Children have been largely overlooked during the COVID-19 pandemic; thankfully the majority of them get mild or even no symptoms if they catch the virus. Much of the discussion around the role of children in the pandemic has been about how they may spread the virus.
However, over time there has been a growing body of evidence that suggests that a proportion of children may develop long COVID, whether or not they had any symptoms when they actually contracted the virus.
Long COVID in adults is defined as signs and symptoms that develop during or following an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
So far there is no medical definition of long COVID in children but support groups and researchers say there may be up to 100 symptoms, including fatigue, “brain fog”, muscle aches, pain, gastrointestinal problems, nausea, dizziness, seizures, hallucinations and testicular pain. The cause of these symptoms is poorly understood, although findings suggest an ongoing immune reaction, after the virus has cleared, plays a part.
A study in Italy looked at 129 children aged between six and 16 years, diagnosed with COVID‐19 between March and November 2020. Some 96 of them had symptoms of COVID-19 during the acute infection phase, while 33 had no symptoms at all but tested positive. The study found that 42.6 percent of the children still had symptoms more than 60 days post-infection. Symptoms like fatigue, muscle and joint pain, headache, insomnia, respiratory problems and palpitations were particularly frequent.
A similar case study was carried out in Sweden, focusing on a smaller group of five children aged from nine to 15. All five children had fatigue, dyspnoea (laboured breathing), heart palpitations or chest pain, and four had headaches, difficulties concentrating, muscle weakness, dizziness and sore throats six to eight months after the initial infection.
A recent report from the UK’s Office for National Statistics estimates that 12.9 per cent of UK children aged two to 11, and 14.5 per cent of children aged 12 to 16, still have symptoms five weeks after their initial infection with COVID-19. Almost 500,000 UK children have tested positive for COVID-19 since March 2020.
More research is needed but as the debate around vaccinating children against COVID-19 rages, it is important to acknowledge as part of that discussion the growing body of evidence that children appear to develop symptoms beyond the initial infection and these symptoms can be debilitating.
The lack of knowledge in this area is also a source of frustration for families who are presenting children to hospitals and GP surgeries with vague and varied symptoms and being turned away without adequate treatment and support. Campaigners are urging policymakers to invest in research in this area so that these children can be managed appropriately and return to normal life.
Until now, the focus has been on COVID-19 in adults. Perhaps now is the time to think about the long-term effects it can have on children. We urgently need research into both the effects the lockdown has had on children and also the long-term effects of the coronavirus on children. Both are vital to their future health.
Progress Report: COVID-19 vaccines for children
The Pfizer-BioNTech vaccine has shown 100 percent efficacy against COVID-19 in 12-to-15-year-olds in the preliminary results of a phase 3 trial.
The phase 3 trial included 2,260 children in the US. A total of 18 cases of COVID-19 were observed in the placebo group whose members were given an alternative vaccine, while none were reported in the vaccinated group. The vaccine also elicited robust antibody responses and was well tolerated, with side effects consistent with those observed in participants aged 16 to 25.
After the success in its phase 2 trial, Pfizer applied for emergency authorisation for the vaccine in the US as well as other parts of the world, including Canada and Europe. According to the American medicines regulatory body, the Food and Drug Administration (FDA), an Emergency Use Authorization (EUA) is a mechanism to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies, such as the current COVID-19 pandemic.
Under an EUA, the regulator may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.
On May 10, the FDA authorised the Pfizer COVID-19 vaccine for children aged 12 to 15. Dr Janet Woodook, the agency’s acting commissioner, called the authorisation “a significant step in the fight against the COVID-19 pandemic”. She added: “Parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data, as we have with all of our COVID-19 vaccine emergency use authorizations”.
According to the Centers for Disease Control and Prevention (CDC), from March 1, 2020 to April 30, 2021, approximately 1.5 million COVID-19 cases in individuals aged 11 to 17 have been reported in the US.
“Having a vaccine authorised for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”
Prior to the US giving the vaccine the green light, Canada also approved its use in children over the age of 12. Supriya Sharma, chief medical adviser to Health Canada, the government’s medical agency, told reporters on May 6 that the vaccine was “safe and effective” and would allow a return to “a more normal life” amid the pandemic. She added that the most common side effects for children are mild and temporary, like “a sore arm, chills or fever”.
Europe and the UK are yet to give their approval of the Pfizer vaccine in those aged 12 to 15, but most experts agree part of the solution to this global pandemic has to be vaccinating children.
