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新冠肺炎对儿童的影响被严重低估

新冠肺炎对儿童的影响被严重低估

David Meyer 2021年10月26日

一项研究表明,在11至17岁的新冠患儿中,有14%在15周后仍有症状,年龄越大,情况似乎越严重。

2020年3月,14岁的基蒂·麦克法兰出现了咽痛和轻微咳嗽的症状。当时,新冠疫情已开始在欧洲传播,和她已经感染新冠的母亲萨米一样,这个小女孩也是连着几天低烧,并且伴有倦怠感。基蒂感觉有些呼吸困难,但却被告知不必去医院就医。倦怠的感觉又持续了几个礼拜,但其他方面逐渐恢复了正常。

萨米说:“现在回过头看,当时我们可能并没意识到自己的病情有多严重”。萨米是英格兰西部的一名普拉提与健康教练。感染新冠约六周之后,基蒂在去散步锻炼后出现了胸痛的症状,萨米说:“基蒂有8个月的时间都没法自己下床”。萨米自己当时也没办法自己下床、洗澡,她回忆道:“当时全靠我老公照顾我们。我们甚至没法自己坐起来,也没法吃东西。”

2020年5月前后,在去看全科医生时(基蒂直到今年1月才获得面诊的机会),医生告诉萨米,自己帮不了她什么,而给萨米抽血的护士则暗示她的症状可能是抑郁症的表现,她的女儿只是在模仿他们。萨米说:“现在依然有很多人认为,儿童不会感染、传播新冠,也不会留下长期症状。一直以来,只是为了让大家相信(儿童会感染新冠)已经是大费周章了。”

“新冠长期症状”是指(感染新冠后出现的)一系列症状,包括倦怠、呼吸急促、器官炎症、行为改变等等,相关症状可能在新冠肺炎痊愈后持续存在,医界目前对此依然知之甚少。此类症状与新冠病毒相关器官损伤的后遗症不同,并且往往只会出现在那些轻症或无症状感染者身上,因此很难知道其影响范围有多大。

有研究表明,约30%的新冠感染者会出现新冠长期症状,虽然大多数人能很快恢复。英国最近的一项研究表明,只有4.4%的新冠肺炎患儿的症状会持续4周以上,只有2%会持续8周以上。不过另一项研究则称,在11至17岁的新冠患儿中,有14%在15周后仍有症状,年龄越大,情况似乎越严重。为便于理解相关数字的含义,我们可以看一下欧盟和美国对“罕见病”的定义,在欧盟,只有当某种疾病的发病率低于两千分之一时,其才会被视为“罕见病”,而在美国,这一数字为二十万分之一。

萨米·麦克法兰在网上找到了面向成人的新冠长期症状支持群组,但却没找到相应的儿童群组,于是她便自行成立了新冠长期症状儿童群组,目前正在为来自不同国家的近4000名儿童提供支持和宣传,群组内儿童的中位年龄为10岁。作为一家慈善机构,该组织已被美国疾病控制和预防中心(CDC)列入资源列表,麦克法兰也被吸收进了英国国家卫生服务(NHS)新冠长期症状特别工作组之中,但她认为,有关当局对此问题的重视程度依然不足。

麦克法兰指出:“有关方面听取了我们的意见,但我认为他们并没有真正听进去。我们没有长时间追踪患儿情况,自然没有纵向数据,不过我们的方法是可行的,有些患儿患病已有12周的时间,(新冠长期症状儿童群组中的部分患儿)患病甚至已有18个月的时间。我们本身就是证据,我们的孩子就是证据。”

缺乏理解

之所以会缺少儿童新冠长期症状的相关数据,原因有很多,比如,目前对此现象尚无明确定义、研究方法存在差异,而且疫情爆发至今仍不足两年时间。

英国医学协会(British Medical Association)负责领导新冠长期症状相关事务,同时也是NHS特别工作组成员的大卫·斯特赖恩表示:“儿童(新冠长期症状)方面最大的问题是,我们尚未真正掌握出现此类症状的儿童的比例,不同报告给出的数字各不相同,从七分之一到三十分之一都有。不过即便是三十分之一,考虑到目前染疫儿童的数量,这也是个大问题”。

相较成人,诊断儿童存在新冠长期症状也更为困难。尽管绝大多数存在此种症状的成年人也有类似症状:疲劳、脑雾、胸痛,但斯特赖恩提醒称,患儿群体尚未发现典型症状。他说:“(新冠长期症状)对每个人产生的影响各不相同,影响的时间也有所差异。”

有些症状与成年人的症状相似,只是更难发现。斯特赖恩称:“孩子们的身体有很多的‘机能储备’,所以如果一个5岁的小孩损失了20%的身体机能,我们可能根本不会发现。”也就是说,已经出现注意力减退(成年人的所谓“脑雾”)、但尚未得到确诊的儿童实际上可能更多,他们可能会在未来遇到学习障碍。

不过一些更严重的症状(正是这些症状促使忧心忡忡的父母加入了儿童新冠长期症状群组)则更令人忧虑。麦克法兰说,群组内的患儿都不同程度地经历过癫痫发作、头痛、恶心、耳鸣、视力障碍、心悸、脑部炎症、发育衰退、皮疹和皮肤损伤等症状,有些情况非常严重,甚至让医生怀疑他们进行了自残。

斯特赖恩说:“关于新冠长期症状,我们现在知道的是,这似乎是一种多系统疾病,可以对血管造成影响,可以有多种不同的表现。我听说过的情况包括:皮肤损伤、疼痛、患儿彻夜难眠、生长疼痛超过正常水平、情绪波动巨大、患儿无缘无故想要上床睡觉。”

伦敦帝国理工学院国家心肺研究所(National Heart and Lung Institute, Imperial College London)的儿科名誉教授约翰·华纳说,他也遇到过患儿手指、脚趾出现冻疮样病变以及复发性皮疹的情况。他说,一些出现长期新冠症状的患儿患有所谓的儿童型多系统炎症综合征(MIS-C),此种病症或将导致器官受损。也有一些患有新冠长期症状的青少年患上了妥瑞症(Tourette’s syndrome),此种疾病表现为抽搐,有时还会不由自主地说脏话。

华纳说:“对于青少年来说,这些都是非常可怕的症状,不仅对孩子,而且对其他家庭成员和周围相关人员都会造成极大的精神压力。”他补充说,他还曾遇到过一位患者,这位患者原本对树木果实有轻度过敏,但在感染新冠后,过敏情况极度恶化,“她对苹果过敏,不过还是喜欢吃,加上之前症状不严重,所以她在感染新冠病毒后又吃了苹果,结果出现了严重的过敏反应,差点丢了性命,之前从未出现过这种情况。”

面对如此众多的症状,加上数量未知的患儿正在遭受新冠长期症状的摧残,决策者应该采取哪些不同措施?现在又该如何行动呢?

平衡风险

随着各国逐步解封,打开国境,有些人通过计算得出,解封的好处大于病毒感染大部分或全部未接种疫苗的少年儿童将会带来的后果。

今年8月,当丹麦决定取消最后的管制措施时,该国国家卫生委员会的主任——索伦·布罗斯特勒姆说,“儿童感染是很自然的事,我们并不打算让儿童成为病毒传播的媒介,但儿童感染对我们而言并非不可接受,因为他们的症状通常并不严重。”丹麦卫生专家尼尔斯·斯特兰德伯格同时表示:“对儿童进行管制毫无意义”,民众应当“接受”大多数儿童会在今年年底前感染新冠病毒的事实。

伦敦国王学院(King’s College London)临床内分泌学教授艾玛·邓肯认为,给儿童接种疫苗的理由不如成年人充分,因为成年人接种疫苗的益处远远大于风险。新冠患儿罹患心脏炎症的风险非常小,可以说是极其罕见,而且大多数患儿会很快康复,但考虑到儿童通常不会像成人那样因患病而出现严重症状,相关计算可能也需要进行一定调整。

邓肯表示:“我们需要对利弊进行权衡,一方面,从个人和社区的角度来看,我们需要考虑预防感染新冠可能带来哪些风险和好处,包括对学校中断教学的影响,另一方面,我们还需要考虑接种疫苗的风险和好处。”邓肯领导的一项研究表明,只有不到2%的儿童的新冠长期症状持续时间超过了8周。

“这个比例很低,”她指出,“虽然根据新冠患儿的数量(取决于社区流动情况和疫苗接种率)来看,该数字的绝对值可能依然很大。”

华纳认为,有关当局“之前”就应该加大儿童群体的疫苗接种力度,这样他们就可以在儿童拥有免疫保护的情况下开放国境了。他不仅担心新冠肺炎可能对儿童造成长期的健康影响,还担心疫情零星爆发导致封校,进而影响儿童的教育。

