Non-hospitalised Children & young people (CYP) with Long Covid (The CLoCk Study), 2021, Stephenson and Crawley

So if my grandchildren's school has a covid outbreak which infected 20% of the children, about 100, only 1 in 7 would get long covid so that gives us 14. The town has about 14 schools so that will be 196 children who now have longcovid. Well that's OK then.

 

Persistent symptoms at 15 weeks is not necessarily an indicator of clinically significant levels of Long Covid. We need to know about severity and range of the symptoms as well.

For example a friend who had Covid some fifteen months ago still has an impaired sense of smell, but this has no impact on his everyday functioning. Though that might have been different had he been a tea taster or a purfumier.

(Though I agree, that here in the UK the government seems happy to condemn a significant number of children and in deed adults to Long Covid.)

 

One of the BIG problems is that there is no consensus definition of LongCOVID. I would hope such a definition would take into account things like impaired sense of smell/taste as being "minor" symptoms and would have agreed upon required symptoms, severity and frequency.

 

Reading about the decision by the jcvi they do not appear to have taken longcovid into account in their risk assessment, let alone long term ME

 

Just found this reference to the Clock study (by accident, I wasn't looking for it deliberately!) :

https://twitter.com/user/status/1433059147138748419


Edit :

Code:

https://twitter.com/EricTopol/status/1433059147138748419

For anyone without a Twitter account, to see the whole thread click on the first sentence, where it says "This doesn't look good".

 

Adam Finn is a member there, and has been promoting Esther Crawley. It wouldn't surprise me if there were some exaggerated views of how useful treatments are likely to be floating around.

 

Apologies, once again only able to skim -- anyone knows and has the time and energy to post what exactly the study investigated?

From skimming it seems, they initially only grouped according to positive or negative test results, and three months after the test then retrospectively asked participants about a variety of symptoms they experienced both at the time of the test and at the current date?

If that is really what they did, I don't understand the scope of conclusions that can be drawn.

I think if participants report symptoms of a flu or a cold at the date of testing they most likely had a cold or even a flu or Covid-19 at the date of testing. On the other hand, a positive test doesn't necessarily mean that people actually fell ill?

Do the investigators consider the possibility that participants with symptoms of a flu or a cold just had another infection than Covid-19 and experience prolonged postviral fatigue from one of whatever infection it was? (And again a small percentage of the latter group will develop ME?)

Also, did they ask about the severity of symptoms?

Edit: link to the preprint:

Terence Stephenson, Terence Stephenson, Snehal Pinto Pereira et al. Long COVID - the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) Study., 10 August 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-798316/v1]
https://www.researchsquare.com/article/rs-798316/v1

 

I think it makes sense to ask about previous mental and physical health but if they didn't ask about actual medical/ psychiatric diagnoses -- not so much.

It looks like they didn't ask about frequency and duration of previous health issues and not even about ongoing chronic illness?

 

Had a look at the SMC expert reactions and saw that some of my questions already were covered in David Strain's comment:

Dr David Strain, Senior Clinical Lecturer, University of Exeter, said:

“There are some significant limitations in this study that may, if anything, under-estimate the effect that this is Covid is having on adolescents. The “control” population were adolescents who tested negative. This does not factor in the reason why those individuals had a test in the first place.

"In the early part of this year, the key indicator for a PCR test was symptoms of a viral illness, compatible with Covid. Thus it is reasonable to assume that all of the “negative” patients had another viral illness.

"The key finding therefore is that Covid is associated with twice the incidence of post viral syndromes compared to other viruses.

"Further, this analysis was based on positive tests from January to March of this year, before the Delta variant was dominant within the UK. We know that the Delta variant is more transmissible amongst adolescents and is causing more significant disease in this population (https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html).

A more significant disease in this population is likely to be associated with more post viral syndrome, although we will need to wait to determine whether that is indeed the case.”


And some other useful observations:

“This is a very well conducted exploration of the symptoms experienced by children and young adults aged between 12 and 17, after a positive test for COVID in the early part of this year, compared to a cohort of adolescents who tested negative. It reports that almost one in three adolescents with a positive PCR for COVID had multiple, non-specific symptoms 3 months after the diagnosis, just less than twice that of younger adults who tested negative (30.6% compared to 16.2%). This is in contrast to the recent publications from King’s College London that suggest that only 1.8% of these younger people experience Long Covid symptoms. There are several potential explanations for this.

