Expanded question: What is the prevalence of Long COVID in different age groups?

Answered on January 3, 2024
The prevalence of Long COVID, defined as the persistence of symptoms beyond 4 weeks from the onset of acute COVID-19, varies across different age groups. In the general adult population, estimates suggest that around 7.3% of all respondents reported long COVID.[1] However, the prevalence of long COVID was found to be higher among respondents who were female, had comorbidities, or were not vaccinated.[1]
In a nationwide population cohort study of Scottish adults, the adjusted prevalence of symptoms attributable to SARS-CoV-2 infection was 6.6%, 6.5%, and 10.4% at 6, 12, and 18 months respectively.[2]
In children and adolescents, the prevalence of long COVID is reported to be around 25.24%, with another study reporting a similar prevalence of 23.36%.[3-4] The most prevalent clinical manifestations in this age group were mood symptoms, fatigue, and sleep disorders.[3]
Risk factors for long COVID in children and adolescents include chronic conditions, obesity, and being in the adolescent age group.[5] In the general population, risk factors include increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma.[6]
It's important to note that these estimates may vary due to differences in study design, population characteristics, and definitions of long COVID. Further research is needed to better understand the prevalence and risk factors of long COVID across different age groups.

References

1.
The Epidemiology of Long Coronavirus Disease in US Adults.

Robertson MM, Qasmieh SA, Kulkarni SG, et al.

Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. 2023;76(9):1636-1645. doi:10.1093/cid/ciac961.

Leading Journal
New Research

Background: We estimated the prevalence of long COVID and impact on daily living among a representative sample of adults in the United States.

Methods: We conducted a population-representative survey, 30 June-2 July 2022, of a random sample of 3042 US adults aged 18 years or older and weighted to the 2020 US population. Using questions developed by the UK's Office of National Statistics, we estimated the prevalence of long COVID, by sociodemographics, adjusting for gender and age.

Results: An estimated 7.3% (95% confidence interval: 6.1-8.5%) of all respondents reported long COVID, corresponding to approximately 18 828 696 adults. One-quarter (25.3% [18.2-32.4%]) of respondents with long COVID reported their day-to-day activities were impacted "a lot" and 28.9% had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection more than 12 months ago. The prevalence of long COVID was higher among respondents who were female (adjusted prevalence ratio [aPR]: 1.84 [1.40-2.42]), had comorbidities (a

Pr: 1.55 [1.19-2.00]), or were not (vs were) boosted (a

Pr: 1.67 [1.19-2.34]) or not vaccinated (vs boosted) (a

Pr: 1.41 [1.05-1.91]).

Conclusions: We observed a high burden of long COVID, substantial variability in prevalence of SARS-CoV-2, and risk factors unique from SARS-CoV-2 risk, suggesting areas for future research. Population-based surveys are an important surveillance tool and supplement to ongoing efforts to monitor long COVID.

2.
True Prevalence of Long-Covid in a Nationwide, Population Cohort Study.

Hastie CE, Lowe DJ, McAuley A, et al.

Nature Communications. 2023;14(1):7892. doi:10.1038/s41467-023-43661-w.

Leading Journal
New Research

Long-COVID prevalence estimates vary widely and should take account of symptoms that would have occurred anyway. Here we determine the prevalence of symptoms attributable to SARS-CoV-2 infection, taking account of background rates and confounding, in a nationwide population cohort study of 198,096 Scottish adults. 98,666 (49.8%) had symptomatic laboratory-confirmed SARS-CoV-2 infections and 99,430 (50.2%) were age-, sex-, and socioeconomically-matched and never-infected. While 41,775 (64.5%) reported at least one symptom 6 months following SARS-CoV-2 infection, this was also true of 34,600 (50.8%) of those never-infected. The crude prevalence of one or more symptom attributable to SARS-CoV-2 infection was 13.8% (13.2%,14.3%), 12.8% (11.9%,13.6%), and 16.3% (14.4%,18.2%) at 6, 12, and 18 months respectively. Following adjustment for potential confounders, these figures were 6.6% (6.3%, 6.9%), 6.5% (6.0%, 6.9%) and 10.4% (9.1%, 11.6%) respectively. Long-COVID is characterised by a wide range of symptoms that, apart from altered taste and smell, are non-specific. Care should be taken in attributing symptoms to previous SARS-CoV-2 infection.

3.
Long-Covid in Children and Adolescents: A Systematic Review and Meta-Analyses.

Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC, et al.

