Damian Sendler: One of the most devastating effects of the COVID-19 epidemic on teenagers is the lockdowns and limitations that have impacted their daily lives. SARS-CoV-2 positive teenagers between the ages of 15 and 18 years old were compared to a control group in terms of health, including signs of long-term COVID.
Damian Jacob Sendler: In Denmark, LongCOVIDKidsDK was a cross-sectional research that included SARS-CoV-2-positive adolescents and matched controls. From July 20, 2021, a survey was issued to all Danish 15–18-year-olds who had tested positive for SARS-CoV-2 between January 1, 2020, and July 12, 2021, as well as a control group that was age and sex matched (1:4). In order to participate, participants had until September 15, 2021. Children with COVID-19 were asked about symptoms, school attendance, and health-related quality of life using auxiliary questions and validated questionnaires (PedsQL and CSSI-24). Descriptive statistics and logistic regression were used in the statistical analysis. NCT04786353 is the ClinicalTrials.gov identifier for this investigation.
Dr. Sendler: SARS-CoV-2 case and control participants were selected among 24 315 teenagers who tested positive for SARS-CoV-2. SARS-CoV-2 infection was suspected in 3013 of the matched controls. In the case study, there were 6630 participants (27.3 percent), whereas there were 21 640 participants (22.3%), all of whom were qualified to take part in the control group. In both groups, the median age was 17 years and 6 months (interquartile range: 16 years and 4 months to 18 years and 5 months). Of the 28 270 respondents, 16 277 (576%) were female and 11 993 (424%) were male. Case group participants were more likely than control group participants to have at least one long-term COVID symptom lasting at least two months (3159 [619%] vs 12340 [570%], odds ratio 122 [95% CI 115–130]; p00001). Mean symptom score (ie, somatic distress) of 10–7 (SD 11–4, median 7–0 [IQR 2–0–15–0]) in the case group was considerably lower than in the control group: compared to 11–9 in the control group, p=0–0001. There was a significant difference in quality of life between the two groups: physical functioning 887 versus 865 (SD 13–9, median 93–8 [IQR 83.4–96.9]; emotional functioning 77–1 (20%, 80–0) versus 71–7 (21–4, 75% [60–90%]); social functioning 93% (12%, 100–0 [90–0–100–0]; and school functioning 66–9 (22%, 65% [60–90%]) versus 88–4 (16%, 95% [80–0–100–0]. In the case group, more individuals than in the control group reported 16 or more illness days (1205 [18.2 percent] vs 2518 [11.6 percent]; p00001) and 16 or more days of school absence (695 [105 percent] vs 1777 [8.2 percent]; p=00001).
In comparison to the control group, those with SARS-CoV-2 positive tests had longer-lasting symptoms and greater sick leave, whereas those in the control group had shorter-lasting symptoms and a worse quality of life. Clinical detection and treatment of long-term COVID in adolescents is critical.
Hospitalization and fatality rates for children and adolescents with SARS-CoV-2 infection are regarded to be lower than for adults.
1, 2 The long-term effects of SARS-CoV-2 infection, such as weariness, headaches, and shortness of breath, have been made more widely known across the world (long COVID).
Damian Sendler
3, 4, and 5 As of October of 2021, WHO classified protracted COVID as symptoms that continue or fluctuate for at least two months after SARS-CoV-2 infection and that cannot be explained by any other diagnosis in adults;5 however, a criteria for children and adolescents has not yet been published. More research has been done on the symptoms of extended COVID in adults than in children and adolescents. In a recent review,10 14 papers were found but only five had a control group, with a total of just 5270 cases and 12 588 controls in total. More than a dozen Cases with SARS-CoV-2 infection were more likely than controls to have persistent symptoms, according to three of these five investigations,13, 14, 15; two studies revealed no difference between cases and controls. 10, 11 The longest period of follow-up was 12 weeks, and no laboratory confirmation of SARS-CoV-2 was found in either study. The ages of 16 and 17 Children and adolescents have been known to experience long-term symptoms following a viral infection, such as persistent coughing following an infection with the respiratory syncytial virus in infants and toddlers18 and persistent fatigue, headaches, and abdominal pain following an infection with the Epstein-Barr virus. 19 As a result, it is not surprising that teenagers have a lengthy COVID.
The LongCOVIDKidsDK cross-sectional research was conducted in Denmark. We surveyed all of the 15–18-year-olds in Denmark who had tested positive for SARS-CoV-2, as well as a group of matched peers who had not.
Damian Jacob Markiewicz Sendler: SARS-CoV-2 positive test results for all 24 315 Danish adolescents aged 15–18 years (case group) were retrieved from the Danish COVID-19 database that includes countrywide coverage of all persons with a positive SARS-CoV-2 test results in the period Jan 1, 2020, to July 12, 2021. On July 12, 2021, this accounted for 9% of the population aged 15–18 years in Denmark. One-fourth (n=97 257) of the cases in the Danish Civil Registration System did not have a positive SARS-CoV-2 test, which allowed researchers to identify a control group. 19 Teenagers who had tested negative throughout the epidemic as well as those who had never been tested made comprised the control group.
