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IDWeek 2021: Post-Acute Manifestations of SARS-CoV2 infection in Children

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Although the majority of patients who have experienced SARS CoV-2 infection recover within weeks of their initial infection, it is being increasingly appreciated that a significant number of patients may experience a wide variety of new and longer term symptoms after they have recovered from their initial illness. Taken together, these symptoms have been variably termed post-COVID conditions, long COVID, long-haul COVID, post-acute COVID, or chronic COVID. Symptoms may last weeks to months after initial recovery and can include chronic cough, shortness of breath, fatigue, post-exertional malaise, cognitive difficulties, abdominal pain, headache, palpitations, joint or muscle pain, abnormal sensations, sleep difficulty, intermittent fevers, dizziness, rashes, changes in mood, changes in smell or taste, and/or changes in menses. Although it is not yet clear which patients are more prone to longer term effects of SARS-CoV-2 infection, it is becoming more apparent that this condition can occur after even mild infection, not only in patients who had more severe infection. 

There has been a global effort to better define the post-acute manifestations of SARS-CoV2 infection. Researchers at IDWeek 2021 presented preliminary data on Long COVID affecting adults at IDWeek 2021, including cognitive and pulmonary effects, as well as possible therapeutic interventions. Although children make up approximately 3-4% of all hospitalizations due to SARS CoV-2 infection, they represent up to 25% of infections, and over 5.5 million children have had lab confirmed infection since the beginning of the pandemic, with over 5000 cases of Multisystem Inflammatory Syndrome of Children (MIS-C). Pediatric providers and researchers have increasingly documented a variety of post-acute manifestations of COVID and MIS-C in the pediatric population, which may have additional or alternate effects on development, mental health, and quality of life compared to adult survivors. Children’s National Hospital in Washington D.C. has implemented one of the first pediatric specific Long-COVID clinics in the United States, which provides patients access to multidisciplinary clinical care in a single coordinated visit, including pediatric infectious diseases, cardiology, pulmonary, neurology, psychology, pain medicine, and physical therapy specialists. Additionally, Children’s National Hospital in partnership with the National Institute of Allergy and Infectious Diseases has embarked on a comprehensive long term outcomes study of pediatric patients through 18 years of age which is enrolling 1000 recovered survivors (COVID and/or MIS-C) and 1000 uninfected household contacts. The study will evaluate each subject longitudinally over 3 years including cardiac imaging (EKG, echocardiogram, cardiac MRI), pulmonary function testing, lung imaging (chest CT or chest radiography), and validated assessments of quality of life, mental health, and neurodevelopment. The study is also building a longitudinal biorepository of clinical specimens to assess immunologic responses as well as underlying genetic factors impacting disease and outcomes. Providers are encouraged to refer potentially eligible and interested patients and families to the study.

Through systematic and comprehensive evaluation of this large cohort of children who have recovered from asymptomatic, mild, and severe COVID, as well as MIS-C, the full spectrum of post-acute manifestations in children will be established, with the goal of providing accurate guidance and developing effective treatments for affected children.

Dr. DeBiasi reports no conflicts of interest.

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