Semmelweis University’s First Department of Paediatrics opened a new outpatient clinic for treating children suffering from long COVID at the end of March. We sat down to discuss the occurrence, symptoms, and treatment of long COVID, as well as the clinic’s work so far and going forward with Dr. Péter Krivácsy, Clinical Chief Physician and Head of the Department of Emergency Care at the 1st Department of Pediatrics.

Why was there a need to establish a long COVID clinic specifically for children?

Around January, we started seeing scientific literature referencing extremely varied and sometimes rather severe long-term effects associated with COVID. Then, patients who displayed just such symptoms started appearing. Since these issues were understood to be collectively related to the coronavirus, and we knew they were going to be affecting a lot of people, we saw fit to establish a separate practice in order to deal with them.

Indeed, we seem to have been right;

"the day we announced the opening of the practice, all of our appointments for the first two months were booked by late afternoon.”
We found out that there are a lot of children suffering from the symptoms of long COVID. It is important for them to know that they are not alone, and that we will do our very best to heal them.

What exactly is the difference between acute, post-acute, and long COVID?

COVID itself typically lasts fourteen days after the first symptoms appear. The (post-acute) inflammatory phase, if it manifests, can last from the beginning of the third week after the onset of the disease until the end of the fourth.

Four weeks after the first symptoms, patients will typically have entered the post-acute phase, and can no longer transmit the disease. However, they may have retained some symptoms, or else they may reappear after a short hiatus, but in the vast majority of cases these will only last until up to twelve weeks after the onset of symptoms. This is usually termed as patients having ongoing symptoms.

Post-COVID Syndrome, specifically, is having one or more of a wide range of symptoms associated with the disease twelve weeks or more after the initial onset of COVID. Symptoms may have continued throughout or reappeared later.
Long COVID is used to denote any kind of illness that lasts beyond the acute phase, the first four weeks, encompassing both ongoing symptoms and Post-COVID Syndrome. Since we deal with all of these collectively, we generally use the term long COVID for what the practice is aimed at.

What percentage of COVID patients develop long-term symptoms?

There is a variety of data relating to this issue;

we currently believe that between 2-10% of those who get COVID develop long-term symptoms, but some experts think it may even be well above 10%.”
We do not know whether there is a difference in these terms between children and adults.

What are the typical symptoms of long COVID?

Typical symptoms include fatigue, shortness of breath and difficulty breathing, consequently the inability to do any sort of physical exercise. Among our patients so far, about 20% were affected so severely that they were unable to walk for more than six minutes without rest.

Headaches, dizziness, loss of smell or taste, and abdominal pain are also very common. Issues with concentrating, retaining memories, and sleeping are frequent as well. Furthermore, chest, muscle and joint pain are also typical.

Most disturbingly, however, in some cases we also see skin lesions appearing in a fit-like manner, very suddenly and over a large area, and children sometimes also see hallucinations. Although this latter symptom appears rare, as we have only seen it in 2% of patients so far, it is nevertheless extremely worrisome.

It is important to note that a single patient will frequently have not only one, but several, sometimes 5-10 symptoms at the same time. Children who have multiple of these symptoms often cannot even go to school. These are very serious conditions indeed. 10-15% of our cases are extremely grave, alarmingly so.

Why are symptoms so varied, and why are there so many that are neurological or psychological in nature?

We do not know exactly why, but we do have ideas. It might be an abnormal immune reaction, the virus might cause damage to nerve cells, and increased blood clotting due to the virus may also play a role in this.

What we see is that coronavirus is a very unpredictable, varied, versatile virus that often causes extremely severe issues. Its effects will stay with us even after the pandemic itself is over.”
Do we know how children’s symptoms differ from those of adults?

Not precisely. We do see that they are a little different, for instance, lung damage is not that prevalent among children, but there are major overlaps. We also think the degree of recovery and the time it takes might be different between adults and minors.

What do we know healing patients with long COVID, and any differences between children and adults?

There is no universal treatment of long COVID yet, owing to the extremely versatile nature of symptoms and our lack of understanding of the condition itself. We are discovering the disease and the ways to treat it together with our patients. However, supporting therapies and complex therapeutic treatment are available and necessary for the symptoms themselves, and we have full hope that we will eventually find ways to heal patients completely.

On this note, I think the way we conduct our care is illustrative of our current understanding of long COVID and how to treat it. Firstly, we have patients and their parents fill out a detailed WHO questionnaire that we translated aimed at understanding the patient’s symptoms and background five to ten days before their appointment. Based on this, we conduct a variety of examinations when the patient comes to the clinic – which span a whole host of medical fields to the varied nature of symptoms, but typically include at least a laboratory examination.

It is interesting to note that based on our results so far, at least 10% of patients have irregularities related to their thyroid. They may also have other issues that the lab results reveal, and of course, if there is a need, we treat these with medication. After the tests, we move on to dealing with the various symptoms specifically, and begin a long and complex process of rehabilitation.

Although you have only been around for a very short time, can you tell us of any successful complete rehabilitations?

I would be hesitant to draw any serious conclusions from the limited work we have done so far. We do not know if the recoveries we have observed to date are permanent or temporary. Medicine is a science, after all, and accordingly, we conduct our assessment of the situation in a scientific manner. We will carry out a statistical analysis of our results in two weeks, on a sample size of about 100 patients. That may reveal some useful pieces of information.

For the same reason, I cannot tell how long recovery might take; it will depend on the individual case, the nature and severity of symptoms. We have seen cases where the vaccine alleviated some symptoms in patients. We do not yet currently understand much about that, but it may be important for whether we need to vaccinate children.

We can also not say whether some patients will have severe long-term health issues due to long COVID. We hope, and believe, that they will not.”
We have no idea whether this will be different between children and parents.

Which will place a greater financial burden on the nation’s healthcare system – COVID itself, or long-term symptoms it can lead to? Might this be different for children and adults?

This is not my area of expertise. The pandemic itself has placed an extreme burden on healthcare. In the long term, however, it depends on how easy it will be to rehabilitate patients. If we can do so easily, then I think COVID itself will have been a bigger issue. Otherwise, dealing with all of its long-term effects may be very costly. This is an area where children and adults might differ significantly, however; it is often easier to rehabilitate children for such conditions as accompany long COVID.

At any rate, we are doing our very best to map out the disease and discover ways of healing our patients. We are in constant consultations with other children’s clinics around the country, and I am confident we will be able to provide increasingly better care.

READ ORIGINAL ARTICLE