The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ripped through the world, causing millions of new acute infections. Many of these develop coronavirus disease 2019 (COVID-19), and some are left with post-acute sequelae.
Study: Post COVID-19 in children, adolescents, and adults: results of a matched cohort study including more than 150,000 individuals with COVID-19. Image Credit: Julija Ogrodowski/ Shutterstock
This is sometimes called long covid. A new study from Germany presents data on long covid in adults and children, which is becoming a major issue in public health planning. The researchers are following a growing trend to use healthcare data available from medical records to carry out their analysis.
Long-term complications are known to occur in some people who have acute COVID-19. These so-called long-haulers complained of diverse mental and physical problems, some of which had been present during the acute episode and had either remitted for a time or persisted through the convalescent period. Others reported new issues.
Some of these individuals had a history of mild or asymptomatic infection. This condition has become the focus of much research, and the World Health Organization (WHO) responded with a preliminary guideline for its diagnosis, calling it “post-COVID condition.”
This refers to multiple health issues that have no origin outside of COVID-19, are present three or more months from symptom onset or date of confirmed SARS-CoV-2 infection, and last for two or more months.
People with severe COVID-19 have shown higher rates of long covid in all research studies. The symptoms seem to decline with time. The vast majority of such studies are in adults, with only 14 studies published on long covid in children and adolescents. This is a needy area, therefore, for evidence on which to base future policy decisions.
The current study analyzed routine healthcare data from a range of health insurance providers in Germany, looking for evidence of higher rates of illness at the three-month mark following a diagnosis of COVID-19 among younger people. The data comes from the Post‐COVID‐19 Monitoring in Routine Health Insurance Data (POINTED) program, which aims at providing evidence-based guidelines for the management of COVID-19.
Set up in December 2020 as part of the German Network University Medicine project egePan Unimed, it is part of the effort to develop, assess and implement such recommendations.
What did the study show?
The study, available on the medRxiv* preprint server, looked at all patients with a confirmed diagnosis of COVID-19 up to and including June 30, 2020, matched in a ratio of 1:5 with age, sex, and propensity scores for common medical conditions to healthy controls. Both cohorts were followed up for three or more months from diagnosis, and the symptoms and outcomes were analyzed.
Of the more than 157,000 individuals in the cohort, the incidence rate of any given health outcome was higher by 30% in the COVID-19 cohort than controls. This included physical, mental, and overlapping areas. In the adult cohorts, all outcomes were present at higher rates, and in 10/13 for children or adolescent cohorts.
About 6% and 1% of adults and children with COVID-19, respectively, were hospitalized, vs. 2% and 0.4% who required intensive care or ventilation. Medical conditions other than COVID-19 were lower in prevalence among children, as expected.
The most significantly raised features among children and young people, malaise and persistent tiredness, cough, and throat or chest pain, were prominent, with the risk being approximately doubled compared to controls. Adjustment disorders, somatization disorder, headache, fever, anxiety disorder/depression, and abdominal pain increased by 50-100%.
Conversely, in adults, dysgeusia, fever, and dyspnea/cough were increased by 3-6 times in those with prior COVID-19 compared to healthy controls. Other symptoms that were more than double in incidence among adults included throat/chest pain, breathing insufficiency, hair loss, malaise, dysphagia, and headache.
Since COVID-19 incidence is 162% higher in adults than younger people, the greatest difference was for symptoms related to the lung. In contrast, overall, the incidence of post-acute symptoms was higher in adults by 41%.
Those in hospital or intensive care had higher incidences of health outcomes captured here, irrespective of age.
What are the implications?
The results of this study suggest a significant number of long Covid manifestations that have newly arisen in children and adults, using health records compiled from routine visits. This is among the few studies addressing this area among younger people, adding to the sparse evidence that COVID-19 causes long-term illness in this age group.
It adds to the findings of a previous large study showing increased overall morbidity following COVID-19 among children and adolescents, though the incidence is lower than in adults. Its novelty lies in the use of documented new-onset illness from physician records and the increased use of healthcare in this group following COVID-19.
While both physical and mental symptoms may be observed in this age group following COVID-19, including malaise, tiredness, pain in the throat, chest, and/or abdomen, depression and anxiety disorders, adjustment, and somatization disorders, mental health issues are more often observed among younger people. This indicates the need for research into these areas, especially in this cohort.
Together with evidence on other relevant aspects not addressed in this study, our results may contribute to recent discussions on preventive measures, including the risk‐to‐benefit ratio of COVID‐19 vaccinations in children and adolescents.”
However, the absolute magnitude of post-acute sequelae in this group is significantly lower than among adults, given their lower COVID-19 rates.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.