physical and mental health 3 months after sars cov 2 infection long covid among CORD-Papers-2022-06-02 (Version 1)

Title: Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study
Abstract: BACKGROUND: We describe post-COVID symptomatology in a non-hospitalised national sample of adolescents aged 1117 years with PCR-confirmed SARS-CoV-2 infection compared with matched adolescents with negative PCR status. METHODS: In this national cohort study adolescents aged 1117 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 134%). At PCR testing 1084 (354%) who tested positive and 309 (83%) who tested negative were symptomatic and 936 (305%) from the test-positive group and 231 (62%) from the test-negative group had three or more symptoms. 3 months after testing 2038 (665%) who tested positive and 1993 (533%) who tested negative had any symptoms and 928 (303%) from the test-positive group and 603 (162%) 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 [390%]) headache (710 [232%]) and shortness of breath (717 [234%]) and among the test-negative group were tiredness (911 [244%]) headache (530 [142%]) and other (unspecified; 590 [158%]). Latent class analysis identified two classes characterised by few or multiple symptoms. The estimated probability of being in the multiple symptom class was 296% (95% CI 274317) for the test-positive group and 193% (177210) for the test-negative group (risk ratio 153; 95% CI 135170). The multiple symptoms class was more frequent among those with positive PCR results than negative results in girls than boys in adolescents aged 1517 years than those aged 1114 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. FUNDING: UK Department of Health and Social Care in their capacity as the National Institute for Health Research and UK Research and Innovation.
Published: 2022-02-08
Journal: Lancet Child Adolesc Health
DOI: 10.1016/s2352-4642(22)00022-0
DOI_URL: http://doi.org/10.1016/s2352-4642(22)00022-0
Author Name: Stephenson Terence
Author link: https://covid19-data.nist.gov/pid/rest/local/author/stephenson_terence
Author Name: Pinto Pereira Snehal M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pinto_pereira_snehal_m
Author Name: Shafran Roz
Author link: https://covid19-data.nist.gov/pid/rest/local/author/shafran_roz
Author Name: de Stavola Bianca L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/de_stavola_bianca_l
Author Name: Rojas Natalia
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rojas_natalia
Author Name: McOwat Kelsey
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mcowat_kelsey
Author Name: Simmons Ruth
Author link: https://covid19-data.nist.gov/pid/rest/local/author/simmons_ruth
Author Name: Zavala Maria
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zavala_maria
Author Name: O aposMahoney Lauren
Author link: https://covid19-data.nist.gov/pid/rest/local/author/o_aposmahoney_lauren
Author Name: Chalder Trudie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chalder_trudie
Author Name: Crawley Esther
Author link: https://covid19-data.nist.gov/pid/rest/local/author/crawley_esther
Author Name: Ford Tamsin J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ford_tamsin_j
Author Name: Harnden Anthony
Author link: https://covid19-data.nist.gov/pid/rest/local/author/harnden_anthony
Author Name: Heyman Isobel
Author link: https://covid19-data.nist.gov/pid/rest/local/author/heyman_isobel
Author Name: Swann Olivia
Author link: https://covid19-data.nist.gov/pid/rest/local/author/swann_olivia
Author Name: Whittaker Elizabeth
Author link: https://covid19-data.nist.gov/pid/rest/local/author/whittaker_elizabeth
Author Name: Ladhani Shamez N
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ladhani_shamez_n
sha: 939d2c18441fb51fc53c108da2718b01198d12e2
license: no-cc
license_url: [no creative commons license associated]
source_x: Elsevier; Medline; PMC; WHO
source_x_url: https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/
pubmed_id: 35143770
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/35143770
pmcid: PMC8820961
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820961
url: https://www.ncbi.nlm.nih.gov/pubmed/35143770/ https://www.sciencedirect.com/science/article/pii/S2352464222000220 https://doi.org/10.1016/s2352-4642(22)00022-0 https://api.elsevier.com/content/article/pii/S2352464222000220
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Keywords Extracted from Text Content: £ 19-21 Supplementary Table 4 21 Supplementary Table Covid-19 people children Amazon LOVE2SHOP participants
Extracted Text Content in Record: First 5000 Characters:19-21 Supplementary Table 4 21 Supplementary Table 5 22 Supplementary Table 6 23 Supplementary Table 7 23 Supplementary Table 8 24 The CLoCk questionnaire given to participants is copied below. Please note, due to copyright reasons, some parts have been omitted, where this is the case, the questionnaire name has been put in place of the questionnaire itself. Health questionnaire for children and young people aged 11-18 to answer directly. These questions are to be answered by the Young Person who had the Covid-19 test. If you need any help, please ask a parent, relative, carer or friend to help you. For questions that ask for a particular date, don't worry if you can't remember it exactly, just enter the closest date. The questions do not need to be completed in one go but can be paused and continued at a later timejust remember to click save. All of the information which you provide will be kept confidential and will not be shared with anyone outside the research team studying Long Covid in young people. Please enter the unique personal number on the front of the letter which we sent you asking you to take part: Before starting the survey, please read the relevant consent and information sheets found here Child information sheet [11] [12] [13] [14] [15] Child information sheet 16 Thank you so much for completing this questionnaire. We will send you the same questionnaire but with fewer questions in a few weeks. You will be asked to complete the questionnaire two or three more times. At the end of the study (in about 2 years) after completing all of the questionnaires, you will receive a £25 voucher. Please indicate which voucher you would prefer Amazon LOVE2SHOP Please remember to click submit (10, 14) 16 (12, 20) 11 (11, 14) 17 (13, 21) Mean