斯特赖恩也表示,他对那些在未向儿童提供充足保护的情况下就执行解封政策的国家感到“非常担心”。他说:“我完全同意儿童入院风险远低于成年人的说法,在所有感染新冠病毒的儿童中,入院的儿童的比例确实很低。但我们并不清楚新冠肺炎会产生怎样的长期影响。”

斯特赖恩补充道:“在我们尚未完全理解此种疾病的机制、并且其后果可能要到多年之后才会慢慢显现的情况下,冒然让孩子们承担如此风险至少显得有些鲁莽。我完全理解重新开放经济的必要性,但采取一定的简单措施,比如在学校佩戴口罩、加强通风,并不会阻碍经济的发展,也不会妨碍我们的生活。我们应当采取这些措施来保护我们的下一代。”

父母的选择

萨米·麦克法兰同样建议在学校强制佩戴口罩、加强通风。她说:“我建议向所有儿童提供疫苗,可以不强制,将选择权交给父母,但我认为我们必须承认,新冠长期症状的风险的确存在,我们应当通过改进学校的预防措施来预防儿童感染新冠病毒。我认为,除非我们能坦诚面对问题,否则普通家庭将无法通过改变自己的习惯来抑制病毒传播。”

各方均认为有必要提供紧急支持,而这种支持的有效性则取决于对新冠长期症状能否有更好的理解。英国政府最近投入了2700万美元用于研究新冠病毒长期症状。华纳表示,此举或将使得更有效的靶向治疗成为可能。

“关键问题在于,医疗系统的所有医生都需要认识到新冠长期症状这一问题的严峻性,而不是仅仅将其当作一种心理问题,让患者自己(从‘心魔’中走出来)或者去看心理医生。这是生理上的问题,因而必须有某种形式的生理解决方案。而且人们常常会忽视相关问题。”

部分出现新冠长期症状的患者存在倦怠的情况,对此,华纳说,应当设立逐渐增加身体和精神活动的项目。“如果我们不促使患者进行相关训练,他们将无法恢复工作能力,甚至可能会永远无法恢复!”(财富中文网)

译者:梁宇

审校:夏林

2020年3月,14岁的基蒂·麦克法兰出现了咽痛和轻微咳嗽的症状。当时,新冠疫情已开始在欧洲传播,和她已经感染新冠的母亲萨米一样,这个小女孩也是连着几天低烧,并且伴有倦怠感。基蒂感觉有些呼吸困难,但却被告知不必去医院就医。倦怠的感觉又持续了几个礼拜,但其他方面逐渐恢复了正常。

萨米说:“现在回过头看,当时我们可能并没意识到自己的病情有多严重”。萨米是英格兰西部的一名普拉提与健康教练。感染新冠约六周之后,基蒂在去散步锻炼后出现了胸痛的症状,萨米说:“基蒂有8个月的时间都没法自己下床”。萨米自己当时也没办法自己下床、洗澡,她回忆道:“当时全靠我老公照顾我们。我们甚至没法自己坐起来,也没法吃东西。”

2020年5月前后,在去看全科医生时(基蒂直到今年1月才获得面诊的机会),医生告诉萨米,自己帮不了她什么,而给萨米抽血的护士则暗示她的症状可能是抑郁症的表现,她的女儿只是在模仿他们。萨米说:“现在依然有很多人认为,儿童不会感染、传播新冠,也不会留下长期症状。一直以来,只是为了让大家相信(儿童会感染新冠)已经是大费周章了。”

“新冠长期症状”是指(感染新冠后出现的)一系列症状,包括倦怠、呼吸急促、器官炎症、行为改变等等,相关症状可能在新冠肺炎痊愈后持续存在,医界目前对此依然知之甚少。此类症状与新冠病毒相关器官损伤的后遗症不同,并且往往只会出现在那些轻症或无症状感染者身上,因此很难知道其影响范围有多大。

有研究表明,约30%的新冠感染者会出现新冠长期症状,虽然大多数人能很快恢复。英国最近的一项研究表明,只有4.4%的新冠肺炎患儿的症状会持续4周以上,只有2%会持续8周以上。不过另一项研究则称,在11至17岁的新冠患儿中,有14%在15周后仍有症状,年龄越大,情况似乎越严重。为便于理解相关数字的含义,我们可以看一下欧盟和美国对“罕见病”的定义,在欧盟,只有当某种疾病的发病率低于两千分之一时,其才会被视为“罕见病”,而在美国,这一数字为二十万分之一。

