August 3, 2021

expert reaction to study looking at long-lasting symptoms from COVID-19 in children

A study published in The Lancet Child & Adolescent Health looks at illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2.

This Roundup accompanied an SMC Briefing.

Dr Jeremy Rossman, Senior Lecturer in Virology at the University of Kent, said:

“Recent analysis from the Zoe app looks at the symptom profile and their duration in children with a confirmed positive SARS-CoV-2 test. The study provides important information about symptomology in children but likely underestimates the actual prevalence of Long COVID in children. The current study only assesses children with a defined illness duration, as such, this excludes all children with on-going disease. Studies on adults with Long COVID have show that symptom duration can be well over a year and patient support groups report many adults and children who have yet to recover. In addition, the study excludes any children that report being asymptomatic for more than one week before symptoms return. Many patient support groups report symptoms changing over time, including periods without symptoms. Thus, the current study provides a rigorous threshold for determining Long COVID that provides good evidence for the occurrence of Long COVID in children, though by excluding some data, the study likely underestimates the actual prevalence of the disease in children.”

Prof Russell Viner, Professor of Child and Adolescent Health, UCL, said:

“This is a useful new study that confirms that most children infected with COVID-19 have few symptoms that generally last a short time.  The most important finding is the low proportion that had persistent symptoms, the great majority of whom recovered by 2 months after illness.  This is much lower than reported in some other studies and is reassuring about the population burden of post-COVID symptoms in children and young people.  This study is a nice example of involvement of a wide range of the population in data collection, however the data have a number of weaknesses and we await high quality controlled data on post-COVID symptoms in children.”

Dr Liz Whittaker, infectious disease lead at the Royal College of Paediatrics and Child Health and  Senior Clinical Lecturer in paediatric infectious diseases and immunology at Imperial College London, said:

“This study is reassuring for the majority of children and young people who develop SARS-CoV-2 infection, and reflects what paediatricians are seeing in clinical practice.  It is important that the small group of children who experience persistent symptoms can access the pathways for assessment that have been established across the country in a timely fashion.  We encourage families, teachers, GPs and paediatricians to recognise and support these young people to do this.  Further research into the mechanism, diagnostics and outcomes is urgently required.”

Dr Alasdair Munro, Clinical Research Fellow in Paediatric Infectious Diseases, said:

“This study from Molteni et al is a welcome contribution to the area of symptom burden of COVID-19 among children.  The methodology is fairly robust, and the addition of a symptomatic, test negative control group helps to add important context to the interpretation of results.  Importantly, the results are consistent with most other studies on the symptomology of paediatric COVID-19.  The most common symptoms, including headache, fatigue and sore throat, would not meet case definition criteria for testing in the UK.  Symptom burden appears to increase with age, and this is also seen for persistent symptoms after acute infection, beyond 28 or 56 days.  This would reaffirm that children are the least likely to suffer from prolonged symptoms after acute infection, and indeed the absolute rates of children with symptoms beyond 28 days (4.4%) or 56 days (1.8%) are low.  Whilst children with negative test results were less likely to suffer from prolonged symptoms (0.9% at 28 days), interestingly this cohort had a higher symptom burden than those testing positive for SARS-CoV-2.  Severe symptoms appear very rare.

“Persistent symptoms after COVID-19 in children fortunately appear uncommon, and families can be reassured that in the event of an infection in children the risk to the individual remains extremely low.  Ongoing research into differing syndromes post acute COVID-19 will remain important to support those children who do suffer from fatigue and anosmia, amongst other symptoms.  Hopefully the NIHR funded CLoCK study will also be able to provide further information to guide us in this emerging field in the near future.”

‘Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2’ by Erika Molteni et al. was published in The Lancet Child & Adolescent Health at 23:30 UK time on Tuesday 3 August 2021.

DOI: 10.1016/S2352-4642(21)00198-X

Declared interests

None received.