In a blog piece I posted earlier this week, I tried to make the case that the public is being too complacent regarding COVID-19, reinfections and infections in children, especially very young children.
I cited a recent study that reported elevations of a blood test (high sensitivity troponin) in infants hospitalized with COVID-19, especially in those under 3 months of age. The study reported the eventual return to normal levels and the absence of detectable heart problems at 1 year of follow-up, but both the authors of the study and I cautioned that we can’t be sure of the long-term health outcomes for these children. That may have seemed confusing to many readers as to why there would be any concern for these kids’ future health if everything seemed to have resolved.
Part of the reason for the concern is that we simply don’t understand enough about how kids’ immune systems work at this young age against SARS-CoV-2. We know that before age 6 months, a child’s immune system is generally not fully developed. We also know that even in adults with fully developed immune systems, there have been a number of studies suggesting that, at least in those with Long COVID, some have evidence to suggest viral persistence – i.e., the body’s immune system does not completely rid the body of the virus and SARS-CoV-2 may be able to hang out in various parts of the body either dormant (not actively replicating) or still replicating (producing more SARS-CoV-2 viruses). It is logical to at least consider this possibility in children, especially those infants less than 6 months of age. Therefore, I cautioned that we don’t know whether there might be future health consequences for these kids – only time will tell. Afterall, there had been earlier reports of persistence of SARS-CoV-2 in the tonsils and adenoids of children, including children who had mild COVID-19, noted in some children following tonsillectomy and adenoidectomy.
Are there other examples of viruses that persist in our bodies? What are the consequences?
Yes, there are plenty of viruses that can persist in our bodies, some being kept in check by our immune systems, but others causing mischief. For example, both hepatitis B and C viruses can persist and, in fact, are the major causes of chronic liver disease and liver cancer in the world. Because these viruses can ultimately cause cancer, they are referred to as “oncogenic” viruses. There are other oncogenic viruses, such as human papillomavirus, which is almost always the cause of cervical cancer in women.
Another virus that persists in our bodies is the chickenpox virus (varicella-zoster virus). Later in life, when our immune systems weaken with age, and/or when we experience a significant stress or undergo treatment with medications that suppress our immune systems, the virus can escape part of the immune mechanisms that keep it in check causing a painful eruption of a rash along the distribution of one or more of our nerves referred to as shingles.
Measles virus can persist for a period of weeks or months before being cleared in most persons who don’t get vaccinated, but get infected. However, some individuals appear to experience persistence of the virus in their brains that can lead to the dreaded complication of subacute sclerosing panencephalitis (SSPE) years after they seemingly fully recovered from measles, a condition that is almost always lethal.
While there is no evidence to date that SARS-CoV-2 is an oncogenic virus, it is believed that, at least in some cases, the persistence of virus may lead to chronic inflammation that may play a role in Long COVID in adults.
Just a couple of days after writing that note of caution about just assuming that COVID-19 doesn’t cause long-term health consequences in children, I noticed a study published in June of 2023 that I had overlooked – Viral persistence in children infected with SARS-CoV-2: current evidence and future research strategies – The Lancet Microbe. This is a review of the literature looking at tissues of children at autopsy who died from COVID-19, biopsies done on children with MIS-C (multisystem inflammatory syndrome in children) or Long COVID, or examination of tissues removed at surgery from children following COVID-19.
The authors selected 21 papers that examined tissues for the presence of SARS-CoV-2 RNA, proteins or antigens in children below the age of 18 that were obtained at least 24 hours following the diagnosis of COVID-19. This was in order to both assess how widely distributed SARS-CoV-2 would be in children with infection (looking at those specimens obtained shortly following infection) as well as how long after infection evidence of the virus could be identified.
As in adults, evidence of the virus could be detected in the brains of children who died from COVID-19. In children who survived their illness, some had evidence of viral persistence in various locations (including plasma, lymph nodes, tonsils, adenoids, spinal fluid and the intestines) at periods of weeks to months following their infection.
One of the risks of a mother becoming infected while pregnant is stillborn birth or death of the newborn infant. In these cases, the majority of these stillborn infants who had autopsies showed evidence of virus in numerous organs. It appears that the virus’ effects on the placenta and its blood vessels likely contributed to dangerously low oxygen levels to the developing fetus, which may have resulted in the stillbirth. In the autopsy of an infant who died days following birth, evidence of the SARS-CoV-2 virus could be found in organs, including the heart.
There are some indicators that viral persistence may be a cause for MIS-C that generally is not seen until after the child has seemingly recovered from their acute infection.
I don’t know whether any of this will contribute to long term health conditions in some children who have been infected with SARS-CoV-2, especially as infants, but neither does anyone else who is currently giving you the assurance that COVID is mild in children and no cause for concern.
To me, this would be a good reason for schools to invest in improved air handling and air filtration and for hospitals to require masking in nurseries, in neonatal ICUs and in areas of the hospital with sick children. Despite what seems like minor sacrifice to ensure that long-term health of our children and grandchildren, it seems that we are convinced that the children will be just fine without immunizations and with repeated SARS-CoV-2 infections, that there is no need to take any precautions or for anyone to be inconvenienced, and that there is nothing to see here. I pray to God this group think is correct, but as of right now, that conclusion is based on little more than a hope and a prayer rather than on medical and scientific evidence.
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