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Children have less severe COVID, but just as much long-haul as adults - April 2022


A battle is raging over long covid in children

From Technology Review April 2022
While potentially millions of children suffer from this mysterious illness, researchers are still debating how big a problem it is.
By Jessica Hamzelou archive page April 6, 2022

Before Jasmin got covid-19 last year, she was an especially active 10-year-old. She loved dancing, swimming, and gymnastics. “She was always upside-down, doing handstands,” says her mother, Binita Kane. Although she only had a mild case of the virus, she developed lasting, debilitating symptoms that kept her out of school. Jasmin, now 11, has abandoned her activities. Today, she uses a wheelchair. 

Jasmin is one of an unknown number of children with long covid. She regularly suffers from fevers, a sore throat, weak and achy limbs, dizziness, and exhaustion, but the symptoms of long covid in children vary greatly. We don't know how many children are affected, and we don’t know which symptoms came from infections and which might have resulted indirectly from the pandemic. Scientists can’t even agree over what it means for children to have long covid.

Clinicians and epidemiologists find themselves at loggerheads over the issue—but this is more than just an academic spat. The lack of understanding means that potentially millions of sick children are not getting the treatments they need. “There’s been a real lack of support, understanding, research, and treatments for children,” says Kane, who is a consultant respiratory physician at Manchester University NHS Foundation Trust in the UK.  

Sizing up the problem

The World Health Organization defines adult long covid as a condition that occurs usually three months after a confirmed or probable SARS-CoV-2 infection, with symptoms that last for at least two months that can’t be otherwise explained. Symptoms commonly include fatigue, brain fog, and shortness of breath. 

The existence of a proper definition means that long covid can be diagnosed. The condition has been recognized as a potential disability under the Americans with Disabilities Act since July 2021, which should offer affected individuals protection from discrimination. So far, there is no agreed-upon definition for long covid in children.  

One of the most heated arguments among doctors and scientists is over how significant a problem long covid in children really is. Estimates of the prevalence can swing between 1.8% and 87% of children, depending on the study. As a result, some researchers warn parents to protect their children from a poorly understood syndrome that may affect them for the rest of their lives, while others say the risks have been overstated.  

The debate hasn’t been helped by the lack of large and rigorous studies.

“Some papers are so bad,” says Sonia Villapol at Houston Methodist Research Institute in Texas, who, along with her colleagues, recently attempted to estimate the prevalence of long covid in children by analyzing all of the studies published so far.

Many children won’t have been tested for SARS-CoV-2, the virus behind covid-19, either because they are asymptomatic or because they have mild symptoms, she says. Some children might have been infected with SARS-CoV-2 without developing covid-19. Her team’s analysis suggests that around 25% of children who contract the virus will have at least one symptom four weeks after their infection

Evidence is growing that in some people covid infections are producing autoantibodies targeting the body’s organs. If true, it could mean years of lingering sickness and misery for many.

Terence Stephenson of the UCL Great Ormond Street Institute of Child Health in London is involved in one of the more highly regarded research efforts into long covid in children. The team is tracking the outcomes of thousands of adolescents aged 11 to 17 in England who tested either positive or negative for SARS-CoV-2. The team’s latest published work found little difference in the prevalence of any lasting symptoms between children who tested positive versus children who tested negative: two-thirds for positive versus just over half for negative. Both groups experienced similar symptoms; headaches and tiredness were especially common. 

What does this tell us? It depends on whom you ask. Study co-author Shamez Ladhani, pediatrician and epidemiologist at Public Health England, says the findings should reassure parents that long covid is very unlikely to affect their children. 

Ladhani also points to data collected from smartphone app users. Health science company ZOE and King’s College London launched the COVID Symptom Study app in March 2020 and have since collected daily symptom reports from hundreds of thousands of contributors. Reports by parents on behalf of 1,734 children found that just 4% of infected children still had symptoms 28 days after the start of their illness.  

The children tended to get better with time, says Emma Duncan, an endocrinologist at King’s College London who co-authored the ZOE study. Just under 2% of children still had symptoms 56 days after the start of their illness.  

Once the children who had asymptomatic infections, who wouldn’t have taken a test at all, are factored in, the percentage of infected children who develop long covid is likely to be significantly lower than even 2%, says Duncan. 

“Long pandemic syndrome”

One still-unanswered question is why so many children who tested negative for covid seem to experience lasting covid-like symptoms. Some of them might be related to other illnesses, but many could be a result of living through the pandemic, says Duncan. 

