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A National Institutes of Health (NIH) study has found that 5.8 million children have experienced long COVID—symptoms of COVID-19 that have persisted long after the initial infection. The Nationwide research effort called the Researching COVID to Enhance Recovery (RECOVER) Initiative involved 10 pediatric hospital in the U.S., sought to provide vital information for doctors on the difficulty of diagnosing and treating post-acute sequelae of SARS-CoV-2 (PASC) and to better understanding its trajectory—and persistence—in these patients over time.

Results of the study are published in the journal Pediatrics.

“At our Long COVID Recovery Care clinic, some patients have symptoms for two months and there are others whose symptoms have still not gone away two years later,” said study co-author Sindhu Mohandas, MD, co-director, Immunocompromised Infectious Diseases Program at the Children’s Hospital Los Angeles.

For this research, the RECOVER collaborators scoured the existing literature across a number of different areas of expertise to provide a comprehensive view of how long COVID has affected children and youth. “Our goal was to summarize all available knowledge from those smaller articles, case reports and clinic-based studies on the full range of long COVID symptoms that we are seeing across the U.S.,” Mohandas stated.

The team found some common factors of long COVID risk among this population: 45% of long COVID patients experienced symptoms of the infection versus only 15% who were asymptomatic. Other factors increasing risk included older age, severity of initial infection, the number of organs initially affected, other underlying medical conditions, and higher weight.

Similar to findings of long COVID in adults, the most common symptoms in younger people include fatigue, persistent headaches, weakness, musculoskeletal pain, shortness of breath, loss of taste and smell, and dizziness.

Further, between two percent and 44 percent of children experience “brain fog” after physical of mental effort, the well documented difficulties some long COVID sufferers have concentrating. The researchers note that brain fog and fatigue symptoms from long COVID  are very similar to the symptoms myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which can last for six months or more.

Additional complications related to long COVID include the development of type 1 and type 2 diabetes a month after initial infection and multisystem inflammatory syndrome in children (MIS-C). This condition is likely related to an abnormally strong activation of the immune system in combating the initial infection and can result is heart damage and other cardiovascular health issues.

Long COVID has also been shown to worsen pre-existing health issues in children, notably chronic respiratory conditions such as asthma, which several studies have shown does not worsen during the initial infection, but often did worsen in the ensuing six months.

In general, the report noted that pediatricians are underdiagnosing long COVID. “Some believe children don’t get long COVID and others just don’t know the signs and symptoms. I think the big ’added value’ to this published study is that it provides some of the characteristic ’fingerprints’ that pediatricians can use to recognize long COVID,” noted co-author John C. Wood, MD, PhD, a cardiologist and investigator at the Children’s Hospital Los Angeles.

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