“The first is “Reporter bias” – only people with something to say respond to questionnaires. 13.3% of the population responded to the questionnaire, which is a very good response rate in itself. However, if we assume that of the 86.7% that didn’t respond none had symptoms (an extremely unlikely assumption) that still results in ~4% of the adolescent population having long Covid (30.6% of the 13.3% that responded).

“A second difference is the proactive nature of this study. Rather than relying on a parent to report symptoms by proxy, this study actively sought out symptoms. People are more likely to recall or respond when prompted than volunteer information, particularly when that information is “by proxy” – i.e. someone else completing the forms on your behalf.

“A third difference is in the time frame. The King’s study looked across the timeline of the whole pandemic, whereas this study was just focusing on January-March this year. There were differences in the nature of the virus, with the Alpha variant being dominant for the Clock study as opposed to a mixture of the wild-type and the Alpha variant for the Zoe. We know that the Alpha variant is more infectious and more likely to be associated with hospitalisations that the original wild type variant. It may also translate into more cases of long Covid, in adolescents at least.

“In my view the results of this report, gives justification for Long Covid to be a significant consideration for the JCVI as they evaluate the role of vaccinating adolescents against Covid. So far the focus for that discussion has been on the impact in reducing spread, acknowledging that adolescents get only minor symptoms of acute covid. The results of this report, in my view, lends weight to the argument that vaccinating adolescents, reducing Covid infection and transmission, may also confer direct benefit by preventing infection and long symptoms that will impair education and learning as well as overall wellbeing.


https://www.sciencemediacentre.org/...lock-study-looking-at-long-covid-in-children/

 

It seems the participants weren't asked about PEM or any form of (delayed) post exertion symptom exacerbation?

 

The response rate was only 13% so the data may not be representative.

They used the 11-item Chalder Fatigue Scale but found no difference between groups: "fatigue (assessed by CFQ) showed no substantial differences between positives (Mean=13.3, SD=5.2) and negatives (Mean=12.5, SD=5.1)." The same was true for mental health questionnaires.

At three months, more symptoms were reported in the PCR-positive group but the increase in symptoms in the control group is rather strange. At the time of testing, 8.3% of test-negatives had any symptoms. 3 months later this percentage increased to 53.4%. Perhaps this shows that counting the number of people that report a symptom (rather than trying to measure disability) is not a useful method?

 

Includes discussing Clock study ...

https://twitter.com/user/status/1438780289896132608

 

I'm sure that none of us will be surprised that this study asks inappropriate questions but this seems to take the biscuit.

https://twitter.com/user/status/1444277494060879875

 

somebody elses biscuit to boot

 

Sorry for late response. They didn’t ask about actual medical/psychiatric diagnoses. The study says to measure mental health they measured mental health and wellbeing using ‘the Strengths and Difficulties Questionnaire (SDQ)16 along with the short 7-item version of the Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS)’ and to measure physical function I think they used the EQ-5D-Y1 and fatigue was measured by the 11-item Chalder Fatigue Questionnaire (CFQ)19, as Michiel says above.

Googling EQ-5D-Y1 is described as a generic, child-friendly self-complete instrument measuring HRQoL in children and adolescents aged 8 to 15 years and measures a patient's health across five different domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

*ETA - actually I may have misunderstood. At baseline they may not have used the mental health and physical questionnaires I listed above as they say ‘We asked CYP to rate their general physical and mental health before their SARS-CoV-2 test, in two separate questions using a 5 category Likert scale; in analyses we recoded these variables into two categories (very poor/poor/ok versus good/very good).’ so 2 really basic questions?

 

Am completely bewildered as to how these authors think there's a link between serious viral illness and kleptomania. Very off-the-wall.

 

C' Mon. Anything can ve connected to anything else... because...

 

They don't necessarily think there's a link, but there will "be" one once they're done building it. Clinical psychology doesn't bother with causation, everything is correlation. All that has to be done is to show the weakest correlation possible, usually by torturing data with the promise of more torture in the future, and simply argue it enough times for it to be cited, faster with a small ideological bubble of self-citation, and with time it becomes a truism. Like every single tropy lie about us.

Or, you know, "evidence"-based medicine, i.e. "someone says so".