There is now growing evidence that Long covid can affect children and young people as well as adults. And it seems likely that some of them will go on and meet with diagnostic criteria for ME/CFS – as is described in these three case reports from doctors at John Hopkins Children's Centre in the USA (below).
Commenting in a newspaper report on the lack of medical help for children with Long covid earlier in the year, Dr Nigel Speight, Paediatric Medical Adviser to the ME Association, said:
“For many years, children and adults with ME have been subjected to disbelief by the medical profession. The same thing might be beginning to happen with Long Covid children.
“The medical profession would be sensible to accept Long Covid as a post-viral, ME-like illness, and treat it open mindedly, believe in it, and be supportive.
“Doctors don’t have too much to offer these children in terms of a cure, so the least they can do is support and protect them.”Dr Nigel Speight, The Sun 15 January 2021
Adolescent and Young Adult ME/CFS After Confirmed or Probable COVID-19
Introduction: Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Methods and Results: We describe three adolescent and young adult patients who had confirmed or probable COVID-19 infections early on during the pandemic and were referred for evaluation to the Chronic Fatigue Clinic at the Johns Hopkins Children's Center.
All patients reported orthostatic intolerance symptoms within the first 2 weeks of illness, and 10-min passive standing tests were consistent with postural tachycardia syndrome. After 6 months of illness, all three patients met criteria for ME/CFS.
Clinical features of interest included strong histories of allergies in all three patients, two of whom had elevations in plasma histamine. Each demonstrated limitations in symptom-free range of motion of the limbs and spine and two presented with pathological Hoffman reflexes. These comorbid features have been reported in adolescents and young adults with ME/CFS.
Conclusion: ME/CFS can be triggered by COVID-19 in adolescents and young adults. Further work is needed to determine the pathogenesis of ME/CFS after COVID-19 and optimal methods of treating these patients.
Our preliminary study calls attention to several comorbid features that deserve further attention as potential targets for intervention. These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment.
Larger studies will need to ascertain the prevalence of these abnormalities.