Long COVID and kids: scientists race to find answers Children get long COVID too, but researchers are still working to determine how frequently and how severely. https://www.nature.com/articles/d41586-021-01935-7 As COVID-19 has ripped through communities, children have often been spared the worst of the disease’s impacts. But the spectre of long COVID developing in children is forcing researchers to reconsider the cost of the pandemic for younger people. The question is particularly relevant as the proportion of infections that are in young people rises in countries where many adults are now vaccinated — and as debates about the benefits of vaccinating children intensify. Most people who survive COVID-19 recover completely. But for some, the poorly understood condition that’s become known as long COVID can last for months — maybe even years. Nobody yet knows. The condition was first described in adults. But several studies have now reported a similar phenomenon, including symptoms such as headache, fatigue and heart palpitations, in children, even though they rarely experience severe initial symptoms of COVID-19. Estimates of how common long COVID is in children vary wildly. Researchers say that pinning this down is crucial, because decisions about school closures and vaccine roll-outs can hinge on the risk the virus poses to children. Getting solid numbers is “very, very important”, says Pia Hardelid, a child-health epidemiologist at University College London. Alarm bells Paediatrician Danilo Buonsenso, at the Gemelli University Hospital in Rome, led the first attempt to quantify long COVID in children. He and his colleagues interviewed 129 children aged 6–16 years, who had been diagnosed with COVID-19 between March and November 2020. In January, they reported in a preprint that more than one-third had one or two lingering symptoms four months or more after infection, and a further one-quarter had three or more symptoms. Insomnia, fatigue, muscle pain and persistent cold-like complaints were common — a pattern similar to that seen in adults with long COVID. Even children who’d had mild initial symptoms, or were asymptomatic, were not spared these long-lasting effects, Buonsenso says. The findings, published in a peer-reviewed journal in April1, sparked a deluge of e-mails and calls from anxious parents. “It was like we opened the door, and everyone — mostly parents themselves — were starting to say, ‘Okay, so maybe this is something we should ask about,’” he says. The hospital now runs a weekly outpatient clinic to meet demand. Data released by the UK Office of National Statistics (ONS) in February and updated in April also sparked concern. They showed that 9.8% of children aged 2–11 years and 13% aged 12–16 years reported at least one lingering symptom five weeks after a positive diagnosis. Another report released in April found that one-quarter of children who were surveyed after discharge from hospital in Russia post-COVID-19, had symptoms more than five months later2. The numbers reported aren’t as high as they are for adults. The ONS data, for instance, show that about 25% of 35–69-year olds had symptoms at 5 weeks. But the numbers still set off alarm bells, because severe COVID-19 in children is much rarer than in adults, and most kids were therefore assumed to have been spared the impacts of long COVID, says Jakob Armann, a paediatrician at Dresden University of Technology in Germany. If 10% or 15% of children, irrespective of the initial severity of the disease, do have long-term symptoms after all, “that’s a true problem”, he says, “so this needs to be studied”. Not so high But Armann suspects numbers might not be that high. Long-COVID symptoms include fatigue, headache, difficulty concentrating and insomnia. He says that other pandemic-related phenomena, such as school closures and the trauma of seeing family members sick or dying from COVID-19 could result in those symptoms too, and artificially inflate long-COVID estimates. “You need a control group to tease out what is truly infection-related,” he says. He and his colleagues have been taking blood samples from secondary-school children in Dresden since May 2020 to track rates of infection. In March and April this year, surveys were taken from more than 1,500 children — nearly 200 of whom had antibodies indicating previous SARS-CoV-2 infection — to see how many reported long COVID. In May, Armann’s group reported in a preprint that it found no difference in rates of symptoms reported by the two groups3. “This was kind of striking,” says Armann, and suggests that long COVID in children is probably lower than some studies have indicated. That doesn’t mean that long COVID doesn’t exist in children, he says, but it does mean the number is probably below 10%, a level that would have been