One initial invitation and two follow-up reminders were sent through e-Boks (a Nordic secure digital postbox that is used by public authorities to communicate with Danish citizens) between July 20 and September 15, 2021, for questionnaires to be answered in REDCap (a secure web application for online surveys).
SARS-CoV-2 positive cases and controls were questioned about comorbidities prior to the date of the SARS-CoV-2 positive test.
Controls who claimed to have been infected with SARS-CoV-2 at some point during the epidemic but were unable to get a test at the time were not included in this study. Survey invitations to those who were infected between July 12, 2021, when the population was extracted from the registration, and the survey invitation were sent were declined by those affected.
According to the data protection agency, this research has been authorized (P-2021-195). The Danish Health Data Authority provided access to registration data (FSEID 00005625 and 00005757). In Denmark, no further ethical permission is given for surveys. Submitting a completed electronic questionnaire in lieu of paper signed off as proof of informed consent.
In order to determine the existence of diverse somatic symptoms in children, the Children’s Somatic Symptoms Inventory-24 (CSSI-24) was created. In order to create a two-week rolling average, each item is given a Likert scale value ranging from 0 (not at all) to 4 (a lot). Somatic distress is more likely to have a higher total score. 26
Damien Sendler: Pediatric Quality of Life (PedsQL) is a 23-item general questionnaire that includes four domains of health-related quality of life in children aged 15–18 years old. The PedsQL provides a total summary score and subscores for physical functioning, emotional functioning, social functioning, and school functioning during the last month.. Healthier children had higher ratings on the Pediatric Quality of Life Scale (PedsQL). 27
For the Long COVID Kids Rapid Survey in January 2021, we used the CSSI-24 and the PedsQL, in addition to the 23 most frequent long COVID symptoms that were discovered.
In addition to 28 questions regarding height and weight to calculate BMI, there were also questions about sick leave and absence from school.
Sources of information and management
All symptoms experienced by adolescents who had been infected with SARS-CoV-2 were requested to be reported, including questions concerning their severity and duration. Participants were asked whether the symptoms had been present before to SARS-CoV-2 infection and if they considered the symptom was linked to the virus. –> Before infection, long COVID symptoms could not have been expected. A nested population was created to look for teenagers in the case group who were experiencing new symptoms that might be linked to COVID-19 (long COVID group). At least one new-onset symptom that had not been present prior to the positive SARS-CoV-2 test was found in this group of subjects.
Damian Jacob Sendler
The control group was questioned about the same symptoms and to assess the strength and duration of them. The control group was split into four equal-sized random groups using statistical tools. It was requested that each of these four groups report on the 23 lengthy COVID symptoms dating back 3, 6, 9, or 12 months.
The Long COVID Kids Rapid Survey, conducted in January 2021, yielded a list of 23 prevalent symptoms.
28 This illness manifested itself in a variety of ways: as indigestion and heartburn to headaches and fatigue to muscle and joint pain to dizziness and skin rashes to mood swings and nausea to difficulty breathing to paleness and memory loss to cold hands and feet to cough to chapped lips to dizziness and extreme paleness. There were 23 common symptoms in the case group and control group that met the WHO criterion for extended COVID: symptoms lasting at least two months or longer. Participants were questioned about the severity of symptoms—eg, “often” or “always”—rather than the length of the symptoms.
As of March 11, 2020, schools in Denmark were open from March 11 to June 21, 2021, with different periods of closure. In the early months of 2020, SARS-CoV-2 testing was only available via a doctor referral; starting in May of that year, walk-in centers would be open to the public. Denmark was not under lockdown at the time of our data collection, but the post-COVID-19 respiratory syncytial virus outbreak was in full swing.
We studied symptoms and quality of life in the Danish teenage population between the ages of 15 and 18 who were SARS-CoV-2 positive and in a sex and age matched control group in this investigation. A higher percentage of those in the case study group had long-term central COVID-19 symptoms, but they also had higher quality of life ratings and less short-term symptoms than those in the control group. The case group’s members missed more days of school due to illness and other absences than did those in the control group.