Similar trends are emerging in data collected in the US. Chris Forrest is a pediatrician at the Children’s Hospital of Philadelphia and principal investigator at PEDSnet, a network of children’s health care services that is researching long covid in children. Forrest and his colleagues are about to publish research on the outcomes of around 660,000 children in the US who underwent PCR testing for SARS-CoV-2.  

Slack groups and social media are connecting people who've never fully recovered from coronavirus to collect data on their condition.

In unpublished work, they examined 500 different outcomes for kids who had contracted the virus versus those who didn’t. Common symptoms post-infection included changes to smell and taste, hair loss, and chest pain. Fatigue was almost as common in the kids who hadn’t had covid as those who had, Forrest says. 

“The point is that the pandemic has been terrible for children,” says Duncan. “With school disruptions, family disruptions, educational disruptions … it’s been terrible for all children, irrespective of whether they personally contracted SARS-CoV-2 or got covid-19.” The phenomenon has been described as “long pandemic syndrome,” says Villapol.  

Pediatricians describe a significant uptick in the numbers of children being referred to mental health care services. Doctors are seeing more children with eating disorders and tics, as well as an increase in symptoms of depression and anxiety. Very few studies have looked at the impact of social changes like school shutdowns, says Forrest. 

Because many people experience headaches and tiredness—the most common symptoms identified in the ZOE study—on a regular basis, it’s hard to draw conclusions about long covid, says Deepti Gurdasani, a clinical epidemiologist and statistical geneticist at Queen Mary University of London. “Statistically, you will not find a signal, because the signal has been massively diluted,” Gurdasani says. Based on the data she’s seen, Gurdasani believes that long covid affects somewhere between 10% and 20% of children who contract the virus, which includes those who don’t develop covid-19 symptoms. Stephenson thinks the figure is around 7%. 

"The point is that the pandemic has been terrible for children"

Emma Duncan at King's College London
London-based pediatrician Michael Absoud says the figure can’t be as high as even 7%, because he just hasn’t seen enough children with suspected long covid. “We’ve set up post-covid clinics across London, which covers a big, big area,” he says. “We’ve seen 90 children since the beginning of July. That’s a small number.”  

But many children might not make it to one of the specialized long covid clinics, says Sammie Mcfarland, founder of the campaign group and nonprofit Long Covid Kids. Both Mcfarland and her 16-year-old daughter have long covid, and they have been told that her daughter’s symptoms are “all in her head,” she says. 

Having heard from other parents of children with long covid, Mcfarland says her daughter’s experience “is far from unique.” Primary care doctors don’t agree on what long covid in children is, and some don’t believe it is a syndrome at all. Others might send children for basic blood tests and scans that come back clear, and discharge them. “Everyone has a different opinion,” says Mcfarland. 

A “squishy” syndrome

Part of what makes defining long covid difficult is that it appears to take many forms. An acute covid infection is rarely life-threatening to children, although a significant number of children have died—over 1,000 in the US alone. But a small number of children can develop a dangerous condition in which many of their organs become inflamed, known as multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS), which can result in lasting organ damage if left untreated. As of March 28, the CDC reported 7,880 cases of MIS-C in the US, which have so far resulted in 66 deaths. But there is disagreement over whether MIS-C falls under the umbrella of long covid or not. 

Children develop many other difficult-to-define syndromes after having covid. Fatigue is common. Some children might have a cough or sore throat for months. Others take months to recover their sense of taste and smell. Some are too weak to attend school or have signs of heart damage, others experience seizures and blackouts. Symptoms can temporarily resolve before relapsing. Some children have a single lasting symptom, while many others experience a constellation. 

The symptoms vary in their severity, too—and these differences may be overlooked in studies that compare children who did or did not contract SARS-CoV-2. A questionnaire that asks children if they had a headache might not differentiate mild head pain from a severe experience that leaves a child unable to open their eyes or get out of bed. 

In truth, long covid is likely to encompass several different conditions. “It’s not a diagnosis, it’s not a disease … we don’t know what it is,” says Forrest. “It’s squishy.” Stephenson and Mcfarland have met with representatives of the WHO to discuss a potential definition for long covid in children, but none has been established so far. The WHO says it will need more studies and research. 

While progress on finding a clinical definition has stalled, there has at least been some agreement over a way to define long covid in children for research purposes. 

