Doctors expect more kids with long COVID. Are Fort Worth schools ready?
For many children, a case of COVID-19 means up to two weeks of fever, fatigue and coughing. Students have to stay home from school and quarantine until their symptoms improve and they’re no longer contagious.
But for some kids, those symptoms can stretch on for weeks or even months. It’s a syndrome called long COVID, and doctors say it can keep patients who were active before their COVID diagnosis from participating in school or other activities they once enjoyed.
Several school districts in the Fort Worth area say they’ve seen, at most, a handful of students who need accommodations because of long COVID. But as the ultra-contagious omicron variant continues to spread and case counts continue to rise in Tarrant County and nationwide, pediatric experts say they expect to see more children with long-term symptoms caused by the virus.
“I think that would be a very logical prediction, that we’re going to see more cases of this,” said Jeffrey Kahn, chief of infectious diseases at Children’s Health in Dallas.
Could omicron variant cause a spike in long COVID?
After months of decline, COVID-19 cases are beginning to rebound in North Texas. The level of community spread of the virus in Tarrant County is high, according to Tarrant County Public Health. Earlier this month, the U.S. Centers for Disease Control and Prevention raised its threat level in Tarrant and Dallas counties to high. County health officials are recommending that residents return to masking indoors and around large groups as the omicron variant continues to spread.
Last summer, the Biden administration announced long COVID could be considered a disability under the Americans with Disabilities Act. That means students who have long-lasting symptoms from the virus are eligible for accommodations in school.
Scientists know little about why some people develop long-lasting symptoms after a COVID diagnosis and others don’t. One of the major challenges that has hampered research into long COVID is the lack of a case definition for the syndrome, said Kahn, who is also a professor of pediatrics at UT Southwestern Medical Center in Dallas.
A case definition provides a single, standardized set of criteria for defining whether a patient has a particular disease. The CDC is working on developing such a definition, Kahn said, but in the meantime, it’s nearly impossible for medical researchers to study the causes and effects of the syndrome.
The lack of research leaves doctors without a lot of insight into why some patients experience COVID-related symptoms for weeks or even months after their initial exposure, which population groups are at increased risk or, crucially, which interventions seem most effective, Kahn said.
“We don’t have a generalized, agreeable definition of what this is, and without that, it gets very, very murky,” he said.
That lack of insight also makes it difficult for public health officials and doctors to advise parents and school districts about how to prepare to help students who come down with the syndrome, Kahn said.
Pediatricians see more patients with long COVID symptoms
Even without a standardized definition, Kahn said, pediatricians are seeing more children with symptoms that would seem to fit long COVID. He’s seen children who were active and successful in school or sports before they contracted COVID-19. But after they became sick, everything changed. Sometimes, it’s hard for doctors to pinpoint exactly what’s wrong, he said.
“We do a full battery of testing, and from an objective point of view, everything looks OK, but they’re fatigued. They have a lack of energy,” Kahn said.
That lack of measurable abnormalities also makes it hard to tell when children are recovering, he said. If tests can’t find what’s wrong with a patient, they also can’t show when the patient is getting better, he said.
Kids with long COVID report having a wide range of symptoms, Kahn said. Most have fatigue, he said, but some also have “brain fog,” or an inability to concentrate. Others might report headaches, sleep problems or dizziness. Others may have joint pain, respiratory problems, chest pain or digestive issues like diarrhea, he said.
The wide range of symptoms of long COVID makes it difficult to create a single district-wide policy that would work for all students, Kahn said. He said the best advice he could offer school officials looking to prepare for an uptick in cases of long COVID is to handle each case individually. Two students who have long COVID may have drastically different symptoms and need different accommodations, he said.
Districts plan to handle long COVID case-by-case
The Texas Education Agency hasn’t issued guidance on how districts should work with students with long COVID, said Jake Kobersky, a spokesman for the agency. Students with symptoms keeping them out of school for four weeks or longer may be eligible to receive instruction through the state’s General Education Homebound program.
