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    新冠肺炎對兒童的影響被嚴重低估

    新冠肺炎對兒童的影響被嚴重低估

    David Meyer 2021年10月26日

    一項研究表明,在11至17歲的新冠患兒中,有14%在15周后仍有癥狀,年齡越大,情況似乎越嚴重。

    2020年3月,14歲的基蒂·麥克法蘭出現了咽痛和輕微咳嗽的癥狀。當時,新冠疫情已開始在歐洲傳播,和她已經感染新冠的母親薩米一樣,這個小女孩也是連著幾天低燒,并且伴有倦怠感?;俑杏X有些呼吸困難,但卻被告知不必去醫院就醫。倦怠的感覺又持續了幾個禮拜,但其他方面逐漸恢復了正常。

    薩米說:“現在回過頭看,當時我們可能并沒意識到自己的病情有多嚴重”。薩米是英格蘭西部的一名普拉提與健康教練。感染新冠約六周之后,基蒂在去散步鍛煉后出現了胸痛的癥狀,薩米說:“基蒂有8個月的時間都沒法自己下床”。薩米自己當時也沒辦法自己下床、洗澡,她回憶道:“當時全靠我老公照顧我們。我們甚至沒法自己坐起來,也沒法吃東西?!?/p>

    2020年5月前后,在去看全科醫生時(基蒂直到今年1月才獲得面診的機會),醫生告訴薩米,自己幫不了她什么,而給薩米抽血的護士則暗示她的癥狀可能是抑郁癥的表現,她的女兒只是在模仿他們。薩米說:“現在依然有很多人認為,兒童不會感染、傳播新冠,也不會留下長期癥狀。一直以來,只是為了讓大家相信(兒童會感染新冠)已經是大費周章了?!?/p>

    “新冠長期癥狀”是指(感染新冠后出現的)一系列癥狀,包括倦怠、呼吸急促、器官炎癥、行為改變等等,相關癥狀可能在新冠肺炎痊愈后持續存在,醫界目前對此依然知之甚少。此類癥狀與新冠病毒相關器官損傷的后遺癥不同,并且往往只會出現在那些輕癥或無癥狀感染者身上,因此很難知道其影響范圍有多大。

    有研究表明,約30%的新冠感染者會出現新冠長期癥狀,雖然大多數人能很快恢復。英國最近的一項研究表明,只有4.4%的新冠肺炎患兒的癥狀會持續4周以上,只有2%會持續8周以上。不過另一項研究則稱,在11至17歲的新冠患兒中,有14%在15周后仍有癥狀,年齡越大,情況似乎越嚴重。為便于理解相關數字的含義,我們可以看一下歐盟和美國對“罕見病”的定義,在歐盟,只有當某種疾病的發病率低于兩千分之一時,其才會被視為“罕見病”,而在美國,這一數字為二十萬分之一。

    薩米·麥克法蘭在網上找到了面向成人的新冠長期癥狀支持群組,但卻沒找到相應的兒童群組,于是她便自行成立了新冠長期癥狀兒童群組,目前正在為來自不同國家的近4000名兒童提供支持和宣傳,群組內兒童的中位年齡為10歲。作為一家慈善機構,該組織已被美國疾病控制和預防中心(CDC)列入資源列表,麥克法蘭也被吸收進了英國國家衛生服務(NHS)新冠長期癥狀特別工作組之中,但她認為,有關當局對此問題的重視程度依然不足。

    麥克法蘭指出:“有關方面聽取了我們的意見,但我認為他們并沒有真正聽進去。我們沒有長時間追蹤患兒情況,自然沒有縱向數據,不過我們的方法是可行的,有些患兒患病已有12周的時間,(新冠長期癥狀兒童群組中的部分患兒)患病甚至已有18個月的時間。我們本身就是證據,我們的孩子就是證據?!?/p>