萨米·麦克法兰在网上找到了面向成人的新冠长期症状支持群组,但却没找到相应的儿童群组,于是她便自行成立了新冠长期症状儿童群组,目前正在为来自不同国家的近4000名儿童提供支持和宣传,群组内儿童的中位年龄为10岁。作为一家慈善机构,该组织已被美国疾病控制和预防中心(CDC)列入资源列表,麦克法兰也被吸收进了英国国家卫生服务(NHS)新冠长期症状特别工作组之中,但她认为,有关当局对此问题的重视程度依然不足。

麦克法兰指出:“有关方面听取了我们的意见,但我认为他们并没有真正听进去。我们没有长时间追踪患儿情况,自然没有纵向数据,不过我们的方法是可行的,有些患儿患病已有12周的时间,(新冠长期症状儿童群组中的部分患儿)患病甚至已有18个月的时间。我们本身就是证据,我们的孩子就是证据。”

缺乏理解

之所以会缺少儿童新冠长期症状的相关数据,原因有很多,比如,目前对此现象尚无明确定义、研究方法存在差异,而且疫情爆发至今仍不足两年时间。

英国医学协会(British Medical Association)负责领导新冠长期症状相关事务,同时也是NHS特别工作组成员的大卫·斯特赖恩表示:“儿童(新冠长期症状)方面最大的问题是,我们尚未真正掌握出现此类症状的儿童的比例,不同报告给出的数字各不相同,从七分之一到三十分之一都有。不过即便是三十分之一,考虑到目前染疫儿童的数量,这也是个大问题”。

相较成人,诊断儿童存在新冠长期症状也更为困难。尽管绝大多数存在此种症状的成年人也有类似症状:疲劳、脑雾、胸痛,但斯特赖恩提醒称,患儿群体尚未发现典型症状。他说:“(新冠长期症状)对每个人产生的影响各不相同,影响的时间也有所差异。”

有些症状与成年人的症状相似,只是更难发现。斯特赖恩称:“孩子们的身体有很多的‘机能储备’,所以如果一个5岁的小孩损失了20%的身体机能,我们可能根本不会发现。”也就是说,已经出现注意力减退(成年人的所谓“脑雾”)、但尚未得到确诊的儿童实际上可能更多,他们可能会在未来遇到学习障碍。

不过一些更严重的症状(正是这些症状促使忧心忡忡的父母加入了儿童新冠长期症状群组)则更令人忧虑。麦克法兰说,群组内的患儿都不同程度地经历过癫痫发作、头痛、恶心、耳鸣、视力障碍、心悸、脑部炎症、发育衰退、皮疹和皮肤损伤等症状,有些情况非常严重,甚至让医生怀疑他们进行了自残。

斯特赖恩说:“关于新冠长期症状,我们现在知道的是,这似乎是一种多系统疾病,可以对血管造成影响,可以有多种不同的表现。我听说过的情况包括:皮肤损伤、疼痛、患儿彻夜难眠、生长疼痛超过正常水平、情绪波动巨大、患儿无缘无故想要上床睡觉。”

伦敦帝国理工学院国家心肺研究所(National Heart and Lung Institute, Imperial College London)的儿科名誉教授约翰·华纳说,他也遇到过患儿手指、脚趾出现冻疮样病变以及复发性皮疹的情况。他说,一些出现长期新冠症状的患儿患有所谓的儿童型多系统炎症综合征(MIS-C),此种病症或将导致器官受损。也有一些患有新冠长期症状的青少年患上了妥瑞症(Tourette’s syndrome),此种疾病表现为抽搐,有时还会不由自主地说脏话。

华纳说:“对于青少年来说,这些都是非常可怕的症状,不仅对孩子,而且对其他家庭成员和周围相关人员都会造成极大的精神压力。”他补充说,他还曾遇到过一位患者,这位患者原本对树木果实有轻度过敏,但在感染新冠后,过敏情况极度恶化,“她对苹果过敏,不过还是喜欢吃,加上之前症状不严重,所以她在感染新冠病毒后又吃了苹果,结果出现了严重的过敏反应,差点丢了性命,之前从未出现过这种情况。”

面对如此众多的症状,加上数量未知的患儿正在遭受新冠长期症状的摧残,决策者应该采取哪些不同措施?现在又该如何行动呢?

