long COVID

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Can addressing gut issues treat long COVID in children?

COVID-19, health, long COVID, Science, syndication / /
Child holding his stomach

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Four years after the outbreak of the COVID-19 pandemic, doctors and researchers are still seeking ways to help patients with long COVID, the persistent and often debilitating symptoms that can continue long after a COVID-19 infection.

In adults, the most common long COVID symptoms include fatigue and brain fog, but for children the condition can look different. A study published last month suggests preteens are more likely to experience symptoms such as headaches, stomach pain, trouble sleeping, and attention difficulties. Even among children, effects seem to vary by age. “There seems to be some differences between age groups, with less signs of organ damage in younger children and more adultlike disease in adolescents,” says Petter Brodin, professor of pediatric immunology at Imperial College London.

While vast sums have been devoted to long COVID research—the US National Institutes of Health have spent more than a billion dollars on research projects and clinical trials—research into children with the condition has been predominantly limited to online surveys, calls with parents, and studies of electronic health records. This is in spite of a recent study suggesting that between 10 and 20 percent of children may have developed long COVID following an acute infection, and another report finding that while many have recovered, some still remain ill three years later.

Now, what’s believed to be the first clinical trial specifically aimed at children and young adults with long COVID is underway, recruiting subjects aged 7 to 21 on which to test a potential treatment. It builds on research that suggests long COVID in children may be linked to the gut.

In May 2021, Lael Yonker, a pediatric pulmonologist at Massachusetts General Hospital in Boston, published a study of multisystem inflammatory syndrome in children (MIS-C), which she says is now regarded as a more severe and acute version of long COVID. It showed that these children had elevated levels of a protein called zonulin, a sign of a so-called leaky gut. Higher levels of zonulin are associated with greater permeability in the intestine, which could enable SARS-CoV-2 viral particles to leak out of the intestines and into the bloodstream instead of being excreted out of the body. From there, they could trigger inflammation.

As Yonker began to see more and more children with long COVID, she theorized that many of the gastrointestinal and neurological symptoms they were experiencing might be linked. But her original study also pointed to a possible solution. When she gave the children with MIS-C a drug called larazotide, an existing treatment for people with issues relating to a leaky gut, the levels of viral particles in their blood decreased and their symptoms improved.

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Long COVID rates have declined, especially among the vaccinated, study finds

covid-10 vaccines, COVID-19, Delta, health, long COVID, omicron, SARS-CoV-2, Science, vaccinated, variants / /

Good news —

In large study, rates of long COVID fell from 10% to 3.5% for the vaccinated.

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Long covid activists attend the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on the

Enlarge / Long covid activists attend the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on the “Fiscal Year 2025 Budget Request for the National Institutes of Health,” in Dirksen building on May 23, 2024.

As a summer wave of COVID-19 infections swells once again, a study published this week in the New England Journal of Medicine offers some positive news about the pandemic disease: Rates of long COVID have declined since the beginning of the health crisis, with rates falling from a high of 10.4 percent before vaccines were available to a low of 3.5 percent for those vaccinated during the omicron era, according to the new analysis.

The study, led by Ziyad Al-Aly, chief of research at the VA Saint Louis Health Care System, used data from a wealth of health records in the Department of Veterans Affairs. The researchers ultimately included data from over 440,000 veterans who contracted COVID-19 sometime between March 1, 2020, and January 31, 2022, as well as over 4.7 million uninfected veterans who acted as controls.

Al-Aly and colleagues divided the population into eight groups. People who were infected during the study period were divided into five groupings by the dates of their first infection and their vaccination status. The first group included those infected in the pre-delta era before vaccines were available (March 1, 2020, to June 18, 2021). Then there were vaccinated and unvaccinated groups who were infected in the delta era (June 19, 2021, to December 18, 2021) and the omicron era (December 19, 2021, and January 31, 2022). The uninfected controls made up the final three of eight groups, with the controls assigned to one of the three eras.

On the decline

In the pre-delta/pre-vaccine era, 10.42 out of 100 unvaccinated people infected developed long COVID in the year after their infection, which the researchers referred to as PASC, or postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the delta era, the rate of long COVID among the unvaccinated fell slightly to 9.51 out of 100. But for the vaccinated, the rate fell much further, to 5.35 out of 100. A similar pattern was seen in the omicron era. For the unvaccinated, the rate of long COVID again fell slightly to 7.76 per 100 people, while the vaccinated saw their rate fall to 3.5 per 100.

In a secondary statistical analysis, called a decomposition analysis, the researchers found that vaccines could explain about 72 percent of the cumulative decline in long COVID rates across the eras, while era-related factors explained about 28 percent. Those era-related factors could include differences in the virus, improved treatments, and use of anti-viral medications.

Further, looking at data on the disease categories related to long COVID cases, the researchers also did an analysis finding a shift in symptoms over the eras. The researchers looked at over 10 disease categories: cardiovascular, coagulation and hematologic, fatigue, gastrointestinal, kidney, mental health, metabolic, musculoskeletal, neurologic, and pulmonary. Compared to the two earlier eras, the researchers noted an increase in gastrointestinal, metabolic, and musculoskeletal diseases involved in long COVID cases in the omicron era.

Overall, the study points to a welcomed decline in the rates of long COVID among the infected, particularly for those who are vaccinated. But, it also makes clear that long COVID isn’t a thing of the past: “a substantial residual risk of PASC remains among vaccinated persons who had SARS-CoV-2 infection during the omicron era,” Al-Aly and his colleagues conclude.

The study also has some limitations, leaving lingering questions for further study. One is whether the type or number of vaccines affect the risk of long COVID—that was not included in the study. The study also didn’t allow researchers to assess whether repeat infections increase the burden of long COVID.

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