    缺乏理解

    之所以會缺少兒童新冠長期癥狀的相關數據,原因有很多,比如,目前對此現象尚無明確定義、研究方法存在差異,而且疫情爆發至今仍不足兩年時間。

    英國醫學協會(British Medical Association)負責領導新冠長期癥狀相關事務,同時也是NHS特別工作組成員的大衛·斯特賴恩表示:“兒童(新冠長期癥狀)方面最大的問題是,我們尚未真正掌握出現此類癥狀的兒童的比例,不同報告給出的數字各不相同,從七分之一到三十分之一都有。不過即便是三十分之一,考慮到目前染疫兒童的數量,這也是個大問題”。

    相較成人,診斷兒童存在新冠長期癥狀也更為困難。盡管絕大多數存在此種癥狀的成年人也有類似癥狀:疲勞、腦霧、胸痛,但斯特賴恩提醒稱,患兒群體尚未發現典型癥狀。他說:“(新冠長期癥狀)對每個人產生的影響各不相同,影響的時間也有所差異?!?/p>

    有些癥狀與成年人的癥狀相似,只是更難發現。斯特賴恩稱:“孩子們的身體有很多的‘機能儲備’,所以如果一個5歲的小孩損失了20%的身體機能,我們可能根本不會發現?!币簿褪钦f,已經出現注意力減退(成年人的所謂“腦霧”)、但尚未得到確診的兒童實際上可能更多,他們可能會在未來遇到學習障礙。

    不過一些更嚴重的癥狀(正是這些癥狀促使憂心忡忡的父母加入了兒童新冠長期癥狀群組)則更令人憂慮。麥克法蘭說,群組內的患兒都不同程度地經歷過癲癇發作、頭痛、惡心、耳鳴、視力障礙、心悸、腦部炎癥、發育衰退、皮疹和皮膚損傷等癥狀,有些情況非常嚴重,甚至讓醫生懷疑他們進行了自殘。

    斯特賴恩說:“關于新冠長期癥狀,我們現在知道的是,這似乎是一種多系統疾病,可以對血管造成影響,可以有多種不同的表現。我聽說過的情況包括:皮膚損傷、疼痛、患兒徹夜難眠、生長疼痛超過正常水平、情緒波動巨大、患兒無緣無故想要上床睡覺?!?/p>

    倫敦帝國理工學院國家心肺研究所(National Heart and Lung Institute, Imperial College London)的兒科名譽教授約翰·華納說,他也遇到過患兒手指、腳趾出現凍瘡樣病變以及復發性皮疹的情況。他說,一些出現長期新冠癥狀的患兒患有所謂的兒童型多系統炎癥綜合征(MIS-C),此種病癥或將導致器官受損。也有一些患有新冠長期癥狀的青少年患上了妥瑞癥(Tourette’s syndrome),此種疾病表現為抽搐,有時還會不由自主地說臟話。

    華納說:“對于青少年來說,這些都是非??膳碌陌Y狀,不僅對孩子,而且對其他家庭成員和周圍相關人員都會造成極大的精神壓力?!彼a充說,他還曾遇到過一位患者,這位患者原本對樹木果實有輕度過敏,但在感染新冠后,過敏情況極度惡化,“她對蘋果過敏,不過還是喜歡吃,加上之前癥狀不嚴重,所以她在感染新冠病毒后又吃了蘋果,結果出現了嚴重的過敏反應,差點丟了性命,之前從未出現過這種情況?!?/p>

    面對如此眾多的癥狀,加上數量未知的患兒正在遭受新冠長期癥狀的摧殘,決策者應該采取哪些不同措施?現在又該如何行動呢?

