Youngsters hit hard by long Covid as Delta variant rises

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Initially safe from the worst of the Covid-19 virus, more children and teens are experiencing “prolonged Covid,” and medical clinics are springing up to treat their symptoms. And while children still account for fewer cases compared to adults, even as the Delta variant increases the numbers, its long-term symptoms are proving to be just as debilitating.

Since the beginning of the Covid-19 crisis, the prevailing opinion among medical experts has been that children and youth are more likely to recover quickly, or be asymptomatic or mildly symptomatic, than adults.

But now a growing number of children and adolescents with even asymptomatic Covid-19 are experiencing long-term effects, sometimes many months after first becoming ill.

And while data on children is sparse, doctors find that prolonged Covid in young people is just as disconcerting as it is in adults.

“We can definitely say that children lengthen Covid,” said Dr Elaine Maxwell of the UK’s National Institute for Health Research in an interview with The Guardian. “But the problem with Long Covid is that it is not a definition.”

Children report a number of persistent ailments, even if their initial symptoms were mild, including headache, muscle aches, fatigue, heart palpitations, gastrointestinal problems, nausea, dizziness, seizures, memory loss, hallucinations, and other sensory symptoms. like the loss of meaning. taste and smell, and even numbness that renders children unable to walk.

Some children and adolescents report that they have difficulty performing daily activities.

Aarati Kasturirangan, who lives in the US state of Philadelphia, knows the challenges very well. Her son Eli was 10 years old when he caught Covid-19 along with the rest of the family in March 2020.

“He’s usually a lively kid, but Eli wouldn’t come out of his room,” Kasturirangan told Jowharabout the weeks and months that followed.

Her symptoms were debilitating: leg pain so bad she couldn’t walk anywhere and gastrointestinal upset and nausea so severe she had to lie down in bed. Unable to climb the stairs, he crawled into place. She also had a high temperature for weeks, but not high enough for doctors to be alarmed.

“I thought that’s not how it’s supposed to be.”

In September of last year, after a series of tests and visits to specialists, he was formally diagnosed with post-viral fatigue.

“The gastrointestinal doctor was the most willing to call it Covid long, telling us: ‘Yes, it probably is, but we still don’t know enough.’ They told us that nothing could be done, but that it would take time. “

At school, basic math equations and completing homework became a huge challenge for the usually A-grade student. Kasturirangan describes it as “kind of confused, because he couldn’t understand the basic things that would normally be so easy for him. deal “.

She credits the school nurse for helping Eli turn a corner after she came up with a study plan that allowed him to work virtually for one hour and then rest for the next, so he could manage his energy.

‘Worrying’ numbers

Dr. Avindra Nath, chief of nervous system infections at the National Institute of Neurological Disorders and Stroke, told the New York Times that the potential impact on school-age children is “enormous.”

“I mean, they are in their formative years,” Nath said. “Once you start to fall behind, it is very difficult because children also lose confidence in themselves. It’s a downward spiral. “

A UK study by the Office for National Statistics published Aug. 5 estimated that 0.47 percent of young people between the ages of 12 and 16 had self-reported long-term Covid, while 0.3 percent of those between the ages of 12 and 16 had self-reported long-term Covid.

Young people of the same age group said their symptoms were limited. your activity either “a little” or “a lot”.

“Although prolonged Covid in children and young people is less common than in adults, the estimated number of people disabled by self-reported prolonged Covid is concerning,” said Professor Esther Crenshaw, a child health specialist at the University of Bristol in the United Kingdom, in response to the study.

Crenshaw noted that the number of children and youth with prolonged Covid is likely to increase as the number of cases increases.

Long Covid Kids, a UK-based advocacy group supporting children and adolescents with prolonged Covid, has 3,500 members ranging in age from seven months to 18 years. Its founder Sammie Mcfarland created the group when her 15-year-old daughter’s health deteriorated after contracting Covid-19 in March 2020.

“She became very upset and could hardly go home to bed,” Mcfarland told a UK parliamentary briefing on 26 January. “And he practically stayed there (in bed) for the next seven months.”

Until now, the pandemic has focused primarily on preventing serious illnesses and deaths in older people, many of whom have already been vaccinated. But many advocates, like Mcfarland, and medical experts want more attention paid to young people.

Last week, pediatric cases of Covid-19 accounted for the highest percentage of new infections since the start of the pandemic, according to the American Academy of Pediatrics, with 94,000 new cases registered (15 percent of all cases, compared to 14, 3 percent on average) in the week ending August 5.

