43% of children suffer from Covid 3 months after infection

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Four out of ten children and adolescents evaluated in a study by the Instituto da Criança of Hospital das Clínicas de São Paulo continue to suffer prolonged effects of Covid in the 12 weeks following infection.

The conclusion reinforces the need for vaccination of this group as a preventive measure and as a follow-up measure for those infected for a longer period.

It adds to a body of evidence that has shown that, like adults, children and teenagers can also suffer the effects of the so-called long Covid, among the most serious myocarditis (inflammation of the heart muscle) and diabetes.

In the HC study, a group of 53 children and adolescents aged 8 to 18 years who had symptomatic Covid were followed for an average of four months. In total, 43% of them had persistent symptoms. Among them, headache (19%), tiredness (9%), dyspnea (8%) and difficulty concentrating (4%). Muscle and joint pain, in addition to poor sleep quality, were also reported (4%).

Of that total, a quarter of the children continued to have at least one of the symptoms after 12 weeks and were classified as having long-term Covid.

The study, published in the scientific journal Clinics, also included a control group of children without SARS-CoV-2 infection. Both were balanced by age, sex, ethnicity, social status, BMI and pediatric chronic diseases.

“These symptoms have a great impact on the quality of life of these children and school losses, since there is a concentration deficit”, says pediatrician Artur Delgado, coordinator of the ICU of the Institute for Children and Adolescents at HC.

The children continue to be supervised, every six months, by a multidisciplinary and multiprofessional team in a new outpatient clinic set up at the institute.

Another recent warning about the lingering effects of Covid on young people came from the US CDC (Centers for Disease Control and Prevention) earlier this month. The disease was linked to a two-fold increased risk of developing diabetes in children.

The researchers looked at health insurance databases and compared new diagnoses of diabetes in children who had and who did not have Covid. The suspicion is that the disease arises from damage to the pancreas caused by Sars-CoV-2.

According to Sharon Saydah, a researcher at the CDC, it is still unclear whether cases of post-Covid diabetes will be permanent or temporary. It is good to reinforce, however, that the disease is not the only risk factor for diabetes. A sedentary lifestyle increased during the pandemic and this led to weight gain in children, which may also have contributed to the rise in cases of the disease.

The serious acute effects of the disease, although rare, are also worrisome. The Brazilian mortality rate from pediatric multisystem inflammatory syndrome (P-SIM) is 6%, four times higher than that recorded in the United States.

Since the beginning of the pandemic, this syndrome has already affected 1,450 children and adolescents in Brazil, with 86 deaths, according to the latest bulletin from the Ministry of Health.

The syndrome usually appears two to six weeks after a generally mild Covid-19 infection and can result in hospitalization for children, with severe symptoms involving the heart and other organs.

“Covid is not as often serious in children as in adults, but it can be very serious and leave sequelae, such as myocarditis. The risk of sequelae due to the disease is much greater than any effect of the vaccine”, says Delgado.

A review of data from 5 million children vaccinated in the US showed a 0.05% rate of adverse effects, mostly mild, such as pain at the injection site, fever and headache.

The Hospital Infantil Sabará, in São Paulo, is also evaluating the persistence of symptoms of Covid in children admitted to the institution during the pandemic, but the work is still in progress.

At Pequeno Príncipe Hospital, in Curitiba (PR), the largest pediatric institution in the country that serves SUS, a cardiology outpatient clinic was created to monitor cases of myocarditis after the acute phase of Covid.

The effects don’t stop there. “We are seeing many children having migraine attacks, developing type 1 diabetes, peripheral neuropathy, headache and depression and anxiety”, says Victor Horácio de Souza Costa, pediatric infectious disease specialist at Pequeno Príncipe.

According to him, the disease also brings many clinical manifestations in the acute phase, such as respiratory failure, meningitis and nephrotic syndrome (loss of protein in the urine), and it is essential that the child continues to be monitored for a period after the infection.

It is not yet known, for example, whether the effects that still persist will be permanent or will disappear over time.

“We had children with myocarditis who progressed very well and others who have been followed up for almost a year, with great difficulty in normalizing the heart muscle”, explains Costa.

The boy David, 8, is part of the first group. He developed myocarditis after infection with Covid, spent a year being followed up at the Pequeno Príncipe cardiology outpatient clinic and is now recovered.

The mother, Sara de Souza, 37, says that the inflammation of the heart muscle was diagnosed during hospitalization. “His heart was very weak.” David was hospitalized for 13 days, eight of them in the ICU, intubated.

Sara says she can’t wait for her son to be vaccinated against Covid. “If I could go around screaming: vaccinate, vaccinate your children so you don’t go through what I went through, I would do that. People still think that nothing happens with children.”

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