Setting Priorities to Address Research Gaps in Long-term COVID-19 Outcomes in Children
Daniel Munblit, Louise Sigfrid, John O. Warner
Abstract
Outcomes in ChildrenIncreasing numbers of people with prolonged symptoms after recovery from COVID-19 infection (long COVID) have been reported, prompting calls for research. 1,2Symptoms of long COVID are poorly characterized, with several phenotypes described, 3 and the causes, treatments, and outcomes are unknown.Calls for research fail to address long COVID in children and adolescents.Given the demand for appropriate care for patients with this condition, agencies have published guidelines on treatment. 4However, these guidelines inappropriately combine research requirements and services for the children and older adults.The long-term consequences of COVID-19 remain unknown, but prolonged symptom duration and disability are commonly reported among adults.National Institute for Health and Care Excellence guidelines classify infection sequalae by the duration of symptoms, 4 providing interim definitions for long COVID based on limited evidence from small cohorts with short-term follow-up of adults.The paucity of high-quality studies is a barrier to a comprehensive definition of long COVID and postacute COVID.This definition and harmonization of research, diagnosis, and treatment of individuals with long COVID could allow for cohesive national and international data collection and better estimation of incidence, prevalence, and risk factors that are tailored to different age groups.Large, harmonized longitudinal studies assessing aspects of SARS-CoV-2 infection sequelae in children and adolescents are needed.Although few studies have focused on children, 5,6 patient support groups have noted that many children experience long-term COVID-19 consequences.To generate high-quality evidence, studies with controls matched for the same social restrictions are urgently required.Robust case-control studies can facilitate identification of the cause of and risk factors for different long COVID syndromes in children, including well-defined characterization of symptoms, signs, psychological features, and protective factors in children in different settings.Estimation of the impact of long COVID vs the impact of wider pandemic restrictions may provide important information for policy makers to guide clinical and public health management.The International Severe Acute Respiratory and Emerging Infection Consortium has developed standardized tools to collect multisite data on COVID-19 globally. 7Harmonization of the protocols for data collection and establishment of an international registry are the main priorities (Table ).Development of standardized research protocols for different resources settings aiming at different aspects of COVID-19 sequelae in children can allow harmonized data collection and reliable comparison across countries.