A significant number of children and adolescents appear to be experiencing symptoms of COVID-19 months after being diagnosed with the disease.

Researchers at Rutgers, Harvard, and Emory University, as well as from Mexico, Sweden, and the Houston Methodist Research Institute came to this conclusion after reviewing 21 studies on Long COVID in PubMed and Embase.

"A total of 80,071 children and adolescents with COVID-19 were included," they stated in their research paper.

The researchers determined that the prevalence of Long COVID was 25.24 percent. Mood disorders, fatigue, and sleep disorders were the most prevalent clinical manifestations, according to the study. 

The lead author, Sandra Lopez-Leon, is an employee of Novartis Pharmaceutical Company, though the paper declares that statements "do not necessarily represent the position of the company". None of the other seven authors disclosed any conflicts of interest.

The paper is a preprint that has not yet undergone peer review, so it should not be used to guide clinical practice.

The studies selected for examination had to meet five criteria:

* a minimum of 30 patients;

* ages ranged from 0 to 18 years:

* published in English;

* published before February 10th, 2022;

* meets the National Institute for Healthcare Excellence (NICE) definition of long COVID, which consists of both ongoing (4 to 12 weeks) and post-COVID-19 (≥12 weeks) symptoms.

No provincewide indoor mask mandate

Despite growing awareness of Long COVID, B.C.'s provincial health officer, Dr. Bonnie Henry lifted a provincewide mandatory mask mandate under almost all circumstances on March 11. She retained it in public schools until the end of Spring Break.

As of May 29, only 57 percent of B.C. children between five and 11 years old had received one dose of a COVID-19 vaccine. According to the B.C. Centre for Disease Control, 44 percent between five and 11 years old had received two doses of a COVID-19 vaccine by that date.

Of those between 12 and 17 years of age, 89 percent had received one dose and 86 percent had received two doses by May 29. Thirty-six percent of 12- to 17-year-olds have received a third dose of a COVID-19 vaccine.

The University of British Columbia chose to retain its indoor mask mandate, but to date, no school district in B.C. has followed suit, even though they have this authority as employers.

The World Health Organization defines "post COVID-19 condition" as "the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The symptoms and effects of post COVID-19 condition cannot be explained by an alternative diagnosis."

According to the WHO, most people fully recover from COVID-19 but "current evidence suggests approximately 10%-20% of people experience a variety of mid- and long-term effects after they recover from their initial illness".

Among the most complex of medical conditions

In 2021, a paper published in the International Journal of Immunopathology and Pharmacology described COVID-19 as a "highly heterogeneous and complex medical disorder".

The fourth authors of "A scoping review of the pathophysiology of COVID-19" claimed that "severe COVID-19 is probably amongst the most complex of medical conditions known to medical science".

"While enormous strides have been made in understanding the molecular pathways involved in patients infected with coronaviruses an overarching and comprehensive understanding of the pathogenesis of COVID-19 is lacking," they stated. "Such an understanding is essential in the formulation of effective prophylactic and treatment strategies."

They pointed to three basic pathological processes, basing this on clinical, proteomic, and genomic studies and autopsy data. They included:

* pulmonary macrophage [a type of white blood cell] activation syndrome with uncontrolled inflammation;

* a complement-mediated endothelialitis [swollen endothelial cells, which are found in most arteries, veins, and capillaries of the brain, skin, lung, heart, and muscle] together with a procoagulant state with a thrombotic microangiopathy [syndromes characerized by the destruction of red blood cells, low platelets, and organ damage due to microscopic blood clots];

* and platelet activation with the release of serotonin and the activation and degranulation of mast cells [found in connective tissue, which release substances during inflammatory or allergic reactions], contributing to the hyper-inflammatory state.