picked up in the study. The true figure is perhaps as low as 1%, he says. Hardelid tapped into data gathered by the Virus Watch study, which tracks infections and symptoms in more than 23,000 households across England and Wales. As they reported in a preprint in June, she and her colleagues found that 4.6% of children with evidence of SARS-CoV-2 infection had persistent symptoms lasting more than 4 weeks4. Another UK study, posted as a preprint in May, found a similar rate. Of more than 1,700 schoolchildren who tested positive for SARS-CoV-2, 4.4% had symptoms, such as headache, fatigue and loss of smell, that persisted; 1.6% had symptoms that remained for at least 8 weeks5. It will also be important to determine how long the condition lasts in children, says Armann. Headaches or trouble sleeping for just 6 months is a vastly different problem from having these symptoms all their life, even if it only happens for 1%, he says. Defining the problem Buonsenso says that one of the challenges in working out how many kids develop long COVID is that there are no set diagnostic criteria in adults, let alone in children. Surveys to detect symptoms usually cast a wide net, and are not yet specific enough to tease out long COVID from other conditions, he says. Nevertheless, he is convinced that some children — perhaps 5–10% of those with COVID-19 — do develop the condition. If psychological distress were a big factor in the symptoms he’s seeing, as Armann has suggested, Buonsenso argues there would have been more children with symptoms from the first wave of infections in 2020, when restrictions were harshest in Rome. Instead, the second wave resulted in more cases of children with symptoms of long COVID, he says. A proper definition of long COVID is urgently needed, says Hardelid, so that studies can determine how much of a problem it presents in children, and which children are most at risk. One suggestion, following a review of the literature in adults by the UK National Institute for Health Research, is that long COVID could be a collection of four different syndromes, including post-intensive care syndrome, post-viral fatigue syndrome and long-term COVID syndrome6. This could be the case in children, too, says Hardelid. Buonsenso has also been looking at immunological changes that occur in people with long COVID, to see if there are biological markers that could lead to treatments. In a small study posted as a preprint in May, he and his colleagues found that only the children with long COVID showed signs of chronic inflammation following infection7. Such investigations into the biological basis of long COVID could have far-reaching effects. In general, we know very little about chronic post-viral conditions, says Buonsenso, because most clinical attention, and funding, has focused on the acute phase of infections. doi: https://doi.org/10.1038/d41586-021-01935-7 References Buonsenso, D. et al. Acta Paediatr. https://doi.org/10.1111/apa.15870 (2021). Article Google Scholar Osmanov, I. M. et al. Preprint at medRxiv https://doi.org/10.1101/2021.04.26.21256110 (2021). Blankenburg, J. et al. Preprint at medRxiv https://doi.org/10.1101/2021.05.11.21257037 (2021).
Half of Covid Hospital Patients Develop Complication, Study Says https://www.bloomberg.com/news/arti...ital-patients-develop-complication-study-says One in two people hospitalized with Covid-19 develop another health complication, a U.K. study showed, in the broadest look yet at what happens to those sick enough to need inpatient treatment. Though complications were most common in those over the age of 50, the study found a significant risk for younger people as well. Among 19- to 29-year-olds hospitalized with Covid, 27% experienced a further injury or attack in an organ system in the body, while 37% of 30- to 39-year-olds experienced a similar complication, the researchers said in The Lancet on Thursday. The study followed 73,197 patientsadmitted to U.K. hospitals between January and August of 2020 -- meaning it didn’t capture the impact of vaccines or improved treatments, or that of the virus variants that have spread around the world this year. The best way to stop complications is to keep people from getting sick enough to need hospitalization in the first place, the research team said at a press conference. “The best way of preventing this is vaccination,” said Calum Semple, a professor of child health and outbreak medicine at the University of Liverpool and the study’s chief investigator. Kidney injuries affected almost one-quarter of all the hospitalized people, the researchers said, and liver and intestine problems were particularly common in younger patients. The study focused on hospital complications, acute attacks that occurred during initial treatment, not on the symptoms of long Covid.
