Most children who contract symptomatic COVID-19 recover within six days and long-COVID is rare, according to a new UK study.
Analysis of data from 1,734 children whose symptoms were reported on the ZOE COVID Study app found that children typically recovered within a week and had few symptoms, with the average illness lasting six days and an average of three symptoms experienced.
Almost all (98.2%) symptomatic children were recovered by eight weeks.
However, 4.4% experienced symptoms beyond four weeks and had an average of two persistent symptoms, usually fatigue, headache or loss of sense of smell.
In what is the first detailed description of COVID-19 illness in symptomatic school-aged children aged five to 17, the report in The Lancet Child & Adolescent Health, says long illness duration after SARS-CoV-2 infection is rare.
Lead and senior author Professor Emma Duncan, from King’s College London, UK, said: “It is reassuring that the number of children experiencing long-lasting symptoms of COVID-19 symptoms is low. Nevertheless, a small number of children do experience long illness with COVID-19, and our study validates the experiences of these children and their families.”
Some adults suffer long-COVID, but it was not known if children can develop a similar condition or how common it is.
Three symptoms
To find out, the researchers used data collected through the ZOE COVID Study smartphone app from 1 September 2020 and 22 February 2021.
During the study period, 1,734 children developed COVID-19 symptoms, which was confirmed by a positive PCR test. Their symptoms were reported regularly until they were healthy again, which meant the researchers could accurately attribute these children’s symptoms to COVID-19 and could assess illness duration robustly.
The children were ill for an average of six days and experienced an average of three symptoms in the first week of illness.
The most common symptom experienced by children with long illness duration was fatigue, with 84% (65/77) of children reporting fatigue at some point in their illness.
Headache and loss of sense of smell were also common, with each symptom experienced by 77.9% (60/79) of children over the course of their illness. Headache was more common early in illness and loss of sense of smell tended to occur later and to persist longer.
Of the 1,379 children who developed symptoms at least two months before the end of the study period (on or before 29 December 2020), fewer than 2% experienced symptoms for longer than eight weeks (1.8%, 25/1,379).
Older children tended to be ill for longer than primary school aged children, with an average of seven days’ illness in those aged 12 to 17 and five days among youngsters aged five to 11.
Older children were also more likely to have symptoms after four weeks than younger children – 5.1% [59/1,146] children aged 12 to 17 years compared with 3.1% [18/588] aged 5 to 11 years, but there was no difference in the numbers of children who still had symptoms after eight weeks.
First study author Dr Erika Molteni, from King’s College London, said: “We found that nearly a quarter of symptomatic children testing positive for SARS-CoV-2 during the UK’s second wave did not report core symptoms, suggesting the UK testing policy needs reconsideration.”
The researchers also assessed the children who tested negative for COVID-19 who may have had other childhood illnesses, such as colds and flu.
They randomly selected a group of age-matched and gender-matched children with symptoms reported through the app who were tested at the same time as the positive children.
Prolonged symptoms
They found that children with COVID-19 were ill for longer compared to children with other illnesses who tested negative, with an average of six days’ illness with COVID-19 compared to three days with other illnesses. They were also more likely to be ill for more than four weeks.
However, at four weeks, the small number of children with other illnesses tended to have more symptoms than those who were ill with COVID-19, with an average of five symptoms in the negative group compared to two in the positive group.
Senior author Dr Michael Absoud, a consultant and senior lecturer at King’s College London, said: “Our data highlight that other illnesses, such as colds and flu, can also have prolonged symptoms in children and it is important to consider this when planning for paediatric health services during the pandemic and beyond.
“This will be particularly important given that the prevalence of these illnesses is likely to increase as physical distancing measures implemented to prevent the spread of COVID-19 are relaxed. All children who have persistent symptoms – from any illness – need timely multidisciplinary support linked with education, to enable them to find their individual pathway to recovery.”
Molteni E, Sudre CH, Canas LS et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child & Adolescent Health 3 August 2021
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