Long COVID in Kids: The New Mono?
In August 2021, the American Academy of Pediatrics reported nearly 4.3 million children have tested positive for COVID-19 since the onset of the pandemic. The Delta variant added almost 94,000 cases in the first week of August 2021, with a reported mortality rate ranging from 0.00-0.03%.1 While it's a relief to see mortality rates are low among children, another problem looms. Up to 15% of infected youths could develop Long COVID, after being infected and presumably recovering from the virus.2 As if the past two school years have not been challenging enough for kids, this new chronic health issue presents an uncertain future of potential mental and physical concerns.
Growing attention on long COVID has so far centered on the millions of adults still struggling to return to life as "normal" since being affected. What we know now is that debilitating symptoms such as fatigue, headaches, brain fog, memory, sleep disturbances, ongoing change in smell and taste are affecting kids as well.3 Whatsmore, older children and teenagers may suffer even more from long-term issues following the virus because, similar to autoimmune diseases, higher hormones can trigger immune responses as well. Read on to find out more—and to ensure your health and the health of others, don't miss these Sure Signs You Have "Long" COVID and May Not Even Know It.
Considering the Mono Connection
Mononucleosis was nicknamed the kissing disease for one simple reason: college students, most at risk for developing this infection, presumably spend massive amounts of time sharing germs with their friends.
While most people recover in two weeks with rest and fluids, the virus that causes mono, Epstein Barr (EBV), is also associated with a chronic inflammatory and painful condition called myalgic encephalomyelitis (ME). Also known as Chronic fatigue syndrome (CFS), this syndrome has itself been compared to Long COVID.4
And the list goes on. Through a protein on the virus, EBV has also been identified as a common infectious activator or trigger of several autoimmune conditions such as multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, type 1 diabetes, juvenile idiopathic arthritis, and celiac disease.5
Indeed, viruses, like EBV, are a known trigger for chronic inflammation and the kinds of autoimmune-like responses we are seeing with long COVID. If we look at the historical precedent set by diseases like Mono, the fact that so many kids are still struggling due to the after effects of Sars-CoV-2, should come as no surprise. Will Long COVID become one more routine childhood illness, with the potential of generating long-term debilitation of adolescents and young adults who should be in their prime?
There are Others, Also Connected
You may not have heard of the following autoimmune disease but PANDAS, when not referring to black and white bears, is a post-infectious autoimmune disorder that affects kids.
Where does it come from? It begins with strep throat, a common childhood illness that is usually treated with a round of antibiotics.
But for those kids who don't respond to the antibiotics, the infection can cause strange behavior changes known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections or PANDAS. According to WebMD, a child with PANDAS may become a different person seemingly overnight, suddenly presenting with symptoms that include moody, anxious, aggressive, obsessive compulsive behaviors, and dealing with tics and other uncontrollable body movements.6
PANDAS is not the only autoimmune disorder connected to the streptococcus infection. John Hopkins Medicine reports that people can develop psoriasis, an autoimmune disease that causes patches of thick, scaly skin, commonly after a strep throat infection.
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What do PANDAS and Long COVID Have in Common?
While PANDAS is the result of a bacteria, and Long COVID, a virus, these pathogens share the capacity to cross the blood brain barrier, and attack the brain, affecting everything from mood, nerves and brain function. An article published in the British Medical Journal in 2005, points out a number of identifiable mechanisms of the mind-body connection. Most relevant being that infectious physical disease, affecting the brain, can give rise, directly, to psychological manifestations.7
We know Sars-CoV-2 has the ability to cross the blood brain barrier. One recent article, points to evidence among adults that anxiety, PTSD and depression should be assessed in Long COVID patients. This also can be the reason why brain fog, memory issues, exercise intolerance and effects of stress response are long term effects. In fact, the majority of infectious central nervous system disorders can present with neurological and psychiatric symptoms. One example is multiple sclerosis (MS), which occasionally turns out to help explain progressive cognitive impairment in adulthood. MS can also present with fatigue, depression, mania or psychosis. Lupus (SLE), which causes widespread inflammation and tissue damage in affected organs, is particularly associated with a transient encephalopathy—"lupoid psychosis."
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One emerging theory to explain long COVID is "molecular mimicry," where infectious agents disguised to "mimic" normal cells produce an autoimmune response. When the immune system eventually finds and fights them, it sometimes also fights the normal cells that the infection is imitating. Depending on which cells are being "mimicked," the result can be a variety of symptoms, including the gastrointestinal, psychological and respiratory issues we're seeing with long COVID. It could also potentiate the development of autoimmune antibodies in many types of cells, including gut microflora.8
The extent of autoimmune involvement in long COVID remains to be seen and it may be months or even years until such theories are definitively resolved, if ever. More importantly, we may be waiting an equally long time until clinical trials produce proven, safe and effective medical treatment for Long COVID. With so little still known about chronic post-viral conditions including their effect on children, researchers must scramble to answer many questions at once.
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How to Track the Symptoms
For the kids awaiting answers to treat their debilitating long COVID symptoms now, rehabilitation can guide meaningful and measurable interventions. Studies have shown external factors like diet and lifestyle control the immune system significantly more than genetics. This provides the basic premise for gathering data about the myriad of variables wreaking havoc in each individual case of long COVID, to find specific correlations – alongside possible solutions – to each child's symptoms.
Adjusting for personal health and lifestyle changes to improve outcomes has long guided non-pharmacological care in people with diabetes or cardiovascular issues. An approach informed by real world evidence can provide much-needed answers in the case of long COVID too.
Long COVID experts acknowledge that rehabilitation offers an immediate way forward. Early treatment in emerging Post-Covid clinics need specialists who can prescribe the right exercise, cognitive behavioral therapy, sleep modification and medication for the myriad of health issues. Gathering real world evidence to understand what makes each kid's case of long COVID unique is an important first step towards answers.
Book a free consultation call with Mymee to learn more about reducing long COVID symptoms through real world evidence, or to register for antibody testing to find out if you or your child are at risk. And to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.
Join Dr. Lytle and other health experts at Mymee's free virtual COVID-19 and Autoimmunity Summit from September 13 – 24, 2021. To learn more about reducing long COVID symptoms through real world evidence book a free consultation call.
- Chronic fatigue syndrome and long covid: moving beyond the controversy https://www.bmj.com/content/373/bmj.n1559