Scientific Reports. 2022;12(1):9950. doi:10.1038/s41598-022-13495-5. Copyright License: CC BY

The objective of this systematic review and meta-analyses is to estimate the prevalence of long-COVID in children and adolescents and to present the full spectrum of symptoms present after acute COVID-19. We have used PubMed and Embase to identify observational studies published before February 10th, 2022 that included a minimum of 30 patients with ages ranging from 0 to 18 years that met the National Institute for Healthcare Excellence (NICE) definition of long-COVID, which consists of both ongoing (4 to 12 weeks) and post-COVID-19 (≥ 12 weeks) symptoms. Random-effects meta-analyses were performed using the MetaXL software to estimate the pooled prevalence with a 95% confidence interval (CI). Heterogeneity was assessed using I statistics. The Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) reporting guideline was followed (registration PROSPERO CRD42021275408). The literature search yielded 8373 publications, of which 21 studies met the inclusion criteria, and a total of 80,071 children and adolescents were included. The prevalence of long-COVID was 25.24%, and the most prevalent clinical manifestations were mood symptoms (16.50%), fatigue (9.66%), and sleep disorders (8.42%). Children infected by SARS-CoV-2 had a higher risk of persistent dyspnea, anosmia/ageusia, and/or fever compared to controls. Limitations of the studies analyzed include lack of standardized definitions, recall, selection, misclassification, nonresponse and/or loss of follow-up, and a high level of heterogeneity.

4.
Prevalence and Risk Factor for Long COVID in Children and Adolescents: A Meta-Analysis and Systematic Review.

Zheng YB, Zeng N, Yuan K, et al.

Journal of Infection and Public Health. 2023;16(5):660-672. doi:10.1016/j.jiph.2023.03.005.

Leading Journal
New Research

Background: Millions of COVID-19 pediatric survivors are facing the risk of long COVID after recovery from acute COVID-19. The primary objective of this study was to systematically review the available literature and determine the pooled prevalence of, and risk factors for long COVID among the pediatric survivors.

Methods: Studies that assessed the prevalence of, or risk factors associated with long COVID among pediatric COVID-19 survivors were systematically searched in PubMed, Embase, and Cochrane Library up to December 11th, 2022. Random effects model was performed to estimate the pooled prevalence of long COVID among pediatric COVID-19 patients. Subgroup analyses and meta-regression on the estimated prevalence of long COVID were performed by stratification with follow-up duration, mean age, sex ratio, percentage of multisystem inflammatory syndrome, hospitalization rate at baseline, and percentage of severe illness.

Results: Based on 40 studies with 12,424 individuals, the pooled prevalence of any long COVID was 23.36 % ([95 % CI 15.27-32.53]). The generalized symptom (19.57 %, [95 % CI 9.85-31.52]) was reported most commonly, followed by respiratory (14.76 %, [95 % CI 7.22-24.27]), neurologic (13.51 %, [95 % CI 6.52-22.40]), and psychiatric (12.30 %, [95% CI 5.38-21.37]). Dyspnea (22.75 %, [95% CI 9.38-39.54]), fatigue (20.22 %, [95% CI 9.19-34.09]), and headache (15.88 %, [95 % CI 6.85-27.57]) were most widely reported specific symptoms. The prevalence of any symptom during 3-6, 6-12, and> 12 months were 26.41 % ([95 % CI 14.33-40.59]), 20.64 % ([95 % CI 17.06-24.46]), and 14.89 % ([95 % CI 6.09-26.51]), respectively. Individuals with aged over ten years, multisystem inflammatory syndrome, or had severe clinical symptoms exhibited higher prevalence of long COVID in multi-systems. Factors such as older age, female, poor physical or mental health, or had severe infection or more symptoms were more likely to have long COVID in pediatric survivors.

Conclusions: Nearly one quarter of pediatric survivors suffered multisystem long COVID, even at 1 year after infection. Ongoing monitoring, comprehensive prevention and intervention is warranted for pediatric survivors, especially for individuals with high risk factors.

5.
Long COVID in Children and Adolescents: A Retrospective Study in a Pediatric Cohort.

Baptista de Lima J, Salazar L, Fernandes A, et al.

The Pediatric Infectious Disease Journal. 2023;42(4):e109-e111. doi:10.1097/INF.0000000000003829.

New Research

Studies on long coronavirus disease (COVID) in children are scarce. We aimed to describe persistent symptoms and identify risk factors for its development. In our study population, 17.6% presented with long COVID, with respiratory symptoms more frequent in the first weeks and neuropsychiatric symptoms over time. Chronic conditions and obesity were risk factors, and adolescents were at a greater risk for long COVID.

6.
Long COVID Burden and Risk Factors in 10 UK Longitudinal Studies and Electronic Health Records.

Thompson EJ, Williams DM, Walker AJ, et al.

Nature Communications. 2022;13(1):3528. doi:10.1038/s41467-022-30836-0. Copyright License: CC BY

Leading Journal

The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.

