Is long Covid contagious and can children get it?: your questions answered

You put your long Covid questions to us. Here are the answers.

At least eight studies have tried to culture virus collected from people’s noses and throats to see if it is capable of replicating itself.

This article titled “Is long Covid contagious and can children get it?: your questions answered” was written by Linda Geddes, for The Guardian on Tuesday 1st December 2020 07.00 UTC

We asked readers what they wanted to know about long Covid. Linda Geddes, our science correspondent, has the answers.

Can people with long Covid infect others?

If I am suffering from long Covid, am I still contagious?”
Laura Clayson, climate justice campaigner, south Wales

People with Covid-19 appear to be most contagious in the first five days after developing symptoms. Although PCR tests can sometimes detect genetic material from the coronavirus in people’s noses and throats, or stool samples, for many weeks (the longest recorded is 83 days), this isn’t necessarily active virus.

At least eight studies have tried to culture virus collected from people’s noses and throats to see if it is capable of replicating itself. “The majority could not culture it after day nine – even if the patients still had high viral loads,” said Müge Çevik, a clinician in infectious diseases at the University of St Andrews, who recently reviewed 98 studies to better understand for how long people remain infectious. “Probably, patients are very infectious in the first week to 10 days [after developing symptoms], but not infectious afterwards,” she said.

It’s likely that the ongoing symptoms associated with long Covid are caused by the body’s response to the virus persisting even after it is inactive, so unless you have been reinfected, you are unlikely to be infectious. However, if you suspect you might have been reinfected, you should get tested, Çevik said.

Can children develop long Covid?

I have seen reports of children suffering with long Covid, is there any significant research into this issue?”
Caroline, Manchester

Long Covid can occur in children, although this seems to be less common than in adults. “At this stage I think it is very hard to say if the mechanisms underpinning the symptoms are the same,” said Jonas F Ludvigsson, a paediatrician at Örebro University hospital in Sweden. He recently published a case report of five children who were still experiencing symptoms six to eight months after catching Covid-19, and said he had been contacted by at least 40 other concerned parents. Their symptoms included fatigue, shortness of breath, heart palpitations and chest pain. “Sometimes more than one person in the same family has long Covid, which could suggest that some shared genetic or environmental factor may play a role,” he said.

Why does long Covid cause such fluctuating symptoms?

I have had long Covid for eight months, which has left me significantly ill.”
Anna Howell, London

Many people with prolonged Covid symptoms report them occurring in waves, or moving from one part of the body to another. In one survey, 89% of people with long Covid said their symptoms fluctuated in frequency and intensity, and 70% said new symptoms appeared at different times.

Although the underlying mechanisms are still being investigated – and there may be several at play – “many of the features, when put together with some of the organ damage seen by MRI or CT scans, look like inflammatory or autoimmune manifestations”, said Danny Altmann, a professor of immunology at Imperial College London.

Autoimmune diseases strike when the immune system mistakes a molecule or antigen on your own tissues as foreign and launches an attack against it. “If this antigen is common to different parts of the body, there could be the impression of disease affecting different parts at different times,” Altmann explained. For instance, people with the autoimmune disease lupus may similarly experience fluctuating symptoms which move around the body – but the underlying process is always the same. And autoimmunity can sometimes be triggered by severe viral infections, including Ebola.

How similar is long Covid to chronic fatigue syndrome (CFS)?

My doctor tells me to rest and I mustn’t exercise, and that I’ll get better soon. But I looked up some research on Sars and it said some people had long-term health issues and the fatigue could last a few years.”
Ian Reed, tennis coach, Brighton and Hove

The extent to which long Covid overlaps with CFS (also known as ME), is generating heated medical debate. Both illnesses are triggered by viral infections and share overlapping symptoms. And at least a subset of people with long Covid also experience relapsing fever, muscle pain and exhaustion if they exercise beyond their capabilities; such “post-exertional malaise” (PEM) is a hallmark of ME/CFS.

However, fatigue can also be triggered by ongoing inflammation or reduced oxygen supply caused by heart or lung damage, and identifying whose fatigue is triggered by what is difficult. Some people may benefit from exercise, whereas it may harm others. Many experts therefore stress the importance “pacing”, which involves listening to your body and resting if you’re showing signs of PEM.

Will my sense of taste and smell ever return?

I had Covid-19 symptoms back in March, and have yet to fully recover both senses. Do you have any suggestions on how I can get my smell and taste back, or could this be permanent?”
Alexandra Geca, fraud investigator, London

Loss of smell and taste are common features of Covid-19, affecting around 60% of those infected, and lasting for longer than a month in about 10% of cases. Some completely lose these senses, others report a partial loss, “phantom” smells, or a distorted sense of smell (parosmia). “Sometimes this is described as a smell of burning rubber, a pungent chemical smell or raw sewage,” said Prof Carl Philpott, director of research and medical affairs for Fifth Sense, a charity supporting people with smell and taste disorders.

The good news is that parosmia is often a sign that your sense of smell is slowly returning and that the body is repairing any nerve damage caused by the virus.

Fifth Sense has developed a toolkit to help people rebuild their sense of smell through “smell training”, which involves doing regular and repetitive smell exercises. “We encourage people to choose a range of smells that they are familiar with so that they will recognise any changes or improvements, and to use their other senses to support them,” said Nina Bleasdale, Fifth Sense’s director of development and operations. For instance, you might grate an orange’s skin to release its scent, as touching it, and using your memory of what an orange smells like.

Are people with ME more susceptible to long Covid?

I had myalgic encephalomyelitis for eight years as a young adult, and live in fear of long Covid. Am I at greater risk of developing long Covid because of my medical history?”
Anonymous, Gloucestershire

This hasn’t yet been tested, so there is no way of knowing for sure. However, people with established ME (ie pre-Covid) should try and avoid getting Covid, just as with all infections. “This is because of the tendency of any infection to cause relapse in their ME, because of the way the immune system is provoked,” said Dr William Weir, a consultant in infectious diseases with a special interest in ME. Based on what we know from relapses triggered by other infections, this would most likely manifest itself as an exacerbation of someone’s existing ME symptoms, rather than something entirely new, however.

Dr Charles Shepherd, medical advisor for the ME Association, said: “We are, not surprisingly, receiving regular reports from people with ME/CFS who have had Covid and have then had a significant and prolonged exacerbation or relapse of their ME/CFS symptoms, which are very similar to long Covid.”

Is it safe for people with long Covid to have the vaccine?

Will it be OK for people still suffering from long Covid symptoms to have the vaccine or would that risk worsening the symptoms?
Robert Fletcher, retired teacher, Sheffield

As with many so things Covid-related, we’re in uncharted territory. None of the Covid vaccines in late stage clinical trials have yet been tested on people who have already had Covid-19 – let alone those still experiencing symptoms. “However, as an immunologist, I can see no reason at all why a vaccine should make them worse,” said Altmann. “The vaccines being developed contain no SARS-CoV-2 virus, just the spike antigen from its surface. If I had long Covid, I wouldn’t want to risk becoming one of the reinfection cases, so I’d get vaccinated.”

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