    平衡風險

    隨著各國逐步解封,打開國境,有些人通過計算得出,解封的好處大于病毒感染大部分或全部未接種疫苗的少年兒童將會帶來的后果。

    今年8月,當丹麥決定取消最后的管制措施時,該國國家衛生委員會的主任——索倫·布羅斯特勒姆說,“兒童感染是很自然的事,我們并不打算讓兒童成為病毒傳播的媒介,但兒童感染對我們而言并非不可接受,因為他們的癥狀通常并不嚴重?!钡溞l生專家尼爾斯·斯特蘭德伯格同時表示:“對兒童進行管制毫無意義”,民眾應當“接受”大多數兒童會在今年年底前感染新冠病毒的事實。

    倫敦國王學院(King’s College London)臨床內分泌學教授艾瑪·鄧肯認為,給兒童接種疫苗的理由不如成年人充分,因為成年人接種疫苗的益處遠遠大于風險。新冠患兒罹患心臟炎癥的風險非常小,可以說是極其罕見,而且大多數患兒會很快康復,但考慮到兒童通常不會像成人那樣因患病而出現嚴重癥狀,相關計算可能也需要進行一定調整。

    鄧肯表示:“我們需要對利弊進行權衡,一方面,從個人和社區的角度來看,我們需要考慮預防感染新冠可能帶來哪些風險和好處,包括對學校中斷教學的影響,另一方面,我們還需要考慮接種疫苗的風險和好處?!编嚳项I導的一項研究表明,只有不到2%的兒童的新冠長期癥狀持續時間超過了8周。

    “這個比例很低,”她指出,“雖然根據新冠患兒的數量(取決于社區流動情況和疫苗接種率)來看,該數字的絕對值可能依然很大?!?/p>

    華納認為,有關當局“之前”就應該加大兒童群體的疫苗接種力度,這樣他們就可以在兒童擁有免疫保護的情況下開放國境了。他不僅擔心新冠肺炎可能對兒童造成長期的健康影響,還擔心疫情零星爆發導致封校,進而影響兒童的教育。

    斯特賴恩也表示,他對那些在未向兒童提供充足保護的情況下就執行解封政策的國家感到“非常擔心”。他說:“我完全同意兒童入院風險遠低于成年人的說法,在所有感染新冠病毒的兒童中,入院的兒童的比例確實很低。但我們并不清楚新冠肺炎會產生怎樣的長期影響?!?/p>

    斯特賴恩補充道:“在我們尚未完全理解此種疾病的機制、并且其后果可能要到多年之后才會慢慢顯現的情況下,冒然讓孩子們承擔如此風險至少顯得有些魯莽。我完全理解重新開放經濟的必要性,但采取一定的簡單措施,比如在學校佩戴口罩、加強通風,并不會阻礙經濟的發展,也不會妨礙我們的生活。我們應當采取這些措施來保護我們的下一代?!?/p>

    父母的選擇

    薩米·麥克法蘭同樣建議在學校強制佩戴口罩、加強通風。她說:“我建議向所有兒童提供疫苗,可以不強制,將選擇權交給父母,但我認為我們必須承認,新冠長期癥狀的風險的確存在,我們應當通過改進學校的預防措施來預防兒童感染新冠病毒。我認為,除非我們能坦誠面對問題,否則普通家庭將無法通過改變自己的習慣來抑制病毒傳播?!?/p>

    各方均認為有必要提供緊急支持,而這種支持的有效性則取決于對新冠長期癥狀能否有更好的理解。英國政府最近投入了2700萬美元用于研究新冠病毒長期癥狀。華納表示,此舉或將使得更有效的靶向治療成為可能。

    “關鍵問題在于,醫療系統的所有醫生都需要認識到新冠長期癥狀這一問題的嚴峻性,而不是僅僅將其當作一種心理問題,讓患者自己(從‘心魔’中走出來)或者去看心理醫生。這是生理上的問題,因而必須有某種形式的生理解決方案。而且人們常常會忽視相關問題?!?/p>

    部分出現新冠長期癥狀的患者存在倦怠的情況,對此,華納說,應當設立逐漸增加身體和精神活動的項目?!叭绻覀儾淮偈够颊哌M行相關訓練,他們將無法恢復工作能力,甚至可能會永遠無法恢復!”(財富中文網)

