Long COVID Symptoms for Individuals 12 to 25 May Not Meet WHO’s Definition

Persistent symptoms of long COVID for individuals aged 12 to 25 years can be related to factors other than a SARS-CoV-2 infection, including psychosocial factors, which contradicts the usefulness of the WHO case definition of post-COVID-19 condition, known as long COVID, according to the results of a study (NCT04686734) published in JAMA Network Open.¹

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Post-COVID-19 condition is defined as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation,” according to WHO.²

Investigators included individuals who were not hospitalized in 2 counties in Norway between age 12 and 25 years. The individuals underwent reverse transcription-polymerase chain reaction (RT-PCR) testing.¹

At the earliest recovery state and 6 months of follow up, individuals underwent a clinical examination, which included cardiac, cognitive, and pulmonary functional testing, immunological and organ injury biomarker analyses, and the completion of a questionnaire.¹

Investigators classified individuals according to the WHO’s definition of post-COVID-19 condition at follow-up. They also performed an association analysis of 78 potential risk factors for the individuals.

Investigators included 404 individuals who tested positive for SARS-CoV-2 and 10 who tested negative with a RT-PCR test. Twenty-two of those who were positive and 4 who were negative did not complete a follow-up, and 16 individuals who were negative were excluded, because of a SARS-CoV-2 infection during the observational period.¹

At 6 months, the prevalence of post-COVID-19 condition was 48.5% in the SARS-CoV-2 group and 47.1% in the control group, which were the individuals who tested negative.¹

Additionally, investigators found that SARS-CoV-2 positivity was not associated with the development of a post-COVID-19 condition. The main risk factor was symptom severity at baseline, which also correlated with personality traits.¹

They found that loneliness and low physical activity were also associated with post-COVID-19 condition, but biological markers were not associated.¹

For individuals who had post-infective fatigue syndrome, 53 who tested positive and 7 who tested negative met the criteria, resulting in a point prevalence of 14% and 8.2%, respectively.¹

Ear-nose-throat symptoms and fatigue were more common in the individuals who had SARS-CoV-2. The majority of individual symptom prevalence overlapped between the groups.¹

The principal component analyses of clinical symptoms and psychological traits, which represented emotional maladjustment and symptom severity, were associated with both post-COVID-19 condition and post-infective fatigue syndrome in the bivariate regression analyses, according to investigators.¹

Other risk factors at baseline included being female, low self-reported physical activity before the infection, loneliness, and negative life events during the preceding year.¹

Limitations of the study included a low number of individuals in the control group, not adjusting for pre-COVID-19 symptoms, and a limitation to external validity.

Investigators also said they do not know to what extent the findings can be applied to those with more severe acute COVID-19.

References

1. Selvakumar J, Havdal LB, Drevvatne M, Brodwall EM, et al. Prevalence and characteristics associated with post-COVID-19 condition among nonhospitalized adolescents and young adults. JAMA Netw Open. 2023;6(3):e235763. doi:10.1001/jamanetworkopen.2023.5763

2. Post COVID-19 condition (long COVID). World Health Organization. Updated December 7, 2022. Accessed April 3, 2023. https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition