What evidence is there that repeated COVID infections won’t negatively impact a child’s health over time?

[anonymous9090]

I’m a new parent and lean incredibly cautious with my five month old primarily because I do still feel like COVID is a novel virus and I don’t yet know or understand the longterm ramifications of repeated, annual infection on children.

The below thread on this subreddit and the accompanying research links contained within the thread definitely touch on many of my thoughts and concerns.

https://reddit.com/r/ScienceBasedParenting/s/QfWAXF8NsE

For the record, I do understand that COVID infections are inevitable and not adequately socializing my baby in order to avoid COVID is also problematic.

Most of the people I talk to assure me COVID is nothing to be concerned about when it comes to my baby. Often the reassurance seems anecdotal, opinion-based, or stems from the fact that a COVID infection in kids does not usually lead to hospitalization or death. Are there actual studies three years into this pandemic that demonstrate that there really is nothing to worry about when it comes to kids getting repeated infections? Is any of this reassurance based on actual data that confirms getting COVID annually from birth has no harmful consequences?

 

[guevaraj]

@anonymous9090 You might appreciate this review which was linked in the thread you posted. It was published in Nature at the close of 2022.

The metanalysis included studies that covered about 80K patients. They found:

“The prevalence of long-COVID was 25.24%, and the most prevalent clinical manifestations were mood symptoms (16.50%), fatigue (9.66%), and sleep disorders (8.42%). Children infected by SARS-CoV-2 had a higher risk of persistent dyspnea, anosmia/ageusia, and/or fever compared to controls.”

However, this data is in no way perfect. This BMJ commentary highlight some of the challenges with original research that makes metanalytic approaches tough. However, it doesn’t seem that we are fully at a “garbage in, garbage out” place. There are a lot of studies showing a lot of links from both mild and serious cases of COVID to longer lasting symptoms. Those studies are not perfect but my read after that thread and diving into it more deeply myself is that yes, kids are getting long COVID, and yes, repeated infections are likely increasing the risk.

On the flip side: long COVID is a constellation of ill defined symptoms. Some of them are very serious and life changing (cardiac problems, diabetes). Some of those are minor and self resolve (fatigue). The research we have doesn’t do a great job separating, nor (mostly!) does it do a great job of disaggregating risk by cohort, eg, older kids seem more at risk than younger ones. We have no idea what the long term effects are, as we’ve only been at this for a few years.

So. We don’t have evidence that repeated COVID infections won’t negatively impact a child’s health over time. In fact, I would suggest we have strong signals that repeated COVID infections will negatively affect some children’s health over time.

How many is some? It’s really hard to tell. Other post viral syndromes seem to hit somewhere between 1-4% of people who contract the initial illness. COVID rates seem to be higher but there’s the data quality caveat above. Some risk factors seem clearer than others: being female, being an adolescent, being overweight, having a more severe initial case. But those are population level risks - there are also young, healthy kids who exhibit symptoms of long COVID. You don’t know which your kid is going to be, so to a degree, you have to roll the dice.

It’s not clear what the odds are but from my point of view, it’s pretty clear that it’s better to not contract COVID than contract it, all things being equal. After reading the research myself, I purchased air filters for my kids classrooms, have been a bit stricter with outdoor only socialization, returned to regular (weekly) testing and am considering but haven’t pulled the trigger on masking again (the social pressure is getting to me, not going to lie). Those things are relatively low cost but reduce the risk. I’ll also be getting my kid boosted.

There’s risk on the other side too though. I didn’t pull him out of school, though that’s the biggest exposure point of our family. I could - we have a nanny, I could make it work. But it’s clear that socialization and his play based learning is creating enormous value for him right now, and I feel the risk on the other side: if I keep him home, and not nearly as stimulated or engaged, that has consequences too. I’m trying to strike a balance and acknowledge that at the end of the day, I’m playing odds I don’t know for sure and doing the best that I can.

 

[bharati21]

@guevaraj It’ll take a long time to get the evidence accumulated down to a young child level. Parents remember milestones like when a preschooler accurately identifies and describes something like a sore throat properly. Babies/toddlers aren’t going to self report symptoms.

We have to wait for data like increasing annual numbers on infant/toddler cardiac events or diabetes diagnosis, then extrapolate when it began and to link it to a likely cause. Non life-threatening symptoms like fatigue and loss of taste are much more difficult to figure out. A baby/toddler experiencing long term fatigue won’t be identified as problematic until they can’t stay awake for Pre-K or Kindergarten. Loss of taste may eventually surge the numbers for feeding therapy, but again toddlers are famous picky eaters. Etc.

 

[nrg23]

@anonymous9090 There isn’t any. This suggests that infections in general during infancy is linked to cardiovascular disease.

https://www.sciencedaily.com/releases/2022/05/220510103012.htm

Journal Reference:

Toby Mansell, Richard Saffery, Satvika Burugupalli, Anne-Louise Ponsonby, Mimi LK Tang, Martin O'Hely, Siroon Bekkering, Adam Alexander T Smith, Rebecca Rowland, Sarath Ranganathan, Peter D Sly, Peter Vuillermin, Fiona Collier, Peter Meikle, David Burgner.

