As the COVID-19 pandemic winds on, and many Americans come down with COVID-19 a second or even third time, there has been a shift in our collective fears. Infection — particularly for the vaccinated — is often mild, and mortality rates have fallen significantly. For many, it is now the risk of aftereffects that is most frightening, more so than the initial diagnosis itself. Colloquially known as "long COVID" or "long-haul COVID," the term applies to an increasingly nebulous array of health afflictions that can appear well after an initial infection. Those afflictions span a variety of cardiovascular, muscular, and neurological conditions, even neurological impairment.
Unlike COVID's mortality rate, long COVID doesn't discriminate based on age: around 10% of children who come down with COVID-19 are estimated to develop one such condition, according to at least one study. And for a variety of reasons, long COVID cases in children have gotten less attention — and in many cases, the very real symptoms some children experience after COVID infections have been dismissed, despite evidence that suggests an actual disorder related to COVID-19. (A similar pattern of dismissal occurred with elderly patients whose impairments were sometimes chalked up to dementia.)
Now, the Centers for Disease Control and Prevention estimates that roughly one out of five adults in the United States have developed a health condition that may be the result of a COVID-19 infection. Yet far less is known about the prevalence among children; and indeed, the studies on children seem to vary wildly in their findings. Some indicate that less than 1% of children will develop one of these conditions; another study found that an estimated half of children who came down with COVID-19 would have long-term symptoms.
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According to Dr. Lynora Saxinger, who leads the COVID-19 Scientific Advisory Group for Alberta Health Services, reporting bias plays a big role in the discrepancy — as does a lack of clear definitions of the condition, or rather a multitude of conditions.
"It is not at all uncommon for people to have symptoms from their infection for a month or six weeks after the infection, depending on how you ask the question and what symptoms you look for," she told Salon.
Often, it is hard for physicians to tell whether very common mental health conditions — such as anxiety or depression — are a result of long COVID or not. One study, titled "Long COVID — the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study," found that about 40% of children involved reported feeling worried, sad, or unhappy. The authors found little discrepancy between those who had tested positive for COVID-19 and those who had not.
"Adolescents are passing through a transition in life where there are a lot of stressors, and if some of them are also suffering these symptoms but there are no lab tests to verify it, then they're kind of left adrift within a system that isn't prepared to support them and has very little evidence to go on about what to do," said Professor Harlan Krumholz, a cardiologist and a professor at Yale University. "It's a terrible situation. It's a predicament."
Long COVID also moves on its own schedule, which complicates diagnoses. Some patients who had asymptomatic COVID-19 cases developed long COVID conditions weeks or months after their infection.
For those who fear long COVID, vaccines do seem to offer protection. Indeed, evidence suggests that vaccinations not only reduce the risk of infection which would lead to long COVID but in fact, vaccinations reduce the risk of developing these post-COVID conditions for those infected as well.
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According to Saxinger, excessive negative messaging about post-COVID conditions has added significantly to nihilism and pandemic fatigue. She highlighted that regardless of whether mental health symptoms are caused by long COVID or the social stress of the pandemic itself, getting children vaccinated is the best solution to balance the risk of long COVID and the detrimental impact of pandemic restrictions.
"We really should get everyone vaccinated," Saxinger said. "Even if you still get infected, we believe it will modulate your body's response to the virus in a way that's protective."
For children under the age of five, COVID-19 vaccination remains out of reach in the United States. In other words, younger children lack protection against long COVID. That may soon change though.
On Wednesday, a Food and Drug Administration committee will meet to discuss approval of the primary series Pfizer and Moderna COVID-19 vaccinations for children 6 months of age and older. Pending their decision and recommendations from the CDC, the White House aims to make vaccinations available for infants as early as next week.
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