RECOVER study highlights variations in Long COVID symptoms among children of different backgrounds
Findings from a recent RECOVER study—which reviewed health records from over 225,000 children across different racial and ethnic groups—can help improve early detection and management of pediatric Long COVID symptoms.
Adults with Long COVID can experience many different symptoms, with over 200 symptoms reported in previous Long COVID studies. A 2023 RECOVER study found that these differences in symptoms can be associated with an individual’s racial or ethnic background, and it described the various symptoms that adults of different races and ethnicities experienced.
Early COVID-19 research revealed differences in COVID-19 testing outcomes among children. For example, non-Hispanic Black, Hispanic, and multiracial children were more likely to test positive for COVID-19 when compared to non-Hispanic White children. However, there has been limited research on the racial and ethnic backgrounds of those impacted by pediatric Long COVID. RECOVER researchers recently published a study in Nature Communications aimed at understanding the differences in Long COVID symptoms among children of different backgrounds.
What did researchers do?
Researchers reviewed over 225,000 pediatric electronic health records (EHRs) across 13 institutions to study how children’s health changed after acute (short-lived) COVID-19. The study included EHRs of children who had a SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The researchers looked at the health conditions children had before their SARS-CoV-2 infection or COVID-19 diagnosis. They focused on conditions broadly associated with Long COVID, including:
Fatigue and malaise (extreme tiredness)
Respiratory symptoms (lungs and airways)
Cardiovascular complications (heart and blood vessels)
Neurological disorders (brain, spinal cord, and nerves)
The researchers then compared these data to information about children’s health conditions after a SARS-CoV-2 infection or COVID-19 diagnosis to determine whether and how the children’s overall health changed after infection.
For the purposes of this study, researchers defined COVID-19 cases as either severe or nonsevere. The term nonsevere described cases in which individuals did not show symptoms or had minor COVID-19 symptoms that did not require hospitalization. The term severe described cases where individuals experienced one or more of the following during their COVID-19 case:
COVID-19 related conditions like gastroenteritis (stomach or intestine irritation), dehydration, or pneumonia
Required hospital intervention, such as admission to an intensive care unit
Needed mechanical ventilation or assistance with breathing
What did the researchers find?
Researchers compared the Long COVID symptoms of non-Hispanic White children with the symptoms of children from other racial and ethnic backgrounds. The study found:
Non-Hispanic Black children experienced more problems with cognitive function (memory, problem solving, attention, and reasoning).
Non-Hispanic Black children experienced fewer changes in skin symptoms.
Hispanic children with severe COVID-19 showed higher rates of hair loss.
Asian American and Pacific Islander (AAPI) children were more likely to experience fever and chills.
AAPI children with nonsevere COVID-19 experienced a higher risk of postinfection illnesses. This category includes Postural Orthostatic Tachycardia Syndrome (POTS), a condition that causes patients to experience fast heart rate, dizziness, and fatigue when standing up, as well as respiratory symptoms.
AAPI children with both severe and nonsevere cases of COVID-19 showed an increased risk of developing at least one Long COVID-related condition or symptom.
Additionally, the researchers noted that similarities existed among all the racial and ethnic groups included in the study depending on the severity of their COVID-19 case. For example, for all groups, children with severe COVID-19 were more likely to experience abdominal or stomach pain when compared to individuals in their same group who had experienced nonsevere cases of COVID-19.
Why are these findings important?
The study noted several differences among groups and communities that were not due to biological (genetic) factors. The authors note that these differences can be attributed to social and financial factors (such as where a child lives or their access to fresh and healthy food), healthcare infrastructure (such as whether hospitals and medical centers have the resources to provide necessary care), and regional healthcare policies. Understanding how Long COVID impacts different communities can help inform more targeted screening and follow-up protocols for providers. These care measures can potentially improve early detection and management of Long COVID symptoms for all children.
In addition, because this study includes a large number of EHRs from 13 different institutions, the study population accurately represents the US population. Conducting a large study like this enables the study’s results to be generalizable, or applicable to a wider population beyond those individuals included in the study. This research could help inform public health strategies aimed at reducing health disparities, or differences in health outcomes, experienced by certain communities. These strategies could include ensuring that people from all walks of life can access healthcare and enhancing specialized pediatric care across all regions in the US.
Read the full study to learn about the impact of pediatric Long COVID and recommendations for improving healthcare for children living with the condition.
