James' World 2

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Since the COVID pandemic began, claims that the disease poses only minimal risk to children have spread widely, on the presumption that the lower rate of severe acute illness in kids tells the whole story. Notions that children are nearly immune to COVID and don’t need to be vaccinated have pervaded.

These ideas are wrong. People making such claims ignore the accumulating risk of long COVID, the constellation of long-term health effects caused by infection, in children who may get infected once or twice a year. The condition may already have affected nearly six million kids in the U.S. Children need us to wake up to this serious threat. If we do, we can help our kids with a few straightforward and effective measures.

The spread of the mistaken idea that children have nothing to worry about has had some help from scientists. In 2023 the American Medical Association’s pediatrics journal published a study–which has since been retracted—reporting the rate of long COVID symptoms in kids was “strikingly low” at only 0.4 percent. The results were widely publicized as feel-good news, and helped rationalize the status quo, where kids are repeatedly exposed to SARS-COV-2 in underventilated schools and parents believe they will suffer no serious harm.

In January 2024, however, two scientists published a letter with me explaining why that study was invalid. Some of the errors made it hard to understand how the study survived peer review. For example, the authors claimed to report on long COVID using the 2021 World Health Organization definition, but didn’t properly account for the possibility of new onset and fluctuating or relapsing symptoms, even though that definition and the subsequently released 2023 pediatric one emphasize those attributes. Any child with four symptom-free weeks—even nonconsecutive ones—following confirmed infection was categorized by the study authors as not having long COVID.

In August, the authors of the study retracted it. They did not admit to the errors we raised. But they did admit to new errors, and said these mistakes meant they understated the rate of affected children.

And that rate, according to other research, is quite high. The American Medical Association’s top journal, JAMA, in August, published a key new study and editorial about pediatric long COVID. The editorial cites several robust analyses and concludes that, while uncertainty remains, long COVID symptoms appear to occur after about 10 percent to 20 percent of pediatric infections.

If you’re keeping score, that’s as many as 5.8 million affected children in the U.S.—so far. And we know studies and surveys of adults have found that repeat infections heighten the risk of long-term consequences.

The JAMA study comparing infected and uninfected children found that trouble with memory or focusing is the most common long COVID symptom in kids aged six to 11. Back, neck, stomach, and head pain were the next most common symptoms. Other behavioral impacts included “fear about specific things” and refusal to go to school.

Adolescents aged 12 to 17 reported different leading symptoms. Change or loss in smell or taste was most common, followed by body pains, daytime tiredness, low energy, tiredness after walking, and cognitive deficits. The study noted that symptoms “affected almost every organ system.” In other words, these symptoms reflect real physiological trauma. For example, SARS-COV-2 can cause or mediate cardiovascular, neurological, and immunological harm, even increasing the relative risk of new onset pediatric diabetes when compared with other lesser infections.

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