Thread by @jeffgilchrist

COVID-19: Real impact on children

We were told early in the pandemic that children don't spread the virus, it is mild and later that schools were not centres of transmission. This thread explores some of the real impacts on children. 🧵1/ #LongCovidKids #FASSST #COVID

While surveillance and data collection is being dismantled in many countries, South Korea continued to test at high volumes and were able to see the differences between ages including children ( researchsquare.com/article/rs-172… ). H/T: @DFisman 2/

It turns out, "We found that children are indeed more susceptible to the Omicron variant compared with the previous strains of SARS-CoV-2." 3/

"The susceptibility among age groups 0–19 years was approximately 5 times higher during the 5th wave (Omicron driven) than that during the 3rd wave (pre-Delta), and 3 times higher than that during the 4th wave (Delta driven)." 4/

The author of the study included some updated figures, showing the significantly higher proportion of COVID-19 cases among children compared to Delta and Pre-Delta periods of the pandemic (

https://twitter.com/June_MD/status/1569480895790448642

). 5/

Then after BC downplayed transmission risk to children and transmission in schools, study results were released from the very same people showing they actually knew and measured just how much transmission was happening among children (

https://twitter.com/CPita3/status/1569866915061055494

). 6/

The study showed that in BC schools in September 2021 at the start of the school year 11-13% of children had been infected with COVID-19 but by the end of the school year in July 2022 that had increased to 70-76% of children (

https://twitter.com/DGBassani/status/1569515303624916992

). 7/

During the school year, children became the age group with the highest percentage of infections ( medrxiv.org/content/10.110… ). 8/

With COVID protection measures removed, now at the beginning of this 2022 school year more than 3/4 of children in BC had been infected and are now becoming reinfected and at further risk for Long COVID and other complications. 9/

Jess has put together a thread highlighting examples of the impact on children (

https://twitter.com/MeetJess/status/1570259687894908928

). 10/

These include:
- virtually all children infected with COVID-19 show signs of blood vessel damage
- 10 year old girl struggles to walk and can barely speak 6 months after infection

11/

- almost 20% of children treated by a pediatrician at Hong Kong public hospital suffered from Long COVID
- neurological complications are relatively common (8% of children hospitalized with COVID)
- heart inflammation can be quite severe in children

12/

- potentially fatal COVID-related brain damage in children
- liver damage in children who contracted COVID-19
- 1 in 4 symptomatic children had Long COVID that lasted at least 4-12 weeks

13/

Let's look at a case study of a 14 year old girl, was infected with COVID-19 in October 2020, develops a fast heart rate and chest pain, then 7 months later admitted to hospital for testing since the symptoms had not gone away (

https://twitter.com/drclairetaylor/status/1566178375953260547

). 14/

The infection, testing, and treatment all happened before COVID-19 vaccines were approved for teens so no, this was not the vaccine that caused her issues. Blood, CT chest, cardiac MRI, ECG tests all come back normal, but fast heart rate continues along with fatigue. 15/

Psychological assessment is normal, 6-minute walk test shows normal oxygen levels but heart races and she tires easily. An exercise test (CPET) suggests pulmonary hypertension and she has some extra blood tests which suggest inflammation (unusual B-cell and T-cell changes). 16/

She finally gets the test that she needed, a VQ SPECT scan that uses radioactive material to image airflow (ventilation) and blood flow (perfusion) in the lungs. 17/

This test found significant defects in the right upper lung lobe which were not visible on CT scan. They conclude peripheral microvascular and endothelial damage, blood clots. 18/

It took 7 months but they finally started her on a treatment of anticoagulation. Had they stopped at the normal results, she would likely still be suffering but thankfully her medical team had read this study and did the VQ SPECT test ( ncbi.nlm.nih.gov/pmc/articles/P… ). 19/

Since the April 2022 outbreak in Taiwan, it has been observed that the BA.2.3 Omicron variant can induce severe neurologic complications in children ( ijidonline.com/article/S1201-… ). Increased inflammatory markers were observed in all of the patients studied. 20/

How do COVID reinfections affect Long COVID ( longcovidkids.org/post/a-world-f… )? 21/

They found reinfection causes a recurrence of Long COVID in 58% of children who were in recovery or remission (

https://twitter.com/LongCovidKids/status/1567804121431818240

). Reinfection worsens the symptoms of Long COVID in the majority of children who are still symptomatic. 22/

Children got Long COVID after infection #:
82% = 1st infection
17% = 2nd infection
1% = 3rd infection

23/

Comparing 1st and 2nd infections, severity was:
43% = less severe than first
22% = same severity
32% = more severe than first
3% = no symptoms with second

24/

It is not just school kids, but babies whose mothers were infected with COVID-19 while pregnant. Being COVID positive during pregnancy was associated with 2x the rate of development delays than controls (

https://twitter.com/LauraMiers/status/1567966355109937156

). 25/

Mothers who get infected during their 1st trimester are more likely to have an early miscarriage and infants that survive pregnancy are more likely to receive a neurodevelopmental diagnosis in the first 12 months following delivery ( forbes.com/sites/williamh… ). 26/

Other studies have found these babies also face a higher risk of brain development disorders such as autism and bipolar disease. 27/

Studies have also found babies infected in-utero showed "lower levels in communication, gross movement, fine movement, problem solving, and personal-social domains … [and] an increased risk of development of neurological disorders." ( iflscience.com/covid-19-infec… ). 28/

Even the Chief Scientist at the WHO has stated, "We need to prepare for large increases in cardiovascular, neurological & mental health disorders in countries affected by the pandemic" (

https://twitter.com/doctorsoumya/status/1564649057599078401

). 29/

Health experts such as those at Michael Garron Hospital sent this letter to principals that despite masks no longer being mandated, all school staff, students, and families should continue wearing masks at school and in other indoor public settings (

https://twitter.com/uhwuhna/status/1567463338094870528

).30/

"Masking is one of our strongest tools in preventing the spread of COVID-19. They offer an extra layer of protection against COVID-19 and other viruses like the flu, which will be circulating alongside COVID-19 during fall and winter." 31/ 👇Click "Show replies" to continue.

If kids get sick, they can't learn, "Wearing a well-fitted, quality mask also reduces the risk of children missing school and having their learning disrupted due to illness." 32/

Some tweets in this thread are showing as "Unavailable" for some people. You can see the whole thing here: threadreaderapp.com/thread/1570390… 33/

Even @PublicHealthON has released an assessment on masks in schools determining they reduce COVID-19 infections and transmissions in schools when masking has been implemented (

https://twitter.com/jeffgilchrist/status/1571088036540354561

). 34/