In February, Stephenson and his colleagues published a definition of long covid in children to be used in research that states that symptoms must follow a confirmed case of covid-19, must impact the child’s life and physical, mental, or social well-being, and must persist for at least 12 weeks. Stephenson hopes the WHO will align its definition with this one, but in the meantime this definition should at least help ensure that researchers are studying the same thing, he says. 

Vaccination value

The only way to prevent long covid is to avoid contracting SARS-CoV-2, which is why many doctors and scientists encourage people to get vaccinated. It is not clear how much protection vaccines may offer against long covid, but a few recent studies suggest that vaccination can reduce a child’s risk of severe illness from the omicron variant by two-thirds. 

Long covid is thought to more frequently follow more severe infections, but it can also follow mild or even asymptomatic cases. “This seems to be more of the case in children, which I think is unique and disturbing,” says Yvonne Maldonado, an infectious disease pediatrician based at Stanford University and chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

Because vaccinations can reduce the severity of cases, and should reduce transmission, they are recommended for all children over the age of 5 in the US. As of March 30, 58% of 12- to 17-year-olds had received both doses of a covid-19 vaccine, according to CDC data published by the American Academy of Pediatrics. Only 27% of those aged 5 to 11 had. 

In the UK, covid-19 vaccinations for young children are the center of another debate. The UK’s Joint Committee on Vaccination and Immunisation (JCVI), which advises the government, announced a plan to offer all children aged 5 to 11 a covid-19 vaccine just last month, and then only on a “non-urgent” basis.  

“I think the JCVI have got it right all along,” says Absoud. “The way they’ve left it now is that it’s a choice for families.” 

"A hell of a lot of children" are affected

Binita Kane at Manchester University NHS Foundation Trust
Of course, there are other ways to reduce transmission among children. The experts we contacted stressed the importance of keeping schools open, and said that measures such as improving ventilation and air quality, and masking, at least among adult caregivers, during surges of transmission can help keep case numbers down and help prevent both long covid and “long pandemic syndrome.” They are also among the only options we have to protect kids under 5. 

All children who are significantly affected by SARS-CoV-2, whether directly or indirectly, will need support to recover, so arguments over the prevalence of long covid in children may be beside the point. “Whether it’s long covid or long pandemic syndrome, everything needs to be treated,” says Villapol. 

Even if only 1% of children develop long covid following an infection, the total number of affected children will reach the millions, given how many children have already contracted the virus. The JCVI’s guidance on immunizing children suggests 85% of children in the UK aged 5 to 11 had been infected with the virus by the end of January 2022, before they were eligible for vaccination. “It’s a hell of a lot of children,” says Kane.  

Today, Kane’s daughter Jasmin is doing better. A new treatment regime seems to have helped, and while it hasn’t completely restored her energy levels, she is “remarkably improved,” says Kane.  

The trouble is, while researchers debate prevalence, the focus is drawn away from biological causes and potential treatments, meaning many other children are still suffering, she says. 

“We can’t wait for years,” Kane says. “We need to move on.”


VitaminDWiki with LONG-HAUL or LONG-COVID in the title (52 as of Oct 2022)