平衡风险

随着各国逐步解封,打开国境,有些人通过计算得出,解封的好处大于病毒感染大部分或全部未接种疫苗的少年儿童将会带来的后果。

今年8月,当丹麦决定取消最后的管制措施时,该国国家卫生委员会的主任——索伦·布罗斯特勒姆说,“儿童感染是很自然的事,我们并不打算让儿童成为病毒传播的媒介,但儿童感染对我们而言并非不可接受,因为他们的症状通常并不严重。”丹麦卫生专家尼尔斯·斯特兰德伯格同时表示:“对儿童进行管制毫无意义”,民众应当“接受”大多数儿童会在今年年底前感染新冠病毒的事实。

伦敦国王学院(King’s College London)临床内分泌学教授艾玛·邓肯认为,给儿童接种疫苗的理由不如成年人充分,因为成年人接种疫苗的益处远远大于风险。新冠患儿罹患心脏炎症的风险非常小,可以说是极其罕见,而且大多数患儿会很快康复,但考虑到儿童通常不会像成人那样因患病而出现严重症状,相关计算可能也需要进行一定调整。

邓肯表示:“我们需要对利弊进行权衡,一方面,从个人和社区的角度来看,我们需要考虑预防感染新冠可能带来哪些风险和好处,包括对学校中断教学的影响,另一方面,我们还需要考虑接种疫苗的风险和好处。”邓肯领导的一项研究表明,只有不到2%的儿童的新冠长期症状持续时间超过了8周。

“这个比例很低,”她指出,“虽然根据新冠患儿的数量(取决于社区流动情况和疫苗接种率)来看,该数字的绝对值可能依然很大。”

华纳认为,有关当局“之前”就应该加大儿童群体的疫苗接种力度,这样他们就可以在儿童拥有免疫保护的情况下开放国境了。他不仅担心新冠肺炎可能对儿童造成长期的健康影响,还担心疫情零星爆发导致封校,进而影响儿童的教育。

斯特赖恩也表示,他对那些在未向儿童提供充足保护的情况下就执行解封政策的国家感到“非常担心”。他说:“我完全同意儿童入院风险远低于成年人的说法,在所有感染新冠病毒的儿童中,入院的儿童的比例确实很低。但我们并不清楚新冠肺炎会产生怎样的长期影响。”

斯特赖恩补充道:“在我们尚未完全理解此种疾病的机制、并且其后果可能要到多年之后才会慢慢显现的情况下,冒然让孩子们承担如此风险至少显得有些鲁莽。我完全理解重新开放经济的必要性,但采取一定的简单措施,比如在学校佩戴口罩、加强通风,并不会阻碍经济的发展,也不会妨碍我们的生活。我们应当采取这些措施来保护我们的下一代。”

父母的选择

萨米·麦克法兰同样建议在学校强制佩戴口罩、加强通风。她说:“我建议向所有儿童提供疫苗,可以不强制,将选择权交给父母,但我认为我们必须承认,新冠长期症状的风险的确存在,我们应当通过改进学校的预防措施来预防儿童感染新冠病毒。我认为,除非我们能坦诚面对问题,否则普通家庭将无法通过改变自己的习惯来抑制病毒传播。”

各方均认为有必要提供紧急支持,而这种支持的有效性则取决于对新冠长期症状能否有更好的理解。英国政府最近投入了2700万美元用于研究新冠病毒长期症状。华纳表示,此举或将使得更有效的靶向治疗成为可能。

“关键问题在于,医疗系统的所有医生都需要认识到新冠长期症状这一问题的严峻性,而不是仅仅将其当作一种心理问题,让患者自己(从‘心魔’中走出来)或者去看心理医生。这是生理上的问题,因而必须有某种形式的生理解决方案。而且人们常常会忽视相关问题。”

部分出现新冠长期症状的患者存在倦怠的情况,对此,华纳说,应当设立逐渐增加身体和精神活动的项目。“如果我们不促使患者进行相关训练,他们将无法恢复工作能力,甚至可能会永远无法恢复!”(财富中文网)

译者:梁宇

审校:夏林

In March 2020, Kitty Mcfarland developed a sore throat and a minor cough. The 14-year-old had a slightly raised temperature for a couple of days and felt fatigued, like her mother, Sammie, who had already caught the novel coronavirus that had begun spreading across Europe. Kitty’s breathing was a bit labored, but she was told she didn’t need to go the hospital. For several weeks, she appeared tired but otherwise recovered.

