The World Health Organization’s clinical management and maternal child adolescent teams will be hosting a webinar on Post COVID-19 Condition in Children and Young People on Wednesday 17 August 2022 from 1:30 – 3:30 pm CET.
I listened to this last night. I came away with mixed feelings. I think there is some good coordination being done, but it's frustrating for there to be presentations of a number of reviews of epidemiological studies and nothing much to be said specifically about the many problems with the studies that are used to produce averages of symptom prevalence and length of illness. Also frustrating to have a couple of presentations about wonderful multi-disciplinary rehabilitation clinics and everyone agreeing that a holistic approach is needed, with the child invited to set their own goals, and an aim of bringing fun back into their life. And no evidence that these clinics are increasing recovery rates and reducing illness length.
So, to my notes:
The webinar will be recorded and made available (as are previous WHO webinars on Long Covid).
Dr Anshu Banerjee of WHO
He noted that there is emerging evidence of Post-COVID Condition in children and young people, but it has not yet been well described. It is important to understand it, particularly in some populations of children and young people who are particularly vulnerable.
I wasn't overly impressed, as what was not said seemed to leave a lot of room for BPS ideas. e.g. who are these particularly vulnerable populations?
Janet Diaz - Health Emergencies Programme - WHO
Post-Covid condition is real, and the health burden is high.
The three symptom clusters are fatigue and mood disorders; cognitive problems; shortness of breath
2020 Sep - ICD code for Post-Covid Condition
2021 Oct - WHO Post-Covid19 Condition case definition for adults finalised
2022 March - WHO webinar on Post-Covid Condition Neurology and Mental Health
2022 May - WHO Post-Covid19 Condition case definition for children and young people finalised
2022 June - WHO Clinical Management of Covid-19 (a living guideline, is being updated as more is known) notes that people with persistent symptoms should have access to care, and the importance of integrated multidisciplinary care
Resources can be found at
https://www.who.int/teams/health-care-readiness/post-covid-19-condition
Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS- CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.
A separate definition applicable for children under development.
There was a good set of research questions listed that included:
Natural history (who gets it and for how long, what the symptoms are)
Pathophysiology - viral persistence? immune dysregulation? thrombotic?
Clinical interventions - pharmacological; rehabilitation
Impact of vaccines
Core outcomes set - has been developed for PCC in adults. The process for this seems to have been quite good, successive Delphi approaches including people with lived experience of PCC. The outcomes mention "post-exertion symptoms" as well as fatigue.
The WHO Clinical Characterisation and Research Working Group meets fortnightly.
The WHO Global Clinical Platform Initiative. This sounded useful. There are standard case report forms, a retrospectively completed one about the Covid-19 illness, one for the PCC evaluation and diagnosis, and one for followup. The data from these forms from clinics around the world are lodged in this platform, so the data is accessible to researchers.
It is hoped that this will hep improve and standardise care and research, increase the recognition of PCC, lead to a better understanding of the pathophysiology, ensure a wide range of populations are represented including children, pregnant women, immunosuppressed people and people from low and middle income countries.
The contact person for WHO Post-Covid-19 Condition can be contacted at
kupallik@who.int
(that seemed like a potentially useful contact)
Elizabeth Semper - she and her three children aged 6 and 3 years and 8 months all developed Long Covid. I can imagine it was, and still is, a nightmare. Unfortunately the sound was terrible, I couldn't make out much of what she was saying. A nice thought from the WHO to listen to the patients, just the execution was lacking. I did make out something about 'in the beginning Munchauesens by proxy was suspected'.
