No school, no games and persistent COVID

Claudia She is 8 years old and loves to dance Zumba and ballet, but has stopped practicing because of her pain. Guille, 14, dreams of eventually studying computer engineering at MIT in the United States, but worries about falling behind in classes and scholarships slipping away. Both of them suffer from persistent COVID for months and, together with their families, they wonder how long the coronavirus will continue to be a stone on the road.

“The elderly with persistent COVID make more noise because we are on sick leave and we have more weight for the State, but children are the great forgotten ones”, says Claudia’s mother, Belén, who is also diagnosed with the disease. She misses more specific attention and social understanding, because her symptoms are often misunderstood as childhood “inventions” to avoid going to school.

The difficult diagnosis of persistent COVID in children

COVID appeared in the life of Guille in February 2021, in the form of “a fever and a worsening headache”. The diagnosis was slow in coming, because the antigen tests were negative, but an antibody test later confirmed that she had had the virus. “Fatigue began to set in. It was hard for me to breathe when I moved, I had mental fog, a lot of tiredness, dizziness… ”, she tells on the phone, in Madrid. Since then, she has spent periods in which he almost fainted just by going for a walk, had mental lapses and suffered from severe headaches. “One day he went to the schoolyard for a while to see his friends and came back crying from the pain. He said they shouted a lot and he couldn’t stand it, ”adds his mother, María.

It is estimated that 10% of adults with COVID-19 develop persistent symptoms, but the prevalence in children is still unknown, with very different figures in the few published studies. “In young children, it is said that it affects around 4% and, as age increases, the prevalence becomes more similar to that of adults”, says Pilar Rodríguez Ledo, vice president of the Spanish Society of General and Family Physicians (SEMG). In her opinion, this is due to an “underdiagnosis” of minors, especially the smallest. First, because they often pass the infection “asymptomatically”, there is no diagnosis of COVID and it is difficult to associate the persistence of symptoms with the virus. And secondly, because “it is very difficult to ask a four-year-old to explain what brain fog is.” Does he have learning disabilities or is it a symptom of something else? Doctors and families ask.

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The delay in defining the disease has also worked against it, but in hospitals such as the Germans Trias i Pujol in Barcelona they have been able to observe the effects on the ground, with a specific pediatric unit for persistent COVID. “Characteristically, they have fatigue, which can be physical and mental. Also the feeling that it is difficult for them to breathe, tachycardia, palpitations… It is very common for them to have headaches, which can be very intense and difficult to control with conventional analgesics, and stomach aches. Sometimes, sensitivity and skin color also appear…”, lists the pediatrician María Méndez, who directs the Catalan unit. There’s a wide range of symptomsbut without a doubt “it has a very important impact at a social and academic level”.

The profile of the patients is also varied: from children of five to young people of 18. “The median age is 13 years old,” she says. “There is also a predominance of the female sex, but it is not as marked as in adults”, where eight out of ten diagnoses correspond to women. In addition, no risk factors have been described beyond allergies. For the rest, continues Méndez, “they are healthy children, who do not have any conditioning, nor are they obese or hypertensive.”

A setback to his school and social life

Persistent COVID has disrupted the lives of children and adolescents like Claudia and Guille. As of her infection in January 2021, the little girl was months without going to school due to fatigue, pain and tachycardia. “In the end, together with the pediatrician, we decided to join her in May. On a physical level he was not well, but on an emotional level we were depriving him of his friends and many other things, ”says her mother from Extremadura.

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In these months, they have been learning to balance the benefits and consequences of their physical efforts. “My girl was superactive. She went to ballet, zumba, regional dance… she Now she only goes to an adapted regional dance class and she leaves exhausted, with pain. She arrives from school the same way, exhausted. It is very difficult for me to be able to lead the life I had before”, Bethlehem continues.

In addition, Claudia’s cognitive problems make it difficult for her to study and “now she takes much longer to do any task, with the handicap that she no longer remembers.” But the symptoms also mark her social relationships. “She misses her friends a lot, being able to play like before and do all her activities. She already asks me: Mom, when will I be able to go back to Zumba?

inequalities in care

Claudia’s question collides with the lack of treatment and inequality of resources in the autonomous communities. Both from Extremadura and from Madrid they regret not receiving specific care for pediatric persistent COVID, so the only answer is trial-error with different medications to help them cope with discomfort and pain.

At the Germans Trias i Pujol Hospital in Barcelona, ​​on the other hand, they have already developed physical and neurocognitive rehabilitation programs. “The recovery time is very variable. There are children who when we see them are already improving and in one or two months they are solved, and others who are for months and months. The truth is that practically everyone is improving,” says pediatrician María Méndez, who coordinates the Persistent COVID Unit, where they also have psychologists.

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Precisely Belén asks for her daughter more mental health support, as well as a curricular adaptation at school. “My daughter is a very strong girl with great integrity, but she sees that there are things that she can no longer do,” she says. Perhaps, she thinks, professionals in pedagogy and psychology they could help you better understand “what is happening to them”. For this, many affected children and adults are relying on patient associations.

All this should be coordinated From the “holistic” view of primary care, according to the vice president of SEMG, Pilar Rodríguez Ledo. “It is necessary to develop facets that until now were not very developed and to set up multidisciplinary teams”, she values ​​in reference to both physical and cognitive rehabilitation as well as psychological support.

Meanwhile, for those affected by persistent COVID and the professionals who work with it, the balance continues to tip on the side of doubt. Will Omicron have as much impact as previous variants?What are the deepest causes of the disease? How many people has it really affected? “We are convinced that the vaccines are going to greatly reduce the risk,” says Méndez, who reports on the articles that have already found “biochemical and morphological alterations in patients.” The first steps have been taken, but more research will be necessary to continue breaking ground.

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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