GOSH study reports most symptoms of severe COVID-19 in children are resolved after six months

Scientists and doctors from GOSH and UCL GOS ICH have reported that, despite severe illness, most children who had PIMS-TS after contracting SARS-CoV-2 infection had their symptoms resolve after six months.

All 46 children in this observational study, published in the journal, The Lancet Child & Adolescent Health were treated at GOSH and, as a specialist paediatric hospital, the study noted that they represent more severe cases and further studies are needed to determine if the findings apply to all PIMS-TS patients. In addition, some children did experience problems at six months that require ongoing physical therapy and mental health support.

PIMS-TS is a rare condition associated with SARS-CoV-2 infection that was first defined in April 2020. More than 250 cases were identified in the UK and Ireland from March to June, 2020. It is not known what triggers the condition, but it is thought to be a rare immune overreaction to SARS-CoV-2 infection. The symptoms include fever, rash, eye infection, and gastrointestinal symptoms (e.g. diarrhoea, stomach ache, nausea). In some rare cases, the condition can lead to multi-organ failure.

As the condition only emerged in 2020 during the COVID-19 pandemic, this is the first research to report six-month follow-up findings, providing an important indication of the longer-term effects, which are vital for clinicians treating PIMS-TS and recovering patients and their families. Howvere, the study did not have a control group, making it difficult to determine to the extent to which some findings are attributable to the experience of being admitted to paediatric intensive care unit, having a severe new condition during a pandemic, or to the PIMS-TS condition itself.

Cautious optimism

Dr Justin Penner, Clinical Fellow in Infectious Diseases at GOSH’ and lead author of the study, says, “As PIMS-TS is a very rare complication from COVID-19 in children, our study included a small number of children from one hospital. Nevertheless, these findings can hopefully signal cautious optimism that many of the most severe effects of PIMS appear to resolve within six months. However, the persisting fatigue, difficulty exercising, and mental health effects we saw in some children, which can interfere with daily lives, must be closely monitored, and patients should continue to be supported by medical teams with a range of specialisms.”

The authors analysed the children’s medical records, including medical tests at the time of admission, six weeks, and six months after discharge. These commonly included SARS-CoV-2 PCR and antibody tests, tests for organ inflammation, echocardiograms, abdominal ultrasounds, a test that measured walking, muscle function, and limb mobility. At follow-up, children and their parents completed questionnaires to assess the child’s physical and emotional wellbeing, as well as their social and school life.

All children had systemic inflammation when they were admitted to hospital, but none of the patients died. Most children experienced severe effects on different systems in the body during their initial illness, with 45 children experiencing gastrointestinal symptoms, 24 children reporting neurological symptoms, and 15 children had heart symptoms.

At six months follow-up, most symptoms were resolved, with systemic inflammation gone in all but one child, echocardiograms in two children showed abnormalities, while six children were still reporting gastrointestinal symptoms.

Although small abnormalities were found on neurological examination in 18 children at six months, children experienced little difficulty walking and carrying out everyday tasks. The researchers say this implies that any lasting neurological effects are probably mild and do not cause disability, although the test used might not be able to capture subtle effects, so they call for more detailed research on long-term neurological effects.

In addition, all but one child were back in full-time education (virtually or face-to-face) by six months.

Road to recovery

Muscle function improved significantly from hospital admission to six months, but in a six-minute walking test, 18 patients were in the bottom 3% for their age and sex after six months. As the study did not have a control group, the authors caution the importance of interpreting this finding within the context of the pandemic.

Dr Karyn Moshal, GOSH Consultant in Paediatric Infectious Disease, says, “The levels of fatigue we found at six months follow-up is concerning and requires close monitoring. However, it’s difficult to determine whether this finding is caused directly by PIMS-TS or if it’s a result of the disruption on children’s lives that the COVID-19 pandemic has caused on a wider scale. Therefore, it’s really important that we continue to monitor this as social distancing relaxes and children return to school and more active routines.”

“There was no control group in our study, so we cannot determine whether these mental health effects were caused directly by PIMS-TS – but we do know that going through any severe illness is likely to have impacts on mental health and the disruption and uncertainty of the wider COVID-19 pandemic could also play a role. These children and their families must be able to access ongoing mental health support in addition to continued monitoring for any long-term physical effects from PIMS-TS.”