Long COVID in Children: Reinfection Doubles the Risk

A recent editorial in The Lancet Infectious Diseases titled 'Long COVID is here to stay—even in children' highlights growing evidence that Long COVID is a genuine and ongoing health concern for children and adolescents.

Drawing on data from the US RECOVER Initiative, involving approximately 400,000 to 465,000 children across 40 hospitals, researchers found that a second SARS CoV 2 infection roughly doubles the risk of Long COVID compared with a single infection. The reported relative risk was around 2.08, and the increased risk was seen regardless of vaccination status.

In the study, Long COVID was defined as symptoms or medical diagnoses recorded 90 to 179 days after infection, confirming that these are persistent rather than short term complications.

What Conditions Were Reported?

Following reinfection, children showed significantly higher rates of:

• Myocarditis and other heart disease

• Blood clots

• Kidney injury

• Severe fatigue

• Cognitive impairment, often described as brain fog

• Dysautonomia, including Postural Orthostatic Tachycardia Syndrome (POTS)

These findings challenge the assumption that children invariably recover quickly and completely from COVID 19.

Why This Matters in Hong Kong and Globally

In high density cities such as Hong Kong, where many children have experienced multiple waves of COVID 19 infection, reinfection is common. This research suggests that repeated infections may carry cumulative risk.

The editorial’s author, Dr Danilo Buonsenso, argues that paediatric Long COVID should be recognised as a lasting public health issue. Health systems need dedicated research, clearer diagnostic pathways and structured clinical support for affected children.

While most children recover well from acute infection, persistent symptoms beyond 12 weeks, particularly fatigue, chest pain, palpitations, dizziness or concentration difficulties, warrant medical assessment.

Long COVID in children is not rare, and it should not be dismissed. Early recognition and appropriate care remain essential.

To learn more, visit our Long Covid Resource Centre.

References

1. Buonsenso, D., 2026. Long COVID is here to stay even in children. The Lancet Infectious Diseases, 26(2), pp.112–113. https://doi.org/10.1016/S1473-3099(25)00496-7  
2. National Institutes of Health (NIH), n.d. RECOVER Initiative: Researching COVID to Enhance Recovery. Available at: https://recovercovid.org/
3. World Health Organization (WHO), 2023. Post COVID-19 condition in children and adolescents. Available at: https://www.who.int/