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Long COVID in Adolescents

 Long COVID Symptoms in Adolescents
   
    Long COVID is defined by the World Health Organization as symptoms following COVID-19 infection that last for at least 2 months that cannot be explained by an alternative diagnosis. These symptoms include fatigue, shortness of breath, cognitive dysfunction, and generally have an impact on everyday function and may fluctuate or relapse over time.  Long-term symptoms after a viral-infection are common among children and adolescents; therefore, long COVID among children and adolescents would not be surprising. However, while there have been several studies on the symptoms and effects of long COVID among adults, few studies have investigated long COVID in children and adolescents. Many adolescents have been affected by the COVID-19 pandemic and a recent study aiming to address the lack of long COVID studies among adolescents investigated the health and symptoms of long COVID in adolescents. This study was recently published in The Lancet on February 7, 2021. 

About the Study

    The study was conducted in Denmark and included COVID-19 positive adolescents and controls aged 15-18 years. The participants of this study either tested positive for COVID-19 from January 1, 2020 to July 12, 2021 and were placed in the case group, or tested negative/did not test for COVID-19 and were placed in the control group. The control group was matched by age and sex and all participants had until September 2021 to fill out a questionnaire.

    The case group, which consisted of adolescents with a positive COVID-19 test, was made up of 6,630 individuals while the control group was made up of 21,640 individuals. The four main objectives of the study were to explore the prevalence of symptoms lasting more than 2 months (long Covid), the duration and intensity of symptoms, quality of life, and psychological and social outcomes of adolescents who tested positive for COVID-19 compared with the controls.

Study Results

    Of the 6,630 participants in the case group, 2997 individuals reported a new-onset symptom present 8 weeks after a positive COVID-19 test and were identified with long COVID. Out of those with long COVID, there was a greater proportion of females than the total COVID-19 positive case group and a smaller proportion of individuals with asymptomatic infection. Participants in the case group had greater odds of having at least one symptom lasting at least 2 months (61.9%) than the control group (57%). The most common symptoms in the case group included chest pain, sore throat, fever, trouble breathing, and a cough (see graph below). In both groups, there were more female than male participants who had symptoms lasting for over 2 months.

Plot of symptoms lasting over 2 months in the case group, with the control group as reference.

    On the Children's Somatic Symptoms Inventory, or a measure of somatic distress, participants in the case group reported significantly lower symptom scores (mean 10.7) than participants in the control group (mean 11.9). In other words, adolescents in the case group are more likely to experience less somatic distress compared to the control group. According to scores on the Pediatric Quality of Life Inventory with a 2-4 week recall, participants in the case group surprisingly had better quality of life scores than participants in the control group. The physical functioning mean score was 88.7 in the case group versus 86.5 in the control group; emotional functioning 80.0 versus 71.7; social functioning 93.1 versus 88.4; and school functioning 66.9 versus 62.9. However, more participants in the case group reported sick days and school absences than participants in the control group. In the case group, 18.2% reported 16 or more sick days and 11.6% reported 16 or more days of school absences compared to 10.5% and 8.2% respectively in the control group. In general, adolescents in the case group had fewer pre-existing conditions than adolescents in the control group.

Discussion

    Overall, adolescents with positive COVID-19 tests had greater odds of long-lasting COVID-19 symptoms than the control group but fewer short lasting symptoms and a better quality of life scores. However, participants in the case also had more sick days and school absences than the control group.

    While researchers were initially surprised with the quality of life score results between the two different groups, they have come up with some possible explanations. One explanation is that the difference may be attributed to the higher rate of comorbidities, or pre-existing medical conditions in the control group. Another explanation is that adolescents in the control group had a greater fear of the coronavirus and thus, had a more restricted lifestyle to protect themselves from the virus. Finally, the questionnaire used in the study had a 2-4 week recall period so many participants in the case group went a while since infection and could be free of symptoms.

    The differences found between the two groups highlight the pandemic's effect on health outcomes in adolescents and the importance of long COVID knowledge in adolescents to guide management of the condition.

Sources

1. Kikkenborg Berg, Selina, et al. “Long COVID Symptoms in SARS-COV-2-Positive Adolescents and Matched Controls (LongCOVIDKidsDK): A National, Cross-Sectional Study.” The Lancet Child & Adolescent Health, 7 Feb. 2022, https://doi.org/10.1016/s2352-4642(22)00004-9.

2. “A Clinical Case Definition of Post Covid-19 Condition by a Delphi Consensus, 6 October 2021.” World Health Organization, World Health Organization, https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1.

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