A wide variety of long-term effects can occur in minors
“The clinical picture is very variable,” explains Markus Hufnagel, pediatric infectiologist from the Center for Pediatric and Adolescent Medicine at the Freiburg University Hospital. For example, he is aware of these consequences, which can also occur in combination: chronic exhaustion, a general reduction in performance, joint and muscle pain or skin changes, similar to chilblains on the toes. In his experience, persistent loss of smell and taste has so far played a subordinate role in children and adolescents compared to adults.
Other viral infections could also be behind alleged post-Covid disease
“In general, the symptoms are not SARS-CoV-2-specific. This means that we are also familiar with such persistent health restrictions from other viral infections such as Pfeiffer’s glandular fever,” says Hufnagel. Doctors would therefore test the children and adolescents to rule out other infections. As a rule, parents expressed the suspicion of a connection with a corona infection, in some cases there is already evidence of antibodies in the children and young people affected.
Hufnagel warns against underestimating the possible long-term corona consequences for children and adolescents. He assumes that the numbers of those affected increase the higher the total number of cases: “The problem is currently getting bigger rather than smaller, we are already seeing significantly more post-Covid cases.” Teenagers are more likely to be affected than children: “These are more likely to be patients in adolescence. Cases in the first ten years of life are significantly less common,” says Hufnagel.
How many children and young people are affected by Long-Covid?
There is currently no extensive data from Germany on the subject, says Hufnagel. Together with colleagues from the Dresden University Children’s Hospital, he has therefore established a register of the disease progression of all inpatient children and adolescents with SARS-CoV-2 infection from the German Society for Pediatric Infectious Diseases. A study in which households with corona cases were followed over a longer period of time showed that five percent of children and adolescents under 14 years of age still had at least one symptom three months after an infection. In adults, however, it affects up to one in three, describes Hufnagel.
A study by the British Office for National Statistics (ONS) assumes that in Great Britain the proportion of those who still have at least one symptom such as cough, fever or fatigue five weeks after a SARS-CoV-2 infection is among the two- up to eleven-year-olds is around 13 percent. For 12 to 16 year olds it is 14.5 percent.
“As a result of the relaxation of the measures, we expect more people to be affected with mostly diffuse, longer-lasting health problems.” Markus Hufnagel, pediatric infectiologist from the Center for Pediatric and Adolescent Medicine at the Freiburg University Hospital
Children and adolescents are not yet vaccinated against Covid-19
Children and young people in the EU are not yet allowed to be vaccinated against Covid-19. Some companies are already testing their corona vaccine on minors: Biontech and Pfizer have been carrying out studies on children aged six months and over since Thursday, Moderna and Astrazeneca are also testing their vaccines on children, and Johnson & Johnson plans to follow soon. Usually, vaccine manufacturers work their way up to younger and younger age groups.
Sharply increasing number of cases, especially among children and young people
Until children and adolescents get a corona vaccine, Hufnagel expects more corona infections among young people in the course of relaxed corona measures and gradual school and daycare openings – and thus more long-term consequences. In fact, the Robert Koch Institute reports in its current situation reports that the number of Covid-19 cases is rising again in all age groups, “but particularly strongly among children and adolescents”. Covid-19-related outbreaks are currently not only affecting private households and the professional environment, but “increasingly also daycare centers and schools”.
Medicine not yet prepared for children and adolescents with post-Covid
Markus Hufnagel is concerned if the number of children and teenagers affected by coronavirus long-term effects also increases: “Compared to the care situation for adults after an infection, pediatrics are not yet prepared for this.” In order to help affected minors and their parents, there are considerations to set up special outpatient clinics for children and adolescents. The self-help initiative “Long Covid Kids” has already been founded in Great Britain, in which children or their parents report long-term consequences and seek like-minded people and help.
Nevertheless, it should not be forgotten that when long-term effects occur after a Covid 19 disease, the generally stressful and tiring pandemic situation can also play a role – and not just the coronavirus alone, Markus Hufnagel points out.
“The lockdown is a major stress factor. If the pandemic situation improves, at least some of those affected should also see better signs of fatigue.” Markus Hufnagel, pediatric infectiologist from the Center for Pediatric and Adolescent Medicine at the Freiburg University Hospital
Severe inflammatory syndrome PIMS / MIS-C after Covid-19
Some studies provide evidence of other consequences of Covid 19 disease that children can suffer from. However, they are often ascribed to a disease of their own and not seen as a post-Covid disease. Nevertheless, children can also suffer long-term damage from this, for example to the heart. In a few cases, for example, a non-specific reaction of the immune system can occur four to six weeks after a SARS-CoV-2 infection. They then develop severe inflammatory syndrome that affects the entire body.
This so-called multi-inflammatory syndrome (MIS-C ; or PIMS or PIM Syndrome for: Pediatric Inflammatory Multisystem Syndrome) can cause fever, severe abdominal pain, diarrhea, vomiting, rashes, conjunctivitis and inflammation of the blood vessels and tissues, among other things. If left untreated, it can lead to circulatory collapse and damage to the coronary arteries. This disease is similar to Kawasaki syndrome, an autoimmune disease that occurs mainly in young children as a result of Covid-19 disease, but is more serious. MIS-C can also be fatal because it attacks many organ systems. This is what researchers around Mubbasheer Ahmed from Texas Children’s Hospital found out in September 2020.
Caroline Diorio from the Children’s Hospital of Philadelphia and her colleagues showed in December 2020 that a coronavirus infection in children can disrupt the blood coagulation system, lead to microthromboses, damage the blood vessel walls and also the kidneys.
Study on children and Covid-19 disease at the Augsburg University Hospital
How children survive corona infections and why they sometimes have a sudden inflammatory reaction, the so-called PIM syndrome, for example, is what the Augsburg University Hospital is now trying to find out. For the “Augsburg plus” study, around 500 children – girls and boys from kindergartens, elementary schools and secondary schools – are to be tested several times and accompanied. The Augsburg doctors take the possible risk of long-term Covid-19 consequences for children and adolescents very seriously. Michael Frühwald, Director of the Clinic for Pediatric and Adolescent Medicine at the University Hospital Augsburg, warns: Covid-19 is not a harmless infection for children either.
“We still know far too little about the long-term progression.” Michael Frühwald, Director of the Clinic for Pediatric and Adolescent Medicine at the University Hospital Augsburg
Examine children and adolescents carefully and accompany them closely
The doctors who deal with corona long-term effects in young people agree on how important it is to also examine children and young people with a SARS-CoV-2 infection carefully and, if necessary, to monitor them medically – and to do so in the longer term accompany. And not only those who have more severe courses of Covid-19, but also those with supposedly mild symptoms. Possible long-term effects can affect anyone, which is why it is also important to test for asymptomatic infections.