6% of children tested for COVID in the ER had symptoms at 90 days

Almost 6% of children who went to the emergency room for a COVID-19 test, including almost 10% of those hospitalized and 5% of those discharged from hospital, reported symptoms of long COVID 90 days later, notes an international study led by researchers from the University of Calgary in Canada and UC Davis Health.

Risk factors included being hospitalized for 48 hours or more, reporting at least four long-lasting COVID symptoms during the emergency room visit, and being 14 years of age or older.

The studypublished today in Open JAMA Networkinvolved a 90-day follow-up of 1,884 children seen in 36 emergency departments in 8 countries from March 7, 2020 to January 20, 2021, including 1,686 children matched to 1,701 uninfected controls, from March 7, 2020 to January 20, 2021.

Fatigue and systemic respiratory symptoms

Among the 1,884 infected children, the median age was 3 years and 52.8% were boys. A total of 110 patients with COVID-19 (5.8%; 95% confidence interval [CI]4.8% to 7.0%) reported long-lasting COVID symptoms, including 44 of 447 children (9.8%; 95% CI, 7.4% to 13.0%) hospitalized for their infections and 66 of 1437 outpatients (4.6%; 95% CI 3.6% to 5.8%).

The most common individual symptom among all COVID-positive children was fatigue or weakness, at 1.1%, while the most cited long-COVID symptoms among the 110 children with long-COVID were respiratory ( 34.5%) and systemic (30.0%).

Risk factors for reporting at least one symptom at 90 days were hospitalization for at least 48 hours, versus no hospitalization (adjusted odds ratio [aOR], 2.67; 95% CI, 1.63 to 4.38); with four or more symptoms in the emergency department, versus one to three symptoms (four to six symptoms: ORa, 2.35; 95% CI, 1.28 to 4.31; seven or more symptoms: ORa, 4 .59; 95% CI, 2.50 to 8.44), and age 14 years or older, compared to less than 1 (aOR, 2.67; 95% CI, 1.43 to 4.99) .

Pediatric COVID-19 patients were more likely than uninfected controls to report long-term COVID-19 symptoms, including outpatients (55 out of 1,295 [4.2%] against 35 out of 1,321 [2.7%] and hospitalized (40 out of 391 [10.2%] against 19 out of 380 [5.0%]). COVID-19 was also related to symptoms of the 90-day long COVID (aOR, 1.63; 95% CI, 1.14 to 2.35), particularly for systemic signs and symptoms such as fatigue, weakness and fever (aOR, 2.44; 95% CI, 1.19 to 5.00).

Rates not significantly higher than controls

“This cohort study found that although 10% of children hospitalized with acute SARS-CoV-2 infections and 5% of those discharged from the emergency room reported PCCs [post-COVID conditions] at 90 days, these levels were only slightly higher than levels among SARS-CoV-2 negative controls,” the authors wrote.

“Our finding that children who initially had multiple symptoms of COVID-19 were at higher risk of developing long COVID is consistent with studies in adults,” said co-lead investigator Todd Florin, MD, MSCE, of the Children’s Hospital of Chicago, in a Children’s Press release.

“Unfortunately, there are no known therapies for long COVID in children, and more research is needed in this area,” he added. “However, if symptoms are important, symptom-targeted treatment is most important. Multidisciplinary care is warranted if symptoms are impacting quality of life.”

The researchers called for proper referral and follow-up of children, especially those at high risk for long-term COVID. “Our findings may inform public health policy decisions regarding COVID-19 mitigation strategies for children and approaches to screening for long COVID among people with severe infections,” they concluded.

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