Thread by @nigeltwitt

#LongCOVID

We reviewed 14 studies of persisting symptoms following #COVID19 in #children & #adolescents

Most had major limitations and should be interpreted with caution.

True risk is likely to be nearer 1 in 100 than often quoted 1 in 7.

#medpeds #IDTwitter

(Long) 🧵1/n

@Dr_Petzi @PittetLaure @MCRI_for_kids @RCHMelbourne @UniMelbMDHS @ASIDANZ @ESPIDsociety @ESPR_EBN @WSPID @PIDSociety @DFTBubbles @PIDJournal

#medpeds #IDTwitter #tweetiatrician #paediatrics #pediatrics #PaedsID #PedsID #PedID #PID

The 14 studies involved 19,426 children & adolescents.

Common persistent symptoms reported 4-12 weeks after acute #COVID19 were:

•headache
•fatigue
•sleep disturbance
•concentration difficulties
•abdominal pain.

Symptoms rarely lasted more than 12 weeks.

Long-term #SARSCoV2 infection-associated symptoms are difficult to distinguish from pandemic-associated symptoms.

Persistent symptoms were just as common in children & adolescents WITHOUT evidence of #SARSCoV2 infection in 2 of the 5 studies which included controls.

Major limitation 1:
No clear case definition of #LongCOVID
• Studies use variable inclusion criteria & f/u times
• Some include self-reported #SARSCoV2 infection without lab confirmation
• Most rely on self/parent-reported symptoms from surveys w/o clinical assessment.

#LongCOVID encompasses many conditions:
• Complications such as pulm/myocardial dysfunction
• Mental health probs, post ICU syndr, PTSD
• Postviral chronic fatigue syndr/ME with nonspecific symptoms highly prevalent in population (e.g. sleep disturbance, conc difficulties).

Major limitation 2:
Just 5 studies had a control group NOT infected with #SARSCoV2 to enable differentiation between symptoms due to #COVID19 & those from effects of pandemic: lockdowns, school closures, social isolation, loss of sports/other activities, sick family/friends.

Major limitation 3:
Non-responder bias. Many studies have a low response rate (13% in CLoCk Study) that can lead to selection bias (those with persisting symptoms more likely to respond).

This can result in a substantial overestimate of the prevalence of #LongCOVID.

Additional limitations:
• As those with mild symptoms might not seek testing, selection & misclassification bias also lead to an overestimate.

• Studies include a wide range of age groups: incidence & characteristics of #LongCOVID likely differ between adolescents & children.

An accurate determination of #LongCOVID risk in children & adolescents is crucial in weighing up the risks & benefits of vaccinating this age grp.

New studies should incl rigorous control grps of children with other infections & those admitted to hosp or ICU for other reasons.

Key question for new #LongCOVID studies:
• What is age-specific risk?
• Is risk different with #DeltaVariant?
• Is risk related to severity of acute COVID?
• Can it follow asymptomatic infection?
• Does vaccination prevent it?
• Underlying immunol mechanisms?
• Treatment?

This fits with the latest ONS data that also suggests the risk of #LongCOVID in children & adolescents is extremely low (0% to 1.7%).

https://twitter.com/apsmunro/status/1438461046956646405

Importantly, even if only a very low % of children & adolescents have #LongCOVID, and regardless of whether their symptoms result from #SARSCoV2 infection or the indirect effects of the pandemic, we need to learn the best way to support them and help them get better.