Long Term COVID-19 for Children and Youth

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experts are studying how seemingly mild cases of COVID-19 turn into debilitating long-distance cases of COVID-19. Svetlana Gustova/Getty Images
  • Recent studies have found that as many as 1 in 4 people who have COVID-19 end up with COVID-19 remotely. But research is still ongoing.
  • Experts are also studying how far COVID-19 affects children and young people.
  • Long-term symptoms of COVID-19 can appear several weeks after the initial infection, even if the initial infection is mild or asymptomatic. Symptoms can also change over time.

While COVID-19 cases are declining in the United States, experts are still studying what impact a year-long global pandemic will have on our long-term physical and mental health.

In particular, attention has turned to people with remote COVID-19, a syndrome that appears in people who have persistent symptoms after an acute COVID-19 case.

While most people with severe COVID-19 are adults, experts are studying how seemingly mild cases of COVID-19 have turned into debilitating long-term cases of COVID-19.

Recent studies have found that as many as 1 in 4 people who have COVID-19 end up with COVID-19 remotely. But research is still ongoing.

Remote COVID-19, often referred to as “long-term COVID-19”, can involve a wide variety of symptoms, some of which include:

  • fatigue
  • difficulty concentrating
  • hard to breathe
  • Muscle ache
  • depression
  • anxiety

Symptoms can appear several weeks after the initial infection, even if the initial infection is mild or asymptomatic. Symptoms can also change over time.

Although much of the attention surrounding remote COVID-19 has focused on adults, preliminary research suggests that it can also affect children and adolescents.

In these cases, many children have apparently mild cases that lead to long-term, debilitating COVID-19.

Researchers are still working to uncover the remote causes of COVID-19 and identify the most effective treatment approaches.

For one family, the effects of the pandemic are not ending anytime soon, even as cases in the United States decline.

Molly Burch was 16 years old in March 2020, when she first developed symptoms of COVID-19.

“He started with a mild cough on March 8, and then on March 9, his cough got worse and he had a fever,” Molly’s mother, Ann Wallace, told Healthline.

Over the next 3 weeks, Molly’s symptoms worsened before improving.

After the initial infection has passed, some of the symptoms persist, and months later, new symptoms appear.

“I thought he was getting better, but in August, his symptoms came back with new shortness of breath,” Wallace said. “I remember because it was her birthday; he was having trouble breathing, and that was very worrying.”

Molly’s acute illness may have subsided, but the teenager never fully recovered.

Walking up the stairs now left Molly out of breath. A day at school exhausted him.

Symptoms are consistent with remote COVID-19, where symptoms persist for weeks or months after a person first contracted the virus that causes COVID-19.

“I feel like in the last week, he was better than the week before,” Wallace said. “But you never know with a long COVID. You can think you’re clear and then get slammed. ”

One of the challenges in diagnosing COVID-19 remotely is that many people who contract the virus are never tested. Or they may have been tested only after the virus was cleared from their system.

Testing capacity was severely limited when Molly fell ill in March 2020. Her doctors suspected she had COVID-19 based on her symptoms, but she did not meet the narrow testing criteria that existed at the time in her home state of New Jersey.

“Molly has never been abroad. He had no contact with any known cases of COVID. And he had a fever and cough, but not shortness of breath,” Wallace recalled.

More than a week after Molly fell ill, Wallace also developed symptoms of COVID-19.

Both were finally tested on March 22: Wallace’s results were positive, but Molly’s was negative.

That doesn’t mean that Molly doesn’t have COVID-19. By the time he was tested, he was already weeks in his illness – at the point where the virus was often no longer detectable.

“The place where we were tested said, ‘Molly is suspected to be positive,’” Wallace said. “Doctors initially said, ‘We think it’s COVID,’ and my positive test gave further credence to that.”

Like COVID-19 itself, remote COVID-19 is a new condition with many unknowns. Health care professionals must learn on the go, which has posed challenges for them and the people they work with, including Molly and Wallace.

“It’s not that people don’t offer to help. It’s just that at first, no help was offered,” Wallace said.

“And it’s still annoying, having trouble getting treatment for people with long-standing COVID,” he said.

