Symptom variation up to two years post-SARS-CoV-2 infection in Children and Young People: results from the Children and young people with Long Covid (CLoCk) study.

backgroundPost Covid-19 Condition (PCC) can fluctuate over time, yet, no in-depth investigation of the heterogeneous PCC trajectories that can exist in children and young people (CYP) has been undertaken. We aim to examine associations between PCC trajectories in CYP over 2-years following infection and (i) factors prior to the COVID-19 pandemic/infection including socio-demographic variables (e.g., age, sex, ethnicity), health and educational needs status and (ii) factors subsequent to infection including the nature, number, functional impact and severity of symptoms, as well as mental health and wellbeing.

methods943 PCR-test positive CYP (enrolled January-March 2021) were followed-up over two-years (till January-March 2023). Five PCC trajectory groups were specified: (i) chronic, (ii) recovered, (iii) fluctuating, (iv) late onset and (v) never PCC. These groups were compared in terms of factors at baseline using multinomial logistic regression and concurrent health during the two-year period using Chi-Square/Fisher's Exact tests.

resultsBaseline factors prior to the pandemic/infection such as female sex, older age, poorer pre-infection mental and physical health, prior healthcare use, and educational needs were strongly and consistently associated with adverse PCC trajectories. Compared to those aged 11-to-14-years at infection, those aged 15-to-17-years had a 2.44 (95%CI:1.39,4.26) higher risk of being in the chronic group (compared to the never group). Similarly, the risk of being in the fluctuating group was 1.57 (95%CI:1.04,2.37), the recovered group was 2.08 (95%CI:1.10,3.92) and the late-onset group was 1.50 (95%CI:1.08,2.07). Other sociodemographic factors, such as ethnicity and region of residence, had more modest and inconsistent associations. PCC trajectories differed by concurrent number, frequency, functional impact and severity of symptoms and mental health. CYP with chronic PCC consistently reported a higher median number of symptoms (5+) compared to the other groups (median symptoms ≤ 3). Mental health and wellbeing, of the chronic PCC group was also consistently worse (e.g., 41% of the chronic group consistently were classified as 'cases' on the Strengths and Difficulties scale vs 17%-to-2% of the other groups).

conclusionsThere were consistent differences between PCC trajectories, in terms of sex, age, pre-infection mental and physical health, healthcare use, and educational needs. Understanding factors associated with PCC trajectory heterogeneity in CYP and how these trajectories differ over time can help with treatment planning.