because of the COVID infection. Still, children who never went to the hospital because of a COVID infection also developed long COVID.
The finding about younger children was a surprise and contradicts other preliminary research that showed older children and teens were more likely than babies and toddlers to have long COVID, Rao said. One possible explanation that needs more exploration is that little kids are less likely to have the words to describe symptoms and their parents might take them to see a doctor because they are fussy and not feeling well, whereas a teenager might mention a headache and take ibuprofen. Teens also might have different long COVID symptoms, such as anxiety and other mental health issues, while younger children have more physical issues, she said.
It also appears that long COVID isn’t as long for children as it is for adults, though further research is needed on that point, too, Rao said. Many of the symptoms of long COVID in children were resolved within six months, including heart rhythm and inflammation problems.
Like many things throughout the pandemic, the study — while providing a baseline of answers — leads to many more questions. Why do certain kids get long COVID and not others? Why is the infection itself linked to higher levels of anxiety? What would prevent kids from getting long COVID?
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Ongoing studies, including one at Children’s that is following kids who developed multisystem inflammatory syndrome after a COVID infection, are trying to answer the questions on a cellular level. The syndrome causes inflammation in multiple parts of the body at once, including the heart, lungs, brain, skin, eyes, kidneys and gastrointestinal organs.
That study, as well as Rao’s research from the electronic health records, are part of a National Institutes of Health program called “RECOVER,” which is focused on COVID research and includes several hospitals across the country.
“This is really something that we’re considering to be exploratory, and as we get more data from this type of work, we really want to try and explore this in greater detail with some of those more prospective, longer-term studies where we follow patients over time,” Rao said.
“The hope is then be able to find ways that we might be able to identify it sooner, find folks who might be at risk of it, and then potentially find ways to help to prevent it or treat it so that kids might recover faster.”
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