    譯者:梁宇

    審校:夏林

    2020年3月,14歲的基蒂·麥克法蘭出現了咽痛和輕微咳嗽的癥狀。當時,新冠疫情已開始在歐洲傳播,和她已經感染新冠的母親薩米一樣,這個小女孩也是連著幾天低燒,并且伴有倦怠感?;俑杏X有些呼吸困難,但卻被告知不必去醫院就醫。倦怠的感覺又持續了幾個禮拜,但其他方面逐漸恢復了正常。

    薩米說:“現在回過頭看,當時我們可能并沒意識到自己的病情有多嚴重”。薩米是英格蘭西部的一名普拉提與健康教練。感染新冠約六周之后,基蒂在去散步鍛煉后出現了胸痛的癥狀,薩米說:“基蒂有8個月的時間都沒法自己下床”。薩米自己當時也沒辦法自己下床、洗澡,她回憶道:“當時全靠我老公照顧我們。我們甚至沒法自己坐起來,也沒法吃東西?!?/p>

    2020年5月前后,在去看全科醫生時(基蒂直到今年1月才獲得面診的機會),醫生告訴薩米,自己幫不了她什么,而給薩米抽血的護士則暗示她的癥狀可能是抑郁癥的表現,她的女兒只是在模仿他們。薩米說:“現在依然有很多人認為,兒童不會感染、傳播新冠,也不會留下長期癥狀。一直以來,只是為了讓大家相信(兒童會感染新冠)已經是大費周章了?!?/p>

    “新冠長期癥狀”是指(感染新冠后出現的)一系列癥狀,包括倦怠、呼吸急促、器官炎癥、行為改變等等,相關癥狀可能在新冠肺炎痊愈后持續存在,醫界目前對此依然知之甚少。此類癥狀與新冠病毒相關器官損傷的后遺癥不同,并且往往只會出現在那些輕癥或無癥狀感染者身上,因此很難知道其影響范圍有多大。

    有研究表明,約30%的新冠感染者會出現新冠長期癥狀,雖然大多數人能很快恢復。英國最近的一項研究表明,只有4.4%的新冠肺炎患兒的癥狀會持續4周以上,只有2%會持續8周以上。不過另一項研究則稱,在11至17歲的新冠患兒中,有14%在15周后仍有癥狀,年齡越大,情況似乎越嚴重。為便于理解相關數字的含義,我們可以看一下歐盟和美國對“罕見病”的定義,在歐盟,只有當某種疾病的發病率低于兩千分之一時,其才會被視為“罕見病”,而在美國,這一數字為二十萬分之一。

    薩米·麥克法蘭在網上找到了面向成人的新冠長期癥狀支持群組,但卻沒找到相應的兒童群組,于是她便自行成立了新冠長期癥狀兒童群組,目前正在為來自不同國家的近4000名兒童提供支持和宣傳,群組內兒童的中位年齡為10歲。作為一家慈善機構,該組織已被美國疾病控制和預防中心(CDC)列入資源列表,麥克法蘭也被吸收進了英國國家衛生服務(NHS)新冠長期癥狀特別工作組之中,但她認為,有關當局對此問題的重視程度依然不足。

    麥克法蘭指出:“有關方面聽取了我們的意見,但我認為他們并沒有真正聽進去。我們沒有長時間追蹤患兒情況,自然沒有縱向數據,不過我們的方法是可行的,有些患兒患病已有12周的時間,(新冠長期癥狀兒童群組中的部分患兒)患病甚至已有18個月的時間。我們本身就是證據,我們的孩子就是證據?!?/p>

