"It's feels like he hasn't fully recovered from COVID," says 10-year-old Saksham's mother, Shubha (name changed).
Saksham, like many healthy kids in India, caught COVID somewhere between the second and the third waves, and fought it without much fuss.
The difference was that, unlike many of his counterparts, Saksham's troubles with COVID only really started after his recovery.
"At that time vaccines were not available to children yet," explains his mother.
"We had started sending him to school when it reopened, and we think he might have caught it from there. The thing is, my husband and I both had COVID once before, but we had managed to keep him from getting infected then somehow."Shubha (name changed)
Elaborating a bit on Saksham's general health, Shubha says, "He would catch a cold sometimes, but nothing serious, he was pretty healthy otherwise."
It was only a couple of weeks after his recovery that Shubha noticed other symptoms emerge. "He would run a fever now and then, and he would complain of not being able to breathe, especially at night. Although his other symptoms subsided, his cough stayed on for over a month," she explains.
Children have been, from the start, on the lowest rung of priority as far as COVID vaccination is concerned. One reason for this is that COVID was initially thought to not infect children, and when it did, it was thought to mostly lead to mild illness.
This is true in most cases, but as we are now finding out, after COVID (in both mild and severe cases), many people are left to fight a whole other battle in the guise of long COVID— adults and children alike.
Can Kids Have Long COVID?
"We have certainly seen many cases of long COVID after the first and the second wave, but we haven't seen many cases after the third wave", says Dr Jesal Sheth, senior consultant, paediatrics, Fortis Mumbai.
"These children," according to Dr Sheth, "typically present high grade persistent fever, along with other symptoms like enlarged lymph nodes, rashes, and in some cases even heart issues."
"With any viral infection, there is a risk of a post viral syndrome, it is not an unknown phenomenon," says Dr Maninder Singh Dhaliwal, Associate Director, Paediatrics, Medanta Gurugram.
"Just because it's (COVID) a new disease, and we're isolating it, we are trying to understand and label things that don't have a label right now."Dr Maninder Singh Dhaliwal, Associate Director, Pediatrics, Medanta Gurugram
However, in the case of COVID, it's not just those who have severe illness that end up with post viral symptoms. Dr Dhaliwal says that in his experience, "children who had mild COVID that was managed at home, and asymptomatic cases, mostly they tend to develop this commonly."
"It is not scientifically proven, but this is what we have been seeing," he adds.
Diagnosing Long COVID in Kids Can be Tricky
"Long COVID in children is not an easy diagnosis to make because symptoms are very vague," says Dr Dhaliwal.
Dr Dhaliwal goes on to explain that they can span from a headache to abdominal pain, to body ache, to simply loss of concentration. "Every kid will come with a different set of symptoms."
"We have also been seeing cases of appendicitis, a couple of cases of mucormycosis, and in some children we found out that their heart function had been altered."Dr Jesal Sheth, senior consultant, paediatrics, Fortis Mumbai
How then, is long COVID diagnosed in children?
It begins with ruling out other issues that may be causing the symptoms. "This takes times," says Dr Dhaliwal.
"If a kid comes with, say a headache, then I have to evaluate for other causes of headache which might be related to the ears, teeth, or eyesight."
"If I am able to rule them all out, and there was a history of COVID, and if the symptoms have been persisting on and off for a period of more than 12 weeks, then I would label that as long COVID."Dr Maninder Singh Dhaliwal, Associate Director, Pediatrics, Medanta Gurugram
"Adults are more vocal about their symptoms, they know when they are not able to work, or are feeling lethargic, or if they're having body ache, but in children, the symptoms can be subtle and go unnoticed," says Dr Dhaliwal.
"Parents tell us things like he's not interested in sports, or that he is not able to cope with studies in school. It is difficult to pick these up these vague symptoms in children."Dr Maninder Singh Dhaliwal, Associate Director, Pediatrics, Medanta Gurugram
Misdiagnosis, in some cases, can be dangerous. For instance, speaking to FIT for a previous story on MIS-C, a rare but deadly long COVID complication in children, Dr Dhaliwal explained that it's important to first rule out tropical infections like dengue and malaria which have similar symptoms. Because if you give steroids (used to treat severe COVID symptoms) in those conditions, the child's condition could worsen.
Many of the children with long COVID symptoms were, initially, given routine medication in the OPD, says Dr Sheth, but they did not respond.
"They became sicker, and needed hospitalisation. Once they were admitted, after running some testes that came back negative, we suspected that maybe this could be COVID. We then got antibody tests done—these then came back positive."Dr Jesal Sheth, senior consultant, paediatrics, Fortis Mumbai
'No Magic Bullet': How is Long COVID Treated in Children?
"Once the symptoms have been made out, then it's all about counselling the parents and symptomatic management," says Dr Dhaliwal. "People are adjusting to the fact that there are no specific treatments."
But it's not all bad news. Even in cases with severe symptoms, Dr Sheth says, "none of the children required hospitalisation for more than 8 days, and all of them recovered."
"It's been two months since he got COVID. I won't say he's at the level that he was before, but he's definitely doing better," says Shubha.
"I just make sure he eats a healthy balanced diet, and stays active. We just take it a day at a time."Shubha