Post-COVID-19-associated morbidity in children, adolescents, and adults... Roessler et al, 2022

Plos Medicine
Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched study including more than 157.000 individuals with COVID-19 in Germany - Roessler et al

Abstract:

Background
Long-term health sequelae of the Coronavirus Disease 2019 (COVID-19) are a major public health concern. However, evidence on post-acute COVID-19 syndrome (post-COVID-19) is still limited, particularly for children and adolescents. Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults.

Methods and findings
We used routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020. The base population included all individuals insured for at least 1 day in 2020. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. The date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). The study population included 11,950 children/adolescents (48.1% female, 67.2% aged between 0 and 11 years) and 145,184 adults (60.2% female, 51.1% aged between 18 and 49 years). The mean follow-up time was 236 days (standard deviation (SD) = 44 days, range = 121 to 339 days) in children/adolescents and 254 days (SD = 36 days, range = 93 to 340 days) in adults. COVID-19 and control cohort were well balanced regarding covariates. The specific outcomes with the highest IRR and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28, 95% CI: 1.71 to 3.06, p < 0.01, IR COVID-19: 12.58, IR Control: 5.51), cough (IRR: 1.74, 95% CI: 1.48 to 2.04, p < 0.01, IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72, 95% CI: 1.39 to 2.12, p < 0.01, IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69, 95% CI: 5.88 to 7.60, p < 0.01, IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33, 95% CI: 3.01 to 3.68, p < 0.01, IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88, 95% CI: 2.74 to 3.02, p < 0.01, IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, 95% CI: 1.25 to 1.35, p < 0.01, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33, 95% CI: 1.31 to 1.34, p< 0.01, IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias.

Conclusions
In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004122

 

Center for Infectious Disease Research and Policy (CIDRAP) has an article about the study. It's worrying if the risk of Long Covid are nearly the same for children and adolescents as for adults. This doctor's response in the CIDRAP article wasn't very reassuring (my bold):

Daniel Blatt, MD, a pediatric infectious disease physician at the post-COVID clinic at Norton Children's Hospital in Louisville, Kentucky, said he was not surprised by the study's findings.

"It's unclear if long COVID is the same in children and adults, in terms of pathophysiology, but it's just as real," he said. Blatt, who was not involved in the study, said his clinic also collects data on children and long COVID. He said the most common symptoms reported in his patients are fatigue, anxiety, and "brain fog," followed by some shortness of breath or muscle pain.

"The good news is kids tend to get better, regardless of what intervention is needed," Blatt said. As in adult long COVID, there's no one-size-fits-all approach for pediatric long COVID patients. "Some need reassurance; some need a graduated exercise program."

Blatt said for all pediatric long COVID cases, families need to be heard that what their child is experiencing is real and serious.

CIDRAP Kids at similar risk for long COVID as adults, study suggests

 

IR=incidence rate
IRR = incidence rate ratio
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While the unspecific diagnosis malaise/fatigue/exhaustion (ICD-10-GM: R53) was represented in the lists for both children/adolescents and adults, the chronic fatigue syndrome (ICD-10-GM: G93.3) was not. However, chronic fatigue syndrome was also coded more frequently in the COVID-19 than in the control cohort in adults (IRR: 3.04, 95% CI: 2.66 to 3.48, p < 0.01, IR COVID-19: 5.94, IR Control: 1.95). In children, the estimated IRR was greater than 1 but not statistically significant (IRR: 1.25, 95% CI: 0.24 to 6.65, p = 0.79, IR COVID-19: 0.26, IR Control: 0.21). Estimation results for all health outcomes are shown in the Supporting information (Section G in S1 Appendix)

 

Bit disappointing that the authors included CFS in the mental diagnosis group:

 

Supplementary figure gives the results of all health outcomes/diagnoses in one graph. It does look that CFS stands out a bit: