Covid: long covid update, including in kids

 -- The UK has an ongoing, updated tally of the prevalence of continuing symptoms following Covid-19 infection, the latest being 5Aug2021 and reflecting data for the four-week period ending 4 July 2021 (see  https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/5august2021/. major points:

    --1.5% of the population (approx 945,000 people) has self-reported in a representative survey that they had "long covid", defined as symptoms persisting >4 weeks after the beginning of suspected covid infection 

        --mostly 25-34yo (132,000 people), 35-49 (253,000), 50-69 (361,000)

    --835,000 (88%) had or suspected to have had covid at least 12 weeks previously (1.3% of population), 232,000 with symptoms 26-39 weeks after infection and 380,000 (40%) at least one year later (0.6% of the population)

       --611,000 (65%) had symptoms that affected day-to-day activities; 182,000 (19%) reported activities were "limited a lot"

    --most common symptoms: fatigue (528,000), shortness of breath (388,000), myalgias (296,000), and loss of smell (285,000)

    --overall, age with highest prevalence for long covid: 35-69yo; also more in females, people living in the most deprived area, those working in health care or social care, and those with another activity-limiting health condition or disability

Commentary:

-- pretty striking when one sees the real numbers of people likely impaired for a long time after this miserable infection.  very different, for example, from influenza, which does have its issues (myocarditis, etc) though much less prevalent

    -- and this long covid syndrome happens most often after only mild to moderate infections, and happens to lots of younger people (see below)

-- interesting that the Israeli study of post-vaccination breakthrough infections found that 19% had symptoms 6 weeks post-infection, though there were only small numbers of people who had these infections (see http://gmodestmedblogs.blogspot.com/2021/08/covid-breakthrough-infections-and-assoc.html )

limitations:

--this study was based on survey information and not actual clinical evaluation, so may not be so accurate

--the Delta variant surge in the UK began in mid-May and peaked in mid-July. so this data is likely not to include the Delta variant much, since there would not be more than 8 weeks of potential post-virus time when survey done

    --and, given the increased transmissibility of the Delta variant, would not be surprising if these numbers grew substantially

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--as an important related note: the NY Times had a rather striking article on long covid in kids, quoting Dr Francis Collins at the NIH that between 11 and 15% of infected youth might "end up with this long-term consequence, which can be pretty devastating in terms of things like school performance".

https://www.nytimes.com/2021/08/08/health/long-covid-kids.html?referringSource=articleShare . this article detailed the lives of several afflicted children with long covid, as well as the dismal rates of vaccination (<50%) in the 12-17yo group and that nearly 4.2 million young people in the US have had covid infection

--a report in Nature (see https://www.nature.com/articles/d41586-021-01935-7?mc_source=MTEyNjQxNzM4NjMzNDg2MjM3NzEwOjo6ZTU2NTZmYzEzYjBhNDczZWIxMGJhZDU5NzQxMjljNGQ6OnY0OjoxNjI3OTYyMDYwOjox ) noted several studies: 

    --a study in the early days of Covid in Italy (see https://onlinelibrary.wiley.com/doi/10.1111/apa.15870), between March and October 2020 reported interviews by pediatricians of 129 children aged 6-16 (mean age 11, 48% female) with covid infection 30 days prior to assessment, finding:

        -- 33 children (26%) were asymptomatic, 96 (74%) symptomatic; 5% hospitalized, 2% ICU

        -- 3 developed multisystem inflammatory syndrome (2%), 2 myocarditis (2%)

        -- assessment on average 163 days after covid diagnosis

        -- 42% completely recovered, 36% had 1-2 symptoms, 23% had 3 or more of: insomnia (19%),  respiratory symptoms (15%), nasal congestion (12%), fatigue (11%), muscle pain (10%), joint pain (7%), concentration difficulties (10%) (ie similar symptoms to adults). These symptoms were "particularly frequent in those assessed >60 days after the initial diagnosis" [ie, 59% were symptomatic at an average of over 5 months after the infection, 23% with 3 or more symptoms!!!!]

        -- these long covid symptoms occurred in both symptomatic and asymptomatic infected children, though more so in symptomatic ones, and even more so in those hospitalized (these numbers were small, and none reached statistical significance)

        -- at >120 days, 21 kids (31%) had 1-2 symptoms; 14 (21%) had 3 or more

        -- 5 (7%) felt the symptoms caused "quite a lot" of distress at >120 days and 6 (20%) at 60-120 days

        -- most of the symptoms got better over time, though at >120 days post-infection, 34% still had some symptoms, (20% in the 60-120 day range), and 7% "quite a lot"

    -- a Swedish study also found that 5 kids (mean age 12) reported suffering from fatigue, dyspnea, heart palpitations, and chest pain >60 days after diagnosis

    -- the UK survey above (much larger than the Italian study, but a survey instead of clinician report, found that 9% of 2-11 year olds and 18% of those 12-16 yo had continuing symptoms at least 12 weeks after covid infection

Commentary:

--this report extends the accumulating findings that long covid occurs in kids, and actually even in those asymptomatic!!

    --and it raises the issue that kids who present with these symptoms (eg insomnia, fatigue) should have prior covid infection (even asymptomatic) on their differential diagnosis. fortunately, many seem to get better over time. 

Limitations:

--only a limited number of studies on children are available, and the Italian one was from a single center, limiting generalizabilty to the overall global population

--many of the symptoms are self-reported, subjective symptoms, so not formally validatable objectively. But these numbers far outdistance those of influenza, for example

--unclear what their sample of asymptomatic kids comes from. were these kids aware they had covid (and perhaps have some placebo effect)??? were they around adults who had long covid, who might have influenced their symptomatology?? was there underlying psych issues (eg depression) associated with living through the horrendous Covid epidemic in Italy at the time?? would therapy (counseling/antidepressants) help?? seems like that should be assessed...

    --and, we do know there has been profound increases in psych/substance use issues during covid: see http://gmodestmedblogs.blogspot.com/2020/08/covid-severe-psych-substance-use.html )

--unclear how long the symptoms will last (Covid, though it may seem to have been here for eons, is actually only a year plus old....). will be important to have longer followup to understand the course of long covid.

so, it is clear that long covid happens in kids, that it can follow mildly asymptomatic or even asymptomatic cases, and that it can be associated with longish term significant disability in this vulnerable group otherwise blossoming at that age in the intellectual and social arenas. and, it is happening in those with quite low vaccination rates but who would qualify for vaccines. these studies and statistics could potentially serve as a real-world, fact-based incentive for those vaccine-hesitant (though facts don't seem to matter to many, especially in our current distorted sociopolitical environment and social media falsehoods/scare tactics). the above also details the rather profound effects of long covid on adults (and the very high-risk middle-aged adults are also not so great on the vaccination front).  on a more positive note, a recent poll of youth though found that 75% were interested in the vaccine, though this study was limited by being a national text message survey of those 14-24yo (see https://jamanetwork.com/journals/jama-health-forum/fullarticle/2783471?utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email )

of course, these percentages of those afflicted with long covid translates to huge numbers of people, given the huger numbers who get covid; and this will likely continue to recur in waves as future cycles of new variants occur, at least until vaccination rates/herd immunity on a global level is adequate....

geoff

 

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