When virus isn’t ‘the scariest part’
Neurological and physical problems linger in some kids
Will Grogan stared blankly at his ninth grade biology classwork. It was material he had mastered the day before, but it looked utterly unfamiliar.
“I don’t know what you’re talking about,” he blurted. His teacher and classmates reminded him how adeptly he’d answered questions about the topic during the previous class. “I’ve never seen this before,” he insisted, becoming so distressed that the teacher excused him to visit the school nurse.
The episode, earlier this year, was one of numerous cognitive mix-ups that plagued Will, 15, after he contracted the coronavirus in October, along with issues like fatigue and severe leg pain.
As young people across the country prepare to return to school, many are struggling to recover from lingering POST-COVID neurological, physical or psychiatric symptoms. Often called “long COVID,” the symptoms and their duration vary, as does the severity.
Studies estimate long COVID may affect between 10% and 30% of adults infected with the coronavirus. Estimates from the handful of studies of children so far range widely. At an April congressional hearing, Dr. Francis Collins, director of the National Institutes of Health, cited one study suggesting that between 11% and 15% of infected youths might “end up with this longterm consequence, which can be pretty devastating in terms of things like school performance.”
The challenges facing young patients come as pediatric COVID-19 cases rise sharply, driven by the highly contagious delta variant and the fact that well under half of 12- to 17-yearolds are fully vaccinated and children under 12 are still ineligible for vaccines.
Doctors say even youths with mild or asymptomatic initial infections may experience long COVID: confounding, sometimes debilitating issues that disrupt their schooling, sleep, extracurricular activities and other aspects of life.
“The potential impact is huge,” said Dr. Avindra Nath, chief of infections of the nervous system at the National Institute of Neurological Disorders and Stroke. “I mean, they’re in their formative years. Once you start falling behind, it’s very hard because the kids lose their own self-confidence too. It’s a downward spiral.”
Nearly 4.2 million young people in the United States have had COVID-19, according to the American Academy of Pediatrics. Relatively small percentages have been hospitalized for initial infections or developed a condition called Multisystem Inflammatory Syndrome in Children (MIS-C) that can emerge several weeks later. Doctors expect considerably more will experience long COVID.
At Boston Children’s Hospital, where a program draws long COVID patients from across the country, “we’re seeing things like fatigue, headaches, brain fog, memory and concentration difficulties, sleep disturbances, ongoing change in smell and taste,” said Dr. Molly Wilson-murphy, a neuroinfectious diseases specialist there. She said most patients were “kids who had COVID and weren’t hospitalized, recovered at home, and then they have symptoms that just never go away — or they seem to get totally better and then a couple of weeks or a month or so after, they develop symptoms.”
Dr. Amanda Morrow, co-director of the pediatric POST-COVID-19 clinic at the Kennedy Krieger Institute in Baltimore, said getting treatment early might help recovery. POST-COVID clinics find they need multiple specialists and approaches including exercise, cognitive behavioral therapy, sleep modification and medication for issues such as respiratory and gastrointestinal problems.
“We don’t yet have any sort of good predictors of who will be affected, how much they’ll be affected and how quickly they’ll recover,”
Wilson-murphy said. “We don’t have any sort of magic treatment.”
Some studies report higher proportions of older children with longterm issues. That might be because adolescents find some symptoms more disruptive or because after puberty, hormones might amplify immune responses, Nath said.
An April study by the United Kingdom’s Office for National Statistics found that 9.8% of 2-11-year-olds and 13% of 12-16-year-olds infected with the coronavirus reported continuing symptoms five weeks later. After 12 weeks, rates remained significant: 7.4% in the younger group and 8.2% in the older group.
In another U.K. study, 4.4% of 1,734 children had symptoms more than four weeks POST-COVID, over four times as high as the percentage with symptoms four weeks after NON-COVID illnesses like flu. About 2% of COVID patients had symptoms after eight weeks.
Many young patients were previously healthy, said Dr. Laura Malone, co-director of Kennedy Krieger’s program.
Some doctors have seen some youths with long COVID who had previous issues like migraines or anxiety, but it’s unclear whether there’s any connection.
“Dang, why am I always so sick?” Messiah Rodriguez, 17, asked himself. Before getting COVID around Thanksgiving, he never had health problems, he and his mother, Kimmie Ezeike, said.
An energetic point guard and shooting guard on school and travel basketball teams, Messiah had to stop playing after running off the court and vomiting in his backpack during two games.
“Messiah is probably one of the more affected kids I’ve seen,” said Dr. Alexandra Yonts, director of the COVID-19 Longitudinal Care Clinic at Children’s National Hospital in Washington, D.C.
Eight months later, some of Messiah’s symptoms have eased. Others, like shortness of breath while climbing stairs, linger, his mother said.
In a June appointment at Children’s National that the Times observed, Dr. Abigail Bosk, a rheumatologist, told him his POST-COVID fatigue was more debilitating than simple tiredness.
His athleticism, she said, should help recovery, but “it’s really not something you can push through.”
“The scariest part,” said Will, the Dallas teenager, was visiting doctors whose “answers were: ‘Hey, bud, take it easy. Go rest.’ I couldn’t blame them. That’s all they could tell me really.”