The elephant and the blind men: the children of long covid

Dear Editor,

As community and neurodisability paediatricians we are used to managing children with disability and chronic disease, and have therefore closely followed important concerns regarding Long Covid raised by Simpson and Lokugamage [1,2]. Media reports following the All Party Parliamentary Group on Coronavirus meeting on schools [3,4] stated that ‘scientists called for reconsideration of Covid-19 vaccinations for children’ due to concerns regarding the prevalence of this condition [5]. The Office for National Statistics (ONS) prevalence of 12.9% (primary school age) and 15% (secondary school age) of Long Covid were cited and are widely quoted by those concerned about the long-term effects of Covid-19 in children. So how much should parents and their children worry? And does this worry warrant vaccination?

The ONS figures [6] need context. Our understanding is that 12.9% represents the proportion of children aged 2-11 years who – within five weeks of a positive Covid-19 test result – developed any of one of the following symptoms for any length of time: fatigue, cough, headache, loss of taste, loss of smell, myalgia, sore throat, fever, shortness of breath, nausea/vomiting, diarrhoea, or abdominal pain. The ONS report individual prevalence for five of these symptoms as follows: fatigue 3.5%; cough 4%; headache 5.3%; loss of taste/smell 2%; myalgia 1.7%. These figures are in line with or lower-than the expected population prevalence of, for example, the prevalence of cough reported in an unselected cohort of 7670 children aged 1-18 in Leicestershire[7] and prevalence of headache and fatigue reported by boys and girls across two decades in a representative Finnish cohort [8]. Given high levels of family and community stress we would expect the prevalence of some of these symptoms to be higher in all children at the current time.

The prevalence estimates being discussed are currently what might be called a ‘floating numerator’, which needs a comparator group, and to be interpreted with much more caution. All of us should be careful to ensure statistics discussed in public are meaningful. We now need to know how many survey participants (by age) without Covid-19 had similar symptoms and have asked the ONS for these data. As paediatricians we argue that “children are not small adults”, and whilst we agree with those calling for Long Covid to be counted in the child population, we add – let’s count properly. In the meantime, we endorse the approach towards vaccination of children laid out by the Royal College of Paediatrics & Child Health who have written clearly on risks and benefits for children whilst trial safety and efficacy data remain unavailable [9].

1 Simpson FK, Lokugamage AU. The elephant and the blind men: the children of long covid. BMJ 2021;372.
2 Simpson F, Lokugamage A. Counting long covid in children. BMJ Opinion. https://blogs.bmj.com/bmj/2020/10/16/counting-long-covid-in-children/ (accessed 3 Feb 2021).
3 About us. March for Change. (accessed 3 Feb 2021).
4 All-Party Group on Coronavirus - Call for Evidence. All-Party Group on Coronavirus - Call for Evidence. https://appgcoronavirus.marchforchange.uk/ (accessed 4 Feb 2021).
5 Scientists say CHILDREN should be vaccinated against coronavirus | Daily Mail Online. https://www.dailymail.co.uk/news/article-9215089/Scientists-say-CHILDREN... (accessed 3 Feb 2021).
6 Updated estimates of the prevalence of long COVID symptoms - Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/... (accessed 3 Feb 2021).
7 Jurca M, Ramette A, Dogaru C, et al. Prevalence of cough throughout childhood: A cohort study. Plos ONE Published Online First: 2017. doi:https://doi.org/10.1371/journal.pone.0177485
8 Luntamo T, Sourander A, Santalahti P, et al. Prevalence Changes of Pain, Sleep Problems and Fatigue Among 8-Year-Old Children: Years 1989, 1999, and 2005*. Journal of Pediatric Psychology 2012;37:307–18. doi:10.1093/jpepsy/jsr091
9 Coronavirus vaccination programme - statement. RCPCH. https://www.rcpch.ac.uk/resources/coronavirus-vaccination-programme-stat... (accessed 3 Feb 2021)