The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While many SARS-CoV-2 infections are asymptomatic or cause mild disease, some become severe or even critical.

Study: Long Term Physical, Mental and Social Health Effects of COVID-19 in the Pediatric Population: A Scoping Review. Image Credit: Ann Rodchua/ Shutterstock

Moreover, the persistence of ill effects in adults following serologic recovery, lasting months, is a concerning aspect of COVID-19. The low prevalence of COVID-19 in children has led to a correspondingly low number of studies in this population. A recent preprint on the medRxiv* server deals with the incidence and importance of long-term COVID-19, often called long COVID, in children.

A preprint version of the study is available on the medRxiv* server while the article undergoes peer review.

Background

In the USA, children make up 22% of the population, but only 15.5% of the total cases of COVID-19 reported to the Center for Disease Control and Prevention (CDC) are pediatric cases.

Pediatric studies on long COVID are few. The number of infections among children is sure to be a gross underestimate due to a general reluctance among parents to have their children tested following contact with a COVID-19-positive individual. The low rate of symptomatic infection among children is another major contributor to this trend.

Hospitalizations among children are much less common than in adults due to the milder phenotype of pediatric COVID-19. A few children do develop severe illness, though very few have died. Some children develop a rare Kawasaki disease–like multisystem inflammatory syndrome (MIS-C), even after asymptomatic infection.

Effects of COVID-19

The acute symptoms of COVID-19 include fever, cough, breathlessness, muscle pain and chills, sore throat, and anosmia/ageusia. While adults most often complain of continuing fatigue and shortness of breath during their recovery, lasting for months, the majority recover within two weeks.

Like long COVID-19 in adults, children may also have persistent joint pain, insomnia, headache, and breathing trouble. Earlier research is based on the reports from one center in Rome, which had a small number of pediatric COVID-19 patients despite being the largest hospital in Rome.

Apart from the physiological impact of the viral illness, COVID-19 has caused profound changes to the environment in which children grow up. The isolation from friends, family, and school, and the loss of educational opportunities, may all have worsened the current emotional, mental, and behavioral profile of today's children.

What did the study show?

The review shows that most children who are reported to have more than acute illness following infection with SARS-CoV-2 have chronic tiredness, inattention or brain fog, insomnia and other sleep disturbances, and lingering problems with taste and/or smell.

A large proportion of studies in children have focused on identifying any significant differences in the clinical features of the illness compared to adult COVID-19. Fortunately, these are insignificant, and diagnosis of pediatric COVID-19 follows the same route as in adults.

MIS-C patients present with shock, fatigue, fever, and inflammation, with myocarditis and other cardiovascular findings. Long-term effects in children with mild infection include fatigue, joint pain, myalgia, headache, breathing problems, concentration issues, and disturbances of sensory function.
Long-term virus shedding has been reported in a few studies on pediatric COVID-19.

Children's mental health issues related to the pandemic include anxiety and depression, mostly related to their restriction to the home environment. One study in the USA did show that children from Chinese-American families suffered from a sense of racial discrimination during the pandemic.

A reduction in positive mood seemed to accompany less physical activity in children, with studies also showing depressive symptoms, marked anxiety, and other mental and social issues. Some children showed insecurity symptoms, clinging to their parents, avoiding questions about the pandemic, and distractibility.

Others were more affectionate or more restless or frustrated. Behavioral changes as reported by parents were mostly negative. Worsening relationships with peers, anger, sleep disturbances, and an overall decline in quality of life were identified in

What are the implications?

The researchers found that few studies dealt with long COVID-19 in children. One study with about 130 children found that more than half had one persistent symptom. This corroborates an earlier review that found little data on long-haulers among children with COVID-19.

The reason for long COVID symptoms in children may be due to an aberrant immune or inflammatory response in certain tissues that have a high expression of the viral receptor, the angiotensin-converting enzyme 2 (ACE2).

The presence of the virus in the central nervous system could also be responsible for anxiety, depression, and other mental health issues. Still, more studies are required to understand how this operates. Physical symptoms may also worsen mental issues, especially if the child experienced MIS-C.

Further research will build up the body of knowledge about the effects of the virus on the human child body, both acute and chronic, mental, emotional, and physical.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.