Ask the Pharmacist

Q) I read your series of articles about Long-COVID recently and they only seemed to talk about adults. Can kids suffer from this syndrome as well?

A) The unfortunate truth is that this syndrome is definitely possible in children and is even more poorly understood in this cohort than it is in adults, which is really saying something. This is an area we will have to address as it is becoming quite clear that the newest variant, the Delta one, is both more contagious and more virulent than any of its predecessors.

We have tended to focus on our most vulnerable, such as our seniors, since the pandemic began and for very good reason as that segment of the population still accounts for the overwhelming majority of our fatalities. However, as that age group’s vaccine rates continue to run higher, we are beginning to see a frightening trend where those most affected by this virus are trending younger.

This is highlighted, once again, by our neighbours to the south of us. Headlines on the CBC indicate that in states such as Tennessee, all pediatric beds will be occupied by the end of this week barring a sudden reversal in case numbers. This is perhaps not surprising since those under the age of 12 still do not have a vaccine option that is proven both safe and effective in addition to many areas in both of our countries are swiftly removing various social safety protocols such as masking indoors.

All that said, the vast majority of children who contract this variant will not require intubation or even hospitalization. Many will get through the initial acute infection without seeming to even lose a step. However, there is mounting evidence that some of our kids, including those that barely seemed sick, will eventually be diagnosed with the syndrome that has been dubbed Long-COVID.

The numbers seem to be high enough to have instigated the development of a number of support groups in the U.K., the U.S and now in Canada called Long COVID Kids Canada. The Canadian chapter had 100 members as of late June and seemed to be growing in membership rapidly.

With all of that being said, we really do not have any data showing how common this is within our population. As such, we have to rely on international studies. These have generally been done on small populations making their results potentially flawed. They have also produced wildly divergent numbers when it comes to predicting the frequency of this syndrome. A study conducted in Rome on 129 kids (with an average age of 11) who tested positive for the COVID-19 virus found that more than 50% of these were still being affected by at least one symptom four months later. Of these, 10% were dealing with more than three or more symptoms and 42.6% reported that their ability to perform the activities of daily living (like school, eating…) was being impaired.

A similar rate of incidence was reported in an Australian study of 171 children (with a much younger average age this time of just 3 years old) where it was reported that 8% of those kids were still symptomatic two months later.

On a grander scale, according to the Long Kids support group, there is data from England that looked at 617,000 kids (ages ranged from 0-19) who had tested positive for COVID-19. It was found that some 50,000 of these were still “sick” after 12 weeks.

Now, not all of the data is proving to be quite so dramatic. A study published in a journal called The Lancet Child and Adolescent Health reported that of the 1734 children they followed (ages ranging from 5 to 17) after they had tested positive for COVID, most got better by the 6 day mark and only 4.4% were sick longer than 4 weeks and only a paltry 1.8% reported still having symptoms at the 8 week mark.

Regardless of what the risk is of kids suffering from long COVID, it is undeniable that there is at least a small risk of it and that this can really set back these kids for months (and counting…). The symptoms of long COVID in children mimic those seen in adults in two main ways.

First the predominant complaints are similar in that overwhelming fatigue, shortness of breath, brain fog, headache and a loss of smell are all very common in these individuals. The second similarity is in the sheer breadth of symptoms experienced. There are over a 100 different symptoms listed as being found in kids with long COVID with many of them being non-specific to an infection such as chest pain, heart palpitations, muscle and joint pain, dizziness and the list obviously goes on and on.

Identifying and then helping these kids is going to be a monumental task given this wide variety of symptoms and the fact that there are no easy diagnostic tools (i.e. there is no scan or blood test that can rule long COVID in or out as a diagnosis) plus knowing that some of these kids had such a mild initial infection that their parents didn’t even know they were ever sick. This is particularly true in the younger age groups where communication can be a real challenge. Even a symptom such as fatigue can be hard to spot in this age group as this symptom often makes young children hyperactive rather than sleepy as any parent trying to put an overtired child to bed can attest to.

In response to this crisis, the United Kingdom has announced it will budget $138 million to create treatment centers around the country as well as to educate pediatricians about this new syndrome. There is no specific treatment in kids at this point in time as care is aimed at being supportive and addressing the specific symptoms rather than getting to the underlying problem.

There are very few clinics that specialize in treating long COVID in children but a few are starting to pop up here and there. One such clinic is C.S. Mott Children’s Hospital in Ann Arbour, Michigan. Here, a child is initially assessed by a pediatrician who serves as the de- facto quarterback of the team and he or she will triage the affected child to such specialists as neurologists, gastroenterologists, cardiologists, physiotherapists, dieticians and the list goes on. Long COVID seems to be a struggle for any age group, but perhaps it is most heartbreaking in children.

The best way to deal with this syndrome is by avoidance. Kids over 12 should, in the vast majority of cases, be vaccinated. Having them wear masks while attending indoor public spaces has been proven effective and is not a big ask for the majority of kids. And for heaven’s sake, the adults around them (particularly those who will be teaching them again this fall) need to be vaccinated so that we do not end up like our friends on the other side of our southern border. For more information about this or any other health related questions, contact your pharmacist.