Long COVID Rates in Kids Revised Upward: What to Know

Gabrielle Jospa, 15, was diagnosed with long COVID after a serious bout with acute COVID-19 that left her hospitalized in 2021. Since then, the Long Island, New York, teen has had crippling headaches, postural orthostatic tachycardia syndrome (POTS), fatigue, joint pain, anxiety, and problems at school. 

But perhaps the worst part for Jospa is that she says she’s often treated like she’s not telling the truth. Teachers and doctors shrug off her symptoms as those of an overly dramatic teenager. 

“Doctors would constantly say that tests showed I was fine, but I wasn ‘t fine. It just leaves you thinking you ‘re going crazy,” she said.

That’s why her recent participation in the National Institutes of Health ‘s Researching COVID to Enhance Recovery (RECOVER) study has been so validating. Jospa said that for the first time, she’s being treated by doctors who listen to her complaints and understand that her symptoms are caused by long COVID. 

Teens like Jospa have become an increasing focus of researchers who have also begun to outline how, and how many, kids and adolescents are affected by the disorder and how the symptoms vary within each age group. Their findings are helping detail what doctors, pediatricians, and parents need to know about the long-term impacts of long COVID on kids and teens — an issue some public health experts say has not received enough attention. 

Experts contend that pediatricians need to be on the lookout for common long COVID symptoms in kids and teens, like complaints of daytime tiredness and general low energy, muscle or joint pain, stomach pain, new or worsening headaches, and trouble with memory or focusing.

Kids and Long COVID: What the Numbers Show 

In the most expansive study of its kind, researchers have for the first time shown serious and prevalent symptoms of long COVID in kids and teens. The August study, published in the Journal of the American Medical Association, is among the first large comprehensive studies of the disorder in this age group. The study, which followed 5367 children, found that 20% of kids (ages 6-11) and 14% of teens met researchers’ threshold for long COVID. 

Until now, research has been lacking because children were thought to be less susceptible to both acute COVID-19 and long COVID, experts say. But by some estimates, up to 5.8 million kids and teens have the disorder.

Study author Rachel Gross, MD, an associate professor in the departments of pediatrics and population health at NYU Langone, is in line with the percentage of adults diagnosed with long COVID. 

The new research found that long COVID affected nearly every organ system in kids and teens. And experts contend that pediatricians need to be on the lookout for gastrointestinal complaints in kids as well as complaints of extreme fatigue and cognitive deficits or perceived changes in mental acuity in teenagers.

By enrolling children who had been infected with acute COVID-19, as well as those who had not, researchers were able to isolate long-COVID symptoms in kids and teens. 

“It allowed us to separate symptoms related to long COVID with those that may have resulted from changes in a child’s environment during the pandemic,” said Gross — for example, learning loss and mental health changes that were caused by the pandemic vs those that were caused by prolonged symptoms associated with long COVID.

Common Long-COVID Symptoms 

Symptoms were also different for kids and teens in different age groups. While younger children had a distinct cluster of symptoms that included attention problems, gastrointestinal issues, and sleep issues, teens were more likely to experience a loss of taste and smell as well as brain fog and extreme fatigue.

Small children are less likely to be able to describe cognitive and mental health issues compared with teens, said Grace McComsey, MD, who leads one of the 15 nationwide long-COVID centers funded by the federal RECOVER Initiative, in Cleveland. For the study, parents helped younger children fill out the survey, but they were able to notice things like attention deficits or a lack of focus in their children, she said.

“Age still impacted which long-COVID symptoms patients were more likely to present,” said McComsey, even considering the ability to communicate within each age group.

Kids and teens also face higher risks for reinfection because they attend school and are constantly exposed to the virus. This, according to experts, means that their symptoms may worsen before they get better. An August 2023 study published in the International Journal of Molecular Sciences highlighted the increased risk for long COVID after acute COVID reinfection, even in vaccinated individuals.

Long-Term Impacts on Child Development 

Researchers are also learning that these impacts are having profound and long-term repercussions on kids and teens who are too sick to engage in the activities that they previously enjoyed. 

Postexertional malaise, a worsening of fatigue that occurs after even minimal exertion, often precludes kids from being able to participate in sports or after-school activities. This may take them away from the things that they enjoyed as well as their friend group, said Lael M. Yonker, MD, an associate professor of pediatrics at Harvard Medical School. 

“Not only are kids not able to play the sports they once did, a lot of them have had to take weeks, months, or even whole years off from school. Other kids have had to switch to homeschooling,” said Yonker. “There’s also been an impact on their social engagements because things like playdates present too much exertion and can set them way back.”

A study recently published in the journal eClinicalMedicine showed that the symptoms of long COVID in children significantly interfered with their lives, specifically their education and social interactions, which may lead to long-term developmental challenges down the line. 

Acknowledging that kids and teens are suffering is one thing, but we’re still not doing nearly enough to help them, and the repercussions could be staggering, said study author Danilo Buonsenso, a researcher focused on long COVID in kids at Gemelli University Hospital in Rome. “We’re past the point of doing observational research; now it’s time to study effective treatments,” he said.

For now, Jospa is feeling better due to a mix of new medications like atogepant for her migraines as well as beta-blockers, compression socks to improve blood flow, and regular visits to a psychiatrist. 

Her mother, Amy Jospa, deserves much of the credit. She’s made her daughter’s treatment regimen a full-time job for the past 4 years. It’s tiring and time-consuming but, said Amy, at least her daughter is back in school, a junior now, and is settling back into the new school year. Still, she has good days and bad. 

“Sometimes it’s a vicious cycle. When I get sick, I get anxious; and when I get anxious, I can’t seem to feel better,” said Jospa.