Duration of COVID-19 symptoms in children: a longitudinal study in a Rio de Janeiro favela, Brazil

TL;DR

This study found that some children in a Brazilian favela took over a month to recover from COVID-19, with longer recovery times during the Omicron wave and differences between boys and girls.

Contribution

The study provides new insights into prolonged recovery times for children in a low-income urban setting during the pandemic.

Findings

The median recovery time for symptomatic children was 11 days, but 9.5% had symptoms for over 33 days.

Children during the Omicron wave had longer recovery times compared to other periods.

Boys were more likely to recover after 34 days, while girls mostly recovered by day 33.

Abstract

COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.

Prospective cohort study.

This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.

A total of 1276 children (boys and girls aged 2–<14 years) were recruited between 2020 and 2022, with 253 testing positive for SARS-CoV-2. The inclusion criterion was SARS-CoV-2-positive children, while the exclusion criteria were loss to follow-up and asymptomatic cases during the acute phase of COVID-19.

COVID-19 recovery time, assessed based on change points on the symptom persistence probability curve (Kaplan-Meier).

Among children who tested positive, 148 (60%) were symptomatic. The median recovery time was 11 days (IQR: 7–16). Two inflection points were identified on the Kaplan-Meier curve: days 16 and 34. Children who were ill during the Omicron wave took longer to recover. More boys became asymptomatic within the first 15 days; about 93% of girls recovered by day 33, and boys were more common among those who recovered in ≥34 days. Children aged 6–<14 years often recovered within 2 weeks; however, both this group and the 2–<6 years group constituted the majority of those with delayed recovery.

Among children from a vulnerable area in Rio de Janeiro, recovery time was longer than that reported in other countries, with 9.5% of children experiencing persistent symptoms for more than 33 days. These findings are crucial for understanding the implications of COVID-19 in specific socioeconomic contexts and the dynamics of paediatric recovery in community settings.

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