The US National Institutes of Health (NIH) has updated its clinical guidelines¹ on Long Covid in children, advising clinicians, “The persistent symptoms after COVID-19 that have been described in children are similar to those seen in adults.”

The NIH says that while the prevalence of Long Covid in children is lower than adults, “given the high overall rate of SARS-CoV-2 infection in children, the burden of post-COVID conditions in children may be quite large.”

The NIH advises that, “The incidence of post-COVID symptoms in children appears to increase with age. The most common symptoms reported include persistent fatigue, headache, shortness of breath, sleep disturbances, gastrointestinal symptoms, and an altered sense of smell.”

The NIH also states that, “Cardiopulmonary injury, neurocognitive impairment, and new-onset diabetes may occur.”

Nearly all children have been exposed to COVID-19 through infection, so this clinical guidance refers to children in the context of reinfection, which calls into question the policy of allowing SARS-CoV-2 to freely circulate in the population, repeatedly infecting children.

Some commentators have downplayed the risk of serious post-acute sequelae of SARS-CoV-2 infection, which have been well evidenced in literature^2-9, so the inclusion of these outcomes in NIH clinical guidelines is overdue.

The John Snow Project provides information for people who want to reduce their risks of catching COVID-19. We would never dream of including a significant statement such as, “Cardiopulmonary injury, neurocognitive impairment, and new-onset diabetes may occur,” in a routine update. This should have been highlighted and clearly communicated to parents and carers as well as clinicians.

People who are cautious about COVID-19 and who are taking steps to avoid infection are out of sync with wider society in most countries, where the majority of the population has returned to pre-pandemic norms and social mixing.

Even if the majority doesn’t want to protect itself from the potentially insidious effects of repeat infection, better communication of the risks by public health agencies and governments would make life easier for people who are following best practice public health guidance and exercising their personal responsibility to protect themselves.

The US Department of Health and Human Services (HSS) has recently advised people to take steps to avoid the increased risk of developing Long Covid with each reinfection¹⁰. One of the protective measures advised by the HSS is the use of respiratory masks, but mask wearers are in the minority in most countries, and if you talk to any of them, they will tell you they have encountered responses ranging from bewilderment to hostility for their continued use of this widely recommended protection¹¹.

So, while we welcome the NIH publishing guidelines that are finally in line with the scientific evidence, we call upon it and other agencies to engage in more effective public information campaigns to educate people about the risks of COVID-19 so they can protect themselves and have a better understanding and awareness of why others choose to do so.