Covid-19 in children is usually asymptomatic or is of mild severity and correspondingly, the rates of hospitalization and death are also low. However, paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), popularly referred to as multisystem inflammatory syndrome in children (MIS-C) associated with severe inflammatory response is of concern. Such children may require intensive care. Post-acute sequelae of SARS-CoV-2 (PASC) or post-COVID Syndrome or long Covid is another issue of concern in children.

While long Covid in adults has been well-researched, evidence is not so robust in the pediatric age group and long Covid in children has not been well-characterised as in adults. Fourteen studies involving 19,426 children and adolescents have reported persistent symptoms post-Covid in this age group. These included 4 cross-sectional studies, prospective cohort studies and one retrospective cohort study.

A review of these studies was conducted by researchers at the Murdoch Children’s Research Institute in Australia.¹

One study suggested that compared to adults, long Covid might not be of so great a concern in children and adolescents as most of their symptoms had resolved by 8 weeks. Whereas, in one study, while only 8% adolescents reported symptoms at the time of testing, the number of adolescents reporting symptoms had increased to 50% at 12 weeks. However, in most of these studies, symptoms did not last longer than 12 weeks.

The prevalence of symptoms of long Covid was found to range from 4% to 66%. The frequency of these symptoms also varied between studies. “The most common reported symptoms were headache (3 to 80%), cough (1 to 30%), fatigue (3 to 87%), rashes (2 to 52%), disturbed smell or anosmia (3 to 26%), sleep disturbance (2 to 63%), abdominal pain (1 to 76%), myalgia or arthralgia (1 to 61%), concentration difficulties (2 to 81%), congested or runny nose (1 to 12%), chest tightness or pain (1 to 31%), loss of appetite or weight (2 to 50%).”

However, there was considerable heterogeneity between studies in terms of age range, outcome measurements, time points of assessment, self-reported symptoms, among others. There were methodological limitations as well. A notable limitation in most of these studies was the absence of a control group because of which symptoms attributed to long Covid could not be reliably delineated. Out of the five studies that had a control group, two did not find persistent symptoms to be more prevalent in children and adolescents who had been infected. Consequently, there is an ambiguity in the true incidence of long Covid in children and adolescents.

By and large, children have been spared so far. But they have also not been vaccinated barring a few countries like the US, although trials are ongoing. Hence, there is an apprehension that children could be the most vulnerable group in the impending third wave.

Hence, the study authors suggest further studies to accurately determine the risk of long Covid in children as a guide to policy decisions for this age group, especially with regard to Covid vaccines.

Reference

1. Zimmerman P, et al. How common is long COVID in children and adolescents? Pediatr Infect Dis J 2021;XX:00–00.