“Looking back, I don’t think we realized how ill we were,” says Sammie, a Pilates and well-being coach in the west of England. Around six weeks postinfection, after going for a walk to get some exercise, Kitty experienced chest pains. “She didn’t get out of bed unaided for eight months,” says her mother, who also found herself unable to get out of bed or clean herself. “My husband became our carer for the entire time. We didn’t even have the ability to sit up and eat meals without being supported.”

When Sammie visited her general practitioner around May 2020—it would take Kitty until January this year to see a doctor, who said he couldn’t help her—the nurse who took her blood suggested that her symptoms might be depressive, and that her daughter was mimicking them. “The narrative is still very much that children don’t get ill, don’t transmit COVID, don’t get long COVID,” Sammie says. “It’s been a battle the whole way through, just to be believed.”

Long COVID is a poorly understood collection of symptoms, ranging from fatigue and shortness of breath to organ inflammation and behavioral changes, that may persist after someone recovers from coronavirus infection. It is distinct from the lingering effects of COVID-related organ damage and, as it often affects people who may have experienced mild or no symptoms during their infection, it is difficult to know how widespread it is.

Some studies suggest around 30% of people who had COVID go on to develop long-COVID symptoms, although most recover quickly. One recent U.K. study suggested only 4.4% of children with symptomatic COVID experience symptoms beyond four weeks, and only 2% beyond eight. However, another study said 14% of 11- to 17-year-olds who contracted COVID were still suffering from symptoms 15 weeks later—older children seem to fare worse. To put those numbers into perspective, the European Union considers a disease “rare” when it affects fewer than one in 2,000; in the U.S., it’s one in 200,000.

Looking online, Sammie Mcfarland was able to find a long COVID support group for adults, but nothing for children, so she founded the Long COVID Kids group, which now provides support and advocacy for nearly 4,000 children in a variety of countries, with a median age of 10. The charity is listed as a resource by the U.S. Centers for Disease Control and Prevention (CDC), and Mcfarland is on the U.K. National Health Service (NHS) Long COVID Task Force, but she still doesn’t believe authorities are taking the issue seriously enough.

“People are listening, but I don’t think they’re hearing what we’re saying,” Mcfarland notes. “We don’t have the longitudinal data [tracking patients over time] so therefore there’s this blasé approach that children are ill for 12 weeks. [Some children in the Long COVID Kids group] have been ill for 18 months. We are the evidence; our children are the evidence.”

Poor understanding

The lack of data around long COVID in children has several contributing factors, including the absence of a clear definition for the phenomenon, variance in research methodologies, and the fact that we are still less than two years into the pandemic.

“The big problem in kids is that we don’t really have a true handle on the rate of it,” says David Strain, the British Medical Association’s lead on long COVID and another member of the NHS task force. “The numbers vary depending on which report you’re reading—anything from one in seven, down to one in 30. But even if it’s one in 30, with the number of children getting it at the moment, that’s a huge problem.”

It’s also harder to diagnose long COVID in children than it is in adults. Whereas the vast majority of adults suffering from the condition have similar symptoms—fatigue, brain fog, chest pains—Strain warns there is no typical presentation in children. “It affects everybody differently and at different timescales,” he says.

Some of the symptoms are similar to those experienced by adults, albeit harder to spot. “Kids have a tremendous biological reserve,” says Strain. “If you take away 20% of the energy of a 5-year-old, you don’t really notice it.” That could mean a large number of children with reduced concentration levels—“what in an older person would be regarded as brain fog”—could remain undiagnosed and could suffer during their ongoing education.

However, some of the more extreme symptoms—the kind that concerned parents enough to join the Long COVID Kids group—are more immediately worrying. Mcfarland says the group’s members have variously experienced seizures, headaches, nausea, tinnitus, visual impairment, heart palpitations, brain inflammation, developmental regression, rashes, and skin lesions so severe that doctors incorrectly suspected they were the result of self-harm.

“One thing we know about long COVID is it seems to be a multisystem disease affecting blood vessels, [and it] can present in a whole host of different manifestations,” says Strain. “I’ve heard of skin lesions, aches and pains, children being awake through the night with more than standard growing pains, huge mood swings, children who just go to bed for no apparent reason.”