Keywords Extracted from PMC Text: SD 5·1 IMD test-positives risk1 UK National Health Service SWEMWBS SD 4·3 sars-cov-2" alpha participants.16 NHS patients EQ-5D-Y. people 17·7–21·0 Adolescents COVLT0022 19–21 appendix p 22 appendix pp 6–11 appendix p 25 SARS-COV-2 NHS patient UKRI appendix pp 16–18, 28–29 ONS throat clock@phe.gov.uk mild1 COVID-19 long-COVID" participants CIs NHS adolescents" ISARIC Paediatric Patient headaches.24 children lockdown adolescents COVID4 constraints).8 REC sad people,1 taste post-COVID Children appendix pp 26–27 appendix p 21 15–17 key,26 fatigue,14 PCR-proven SARS-CoV-2 Humber— medRxiv appendix pp 16–18 PHE COVID-19 questionnaire,9 appendix pp 19–21 appendix p 24 period;19 treatments.25 surveys.10 age,1 England,8 COVID-19" TC respondents " appendix p 19 SDQ test-negatives SARS-CoV-2 UK
Extracted PMC Text Content in Record: First 5000 Characters:SARS-CoV-2 in children and young people is usually mild1 compared with adults.2 However, little is known about the diagnosis, prevalence, phenotype, or duration of long COVID (also known as post-acute COVID syndrome) in children and young people.3 The English National Institute for Health and Care Excellence (NICE) defines acute COVID-19 as disease with symptoms that last less than 4 weeks after confirmed infection. Ongoing symptomatic COVID-19 is defined as disease with symptoms lasting 4–12 weeks, and post COVID-19 syndrome as disease with symptoms lasting more than 12 weeks. Research in context Evidence before this study This study was designed in November, 2020, when there was little known about long COVID in general and long COVID in children and young people in particular. Of the few publications, most reported data from clinical populations of children and young people seeking treatment and did not include controls. A search on July 26, 2021, of Medline, Cochrane, medRxiv, and PROSPERO, using the terms "COVID-19", "sars-cov-2", "child", "adolescents", "youth", "young", "long-COVID", "sequelae", "post acute" and "persistent", from inception and with no language restrictions, did not identify any controlled, cohort studies of continuing symptoms following SARS-CoV-2 infection in non-hospitalised children or adolescents before our study was designed. Added value of this study This is a large cohort study of adolescents with PCR-proven SARS-CoV-2 status, not self-reported infection. The symptoms were reported by the adolescents themselves and, importantly, there was a matched test-negative group of adolescents who have lived through the pandemic but never tested positive for SARS-CoV-2. The participants were recruited nationally. Physical and mental health symptoms were described rather than undefined, self-reported long COVID. There was an increase in symptoms in adolescents who were either test-positive or test-negative 3 months after testing. The symptom profile was similar between the two groups but with a higher prevalence of symptoms in adolescents who tested positive than in those who tested negative and, importantly, adolescents who tested positive were more likely than those who tested negative to have multiple symptoms at the time of PCR testing and 3 months later. Subsequent waves of data collection will allow prospective tracking of mental and physical health symptoms in this cohort. Implications of all the available evidence We provide data on the presence of 21 physical symptoms and four wellbeing scales 3 months after SARS-CoV-2 testing in 6804 adolescents. Overall, this evidence shows the multiplicity and heterogeneity of long COVID in young people. These findings have implications for services, commissioners, researchers, clinicians, and affected families in understanding the prevalence and manifestation of long COVID in children and young people not accessing hospitals, and in informing health-care systems on service planning. Ongoing symptomatic COVID-19 and post COVID-19 syndrome are referred to as long COVID4 but the term post COVID-19 condition is also used. Researchers funded by the UK National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) continue to use the term long COVID because this is used by the public, healthcare professionals, and in literature searches and systematic reviews. Therefore, we use the term long COVID but are explicit that what we report are symptoms 3 months after a positive SARS-CoV-2 test. More than 200 symptoms have been associated with long COVID5, 6 in individuals symptomatic or asymptomatic with acute SARS-CoV-2 infection and as persistent or intermittent symptoms.5, 6 Adolescents might have a higher risk1 than young children but it is unclear if long COVID symptoms are related to the viral infection or the effects of lockdown, school closures, and social isolation. A July, 2021, literature review of long COVID in children and young people identified 21 relevant publications (appendix pp 16–18, 28–29). These studies included 16 243 children and young people aged 0 to 20 years with follow-up ranging between 28 and 324 days; median follow-up was 125 days (IQR 99–231; appendix pp 16–18, 28–29). Fourteen (67%) were cohort studies, six (29%) were cross-sectional studies, and one was a case report. Seven of the 21 studies included population-based control groups. Nine (43%) recruited from a mix of hospitalised and non-hospitalised children and young people, eight (38%) recruited from non-hospitalised children and young people, and four (19%) recruited hospitalised children or young people post-discharge. The most common symptoms at 3 months were fatigue, insomnia, anosmia, and headaches. The reported rate of long COVID in children and young people was 1–51%, with smaller studies reporting higher rates. Additionally, a UK survey of self-reported or parent-reported long COVID reported a prevalence of 0·16% in those aged 2–11 years
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