Long COVID and Children

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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