    缺乏理解

    之所以會缺少兒童新冠長期癥狀的相關數據,原因有很多,比如,目前對此現象尚無明確定義、研究方法存在差異,而且疫情爆發至今仍不足兩年時間。

    英國醫學協會(British Medical Association)負責領導新冠長期癥狀相關事務,同時也是NHS特別工作組成員的大衛·斯特賴恩表示:“兒童(新冠長期癥狀)方面最大的問題是,我們尚未真正掌握出現此類癥狀的兒童的比例,不同報告給出的數字各不相同,從七分之一到三十分之一都有。不過即便是三十分之一,考慮到目前染疫兒童的數量,這也是個大問題”。

    相較成人,診斷兒童存在新冠長期癥狀也更為困難。盡管絕大多數存在此種癥狀的成年人也有類似癥狀:疲勞、腦霧、胸痛,但斯特賴恩提醒稱,患兒群體尚未發現典型癥狀。他說:“(新冠長期癥狀)對每個人產生的影響各不相同,影響的時間也有所差異?!?/p>

    有些癥狀與成年人的癥狀相似,只是更難發現。斯特賴恩稱:“孩子們的身體有很多的‘機能儲備’,所以如果一個5歲的小孩損失了20%的身體機能,我們可能根本不會發現?!币簿褪钦f,已經出現注意力減退(成年人的所謂“腦霧”)、但尚未得到確診的兒童實際上可能更多,他們可能會在未來遇到學習障礙。

    不過一些更嚴重的癥狀(正是這些癥狀促使憂心忡忡的父母加入了兒童新冠長期癥狀群組)則更令人憂慮。麥克法蘭說,群組內的患兒都不同程度地經歷過癲癇發作、頭痛、惡心、耳鳴、視力障礙、心悸、腦部炎癥、發育衰退、皮疹和皮膚損傷等癥狀,有些情況非常嚴重,甚至讓醫生懷疑他們進行了自殘。

    斯特賴恩說:“關于新冠長期癥狀,我們現在知道的是,這似乎是一種多系統疾病,可以對血管造成影響,可以有多種不同的表現。我聽說過的情況包括:皮膚損傷、疼痛、患兒徹夜難眠、生長疼痛超過正常水平、情緒波動巨大、患兒無緣無故想要上床睡覺?!?/p>

    倫敦帝國理工學院國家心肺研究所(National Heart and Lung Institute, Imperial College London)的兒科名譽教授約翰·華納說,他也遇到過患兒手指、腳趾出現凍瘡樣病變以及復發性皮疹的情況。他說,一些出現長期新冠癥狀的患兒患有所謂的兒童型多系統炎癥綜合征(MIS-C),此種病癥或將導致器官受損。也有一些患有新冠長期癥狀的青少年患上了妥瑞癥(Tourette’s syndrome),此種疾病表現為抽搐,有時還會不由自主地說臟話。

    華納說:“對于青少年來說,這些都是非??膳碌陌Y狀,不僅對孩子,而且對其他家庭成員和周圍相關人員都會造成極大的精神壓力?!彼a充說,他還曾遇到過一位患者,這位患者原本對樹木果實有輕度過敏,但在感染新冠后,過敏情況極度惡化,“她對蘋果過敏,不過還是喜歡吃,加上之前癥狀不嚴重,所以她在感染新冠病毒后又吃了蘋果,結果出現了嚴重的過敏反應,差點丟了性命,之前從未出現過這種情況?!?/p>

    面對如此眾多的癥狀,加上數量未知的患兒正在遭受新冠長期癥狀的摧殘,決策者應該采取哪些不同措施?現在又該如何行動呢?