Items found: 51
Title Modified
Long-COVID fatigue reduced by Vitamin C and l-Arginine in one month– RCT Nov 2022 24 Nov, 2022
Adrenal, Long-COVID and Vitamin D - several studies 31 Oct, 2022
Long Covid, Short Magnesium - Chambers April 2022 30 Oct, 2022
Fatigue and other long-haul problems appear to be associated with low Magnesium - Chambers Oct 2022 30 Oct, 2022
Long-COVID symptoms in 10 Percent of women 3 months after infection (22 countries) – Oct 2022 29 Oct, 2022
Long-COVID is now the biggest COVID concern - many studies 16 Oct, 2022
Epstein-Barr Virus probably causes Long-COVID, CFS, and MS - many studies 02 Oct, 2022
Anti-oxidants and Long-Covid (Mg, Glutamate, Butyrate, etc) – Sept 2022 02 Oct, 2022
Chronic Fatigue Syndrome and long-haul COVID-19 26 Sep, 2022
Over Two Million Americans Aren’t Working Due to Long-COVID - Aug 2022 27 Aug, 2022
Long-COVID: often had not been hospitalized - May 2022 25 Aug, 2022
COVID virus persists in most body tissues (Long-COVID) - 2022 23 Aug, 2022
Long COVID Persists in Almost All Tissues of The Body 23 Aug, 2022
Long-COVID in VitaminDWiki 16 Aug, 2022
LONG-COVID may be permanent in 1 in 200 of people infected – July 2022 06 Aug, 2022
LONG-COVID may be permanent in 1 in 200 of people infected – July 2022 06 Aug, 2022
Long-Haul more prevalent among seniors - June - 2022 26 Jun, 2022
Long-Haul can now be claimed a work disability in the UK – June 2022 24 Jun, 2022
Half as much Long-Haul with Omicron - June 2022 19 Jun, 2022
Half as much Long-Haul with Omicron - June 2022 19 Jun, 2022
COVID Spike persists in Long Haul - June 2022 18 Jun, 2022
COVID Long-Haul prevalence increases with time: 50% at 4 months - meta June 2022 17 Jun, 2022
COVID and Magnesium - hypothesis, clinical trials, Long-Haul - Oct 2021 10 Jun, 2022
Mass disabling events: Polio, WWII, HIV, and COVID Long-Haul - June 2022 06 Jun, 2022
1 in 5 Americans who got COVID had Long-Haul for a while - CDC May 2022 27 May, 2022
Long-Haul COVID after 3 months – only 5 percent had even 30 ng of Vitamin D – April 2022 04 May, 2022
Hypothesis: 2 long-haul COVIDs: had mild symptoms and had needed ICU - April 2022 15 Apr, 2022
COVID Long-Haul at 49 weeks: overactive immune system, type O blood - March 2022 07 Apr, 2022
Children have less severe COVID, but just as much long-haul as adults - April 2022 06 Apr, 2022
Dietary Recommendations for COVID Long-Haul – March 2022 20 Mar, 2022
Mild Long-Haul 4.2 X more likely if type O blood - preprint March 16, 2022 20 Mar, 2022
Long-Haul COVID is somewhat less of a problem if vaccinated – Nov 2021 18 Mar, 2022
COVID Long-Haul NYT - Feb 2022 19 Feb, 2022
COVID Long-Haul fought by probiotics - Jan 2022 29 Jan, 2022
COVID Long-Haul predicted by 4 factors (Epstein-Barr virus, etc) – Jan 24, 2022 26 Jan, 2022
COVID Long-Haul predicted by 4 factors (Epstein-Barr virus, etc) – Jan 24, 2022 26 Jan, 2022
Some COVID-19 infection become COVID Long-Haul - Nov 2020 15 Dec, 2021
Epstein-Barr virus appears to cause Long-Haul and Chronic fatiure Syndrome (Vitamin D might help) 11 Dec, 2021
Long-haul after breakthrough COVID – Nov 2021 11 Dec, 2021
Long-haul, VAERS, Ivermectin, vaccines, etc. Drs. Seheult, Patrick: Video with table of contents - Sept 17, 2021 21 Sep, 2021
Your Brain on Covid-19 Long-Haul, Dr. Galland video and transcript - Aug 1, 2021 07 Aug, 2021
Long-haul COVID-19 blood tests at Mayo include vitamin D (but no results published) – July 2021 20 Jul, 2021
Most people with Long-Haul COVID-19 have low Vitamin D – July 2021 15 Jul, 2021
‘Long haul’ COVID rehab worse than cancer rehab, CDC – July 2021 13 Jul, 2021
Long-Haul COVID-19 occurred to 1 in 20 who had been asymptomatic (a study of 2 million with COVID-19) – June 2021 15 Jun, 2021
COVID-19 Long haul - excellent graph - systematic review May 26, 2021 26 May, 2021
COVID-19 vaccines look good in the short term, but probably not good for the long term 29 Apr, 2021
Long-haul COVID-19 - another hint that Vitamin D should help - Dec 2020 16 Apr, 2021
Probably fewer long-haul COVID-19 problems when rejuvenated immune system (Vitamin D, etc.)– Dec 2020 21 Feb, 2021
Long-haul fatigue, etc. common after viral infections (SARS1,2, MERS, Swine, 1918,...) 21 Feb, 2021
Long-distance truck drivers more likely to get COVID-19 (perhaps UVA)- July 2020 12 Aug, 2020

VitaminDWiki: Virus and Children 42 studies

This list is automatically updated


Infection after vaccination (breakthru) decreases long-haul by only about 20%

Long-Haul COVID is somewhat less of a problem if vaccinated – Nov 2021


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