Early life infection and proinflammatory, atherogenic metabolomic and lipidomic profiles in infancy: a population-based cohort study. eLife, 2022; 11 DOI: 10.7554/eLife.75170

 

[bluechap]

@nrg23 This type of research reminds me that long before Covid babies and toddlers got sick and that had impacts that weren't talked about. And then attempts to prevent illness (over sterilization) led to more allergies and asthma.

The reality is that Covid guidance is just one of many, many pieces of imperfect health guidance. New research happens and guidance changes, but no amount of internet research spiral is going to let your perfectly predict the "right" answer on things that experts are undecided on.

 

[lemar349]

@bluechap

long before Covid babies and toddlers got sick and that had impacts that weren't talked about.

Because if there simply isn’t any effective way to prevent a widespread, common, seasonal illness, it doesn’t make much sense to be constantly anxious about it. If our brains let us be consistently anxious about the many routine risks we experience daily, we’d all be a blubbering mess.

I got an autoimmune disease and a sleep disorder, both triggered by Epstein-Barr. One of the most common viruses on the planet that everyone reading this has almost certainly had at some point. Is it a bummer that I got relatively rare lifelong effects from a common virus? Absolutely! Do I wish I’d spent my life afraid of the longterm effects that I might get from a common, nearly unavoidable virus? Definitely not.

 

[guevaraj]

@lemar349 I hear your point about not living in anxiety, and I think it's very true. At the same time, though, it seems like COVID falls victim to all or nothing thinking. Either you're wearing a respirator mask when you make your single weekly grocery trip that is the only outside contact your family ever has or you've given up, maybe vaccinated, and that's it. But there's so much room in between those choices. While there aren't effective ways to prevent the risk entirely, there are plenty of (low cost/limited impact) ways to reduce your risk of contracting it, and vaccination is only one of those.

(I'm still confused why, before exiting lockdown, we did not coalesce as a society around improving indoor air quality, which would have tons of positive effects, not limited to reducing the spread of COVID and other airborne illnesses!)

 

[seditthis]

@guevaraj Very confused that indoor air quality hasn’t improved much since 2020!!

 

[leoooyu]

@bluechap “Over sterilization led to more allergies and asthma”

I’m interested in hearing where you got that from?
If it’s from ‘hygiene hypothesis’, it’s been debunked sufficiently but I still see so many Instagram & mommy bloggers spreading that misinformation.

 

[seditthis]

@leoooyu Yeah. Once a theory is popular nobody cares that there’s evidence that it’s wrong.

 

[anw0001]

@anonymous9090 Long term? How long term can we know when the virus appeared in 2019?

https://www.nm.org/healthbeat/medic...es-and-drug-trials/covid-19-pandemic-timeline.

 

[bilalamjad3]

@anw0001 And the virus has mutated many times now. And with vaccines available that changes long term outcomes. And many kids will get it now and not test positive (because they’re not testing anymore or because the tests are not specific enough). It would be nice to have research but it’s next to impossible to study this.

 

[anw0001]

@bilalamjad3 That’s what I’m saying! How do we even begin to understand the long term when we can’t understand or measure the short term?

 

[seditthis]

@anonymous9090 It’s hard because so much conventional-wisdom advice is all-or-nothing.

You can’t keep your kids from getting covid, I mean, you can’t make the risk zero.

But you can tend to play outside, look for childcare that expects sick kids to stay home, wear masks indoors & hang out with people who also wear masks indoors so you don’t feel like a weirdo, choose restaurants that are using air filters for good indoor air quality…..

You can REDUCE risk without “living in fear” or whatever.

Risk reduction tips:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html#:~:text=In%20those%20situations%2C%20use%20as,sick%20or%20who%20tested%20positive.

 

[lionheartiv]

@anonymous9090 The long term effects of not socializing your baby in the effort to avoid getting a virus that they’re going to get anyway once you can no longer avoid it are worse.

https://www.health.harvard.edu/blog...es-possibly-in-long-lasting-ways-202201132668

A lot of us had no choice but to not socialize our babies. I remember my sons daycare educator getting in trouble for not wearing a mask at some point and I defended her at all costs because no virus was worth my son not seeing a smiling face all day during the week. I’ll take a “maybe this will mess my kid up” vs a “this will definitely mess my kid up” any day.

 

[guevaraj]

@lionheartiv While I understand your macro point about risk, I think you’re misreading that study. Yes, they saw definite differences between children born between March and December of 2020 and children born afterward.

