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Four years after the outbreak of the COVID-19 pandemic, doctors and researchers are still looking for ways to help patients with long-term COVID-19, the persistent and often debilitating symptoms that can last long after a COVID-19 infection.
In adults, the most common long-term COVID symptoms are fatigue and brain fog, but in children the condition can look different. A study published last month suggests that young teens are more likely to experience symptoms such as headaches, stomach aches, sleep problems and attention problems. Even in children, the effects appear to vary by age. “There appear to be some differences between age groups, with fewer signs of organ damage in younger children and more adult-like disease in adolescents,” said Petter Brodin, professor of pediatric immunology at Imperial College London.
While enormous sums have been spent on long-term COVID research – the US National Institutes of Health has spent more than a billion dollars on research projects and clinical trials – research on children with the condition has been mainly limited to online surveys, phone calls with parents and electronic health record research. This is despite a recent study suggesting that between 10 and 20 percent of children may have developed long-term COVID after an acute infection, and another report showing that while many have recovered, some are still ill three years later.
Now believed to be the first clinical trial specifically targeting children and young adults with long-term COVID-19, recruiting subjects aged 7 to 21 to test a potential treatment. It builds on research suggesting 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 on multisystem inflammatory syndrome in children (MIS-C), which she said is now considered 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 so-called leaky gut. Higher levels of zonulin are associated with greater intestinal permeability, which allows SARS-CoV-2 viral particles to leak out of the intestines and into the bloodstream rather than being excreted from the body. From there they can cause inflammation.
As Yonker started seeing more and more children with long-term COVID-19, she theorized that many of the gastrointestinal and neurological symptoms they were experiencing may be related. But her original research also pointed to a possible solution. When she gave the children with MIS-C a drug called larazotide, an existing treatment for people with problems related to leaky gut, the number of virus particles in their blood dropped and their symptoms improved.
