Exploring post-Covid-19 condition in children and young people 3.5 years after infection: a mixed-methods analysis from the CLoC..., 2026, Dhir-Hewitt

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Exploring post-Covid-19 condition in children and young people 3.5 years after infection: a mixed-methods analysis from the CLoCk study
Emma Dhir-Hewitt, Fiona Newlands, Roz Shafran, Terence Stephenson, Alvin Richards-Belle, Emma Dalrymple, Trudie Chalder, Tamsin Ford, Lana Fox-Smith, Isobel Heyman, Shamez N Ladhani, Malcolm G Semple, Terry Y Segal, Olivia Swann, Elizabeth Whittaker; CloCk Consortium; Snehal M Pinto Pereira

Abstract

Background

Comprehensive data on the persistence of Post-COVID-19 Condition (PCC; also known as Long COVID) and its impact on children and young people (CYP), incorporating their own perspective, is crucial to enhance our understanding of the condition, improve service provision and inform clinical management.

Methods
We examine long-term symptoms, health, and well-being among CYP persistently meeting PCC criteria up to 3.5-years after SARS-CoV-2 infection (when they were aged between 11-to-17-years), using a mixed-methods approach. 68 CYP from the CLoCk study who persistently met PCC criteria at 3- (April-June 2021), 6- (July-September 2021), 12- (January-March 2022), and 24-months (January-March 2023) post-infection were invited to complete an additional follow-up (October-November 2024). The survey assessed current symptoms and health status using validated measures, and symptom experiences through open-text responses. Quantitative data were analysed descriptively; qualitative data were analysed using thematic framework analysis. Findings were integrated using a convergent parallel design.

Results
50 CYP completed the survey; of these 42 (84%) responders continued to meet the PCC definition 3.5-years post-infection. All 42 (100%) reported tiredness and 34 (81%) reported 5 + symptoms 3.5-years post-infection. Qualitative analysis reinforced tiredness as a central symptom, alongside co-occurring symptoms that impact daily life. While quantitative and qualitative findings largely converged, context as to why CYP reported high levels of impact were only available from qualitative data.

Conclusions
CYP with PCC persisting for 3.5-years post-infection experience multiple symptoms of wide-ranging severity and disruption to daily life, education and social participation.
 
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Exploring post-Covid-19 condition in children and young people 3.5 years after infection: a mixed-methods analysis from the CLoCk study
Dhir-Hewitt, Emma; Newlands, Fiona; Shafran, Roz; Stephenson, Terence; Richards-Belle, Alvin; Dalrymple, Emma; Chalder, Trudie; Ford, Tamsin; Fox-Smith, Lana; Heyman, Isobel; N Ladhani, Shamez; G Semple, Malcolm; Segal, Terry Y; Swann, Olivia; Whittaker, Elizabeth; Pinto Pereira, Snehal M

Web | DOI | PDF | BMC Public Health | Open Access
 
Importantly, the prominence of fatigue in CYP after SARS-CoV-2 infection […] underscores its significance. During adolescence, energy levels, cognitive stamina, and physical capacity are intertwined with developmental, educational, and social milestones. Thus, enduring fatigue can derail key developmental processes, disrupt learning trajectories, and impair psychosocial adjustment. This makes persistent fatigue in CYP not only a symptom of PCC but a potential long-term threat to health, wellbeing, and life chances.

We identified notable mental health difficulties in the qualitative data. CYP described anxiety, distress, and frustration linked to ongoing symptoms, and resulting consequences to education and activities. Quantitatively, there was no evidence of difference between those who continued to meet the PCC definition vs those who did not at 3.5 years post-infection.

Several possibilities could explain these findings. For example, the validated scales used may not be sufficiently sensitive to capture PCC specific distress (e.g., where difficulties relate to fluctuating symptoms or uncertainty). In addition, the small sample size may have limited statistical power to detect meaningful differences. Alternatively, these findings may reflect the broader context, with survey data showing that around 20% of CYP in England had a probable mental disorder in 2023, highlighting the generally poor state of mental health in this population.

Quantitative and qualitative findings converged to demonstrate that tiredness was a common and central symptom of PCC. CYP experiencing PCC up to 3.5-years post-infection also present with multiple symptoms with wide-ranging severity that impact daily life and self-rated health. Current guidance on treating PCC recommends multidisciplinary rehabilitation and symptom-based approaches[35].
 
Can someone explain to me what "a probable mental disorder" is?

It is likely to mean that someone is considered a probable case of some mental health diagnosis. 'Probable' is often an appropriate qualifier when assigning diagnosis for borderline cases.

However, it is unclear to me whether 'disorder' is meant to indicate something pathological or just a symptom category. Anxiety is not pathological if a forest fire is approaching your house or your father is gravely ill. Or indeed, if you have persistent fatigue which nobody can explain or help with.

I don't think any of this stuff has any useful meaning for us.
 
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