    平衡風險

    隨著各國逐步解封,打開國境,有些人通過計算得出,解封的好處大于病毒感染大部分或全部未接種疫苗的少年兒童將會帶來的后果。

    今年8月,當丹麥決定取消最后的管制措施時,該國國家衛生委員會的主任——索倫·布羅斯特勒姆說,“兒童感染是很自然的事,我們并不打算讓兒童成為病毒傳播的媒介,但兒童感染對我們而言并非不可接受,因為他們的癥狀通常并不嚴重?!钡溞l生專家尼爾斯·斯特蘭德伯格同時表示:“對兒童進行管制毫無意義”,民眾應當“接受”大多數兒童會在今年年底前感染新冠病毒的事實。

    倫敦國王學院(King’s College London)臨床內分泌學教授艾瑪·鄧肯認為,給兒童接種疫苗的理由不如成年人充分,因為成年人接種疫苗的益處遠遠大于風險。新冠患兒罹患心臟炎癥的風險非常小,可以說是極其罕見,而且大多數患兒會很快康復,但考慮到兒童通常不會像成人那樣因患病而出現嚴重癥狀,相關計算可能也需要進行一定調整。

    鄧肯表示:“我們需要對利弊進行權衡,一方面,從個人和社區的角度來看,我們需要考慮預防感染新冠可能帶來哪些風險和好處,包括對學校中斷教學的影響,另一方面,我們還需要考慮接種疫苗的風險和好處?!编嚳项I導的一項研究表明,只有不到2%的兒童的新冠長期癥狀持續時間超過了8周。

    “這個比例很低,”她指出,“雖然根據新冠患兒的數量(取決于社區流動情況和疫苗接種率)來看,該數字的絕對值可能依然很大?!?/p>

    華納認為,有關當局“之前”就應該加大兒童群體的疫苗接種力度,這樣他們就可以在兒童擁有免疫保護的情況下開放國境了。他不僅擔心新冠肺炎可能對兒童造成長期的健康影響,還擔心疫情零星爆發導致封校,進而影響兒童的教育。

    斯特賴恩也表示,他對那些在未向兒童提供充足保護的情況下就執行解封政策的國家感到“非常擔心”。他說:“我完全同意兒童入院風險遠低于成年人的說法,在所有感染新冠病毒的兒童中,入院的兒童的比例確實很低。但我們并不清楚新冠肺炎會產生怎樣的長期影響?!?/p>

    斯特賴恩補充道:“在我們尚未完全理解此種疾病的機制、并且其后果可能要到多年之后才會慢慢顯現的情況下,冒然讓孩子們承擔如此風險至少顯得有些魯莽。我完全理解重新開放經濟的必要性,但采取一定的簡單措施,比如在學校佩戴口罩、加強通風,并不會阻礙經濟的發展,也不會妨礙我們的生活。我們應當采取這些措施來保護我們的下一代?!?/p>

    父母的選擇

    薩米·麥克法蘭同樣建議在學校強制佩戴口罩、加強通風。她說:“我建議向所有兒童提供疫苗,可以不強制,將選擇權交給父母,但我認為我們必須承認,新冠長期癥狀的風險的確存在,我們應當通過改進學校的預防措施來預防兒童感染新冠病毒。我認為,除非我們能坦誠面對問題,否則普通家庭將無法通過改變自己的習慣來抑制病毒傳播?!?/p>

    各方均認為有必要提供緊急支持,而這種支持的有效性則取決于對新冠長期癥狀能否有更好的理解。英國政府最近投入了2700萬美元用于研究新冠病毒長期癥狀。華納表示,此舉或將使得更有效的靶向治療成為可能。

    “關鍵問題在于,醫療系統的所有醫生都需要認識到新冠長期癥狀這一問題的嚴峻性,而不是僅僅將其當作一種心理問題,讓患者自己(從‘心魔’中走出來)或者去看心理醫生。這是生理上的問題,因而必須有某種形式的生理解決方案。而且人們常常會忽視相關問題?!?/p>

    部分出現新冠長期癥狀的患者存在倦怠的情況,對此,華納說,應當設立逐漸增加身體和精神活動的項目?!叭绻覀儾淮偈够颊哌M行相關訓練,他們將無法恢復工作能力,甚至可能會永遠無法恢復!”(財富中文網)

    譯者:梁宇

    審校: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 S?ren Brostr?m, 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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