Post-Acute Sequelae of SARS-CoV-2 Infection and Its Impact on Adolescents and Young Adults
Jul 14, 2024 23:11:38 GMT
Post by Nadica (She/Her) on Jul 14, 2024 23:11:38 GMT
Post-Acute Sequelae of SARS-CoV-2 Infection and Its Impact on Adolescents and Young Adults - Published May 8, 2024
Sorry this one is a mess. I didn't want to spend too much time on an article that's just going in paywall jail...
KEYWORDS
Long COVID Post-COVID-19 condition
Post-acute sequelae of SARS CoV-2 infection Myalgic encephalomyelitis
Chronic fatigue syndrome Orthostatic intolerance Adolescent
KEY POINTS
Post-acute sequelae of SARS CoV-2 infection (PASC) in adolescents and young adults
(AYAs) presents heterogeneously, often with multisystem involvement.
Between 3 and 6 months after infection, the most common persistent symptoms reported
are fever, sore throat, fatigue or muscle weakness, and sleep disturbances.
A subset of AYAs with persistent symptoms 6 months post-acute SARS CoV-2 infection
meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome, among whom fatigue, cognitive difficulties, post-exertional malaise, sleep disturbance, and symptoms
of orthostatic intolerance are most common.
PASC can be incredibly debilitating for AYAs in physical, social, and emotional domains
which may interrupt normal adolescent development and transition to adulthood.
Primary care providers have a key role in initial diagnosis, assessment, and treatment for
the numerous AYAs affected by PASC.
The complexity of defining post-acute sequelae of SARS-CoV-2 infection
Discussions about what constitutes post-acute sequelae of SARS CoV-2 infection (PASC), also referred to as long COVID and post-COVID-19 condition, have been occurring within health care settings, research institutions, governments, communities, schools, families, media, and among patients. PASC has been identified in both adult and pediatric populations and varying definitions have been developed1,2 (Table 1). The Centers for Disease Control and Prevention utilizes a time frame of symptoms
Burden and impact of post-acute sequelae of SARS CoV-2 infection on adolescents and young adults
Although there are reports of milder COVID-19 disease and lower hospitalization rates in the pediatric population,4 AYAs are still at risk for developing PASC. Published prevalence estimates vary widely, ranging from 4% to 25%, in part due to varying case definitions.5, 6, 7, 8 Adolescents are typically included in aggregate pediatric data, while young adults are typically included in aggregate adult data. However, AYAs are a unique group with unique needs. Obtaining an appropriate control
Symptom profiles
AYAs with PASC have presented heterogeneously with a variety of symptoms; some presenting with one persistent symptom and some presenting with multiple persistent symptoms (Table 2).3,19, 20, 21, 22 Fatigue, concentration difficulties, and PEM (when patients experience a “crash” or exacerbation of symptoms lasting more than 24 hours after physical, cognitive, or orthostatic stress) are 3 of the most common symptoms reported by AYAs with PASC.5,8,12,20,23,24 Respiratory symptoms are more
Risk and protective factors for post-acute sequelae of SARS CoV-2 infection
Risk factors for PASC identified through observational studies include having pre-existing comorbidities, assigned female sex at birth, age older than 10 years, and hospitalization or severe illness or during acute COVID-19 infection.6,7,12,25,44 Comorbid conditions that confer an increased risk include allergic disease, asthma, obesity, anxiety, heart disease, and neurologic diseases.12,44 Additionally, pediatric patients who reported anosmia and/or dysgeusia during acute COVID-19 infection
Assessment of Symptoms Suggestive of Post-Acute Sequelae of SARS CoV-2 Infection
AYAs typically present to primary care with symptoms as discussed earlier (for case example, see Box 1). While this can present quite a challenge for primary care providers and various subspecialty providers to whom patients are often referred, some models of care have been developed.48, 49, 50 Additionally, there is a consensus guidance statement regarding the assessment and treatment of PASC in children and adolescents that details a system-based approach.20 For young adults, there are
Support for adolescents and young adults with post-acute sequelae of SARS CoV-2 infection
Given the impact of PASC symptoms on school/work attendance and performance, school and/or work accommodations can be beneficial for most AYAs with PASC. Examples of academic accommodations and sample letters written to schools can be found in Appendices D and E in reference38. These can include
•
A later start to the day as mornings can be more difficult symptom-wise.
•
Flexibility in assignment due dates and scheduling of testing dates.