John Warner, emeritus professor of pediatrics at the National Heart and Lung Institute, Imperial College London, says he has also come across chilblain-like lesions on children’s fingers and toes, as well as recurrent rashes. Some kids with long COVID have what is known as multisystem inflammatory syndrome in children (MIS-C), which can leave them with organ damage, he says. Then there are the teenagers with long COVID who have also developed Tourette’s syndrome, which manifests in tics, sometimes including uncontrollable outbursts of foul language.

“These are horrible symptoms for a teenager, causing incredible mental stress, not only for the child but also for the rest of the family and everybody around them,” says Warner. He adds that he also spoke to a sufferer whose mild allergy to tree fruits had suddenly become worse after her illness: “She had the COVID infection and, because she still likes eating apples, she had an anaphylactic reaction that nearly killed her, having never had anything like that before.”

So with such a vast array of symptoms manifesting, and with an unknown number of children being affected by long COVID, what should policymakers have done differently—and what should they be doing now?

Balancing risks

As countries open up after a period of lockdowns, some have calculated that the benefits will outweigh the effects of the virus ripping through largely or entirely unvaccinated younger age groups.

“It is quite natural for infection to occur among children,” said Søren Brostrøm, director of Denmark’s National Board of Health, in August when the country dropped its last restrictions. “We don’t have a strategy that the infection should spread through the children, but we accept infection because children don’t get so sick.” Danish health expert Nils Strandberg said at the same time that “restrictions among children serve no purpose” and that people would have to “get over” the fact that most of their kids would be infected by the end of this year.

According to Emma Duncan, professor of clinical endocrinology at King’s College London, the case for vaccinating children is less clear-cut than it is for adults, where the benefits of vaccination vastly outweigh the risks. There is a very small risk of heart inflammation in children who get the COVID jab—it’s extremely rare, and most people recover from it quickly, but it may change the calculus when children typically don’t get as sick from the disease itself as adults do.

“There is a balance to be considered: On the one hand, the risks and benefits of avoiding SARS-CoV-2—both from an individual and a community perspective, including the effect on school interruption—and on the other, the risks and benefits of vaccination,” says Duncan, who led the research showing that fewer than 2% of children presenting with long COVID have symptoms for longer than eight weeks.

“This percentage is low,” she notes, “though as the number of children infected with SARS-CoV-2 depends on community circulation and vaccination rates [it] could still represent a large absolute number.”

Warner argues that authorities should have pushed harder for kids’ vaccines “some time ago, so they could then open up with children having been protected.” He is worried not only about the long-term health legacy for today’s children, but also about COVID outbreaks closing schools and further damaging pupils’ education.

Strain also says he is “very concerned” about countries opening up with insufficient protection for kids. “I fully accept that children have a much lower risk of ending up in hospital. It does represent a very small percentage of the children who get it,” he says. “But we don’t know the long-term consequences.

“The risk of voluntarily putting children through this, when we don’t fully understand it and the problems might not be manifest for years, is reckless to say the least,” adds Strain. “I fully appreciate the need to reopen the economy, but simple measures like wearing masks in school, like enhanced ventilation, they’re not going to hold the economy back or prevent us from getting on with our lives. They are the sorts of measures we should have in place to protect the future generation.”

Parental choice

Sammie Mcfarland also recommends mandatory mask-wearing in schools, and better ventilation. “I would recommend offering the vaccine to all children,” she says. “I don’t think it should be mandatory—I believe in parental choice—but I think we have to admit that long COVID is a risk and look at how we can prevent infection by improving mitigation measures in school. Until we have that honesty, I don’t think families will moderate their habits enough to reduce transmission.”

Everyone agrees there is a need for urgent support, the effectiveness of which will depend on a better understanding of long COVID. The British government recently devoted $27 million to long-COVID research, and Warner says this could make it possible to better target treatments.

“The key issue is about physicians throughout the health service recognizing that long COVID is a real issue and…not a mental health problem where it’s just a matter of trying to get people to [pull themselves through it] or if anything just going to see a psychologist or a psychiatrist,” he says. “This is a physical problem that has to have some form of physical solution. And there has been a tendency for people to just be dismissed.”

Some cases of long COVID involve post-viral fatigue, which Warner says requires programs that gradually increase physical and mental activity. “Unless people have to do that, they will remain incapacitated,” he warns. “Maybe forever.”

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