SARS-CoV-2 PCR findings for the whole population of Denmark and the Danish Civil Registration System, which allows for nationwide survey matching, are two of the study’s main strengths. National secure digital post-boxes reach all residents without delays imposed by postal mail and have a direct interface with the survey. They also provide immediate access to respondents. The research also includes a number of flaws, though. COVID-19 has been implicated with a slew of symptoms. 10 We included symptoms from two previously validated questionnaires26, 27 as well as 23 previously described symptoms, as well as information on individuals’ preexisting conditions, which may have influenced the results. 28 All relevant symptoms may not have been taken into account due to the incompleteness of the list we utilized. 23–27 percent of participants responded to our study, which is significantly lower than earlier research involving teenagers in general,30,31 but substantially higher than recent studies examining COVID-19 symptoms among adolescents.30, 31 (less than 14 percent ). 10, 13, 15, 17 There may be a non-response bias since there were more male non-responders than female non-responders. Due to the equal response rates of the two groups, sampling bias seems improbable. It is important to note that participants in the case group were asked to report on acute symptoms and whether or not they were new and connected to COVID-19, while individuals in the control group were not. Comorbidities prior to a SARS-CoV-2-positive test were questioned of participants in the case group, whereas those in the control group were asked to report on past comorbidities with no index date. This discrepancy resulted in a malfunction of the overall response mechanism. Recall bias may have resulted from a 12-month retrospective recall. Symptoms such as headache, worry, and weariness are all subjective, but this is the nature of the data. Because there are no relevant controls, case-only reporting is critical for identifying previously unknown symptoms of SARS-CoV-2 infection. The results, however, should be regarded with care.
Compared to the control group, individuals in the case group had fewer pre-existing conditions. Participants in the case group experienced a greater number of long-lasting conditions, such as chest discomfort, difficulty breathing, cough, headaches, sore throat and dizziness compared to the control group. It’s possible that these are long-term signs of COVID-19 infection. Five prior investigations of lengthy COVID in adolescents with a control group indicated a difference in persistent symptoms, with the case group having more of them, although two studies11 and 12 found no difference. Compared to the studies that found a difference in the persistence of symptoms, those that found no difference had shorter follow-up periods (15 to 3 months), fewer samples, different symptoms (e.g. sleep disruption and myalgia/arthralgia), and different techniques. In our research, individuals on the control group reported poorer results in the validated generic questionnaires for symptoms, psychological outcomes, and quality of life after 2–4 weeks of recall time compared to those in the case group, which was surprising. Despite the fact that the differences were statistically significant, the impact sizes for emotional and social outcomes were just modest enough to be clinically important. Aside from skin rashes, mood swings, dark bags under the eyes, and chapped lips, we also discovered greater reporting in the control group compared to those in the case group. At the outset, the demographic and clinical characteristics of the two groups differed, with the control group having higher comorbidity than the treatment group. It’s possible that the people in the control group were more afraid of COVID-19 and had less freedoms because they were trying to protect themselves from the virus. We have validated questionnaires with 2–4 weeks of recall, thus many people in the case group may have been free of symptoms for a long period after infection.
The idea that lockdowns and social limitations are causing pandemic symptoms has been floated10, and it’s possible that these symptoms are the result of the poor flourishing that comes as a result of them.
10 – 32 Long-term COVID symptoms may be difficult to detect in surveys because of suspected pandemic symptoms such insomnia, anxiety, and depression,22 as well as the respiratory syncytial virus and vaccination side effects.23. Many individuals suffer with the symptoms on a regular basis. Thus, any variations in the strength and duration of these symptoms may have been obscured by the study.
As the epidemic progressed, Denmark was one of the nations that tested the most, with an average of almost 10 PCR tests per individual and as many antigen tests. The observed mean symptoms differences between our case and control groups may be bigger than those experienced by the typical person who contracts a SARS-CoV-2 infection since some teenagers may have been infected with SARS-CoV-2 but remained asymptomatic.
Sick days and school absences varied widely between the two groups, as expected. It is possible that quarantine regulations may have contributed to some of the absences from school. It’s important to consider the impact of COVID-19 from a variety of angles, including the impact on the health of families, the economy, and the well-being of children.
Of the 6264 patients in the case study, 2997 (47.8%) had at least one new symptom that had not been evident before 8 weeks following infection. In previous smaller studies, the prevalence of symptoms ranged from 4% to 66% 10 based on criteria such as the number and kind of symptoms included in the study. In our research, the most common symptoms were headache, nausea, and exhaustion. However, trouble breathing was not previously described in prior studies, which have confirmed similar results with variable rates of prevalence10. However, this research offers more solid evidence of a reduction in the quantity and severity of symptoms over time. While it is possible that new-onset symptoms may have occurred in the control group, the lack of an index event in the control group makes a comprehensive comparison very challenging.
Female individuals showed higher symptoms in both the case and control groups compared to male participants. Molteni and colleagues discovered the same thing. 13 In general, female teenagers have a greater number of complaints, symptoms, and diseases to report. 34, 33 There was a greater correlation between increased anxiety, sadness, and life satisfaction among female participants during the COVID-19 pandemic than there was among male participants. 35
The conditions of social pandemic management may have affected health outcomes in teenagers when evaluating generalisability. There may also be differences in teenage body mass index and mental health across nations.
Differences were discovered between the two groups, with the SARS-CoV-2 positive group experiencing more long-term symptoms and taking more sick time, whereas the control group had more short-term symptoms and a lower quality of life.. Post-COVID-19 diagnoses, recommended medications, and health-care use should be studied further.
