Communicating radiation risk in healthcare: an ethical imperative amidst scientific uncertainty.

Long coronavirus disease (COVID), or postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), is increasingly recognized as a substantial public health concern, including among pediatric populations. It is provisionally defined as a condition characterized by symptoms that persist for at least 3 months after acute SARS-CoV-2 infection and are not explained by alternative diagnoses. Symptoms vary widely and may include fatigue, brain fog, dyspnea, autonomic dysfunction and neuropsychiatric complaints such as depression and anxiety. Although most research has focused on adult populations, emerging evidence suggests that children and adolescents can also develop long COVID, albeit with potentially distinct symptom patterns. According to data from the National Center for Health Statistics in 2022, 1.3% of US children were reported to have experienced long COVID, and 0.5% had symptoms at the time of the survey. Adolescents aged 12–17 years were more likely than younger children to report long COVID and prevalence varied by sex and race/ethnicity. Given the developmental implications of persistent symptoms during childhood and adolescence, a better understanding of risk factors and potential modifiers of long COVID in this population, including neuropsychiatric conditions and their treatment with medications, is urgently needed. Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are widely used in pediatric populations to manage mood, anxiety and other neuropsychiatric disorders. SSRIs/SNRIs have been hypothesized to mitigate the risk of long COVID through several potential mechanisms. These include anti-inflammatory and immunomodulatory properties, antiplatelet activity that may reduce COVID 2019 (COVID-19)-related microthrombosis and serotonergic modulation that may address postviral fatigue and cognitive symptoms associated with a hyposerotonergic state. In adult populations, several observational studies and clinical trials (for example, the TOGETHER trial and STOP COVID) have suggested that fluvoxamine and other SSRIs may reduce COVID-19 (refs. ). However, data on the effects of these agents in pediatric patients, particularly those taking SSRIs/SNRIs before infection, remain limited.