Over the past year, more specialized clinics have opened across the country to provide rehabilitation support to people recovering from COVID-19.

Norton Children’s COVID-19 Follow-up Clinic in Louisville, Kentucky, focuses on the care of children and adolescents in particular.

“We’re starting to pay attention to children who have persistent symptoms of COVID-19, and there’s not a lot of data or resources to help some of these kids,” said Dr. Daniel B. Blatt, pediatric infectious disease specialist at the clinic. . “So we decided to create our own clinic to not only treat these children, but also investigate the nuances of the syndrome.”

Before Blatt gives a child a remote diagnosis of COVID-19, he examines other potential causes of their symptoms.

Remote COVID-19 causes common symptoms, meaning they are similar to other conditions. For example, fatigue and shortness of breath can be caused by various infections.

“One thing we’re really good at as infectious disease doctors is figuring out if it’s long COVID or another infection that could look like long COVID,” Blatt said.

“Then we will have the patient come back and follow up at our clinic or we will refer them to a different sub-specialist depending on their symptoms,” he continued.

For example, Blatt might refer a child to a pulmonologist or cardiologist if they have shortness of breath.

He or she may refer them to a psychologist or psychiatrist if they experience anxiety or depression.

Doctor Molly recently ordered a chest X-ray and referred her to a cardiologist.

To help children and families cope with COVID-19 long-term, Blatt said one of the most important things a healthcare professional can provide is emotional support and reassurance.

“Almost everyone we’ve dealt with so far with old COVID gets better over time,” Blatt said. “It’s scary and frustrating to have prolonged symptoms, but the reassurance that they will get better helps with a lot of anxiety.”

Emotional support is also a key aspect of the care that Noah Greenspan, DPT, CCS, EMT-B provides to patients at the COVID-19 Rehabilitation and Recovery Center at H&D Physical Therapy in Manhattan, New York. Greenspan is a cardiopulmonary and complex medical physical therapist and founder of the Pulmonary Wellness Foundation.

“COVID-19 is a global pandemic,” Greenspan told Healthline. “The situation is constantly evolving. The information is only as good as the last news cycle, and recommendations are constantly changing.”

“That in itself triggers anxiety,” he continued. “Plus, the isolation, the inability to get tested, dealing with this critical illness. This is a very challenging time.”

Greenspan has been treating Wallace’s persistent symptoms on his own after COVID-19, while also offering his support in managing his daughter’s health needs.

“One thing Noah has to offer is awareness about how my family is affected, how I’ve been affected by my daughter’s health, and how helping her get better has also helped me,” Wallace said.

Children with remote COVID-19 also need support from other members of the community, including school personnel.

“I think we need school leaders to pay attention to kids who have COVID, so they’re not pushed too hard,” Wallace said.

Molly’s school recently adopted a hybrid learning approach, meaning she has face-to-face classes 2 days a week and round-the-clock online classes. The academic demands have been difficult for him to manage.

“Several weeks in a row, he went to school on Wednesdays and then couldn’t get out of bed on Thursdays,” Wallace said. “You know, trying to go to school just knocked him out.”

Even when Molly attends online classes from home, it requires very little energy.

“We need accommodation, even when the kids are learning from home,” Wallace said.

Wallace would like to see people take the risks of COVID-19 in children more seriously, including the long-term risks of COVID-19. These conditions can have far-reaching effects on a child’s health and well-being.

“In a child’s life, being sick for a year is a big deal,” Wallace said. “Think of all the developmental and social milestones children go through in a year.”

Blatt told Healthline that the only way to avoid COVID-19 remotely is to do what you can to avoid COVID-19 in the first place.

“And the best way not to catch COVID is to get vaccinated,” he said.

That Centers for Disease Control and Prevention (CDC) recommends COVID-19 vaccination for adults and children 12 years of age and over. Researchers continue to study the safety and efficacy of the vaccine in younger children, who are not currently eligible to be vaccinated.

The more adults and older children get vaccinated, the more protection younger children can provide.

Higher vaccination rates in a community help stop the infection from spreading.

Wearing a mask also lowers the risk of transmission.

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