Covid-19: UK studies find gastrointestinal symptoms are common in children

Authors: Susan Mayor BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3484 (Published 07 September 2020)Cite this as: BMJ 2020;370:m3484

Gastrointestinal symptoms are common in children infected with SARS-CoV-2 and should trigger tests for the virus, researchers have said.

A prospective study of 992 healthy children (median age 10.1 years) of healthcare workers from across the UK found that 68 (6.9%) tested positive for SARS-CoV-2 antibodies.1 Half of the children testing positive reported no symptoms, but for those that did the commonest were fever (21 of 68, 31%); gastrointestinal symptoms, including diarrhoea, vomiting, and abdominal cramps (13 of 68, 19%); and headache (12 of 68, 18%).

Latest findings from the Covid-19 Symptom Study app,2 which was launched in late March to track people’s symptoms, also show that gastrointestinal symptoms occur frequently in children with positive swab tests.3

Tom Waterfield, lead author of the antibodies study, told The BMJ, “Based on our findings I think that gastrointestinal symptoms should be added to the current list—high temperature, cough, and loss or change in sense of smell or taste—that trigger testing for coronavirus.” He added, “Diarrhoea and vomiting in children should trigger a test.”

Modelling showed that gastrointestinal symptoms were significantly associated with the presence of SARS-CoV-2 antibodies, in addition to known household contact with confirmed SARS-CoV-2, fatigue, and changes in sense of smell or taste.

“Although diarrhoea and vomiting may not be on the official covid-19 testing strategy, we need to be cautious in children with these symptoms,” said Waterfield, senior lecturer at Queen’s University Belfast and paediatric emergency medicine physician at the Royal Belfast Hospital for Sick Children. “They need to have had 48 hours clear of gastrointestinal symptoms before they go back to school to help reduce the potential spread of the virus.”

Tim Spector, the study lead and professor of genetic epidemiology at King’s College London, said, “Looking at data from 250 000 children we found those with a positive swab test have a different range of symptoms to adults. Cough and shortness of breath are much less frequent and gastrointestinal problems, especially loss of appetite, more frequent. Fever is still a feature, as in adults.”

He said that the study confirmed the need to add a wider range of symptoms to those listed for covid-19. “Around 50% of children did not have the three core adult symptoms (high temperature, cough, and loss or change in sense of smell or taste) and may present with a wide range of non-specific symptoms, such as malaise and loss of appetite, although skin rash affected one in six,” he said. “The key is for parents to keep children at home with these non-specific signs until they feel better, until tests get more rapid and accessible.”

Spector is asking parents to start logging information for their children on the app, which invites users to report regularly on their health. He added that the team is adding school specific features to help provide data on infection rates related to schools.

References

  1. Waterfield T, Watson C, Moore R, et al. Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study. medRxiv 2020.08.31.20183095 [Preprint]. 2 September 2020. www.medrxiv.org/content/10.1101/2020.08.31.20183095v1.
    1. Covid Symptom Study
    https://covid.joinzoe.com/data.Google Scholar
    1. Mayor S
    . Covid-19: Researchers launch app to track spread of symptoms in the UK. BMJ2020;368:m1263. doi:10.1136/bmj.m1263 pmid:32220898FREE Full Text

Parosmia post COVID-19: an unpleasant manifestation of long COVID syndrome

As we begin to slowly unravel the mystery hidden behind the current pandemic, novel clinical manifestations are emerging ceaselessly following SARS-CoV-2. Olfactory dysfunction, which has become one of the sought-after clinical features of COVID-19, has been associated with less severe disease manifestation.1 Yet, the previously deemed ‘fortunate’ patients with olfactory dysfunction who successfully recovered from COVID-19 are now being afflicted by another sinister condition known as parosmia, which is found to be more debilitating than loss of smell. Parosmia or distortion of smell is currently regarded as one of the long COVID-19 syndrome or chronic COVID-19 syndrome. Carfi et al found that 87.4% of patients in their study who recovered from COVID-19 had at least one persistent symptom with loss of smell among them.2 However, recent reports have discovered that a number of patients with loss of smell or anosmia regained their smell, yet surprisingly this time, the smell was distorted. The magical aroma of coffee had turned into a nightmare as coffee began to smell pungent like gasoline and favorite dishes were turning to smell more like rotten food or garbage, which inadvertently affects taste as food becomes almost unpalatable. The word parosmia is taken from the Greek words: para and osme (smell) which is defined as a distortion of smell with the presence of odorant, whereas phantosmia is a condition when there is a distortion of smell with the absence of odorant. Anosmia, on the other hand, means complete loss of smell. As of the latest report, three hypotheses exist to explain the pathophysiology of olfactory dysfunction secondary to COVID-19, which include: (1) Mechanical obstruction ensuing the inflammation around the olfactory cleft, which prevents the odorants from binding with the olfactory receptors,3 (2) infection of the ACE-2 expressing supporting cell, mainly the sustentacular cell of the olfactory epithelium4 and (3) direct invasion of olfactory neurons by SARS-CoV-2, which impedes the olfaction transmission.5

For More Information: https://pmj.bmj.com/content/postgradmedj/early/2021/03/31/postgradmedj-2021-139855.full.pdf

Long-Term Neurologic Symptoms Emerge in COVID-19

— Hospitalized patients show deficits including cognitive impairment 6 months later

Authors: by Judy George, Senior Staff Writer, MedPage Today January 7, 2021share to facebookshare to twittershare to linkedinemail article

Long-term neurologic manifestations were seen in more than a third of patients hospitalized with SARS-CoV-2 infection, a prospective study in Italy showed.

