Long COVID and Children June 7, 2022 Peter C. Rowe, MD Professor of Pediatrics Sunshine Natural Wellbeing Foundation Professor of Chronic Fatigue and Related Disorders Director, CFS Clinic, JHCC
• Random sample of families in the AddressBase in the UK • 273,225 households with 581,637 individuals • Self-reported symptoms persisting > 4 weeks after first suspected COVID19 infection, not explained by something else.
% 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
Estimated % with Ongoing Symptoms of COVID-19 (collected in the 4 weeks before 6 Dec 2021) At 12 weeks
2 to 11 yrs
At 12 months
12 to 16 yrs
17 to 24 yrs
25 to 34 yrs
Estimated UK national pediatric cases: 48K at 12 months (UK has ~ 1/5 the population of the USA). https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases
How we define Long COVID has major implications for access to treatment Definition of “Long COVID” • • •
> 1 month [CDC] > 3 months [WHO] > 6 months with frequency/severity criteria like in ME/CFS
Implications if the diagnosis is made early in the postinfectious period: lessons from EBV mononucleosis
37% 13%
(estimated from Katz et al, Pediatrics 2009;124:189-93)
6
Post-Covid POTS HR
BP / HR
150
HA
BP
100
70 bpm
50
-5
0 Supine
5 Standing
15
10 Supine
min
3 months post-onset
Allergic/inflammatory manifestations • Pt 1: Asthma, allergies to pollens, grasses; allergies to foods (cashews, carrots, cherries → oral allergy syndrome); positive FH • Pt 2: Asthma, allergic rhinitis, eczema, urticaria with citrus • Pt 3: Dermatographism, facial flushing with activity; + FH (father on Cromolyn and H1 antihistamine) • Elevated histamine levels in two: 3.5, 4.2 (normal ≤ 1.8 ng/dL) MCAS: Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis 2020; 100:327-332. Glynne P, Tahmasebi N, Gant V, Gupta R. Long COVID following mild SARS-CoV- 2 infection: characteristic T cell alterations and response to antihistamines. J Investig Med 2021 doi:10.1136/jim-2021-002051 Weinstock LB, et al. Mast cell activation symptoms are prevalent in Long COVID. Int J Inf Dis 2021;112:217-26.
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van Campen, C.M.C.; Rowe, P.C.; Visser, F.C. Orthostatic Symptoms and Reductions in Cerebral Blood Flow in Long‐Haul COVID‐19 Patients: Similarities with Myalgic encephalomyelitis/Chronic Fatigue Syndrome. Medicina 2022, 58, 28. https://doi.org/10.3390/
Long haul COVID subject Left carotid artery supine
Left carotid artery end-tilt CBF 134 ml
CBF 221 ml
-39%
Left carotid artery supine
Healthy Control Left carotid artery end-tilt CBF 299 ml
CBF 276 ml
-8%
Van Campen, Rowe, Visser, Medicina 2022
PedsQL scores in ME/CFS & other pediatric chronic illnesses* 100 80 60 40 20 0 C
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Peds QL ME/CFS data from JH Pediatric ME/CFS Cohort Study (Frontiers in Pediatrics, submitted); Peds QL data in other conditions from Ingerski LM, et al., J Pediatr 2010;156:63944
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