Prevalence and Characteristics Associated With Post–COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults

Abstract

ImportanceThe prevalence and baseline risk factors of post–COVID-19 condition (PCC) remain unresolved among the large number of young people who experienced mild COVID-19.ObjectivesTo determine the point prevalence of PCC 6 months after the acute infection, to determine the risk of development of PCC adjusted for possible confounders, and to explore a broad range of potential risk factors.Design, Setting, and ParticipantsThis cohort study included nonhospitalized individuals from 2 counties in Norway between ages 12 and 25 years who underwent reverse transcription–polymerase chain reaction (RT-PCR) testing. At the early convalescent stage and at 6-month follow-up, participants underwent a clinical examination; pulmonary, cardiac, and cognitive functional testing; immunological and organ injury biomarker analyses; and completion of a questionnaire. Participants were classified according to the World Health Organization case definition of PCC at follow-up. Association analyses of 78 potential risk factors were performed.ExposuresSARS-CoV-2 infection.Main Outcomes and MeasuresThe point prevalence of PCC 6 months after RT-PCR testing in the SARS-CoV-2–positive and SARS-CoV-2–negative groups, and the risk difference with corresponding 95% CIs.ResultsA total of 404 individuals testing positive for SARS-CoV-2 and 105 individuals testing negative were enrolled (194 male [38.1%]; 102 non-European [20.0%] ethnicity). A total of 22 of the SARS-CoV-2–positive and 4 of the SARS-CoV-2–negative individuals were lost to follow-up, and 16 SARS-CoV-2–negative individuals were excluded due to SARS-CoV-2 infection in the observational period. Hence, 382 SARS-CoV-2–positive participants (mean [SD] age, 18.0 [3.7] years; 152 male [39.8%]) and 85 SARS-CoV-2–negative participants (mean [SD] age, 17.7 [3.2] years; 31 male [36.5%]) could be evaluated. The point prevalence of PCC at 6 months was 48.5% in the SARS-CoV-2–positive group and 47.1% in the control group (risk difference, 1.5%; 95% CI, −10.2% to 13.1%). SARS-CoV-2 positivity was not associated with the development of PCC (relative risk [RR], 1.06; 95% CI, 0.83 to 1.37; final multivariable model utilizing modified Poisson regression). The main risk factor for PCC was symptom severity at baseline (RR, 1.41; 95% CI, 1.27-1.56). Low physical activity (RR, 0.96; 95% CI, 0.92-1.00) and loneliness (RR, 1.01; 95% CI, 1.00-1.02) were also associated, while biological markers were not. Symptom severity correlated with personality traits.Conclusions and RelevanceThe persistent symptoms and disability that characterize PCC are associated with factors other than SARS-CoV-2 infection, including psychosocial factors. This finding raises questions about the utility of the World Health Organization case definition and has implications for the planning of health care services as well as for further research on PCC.

Post‐COVID syndrome, the real matter of debate

“…In a recent paper by Selvakumar et al, 1 for example, it is hard to know the exact number of people suffering from fatigue, as this symptom is commonly associated with post-COVID and CFS, and our general impression is that controls show confounders due to the introduction of symptoms recalling fatigue of psychic or mood origin, rather than related to COVID-19.…”

“…For PIFS, the margin of error was 3.49% (<5%, 95% CI) for SARS-CoV2-positive subjects, yet the error was >5% (5.84%, 95% CI) for SARS-CoV2-negative subjects. 1 This would mean that the screening of typical symptoms associated with post-COVID in subjects without signs of infections was presumptively flawed. By using an SPSS Statistical software (v.24.0), we recalculated the actual relative risk (RR) to associate PCC with the absence of a previous COVID-19 infection; recalculation was done taking into account the statistical errors (1.1686; 95% CI = 0.8546-1.5980), indicating that PCC may be a collection of symptoms not related to SARS-CoV2 infections even from the beginning, that is, the authors erroneously included subjects with symptoms resembling a PCC but without any relationship with current SARS-CoV2-negative swabs.…”

“…For PIFS, the recalculated RR in controls was 0.2909 (95% CI = 0.2122-0.3987). 1 We took into account a recently published paper 1 as an outstanding example of how science may dismiss post-COVID syndrome as a "psychic" rather than an actual, postinfective syndrome with numerous symptomatic similarities with CFS.…”

“…For example, some authors reported that the persistence of a complex of symptoms, which they named post-COVID conditions (PCCs), should be associated with factors far from the causative SARS-CoV2 infection, even related to psychological backgrounds. 1 The first question that was raised while reading the paper was how the authors had introduced a novel terminology such as postinfective fatigue syndrome (PIFS) and attached this to references regarding the Fukuda et al's CDC classification of chronic fatigue syndrome (CFS) 2 ; perhaps, the authors intended CFS instead of PIFS. It is a bit misleading when addressing particular symptoms such as fatigue, usually associated with CFS and post-COVID, inasmuch as fatigue is erroneously intended as a mood disorder in people suffering from the psychological consequences of the COVID pandemic.…”

“…1 Furthermore, post-COVID syndrome, particularly if referring to fatigue, is usually considered in mature and older adults, 4,5 despite the claim that it is widely present in young people as well. 1 Clarifying the term post-COVID to date is of utmost importance. Probably, COVID-19, as a scary pandemic, is turning to an end but its "poisoning tail" is going ahead through post-COVID syndrome, which deserves greater attention than before.…”