In a group of hospitalized COVID-19 patients with no prior neurologic disease, 37.4% showed abnormalities on neurologic exam 6 months later — most commonly cognitive deficits, hyposmia, and postural tremor — according to Alessandro Padovani, MD, PhD, of the University of Brescia, and co-authors. The findings were reported in a medRxiv preprint and have not undergone peer review.

Patients also noted fatigue, memory impairment, and sleep disorders, Padovani said. “The severity of SARS-CoV-2 infection was an important predictor, together with age and premorbid condition, of long-term neurological symptoms and features in the cohort.”

The findings are important for long-term management of COVID-19 patients, he told MedPage Today. “They showed that the severity of SARS-CoV-2 infection may impact on neurological sequelae, but also that the symptoms reported do not always reflect neurological features at examination.”

The study is one of the first to look specifically for new long-term neurologic manifestations in COVID-19 patients who were hospitalized. Earlier research showed that 87% of patients hospitalized with COVID-19 reported persistence of at least one lingering symptom, notably fatigue and dyspnea, 60 days after discharge. Fatigue and dyspnea also were the most prevalent symptoms reported during infection and at 3-month follow-up in an analysis of both hospitalized and non-hospitalized COVID-19 patients.

For More Information: https://www.medpagetoday.com/infectiousdisease/covid19/90587

Recovered COVID Patients Suffering ‘Significant Cognitive Deficits’ According To Large-Scale UK Study

Over 190 million people have officially contracted SARS-CoV-2, the virus which causes Covid-19. Of that, the vast majority have recovered – while up to one-third reportedly suffer from lingering symptoms of varying severity, known as ‘long covid.’

Common complaints include a lack of smell and taste, as well as “brain fog” – in which sufferers often complain of ongoing confusion, lack of focus, and migraines – well after they’ve ‘recovered’ from the disease.

Last week, The Independent reported that Covid-19 may accelerate the onset of Alzheimer’s disease in patients suffering from neurological symptoms, while another study noted in the report found that coronavirus patients “are more susceptible to long-term memory and thinking problems.”

Last September, a study offered the first clear evidence that Covid-19 ‘hijacks’ brain cells to make copies of itself – starving nearby cells of oxygen. The same researchers found last July that some Covid-19 patients have developed serious neurological complications, including nerve damage.

For More Information: http://wp.cov19longhaulfoundation.org/wp-admin/post.php?post=1508&action=edit

Eye scan could determine whether COVID patients will be ‘long haulers’

Authors: by Study Finds

Long COVID” continues to confound doctors as patients still struggle with debilitating symptoms months after first being infection. A new study now suggests that COVID patients who could be long-haulers could be diagnosed by taking a close look at their eyes. Nerve fiber loss and an increase in key immune cells on the surface of the eye may be a way of identifying the long term impact of the virus, say scientists.

The changes are particularly evident among those with neurological symptoms, such as loss of taste and smell, headache, dizziness, numbness, and neuropathic pain. Doctors at Weill Cornell Medicine-Qatar say long COVID is characterized by a range of symptoms which continue for more than four weeks after the acute phase of the infection has passed, and which aren’t explained by an alternative diagnosis.

Around one in 10 people infected by the virus will become COVID long-haulers. It has been suggested that small nerve fiber damage may underlie its development.

To explore the theory, researchers used a real-time, non-invasive, high-resolution imaging laser technique, called corneal confocal microscopy — or CCM — to pick up nerve damage in the cornea. The cornea is the transparent part of the eye that covers the pupil, iris, and the fluid-filled interior. Its main function is to focus most of the light entering the eye.

CCM has been used to identify nerve damage and inflammatory changes attributable to diabetic neuropathy, multiple sclerosis, and fibromyalgia..

For More Information: https://www.studyfinds.org/eye-scan-determines-long-covid/

Long covid: How to define it and how to manage it

Authors: Nikki Nabavi, editorial scholar

“Profound fatigue” was a common symptom in most people with long covid, she said, but added that a wide range of other symptoms included cough, breathlessness, muscle and body aches, and chest heaviness or pressure, but also skin rashes, palpitations, fever, headache, diarrhoea, and pins and needles. “A very common feature is the relapsing, remitting nature of the illness, where you feel as though you’ve recovered, then it hits you back,” she said.

Nick Peters added to this definition by highlighting a “distinction between very sick people who have recovered to an extent and [and have been] left with some impact of their severe sickness, versus those who had a relatively mild sickness from the start, in whom it is ongoing.”

Alwan described the fluctuations of her own illness: “It’s a constant cycle of disappointment, not just to you but people around you, who really want you to recover.”

Paul Garner, who also has long covid, described it as a “very bizarre disease” that had left him feeling “repeatedly battered the first two months” and then experiencing lesser episodes in the subsequent four months with continual fatigue. “Navigating help is really difficult,” he said.

Tim Spector said that his team at the Covid Symptom Study had identified six clusters of symptoms for covid-19,1 a couple of which were associated with longer term symptoms, indicating a possible way of predicting early on what might occur. “If you’ve got a persistent cough, hoarse voice, headache, diarrhoea, skipping meals, and shortness of breath in the first week, you are two to three times more likely to get longer term symptoms,” he said.

He said that patterns in the team’s data suggested that long covid was about twice as common in women as in men and that the average age of someone presenting with it was about four years older than people who had what might be termed as “short covid.”

But Spector added, “We do seem to be getting different symptom clusters in different ages, so it could be that there is a different type in younger people compared with the over 65s. As we get more data we should be able to break it into these groups and work out what is going on … which could be very interesting and help us to get early interventions for those at-risk groups.”

Peters said that the data showed fatigue was the most common trait in people who had symptoms beyond three weeks. He also said that around 80% of people who had symptoms lasting more than three weeks reported “having had clear good days and bad days.”

For More Information: https://www.bmj.com/content/370/bmj.m3489