Claudia Garibay, a spokeswoman for the Fort Worth Independent School District, said the district has seen only a small handful of students needing accommodations for long COVID. In an emailed statement, Michael Steinert, the district’s superintendent of student support services, said the district has a plan and the infrastructure necessary to scale up its response if there’s an uptick of students needing those accommodations. The district will follow any guidance it receives from TEA, he said.
Anthony Tosie, a spokesman for the Northwest Independent School District, said the district would work with students who developed long COVID on a case-by-case basis. Teachers and schools will continue to send out communication while the student is away, and depending on the length of the illness and documentation from a doctor, the student may be eligible for certain special arrangements until they can come back to school. No students have needed those arrangements up to this point, Tosie said.
Bryce Nieman, a spokesman for the Keller Independent School District, said the district’s Health Services Department had reported no cases of long COVID among students as of the end of the last school year. When students return to school next month, the district is prepared to work with any students who need accommodations for long-lasting COVID symptoms the same way it would with students with any other long-term illness, Nieman said.
Millions of U.S. children may have long COVID
Long COVID appears to be much less common in children than it is in adults, said Alicia Johnston, a pediatric infectious diseases clinician at Boston Children’s Hospital. Early in the pandemic, some studies suggested as many as 50% of children who contracted the virus would go on to develop long-lasting symptoms. But those studies were based on small sample sizes and had no control groups, meaning their results could be skewed, she said. More recent, more reliable studies suggest between 0.8% and 6% of children who are infected with COVID-19 will go on to develop long COVID, she said, compared to about 30% of adults who are infected.
Those numbers may sound reassuring, Johnston said, but she pointed to CDC estimates indicating that 75% of children in the United States have had COVID-19. That means about 58 million American children have had the disease. Even if only a small percentage of those kids go on to develop long COVID, that’s still potentially millions of students nationwide with long-term symptoms.
While there’s no such thing as a typical case of long COVID, Johnston, who leads a clinic focused on children with long COVID, said the most common symptom is fatigue after even minor physical or mental exertion. Some patients describe having a good day after weeks of serious symptoms and going back to school for a full day or returning to an extracurricular activity and ending up so exhausted that they’re wiped out for the rest of the week.
“It becomes this kind of sawtooth pattern of one good day, a couple of bad days,” Johnston said.
Other patients say they have daily chronic headaches for weeks after contracting the disease, Johnston said. Others described having “brain fog,” including problems with concentration or memory. Others have disrupted sleep patterns, in which they can’t fall asleep at night or wake up too early in the morning. Still others report having chest pains, dizziness and lightheadedness, particularly after exertion, she said.
Unlike with adults, there’s little relationship between the severity of the initial disease and the likelihood that a child will develop long COVID, Johnston said. She’s seen kids come into her clinic who didn’t know they’d contracted the virus at all and had no memory of an acute COVID episode, but later developed symptoms consistent with long COVID.
Students may need cognitive breaks, less screen time, pediatric expert says
Students who contract long COVID generally report prolonged absences from school and declines in academic performance, Johnston said. They also often withdraw from extracurricular activities, she said.
School districts need to be prepared to offer those students accommodations like increased test-taking time, reduced assignment volume and cognitive breaks during class time, she said. Students who suffer from chronic headaches as a result of long COVID may need frequent breaks from screens, she said. Students who have frequent assignments on computers may need a pencil-and-paper option until their symptoms subside, she said. Some students may also need reduced after-school activities, she said.
Kids are now eligible for the COVID vaccine when they turn 6 months old. Scientists and public health officials say the vaccines offer children strong protection against severe illness and hospitalization. But scientists still don’t know if vaccinated children who contract the virus are less likely to develop long COVID, Johnston said.
“What I can tell you is there are definitely children who have been fully vaccinated, gotten COVID and develop long COVID. So, it happens,” she said. “Does it decrease your chance of developing long COVID? I don’t think that we have that data yet.”