Long COVID: with one in three patients back in hospital after three months, where are the treatments? https://knowridge.com/2021/07/long-...-after-three-months-where-are-the-treatments/ The pace of acute therapy and vaccine development for COVID have been dizzying. But even as we hope a route to bringing the pandemic under control is within sight, we’re now facing the possibility of another urgent public health emergency thanks to what’s known as long COVID, a group of symptoms that last long after the initial infection. With such a potential crisis looming, it is reasonable to ask what we are doing about it, and why treatments don’t appear to be forthcoming. There are a few reasons why the long COVID story may pan out differently. Let’s take the first problem: long COVID is not a diagnosis itself. It encompasses many different problems, from blood clots and lung scarring to commonly recognised symptoms, with up to 82% still reporting symptoms like breathlessness, fatigue and brain fog 3-6 months after discharge from hospital. Though this aspect of recovery has received much attention, most people are less aware that one in three COVID patients who leave hospital are back within three months of their apparent recovery – and one in ten are dead. Stark numbers and not many people are talking about them. This complexity is a major challenge for those wanting to develop and trial treatments. One of the most important questions is the measure of health you wish to improve, or the primary endpoint. Each of the above diagnoses may need a different endpoint. If you have a clot you might die. If you have lung scarring you might be breathless and it might have changed your lung function. If your primary problem is fatigue, the most important thing may be improving the symptoms, getting you back to work or reducing the support you need. Patient-led research has associated as many as 200 symptoms with long COVID. It is probable that some of these are not truly COVID-related, but how do you choose what to measure in a trial? Each time you add a new measurement in a trial you increase the size the trial needs to be to avoid false positive results. Compromises need to be made about what can be done versus what the patient might value as an outcome. Recovery data Next up is the underlying biology, of which we have a limited understanding. We know, for example, that clots form, but still not clearly why. We know that patients’ blood vessels are not normal, but not for how long this persists. And we know that some patients have prolonged inflammation, but we cannot predict who. This makes it hard to choose therapies to trial and patients to include in those trials. It means we need to make some educated guesses who and when to treat, and with what. Many patients recover, so should we enrol all patients when most of them will get better, pick out patients at higher risk of problems or wait until symptoms are established? No treatment comes without side-effects. We need to minimize the chances of harming someone who was going to get better anyway. Added to this, the group we are studying may change with the advent of acute treatments and vaccines. Early reports suggest a younger population in the current wave. This can have big effects on clinical trials. If you set a trial up to pick up a signal with an assumption of a third of people having long-term problems, if this reduces, then your trial might not be able to answer the question. So what can we do about all this? The first thing is to run trials that are big enough for definitive answers and flexible enough to react to evolving knowledge, by including extra treatment arms if evidence changes. The second is to have a mix of trials looking at different populations. Post-hospital patients are almost definitely at higher risk of problems like clots or scarring than those that were never admitted. Prevention is always better than treatment, so therapies aimed early in the disease course are important. The community patients who are living with persistent problems may need different trials. Complex funding The good news is that a lot of funding is being released to point at the problem, even if we don’t yet know the best areas to focus on. Another positive is that big trials like the vaccine studies and the Recovery trial (the world’s biggest clinical trial to identify treatments for people hospitalized with COVID), have shown we can do big trials at pace and scale. Unfortunately, the current funding system is competitive, lacks co-ordination and doesn’t really reward collaboration. These big trials were the exceptions, not the rule. So we need pressure on funders and researchers to do things differently. In the UK, we have set up an early example of the sort of trials we think we need, called Heal-COVID. It already has around 100 centres in the UK involved and puts into practice some of the ideas above. If you had told me before the pandemic that this type of trial could be set up in weeks, I would not have taken you seriously. Despite this, the long-term nature of the problems mean it will be months before trials start to report and we need to explain to the public why. There are a lot of people out there desperate for something/anything and this will be fertile ground for charlatans and opportunists. So in the meantime, if patients are going to experiment they must always ask who benefits, make sure the treatments are at least safe, and take heart that a lot of patients are still on a journey of improvement. There remains hope.
Read through the article. No source on the claim 1 in 3 are back in the hospital. Where is the data showing this? Does the data also show additional information like age of patient, etc?
The study is linked and referenced in the original article -- you can easily go to it. https://www.medrxiv.org/content/10.1101/2021.03.22.21254057v1.full.pdf
Thanks for posting the link. "We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a healthrelated change in occupation. Factors associated with failure to recover were female, middleage, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation determined by C-reactive protein was related to cluster severity, but not acute illness severity" So mean age 58 with half having at least two co-morbidities (read, older and sicker) had belief that they felt just as, or more, ill than before (which could be physical or mental). Riight. So if you ask someone who isn't well if COVID made them more unwell, this is supposed to be surprising that 29% only felt fully recovered? What is surprising is that more didn't say they blamed COVID for their problems when given the chance. If you go looking for a problem, you're gonna find one.
I would urge everyone read the entire study rather than the tiny portion of the Findings you posted which does not provide the full context. Do you disagree with the study showing 1 in 3 patients were back in the hospital after three months?