Answered on January 3, 2024
Evidence-based treatments for long COVID, which is characterized by a range of symptoms persisting beyond the acute phase of SARS-CoV-2 infection, include physical therapy and rehabilitative care. Physical therapy has been shown to improve symptoms and overall physical function in patients with long COVID. Specifically, inspiratory muscle training exercises have demonstrated statistically significant results when included in treatment programs of at least 6 weeks duration.[1]
Outpatient rehabilitative care for long COVID should be individualized and adapted to the patient's performance level, with regular reassessment. Therapeutic options should address the main symptoms of long COVID, such as fatigue, dyspnea, and cognitive impairment. Informing patients about potential relapses and how to manage them is also recommended as part of the treatment regimen.[2]
Physical exercise-based rehabilitation has been identified as a promising strategy for managing long COVID. A systematic review and meta-analysis found that physical exercise-based rehabilitation can have beneficial effects on long COVID-related symptoms, including dyspnea, fatigue, and depression. It also showed improvements in the 6-minute walk test, forced expiratory volume in 1 second/forced vital capacity, and quality of life in individuals who had recovered from COVID-19.[3]
While these interventions are supported by current evidence, it is important to note that the field is rapidly evolving, and high-quality intervention studies are necessary to further substantiate these findings and to develop customized rehabilitation programs for specific types of long COVID.[2-3]

References

1.
Long COVID and Physical Therapy: A Systematic Review.

Sánchez-García JC, Reinoso-Cobo A, Piqueras-Sola B, et al.

Diseases (Basel, Switzerland). 2023;11(4):163. doi:10.3390/diseases11040163.

New Research

Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle pain, sleep disturbances, "brain fog", respiratory, cardiovascular, digestive, neurological and dermatological symptoms. Physical therapy has been identified as a crucial aspect of the management of patients with long COVID, as it can help improve symptoms and overall physical function. The investigation of long COVID poses significant challenges due to the diversity and variability of symptoms, lack of clear diagnostic criteria, and limited understanding of the underlying mechanisms. The aim of this study is to conduct a systematic review of studies conducted in patients with long COVID in conjunction with interventions targeting respiratory function, particularly involving physical activity. To this end, we conducted a systematic review to analyze studies conducted on treatment programs for long COVID based on some form of physical activity. The protocol of the review was registered in the PROSPERO website, and the databases PubMed, Scopus, CINAHL and WOS were searched. Of the 62 initial articles, six were included in the review. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed. Further research is needed to better understand long COVID and develop effective treatment strategies.

2.
Outpatient Rehabilitative Care for Patients With Long-Covid - A Guideline-Based Clinical Practice Guideline.

Teixido L, Andreeva E, Gartmann J, et al.

Laryngo- Rhino- Otologie. 2023;102(7):521-532. doi:10.1055/a-1985-0450.

New Research

Results For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen.
Discussion Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

3.
Effect of Physical Exercise-Based Rehabilitation on Long COVID: A Systematic Review and Meta-Analysis.

Zheng C, Chen XK, Sit CH, et al.

Medicine and Science in Sports and Exercise. 2023;. doi:10.1249/MSS.0000000000003280.

New Research

Purpose: The number of persons living with post-coronavirus disease 2019 (COVID-19) conditions or long COVID continues to rise worldwide; however, the etiology and treatment of long COVID remain nebulous. Therefore, efficient, feasible, and cost-effective therapeutic strategies for a large population with long COVID remain warranted. Physical exercise-based rehabilitation is a promising strategy for long COVID, although its therapeutic effects remain to be determined. This systematic review and meta-analysis aimed to examine the effects of physical exercise-based rehabilitation on long COVID.

Methods: The electronic databases Medline, Embase, Global Health (Ovid), CINAHL (EBSCO), Web of Science, WHO Global Research Database on COVID-19, LitCovid, and Google Scholar were searched from their inception to November 2022. The identified articles were independently screened by three reviewers, and a random-effects model was utilized to determine the mean differences in the meta-analysis.

Results: Twenty-three studies involving 1,579 individuals who had COVID-19 (752 women) were included. Physical exercise-based rehabilitation showed beneficial effects on long COVID-related symptoms characterized by dyspnea, fatigue, and depression, as well as on the 6-minute walk test, forced expiratory volume in 1 second/forced vital capacity, and quality of life in people who had COVID-19.

Conclusions: Physical exercise-based rehabilitation is a potential therapeutic strategy against long COVID and can be applied as a routine clinical practice in people who have recovered from COVID-19. However, customized physical exercise-based rehabilitation programs and their effects on specific types of long COVID require future large-scale studies.