Even with mild courses: Corona can have long-term consequences and be particularly dangerous for young patients at risk., iStockphoto.com | FamVeld © iStockphoto.com | FamVeld

Important Patient Information

Corona: Courses, Consequences, and Complications

What do we know from research so far

Since the beginning of the pandemic, intensive research has been conducted both internationally and nationally into the consequences of a covid-19 infection and its associated complications, including those in the case of congenital heart defects.

Various scientific analyses, with support from the National Registry of the Competence Network for Congenital Heart Defects, also investigate the indirect health consequences of the pandemic, such as its impact on quality of life.

Long-term Consequences are Possible Even in Mild Cases

In many cases, infection with the corona virus has so far led to mild symptoms or none at all. However, about ten percent of those infected become so severely ill that they have to be treated in hospital. Current research confirms that infection with the corona virus, particularly in children and adolescents, is mostly and often without signs of illness, even in those with congenital heart defects.

The most common symptoms include dry cough, runny nose, and fever. However, a number of other symptoms are also possible. These include sore throat, shortness of breath, loss of smell and taste, muscle and joint pain, and headache. Covid infection can have longer-term health consequences, regardless of the severity of the disease. The Corona information page of the German Federal Ministry of Health (BMG) also provides detailed information about this and the current study situation.

Not to be Taken Lightly

Researchers warn against taking an infection lightly. This also applies to children and adolescents. According to an initial U.S. study, covid-19 hospitalizations in this age group were rare, but still three times more common than with influenza.

The German Society for Pediatric Infectious Diseases (DGPI) has recorded 6,264 cases of children and adolescents with covid-19 in Germany and Austria who required hospital treatment since the beginning of the pandemic up to and including July 2022. 193 children and adolescents (3.1 percent) were admitted to the intensive care unit, and 0.2 percent died due to Covid-19. According to DGPI data, 22.7 percent of those with the disease had residual signs of illness at discharge, and 0.3 percent of the inpatients  were diagnosed with secondary diseases.

The coagulation factors of the children to be treated as inpatients must be checked, as these can indicate such consequential risks. The experts are particularly concerned about long covid or post covid or complications such as PIMS/MIS-C.

Pediatric cardiologists therefore urgently advise following the recommendations of the Standing Commission on Vaccination (STIKO) and getting vaccinated from the age of five, especially if risk factors are present. (see also Vaccination is the Best Protection).

  • Our Recommendation

    Vaccinate, AHA+A+L, Check Vaccination Protection

    Even with mild courses: Corona can have long-term consequences and be particularly dangerous for young patients at risk. © iStockphoto.com | FamVeld
    Even with mild courses: Corona can have long-term consequences and be particularly dangerous for young patients at risk.

    In addition to the mRNA vaccination recommended by the vaccination commission (STIKO) from the age of five and the booster vaccination three months after complete vaccination, we continue to advise unconditional compliance with the current instructions of the responsible authorities.

    We also continue to urgently recommend compliance with the AHA+L+A rules (A = distance, H = hygiene, A = everyday life with mask, L = ventilation, A = corona warning app) including recovered, fully vaccinated, and boosted vaccinated persons. Therefore, an FFP2 (OR-) mask that completely covers the mouth and nose should always be worn during close contact, especially with persons who belong to a risk group due to pre-existing conditions, as well as in enclosed indoor spaces and means of transport.

    If you have a congenital heart defect, we also strongly recommend to review your flu and pneumococcal vaccination coverage to ensure appropriate vaccination coverage of your child. Typically, this vaccination is part of the routine check-up provided by your pediatrician. Vaccination against pneumococci and influenza is generally recommended by the STIKO for children with congenital heart defects. Cases of corona and influenza have also been reported as dual infections. Since pneumonia is the main complication of Covid-19/SARS-CoV infection, the recommended vaccination against pneumococci should be checked and, if necessary, refreshed in grown-ups with congenital heart disease as well.