“Simply put, the Delta variant has created a new and urgent risk for children and adolescents across the country,” the academy said in a letter to the US Food and Drug Administration, urging acceleration. vaccine approvals for those under 12 years of age.

Lack of data

It is unclear how many children could be affected by prolonged Covid and for how long, given the few studies available.

Danilo Buonsenso, a pediatrician at the Gemelli University Hospital in Rome, is the most cited researcher on prolonged Covid in children after having been the first to study the phenomenon.

He and his colleagues studied 129 children between the ages of 6 and 16 who were diagnosed with Covid-19 between March and November 2020.

The study, published in a peer-reviewed journal in April, found that more than a third of the participants had one or two persistent symptoms four months or more after infection, and another quarter had three or more symptoms.

Symptoms the children reported included insomnia, fatigue, muscle pain and persistent cold-like complaints, a pattern similar to that seen in adults with prolonged Covid.

“Long Covid is much rarer in children, which is good news,” he told The Guardian. “But it is still real.”

In April, the US National Institutes of Health cited a study that suggested that between 11 and 15 percent of infected youth could “end up with this long-term consequence.”

The lack of data, which is due, in part, to the delays involved in obtaining approval to study the children, has contributed to skepticism.

Fighting to be heard

“We are still at the stage where some people say that children don’t have a lot of Covid,” Maxwell told The Guardian.

Differentiating prolonged Covid from other conditions, particularly when many of the symptoms such as fatigue, headache, inability to concentrate can be attributed to other illnesses, is one of the biggest challenges for healthcare professionals and patients alike.

According to skeptics, some symptoms can also be a sign of mental anguish, cases that spiked during the pandemic when isolation, social distancing and other restrictions were imposed en masse.

Questions about whether some of the symptoms could be psychological gained steam after a US study of 2 million insurance claims by Fair Health found that those under 18 were more likely to report intestinal problems and “adjustment disorders.” “described as emotional or behavioral reactions to stressful life events.

The struggle to be heard is sometimes exacerbated for children who report feeling symptoms that do not always show up on medical examinations.

In adults, CT scans and blood tests will show certain abnormalities. But in children, the tests show no abnormalities “and yet they are clearly deteriorated,” said Dr. Alicia Johnston, director of the Covid clinic at Boston Children’s Hospital, which has treated 40 young patients with long-term Covid, in an interview with STAT. an online health magazine.

Jakob Armann, a pediatrician at the Dresden University of Technology in Germany, is among the skeptics and believes there may be fewer cases of prolonged Covid in children than some of the studies suggest.

But he admits that even if 10 to 15 percent of children infected with Covid turn out to have long-term symptoms, “that’s a real problem. So this must be studied, ”he told the journal Nature.

Buonsenso questions the theory that psychological factors are one of the main causes of prolonged Covid. If that were the case, he argues in Nature, there would have been a longer Covid during the first wave in Italy in 2020, when the restrictions were even tougher.

Long Covid Clinics for Children

A review by the UK’s National Institute for Health Research suggests that prolonged Covid in adults could also be a number of different syndromes, including post-intensive care syndrome and post-viral fatigue syndrome, both of which also affect to the kids.

For those with long-time Covid and their families, such labels do little to ease the burden and heartache of living every day with so much uncertainty.

In recent months, however, Kasturirangan has had more reason to be optimistic. On a good day, Eli can go out to the park and play with a friend, and sometimes he can walk more than a block.

“The good days are better than before and maybe the bad days are not so bad,” Kasturirangan said. “I can see the progress, but it has been very slow.”

It is also essential to advance the long Covid investigation.

“We certainly don’t have enough data on the long-term impacts of Covid on children to make good policy decisions at this time,” said Dr. Natalie Lambert, research director at Survivor Corps, the Covid-19 advocacy group plus biggest in the world. .

However, many governments are taking steps to recognize long-lived Covid despite the absence of widespread data for children and young adults.

The British government announced in June that it would implement 15 pediatric clinics for children and adolescents with long-term Covid symptoms under its National Health Service (NHS). There are similar clinics in the US.

Vaccinating those under the age of 18 is part of the solution, as has been the policy in the US, which is ending vaccine trials for those under 12. In the UK, only those over the age of 16 are eligible for the vaccine, while children in the EU are eligible from 12.

“I think public health interventions and vaccines are a way to end this disease,” Kasturirangan said. “And whenever I can, I will talk about my experience because I don’t want anyone to go through what we did last year. It’s taken its toll on us as a family, and what’s scary is that we don’t know how long we’ll have to live with this. “

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