COVID Transmissions for 8-4-2021
How frequent are long-term symptoms in children?
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 626 days since the first documented human case of COVID-19. “626” is the area code for Pasadena, California, the city where I got my undergraduate degree. As a result it is one of those numbers that I will arbitrarily always perk up at seeing.
Today, we’re going to talk about long-term symptoms from COVID-19 in children. How common are they?
Also, a story about a monoclonal antibody cocktail being approved for use in preventing COVID-19.
Since it’s hyper-local news, the announcement that New York City will soon require vaccination in bars, restaurants, and gyms didn’t make it into today’s headlines, but I still wanted to call it out—this kind of thing is a good move. It needs to happen, because both vaccinated people and unvaccinated people are dangerous to unvaccinated people. No business should have to take the risk of being a place where someone caught a deadly infection, so a logical conclusion is that unvaccinated people need to stay home, so they don’t get COVID-19. Either that, or they can get vaccinated. It’s a personal choice, after all. Vaccinated people, being rather well protected from COVID-19, are pretty safe to go out. It’s sensible policy to restrict these public settings to the vaccinated, and I’d like to see it implemented elsewhere.
Bolded terms are linked to the running newsletter glossary.
Keep COVID Transmissions growing by sharing it! Share the newsletter, not the virus. I love talking about science and explaining important concepts in human health, but I rely on all of you to grow the audience for this, which you can do by using this button here:
Now, let’s talk COVID.
The risk of serious long-term outcomes in children
A lot of you have asked about the chance of long-term symptoms from COVID-19 in children, so I keep my eye out for new studies of this any time that there is something to report.
Last night, a study was released from Lancet Child and Adolescent Health that looked at a cohort of more than 250,000 children, with around 1700 of them having tested positive for COVID-19 at some point during the study.
There are a lot of interesting pieces of information in this study, but the most concerning one to me is that 4.4% of the children in the study had illness with a duration of at least 28 days. That is unacceptably high, even though it may seem small. 4.4% of the children in the US would be millions of children. Millions of children being sick for an entire month at least?
When we go further—to 56 days—the number falls to 1.8%. That’s still very high! To put this in perspective, the odds that a randomly-chosen person’s IQ is over 130 are about the same—1 in 50. If parents are to be believed, children with well above-average intelligence are quite common. Even if parents exaggerate a bit, clever children are far from unheard of. A 2% event rate is not a rare event. I think we should be pretty concerned about a rate of long-duration COVID-19 symptoms that is so high.
You can read the full study here: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00198-X/fulltext
Prophylaxis with monoclonal antibodies
While vaccines are fantastic as a means of prevention, we know they are not perfect. For that reason, I was pleased to see the US FDA authorize the use of the Regeneron antibody cocktail, REGN-COV, for use in “post-exposure prophylaxis” (often abbreviated to PEP) for people 12 and older who are at high risk of severe COVID-19. This means the drug can be administered to a person who has been exposed to SARS-CoV-2, but has not yet developed COVID-19, and may be able to help prevent COVID-19 from developing in that person.
This is important, because often the people who are at the highest risk of severe disease are also those at the greatest risk for limited vaccine benefits.
The authorization is based on Phase 3 clinical trial data showing that the cocktail could be as much as 81% effective in eliminating COVID-19 cases in candidate patients.
Read the statement from the FDA here: https://www.fda.gov/drugs/drug-safety-and-availability/fda-authorizes-regen-cov-monoclonal-antibody-therapy-post-exposure-prophylaxis-prevention-covid-19
What am I doing to cope with the pandemic? This:
Watching: Brooklyn Nine-Nine
At this point, Brooklyn Nine-Nine has been around a while and counts as a hit sitcom, so I don’t thin I’m delivering news here in saying it’s good. The show, which focuses on NYPD detectives in a fictional precinct, is from Dan Goor and Michael Schur. The latter is someone whose work universally gets my attention, because he tends to select projects where the characters are generally good people who do their jobs competently. The shows end up being funny not because the characters are irredeemably awful, but because even people who are competent and kind can have funny quirks and end up in hilarious situations. So many other shows rely on their characters being mean or awful to each other, and…well, sometimes that’s funny, but if I want to relax, I prefer a show that is positive in nature.
Brooklyn Nine-Nine is like that, so I’m rewatching it. I hear a final season is coming out sometime soon though.
You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.
Join the conversation, and what you say will impact what I talk about in the next issue.
Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
Hmm. I guess I'm not as worried about the "4.4% for at least 28 days" number as you are, because when I compare to the flu, there have been years where there was a bad flu circulating around and anecdotally it sure seemed like at least one out of twenty kids I knew who got the flu was still not feeling great 3-4 weeks later.
The 56 day number is rather more concerning, though! Two months seems like a long time for a kid to be sick, and going back to the flu analogy, I don't think I've ever seen a kid who was sick for two months from the flu (and there are enough kids in our school/other communities that odds are, if this were common at the 2% rate, I feel like I would have heard about it).
I keep seeing that Lancet study described on social media as "reassuring," indicating that long COVID is "rare" in kids, even by people I respect. Of course, it's neither of those things, for reasons well articulated by you. Under normal circumstances, seeing a parent willingly subject their kid to a one-in-fifty chance of permanent injury would warrant a call to Child Protective Services.
I do wonder, though, if the apparently low incidence of post-acute symptoms in children relative to adults tells us anything about the mechanism(s) underlying long COVID. Certain autoimmune conditions are less common in children. And children may be less likely to harbor dormant viruses that could perhaps be reactivated by SARS-CoV-2 infection.