    Overall, the urgent recommendation applies to all patients with congenital heart defects aged five years and older, as well as to people with a healthy heart, to take advantage of the free protective and booster vaccinations and thus protect even the youngest. Children should be vaccinated with BioNTech's appropriately dosed Comirnaty mRNA vaccine.


What Do Studies Say About the Risks of Severe Covid 19 Courses?

Studies from the USA and Great Britain in particular, but also from Germany, have shown that in connection with severe courses of the disease, it was less a congenital heart defect alone than the combination with concomitant diseases of the lungs and other organs, as well as with risk factors independent of these, such as diabetes, male gender, and obesity, that were decisive. The study situation for children and adolescents under 18 years of age shows a similar picture. The strongest risk factors for hospitalization were type 1 diabetes and severe obesity. Severe disease progression has been observed in type 1 diabetes and congenital heart disease. You can find out more about these studies and the current state of research on Long Covid and PIMS/MIS-C in the German Heart Foundation's fact check with Professor Dietmar Schranz.

Severe Congenital Heart Defects are Among the Major Risk Factors

The group of CHD patients with the highest risk of severe Covid 19 infection includes children, adolescents, and adults with single-chamber hearts (Fontan circulation), severely reduced lung function (cyanosis), severe heart failure, severe pulmonary hypertension, after heart transplantation, and with chronic lung, liver or kidney disease, immunodeficiency (including Di George syndrome, asplenia, trisomy 21), and with pre-existing coronary artery disease.

What Virus Variants Have Been and Are Being Researched?

The current state of facts on the consequences of infection is predominantly based on results from data collection and analysis related to infections with the wild and alpha types of SARS-CoV-2. On the other hand, the data available on the course of disease with the delta variant, which predominate in 2021 and is considered to be more aggressive, are not yet sufficiently informative. The same applies to the even more contagious omicron variant and its subtypes, which have dominated the infection scene since the summer of 2022, causing the number of people infected to skyrock once again.

In contrast to its predecessors, the delta variant was observed to be more easily transmissible, to have an increased ability to cause disease (virulence), as well as more severe disease courses, and a higher mortality rate in unvaccinated or incompletely vaccinated individuals. The even more contagious omicron mutant and its subtypes, in contrary, appear to cause milder courses of disease.

Boosters are Absolutely Advisable

According to the current state of research, the new virus variants are less well repelled by the immune system of persons who have already recovered or have been fully vaccinated. A booster vaccination about three months after the last vaccination is therefore highly advisable, especially for people with previous illnesses. Approval for the modified vaccines, which also offer protection against the omicron variant, seems to be imminent. Experts expect a decision from both the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in the coming weeks.

Drugs Are No Substitute for Vaccination

Intensive research has also been and is still being conducted into drugs to treat Corona. According to current studies, the drug paxlovid, which has now also been approved in Germany, helps prevent severe disease progression in high-risk patients, but it has a number of interactions and must be taken early in the event of disease. Negative interactions with anticoagulants (e.g. Eliquis®/Apixaban) or lipid-lowering agents should be noted. Last year, the U.S. Food and Drug Administration (FDA) declared that the drug is not a substitute for vaccination. The latter remains the most effective measure to date.

Recommendations According to Risk Group

  • Moderate Risk

    All patients whose diagnoses do not fall under those of low or high risk.

    Basic Recommendation

    Be sure to vaccinate children five years of age and older and refresh vaccination starting three months after basic immunization.
    For children five years of age and older, adolescents and adults up to age 30, vaccination with BioNTech's Comirnaty mRNA vaccine is recommended.

    Recommendations for Work, Kindergarten, Daycare, School, and Leisure time

    Avoid contact with ill persons or persons suspected of having the disease. Follow AHA+A+L rules (A = distance, H = hygiene, A = daily life with mask +  A = corona warning app + L = ventilate) and state pandemic regulations.

    Medical Care in Case of Illness from Covid-19

    See pediatric cardiologist/GUCH cardiologist for medical evaluation even if symptoms are mild. If shortness of breath, lack of fluid or increase in symptoms occur, seek early hospitalization and consultation with pediatric cardiologist/GUCH cardiologist.


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