However, it does not then follow that the cause of that was masking or lack of socialization. Other causes could include, off the top of my head:

1) increased parental stress, due to lowered income due to stay at home orders, lack of childcare, needing to homeschool older children, or you know, a global pandemic led to less time spent interacting

2) poorer health care during and after pregnancy due to the shortage of medical personnel and reallocation of medical personnel to COVID related response

3) increased rates of ACEs like domestic violence once everyone was forced to stay home

4) lack of travel leading to less familial support for parents and less extended family interaction

5) childcare worker shortage began, necessitating the continued hiring of less qualified personnel

In fact, the researchers even call out one of those reasons in the discussion:

“
Together, the lack of neurodevelopmental differences between infants with and without in utero SARS-CoV-2 exposure and the observed group differences between the historical and pandemic cohorts suggest COVID-19–related stress should be considered as a potential underlying mechanism. Reported stressors have included job loss, food insecurity, and loss of housing,51 and the pandemic has resulted in significant increases in symptoms of anxiety and depression.52 Consistent with our finding that infants born to women who were in the first trimester of pregnancy during the pandemic peak had the lowest scores in gross motor, fine motor, and personal-social subdomains, data from numerous cohort studies have demonstrated that prenatal perceived stress, loneliness, and objective stress, especially during early gestation, are associated with an increased risk for adverse neurodevelopment in children.4,53-61”

I’m not saying infants don’t need high quality serve and return interactions but it is also absolutely possible to deliver those interactions while taking precautions to avoid COVID infections.

 

[lionheartiv]

@guevaraj I’d definitely say half-read the study vs. Misread sorry it’s been a long day lol.

Anecdotally I can see the differences in pre-pandemic babies and pandemic babies. Personally, my son actually got to experience more one-on-one parental interaction during the pandemic; Sure, there was stress but it was linked mostly to point 4 that you made: less familial interaction. He still had regular check-ups (including a two-week hospital stay that was only exasperated by the endless covid tests and the fact that no one was allowed to visit ) we cooked like crazy during the pandemic, played all the games we could think of and tried to make the very best of it. I loved being able to spend all that extra time with my baby.

That being said, I experienced raising my child in a bubble for a few years and watched my crazy social child turn into this shy little thing that was afraid of people. I’m not saying don’t take precautions, but also don’t raise your child in a bubble because something might happen. Maybe they’ll break a leg playing on the jungle gym or learning to skate or to ride a bike (and perhaps have lifelong implications) but is your own fear a reason to deprive them of their childhood?

Nah, vaccinate your kids and let them live.

 

[011235813]

@lionheartiv Isn’t the underlying problem you described just a lack of (paid) parental leave for parents of babies/young toddlers? You don’t need to mask at home with family.

In Canada we can have mat/parental leave up to 18 months. You’re not required to bring them to baby activities etc and there’s no raging epidemic of poorly socialized Canadian babies. Same with other countries with normal maternity/parental leaves.

To be clear, I am not daycare shaming. Lots of people here put their babies in daycare at 12 months or earlier if they need to or choose to, but I’ve never encountered this overwhelming pressure to “socialize” literal infants/babies (beyond their close family/friends) as a reason for it, instead just simply needing childcare.

I suspect this is a particularly American point of view.

And given that we now know many things can be done to mitigate risk of spreading covid (like vaccination, air purification, CO2 monitoring & ventilation, etc00229-1/fulltext)), it doesn’t make sense to pit socialization vs long term health against each other? Like, why go there?

We now know CAN reduce the risk of covid infection in childcare settings and schools not just through masking, so arguing about how things should have been done in 2020 seems like a moot point?

 

[lionheartiv]

@011235813 I’m also in Canada. Let’s be clear you have to be in a very nice position, economically to benefit from the 18 month maternity leave, but anyway.

I had my son signed up for swimming lessons at 8 months, which was cancelled due to the pandemic. I didn’t have a pool at home and so by the time the restrictions were lifted my son was 2 and was terrified of the water.

He didn’t know his grandparents until he was well into toddlerhood. My mom still refuses to see him if he has a minor sniffle, which lets be clear: is mostly all the time. When she did see him she was 100% masked up so he didn’t know what his grandmothers smile looked like (not on FaceTime) until he was almost three years old.

My son got covid recently, right before his vaccine , and was sick for two days and then 100% fine. The time that he’s spent crying because he wants to see grandma and she won’t come see him on the other hand is exponentially larger. Sure he didn’t notice as a baby so much but it became a larger issue.

I said it in a comment above but you can’t raise kids in a bubble

 

[011235813]

@lionheartiv My kid didn’t go into a pool until 2 either and now at 3.5 is finally doing swimming lessons and having fun with it. Maybe your kid just doesn’t love the water. That’s okay. You can try again next year or the following year and it’ll be fine.

I sure as hell didn’t have swimming lessons as an infant. I didn’t get proper lessons until I was maybe 8, but kept it up until I was just one class shy of becoming a lifeguard.

A lot of what you’ve experienced is individualized, not universal.

Again, why are we pitting socialization against protecting children from covid complications? It doesn’t have to entirely be an either/or situation. We can mitigate risk of covid infection with monitoring and maintaining indoor air quality and ventilation, particularly in childcare/school settings.

If you were a SAHM and lived in the rural backwoods with just one car, you’d be effectively living in a “bubble” too.

Like, so many parts of the pandemic sucked and they sucked differently for different people, and I’m sorry that you’ve had a hard time. But when someone says “how can we prevent covid infection?” it doesn’t make sense to simply respond with “preventing covid infection hurts socialization”, where there isn’t enough evidence to say that response is true…