Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk):..., 2022, Stephenson et al

Full title: Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study

Summary

Background
We describe post-COVID symptomatology in a non-hospitalised, national sample of adolescents aged 11–17 years with PCR-confirmed SARS-CoV-2 infection compared with matched adolescents with negative PCR status.

Methods
In this national cohort study, adolescents aged 11–17 years from the Public Health England database who tested positive for SARS-CoV-2 between January and March, 2021, were matched by month of test, age, sex, and geographical region to adolescents who tested negative. 3 months after testing, a subsample of adolescents were contacted to complete a detailed questionnaire, which collected data on demographics and their physical and mental health at the time of PCR testing (retrospectively) and at the time of completing the questionnaire (prospectively). We compared symptoms between the test-postive and test-negative groups, and used latent class analysis to assess whether and how physical symptoms at baseline and at 3 months clustered among participants. This study is registered with the ISRCTN registry (ISRCTN 34804192).

Findings
23 048 adolescents who tested positive and 27 798 adolescents who tested negative between Jan 1, 2021, and March 31, 2021, were contacted, and 6804 adolescents (3065 who tested positive and 3739 who tested negative) completed the questionnaire (response rate 13·4%). At PCR testing, 1084 (35·4%) who tested positive and 309 (8·3%) who tested negative were symptomatic and 936 (30·5%) from the test-positive group and 231 (6·2%) from the test-negative group had three or more symptoms. 3 months after testing, 2038 (66·5%) who tested positive and 1993 (53·3%) who tested negative had any symptoms, and 928 (30·3%) from the test-positive group and 603 (16·2%) from the test-negative group had three or more symptoms. At 3 months after testing, the most common symptoms among the test-positive group were tiredness (1196 [39·0%]), headache (710 [23·2%]), and shortness of breath (717 [23·4%]), and among the test-negative group were tiredness (911 [24·4%]), headache (530 [14·2%]), and other (unspecified; 590 [15·8%]). Latent class analysis identified two classes, characterised by few or multiple symptoms. The estimated probability of being in the multiple symptom class was 29·6% (95% CI 27·4–31·7) for the test-positive group and 19·3% (17·7–21·0) for the test-negative group (risk ratio 1·53; 95% CI 1·35–1·70). The multiple symptoms class was more frequent among those with positive PCR results than negative results, in girls than boys, in adolescents aged 15–17 years than those aged 11–14 years, and in those with lower pretest physical and mental health.

Interpretation
Adolescents who tested positive for SARS-CoV-2 had similar symptoms to those who tested negative, but had a higher prevalence of single and, particularly, multiple symptoms at the time of PCR testing and 3 months later. Clinicians should consider multiple symptoms that affect functioning and recognise different clusters of symptoms. The multiple and varied symptoms show that a multicomponent intervention will be required, and that mental and physical health symptoms occur concurrently, reflecting their close relationship.

Open access, https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00022-0/fulltext

 

New definitions for long COVID developed with patients and carers

"Defining long COVID in children and young people
The CLoCk researchers worked with a panel of more than 100 researchers, experts in health service delivery, and children with long COVID and their parents to score 49 statements on long COVID. These statements were then reviewed by a panel of eight 11-17 year olds affected by long COVID to reach final agreement.

Their definition of long COVID is a condition in which a child or young person has symptoms (at least one of which is a physical symptom) that:

• Have continued or developed after a diagnosis of COVID-19 (confirmed with one or more positive COVID tests)
• Impact their physical, mental or social wellbeing
• Are interfering with some aspect of daily living (eg, school, work, home or relationships) and
• Persist for a minimum duration of 12 weeks after initial testing for COVID-19 (even if symptoms have waxed and waned over that period)

The definition, published in the journal of Archives of Disease in Childhood, closely complements the WHO definition for long COVID in adults.

Professor Sir Terence Stephenson, Nuffield Professor of Child Health at UCL Great Ormond Street Institute of Child Health and Honorary Consultant Paediatrician University College Hospital & Great Ormond Street Hospital, said: “This research definition will allow us to compare research from different countries and will reduce the variability in prevalence estimates of long COVID.”

The researchers emphasise the need to differentiate between a clinical case definition and a research definition of long COVID. “It is understandable that the patient groups representing people with long COVID are concerned that a definition could restrict access to services,” said Prof Stephenson. “In our view, the decision whether a child or young person can see a healthcare professional, access any support needed, or be referred, investigated or treated for long COVID should be a shared decision involving the young person, their carers and clinicians.”

The process of arriving at this definition also took into account quantitative data from the CLoCk study, an innovation within the Delphi approach process. This data has now been published as a peer reviewed paper in Lancet Child and Adolescent Health."

https://www.nihr.ac.uk/news/new-definitions-for-long-covid-developed-with-patients-and-carers/29865

Main thread on the CLOCK study, Non-hospitalised Children & young people (CYP) with Long Covid (The CLoCk Study), 2021, Stephenson and Crawley