•
Extended time for test-taking or ability to take breaks during
Equity in caring for adolescents and young adults with Post-acute sequelae of SARS CoV-2 infection
Overwhelmingly, access to care for PASC has been limited to those who can navigate health care systems, afford to travel for care, afford off-label treatment, and/or have social capital to gain access to specialty clinics or knowledgeable providers. Reports in the media and medical literature call attention to PASC care being limited to mostly affluent, female, and White populations.73,81, 82, 83 It is possible to improve access to care for racially, ethnically, and socioeconomically diverse
Summary
There still is much to be discovered regarding PASC in AYAs. Acute respiratory symptoms and problems with taste and smell generally improve within 1 to 5 months after infection. Common persistent symptoms after COVID-19 infection in AYAs include fatigue, cognitive difficulties, PEM, headaches, and lightheadedness. A subset of AYAs develop more substantial impairments in function similar to those seen in ME/CFS. As we await data from observational and interventional studies in PASC, many of the
Sorry this one is a mess. I didn't want to spend too much time on an article that's just going in paywall jail...
KEYWORDS
Long COVID Post-COVID-19 condition
Post-acute sequelae of SARS CoV-2 infection Myalgic encephalomyelitis
Chronic fatigue syndrome Orthostatic intolerance Adolescent
KEY POINTS
Post-acute sequelae of SARS CoV-2 infection (PASC) in adolescents and young adults
(AYAs) presents heterogeneously, often with multisystem involvement.
Between 3 and 6 months after infection, the most common persistent symptoms reported
are fever, sore throat, fatigue or muscle weakness, and sleep disturbances.
A subset of AYAs with persistent symptoms 6 months post-acute SARS CoV-2 infection
meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome, among whom fatigue, cognitive difficulties, post-exertional malaise, sleep disturbance, and symptoms
of orthostatic intolerance are most common.
PASC can be incredibly debilitating for AYAs in physical, social, and emotional domains
which may interrupt normal adolescent development and transition to adulthood.
Primary care providers have a key role in initial diagnosis, assessment, and treatment for
the numerous AYAs affected by PASC.
The complexity of defining post-acute sequelae of SARS-CoV-2 infection
Discussions about what constitutes post-acute sequelae of SARS CoV-2 infection (PASC), also referred to as long COVID and post-COVID-19 condition, have been occurring within health care settings, research institutions, governments, communities, schools, families, media, and among patients. PASC has been identified in both adult and pediatric populations and varying definitions have been developed1,2 (Table 1). The Centers for Disease Control and Prevention utilizes a time frame of symptoms
Burden and impact of post-acute sequelae of SARS CoV-2 infection on adolescents and young adults
Although there are reports of milder COVID-19 disease and lower hospitalization rates in the pediatric population,4 AYAs are still at risk for developing PASC. Published prevalence estimates vary widely, ranging from 4% to 25%, in part due to varying case definitions.5, 6, 7, 8 Adolescents are typically included in aggregate pediatric data, while young adults are typically included in aggregate adult data. However, AYAs are a unique group with unique needs. Obtaining an appropriate control
Symptom profiles
AYAs with PASC have presented heterogeneously with a variety of symptoms; some presenting with one persistent symptom and some presenting with multiple persistent symptoms (Table 2).3,19, 20, 21, 22 Fatigue, concentration difficulties, and PEM (when patients experience a “crash” or exacerbation of symptoms lasting more than 24 hours after physical, cognitive, or orthostatic stress) are 3 of the most common symptoms reported by AYAs with PASC.5,8,12,20,23,24 Respiratory symptoms are more
Risk and protective factors for post-acute sequelae of SARS CoV-2 infection
Risk factors for PASC identified through observational studies include having pre-existing comorbidities, assigned female sex at birth, age older than 10 years, and hospitalization or severe illness or during acute COVID-19 infection.6,7,12,25,44 Comorbid conditions that confer an increased risk include allergic disease, asthma, obesity, anxiety, heart disease, and neurologic diseases.12,44 Additionally, pediatric patients who reported anosmia and/or dysgeusia during acute COVID-19 infection
Assessment of Symptoms Suggestive of Post-Acute Sequelae of SARS CoV-2 Infection
AYAs typically present to primary care with symptoms as discussed earlier (for case example, see Box 1). While this can present quite a challenge for primary care providers and various subspecialty providers to whom patients are often referred, some models of care have been developed.48, 49, 50 Additionally, there is a consensus guidance statement regarding the assessment and treatment of PASC in children and adolescents that details a system-based approach.20 For young adults, there are
Support for adolescents and young adults with post-acute sequelae of SARS CoV-2 infection
Given the impact of PASC symptoms on school/work attendance and performance, school and/or work accommodations can be beneficial for most AYAs with PASC. Examples of academic accommodations and sample letters written to schools can be found in Appendices D and E in reference38. These can include
•
A later start to the day as mornings can be more difficult symptom-wise.
•
Flexibility in assignment due dates and scheduling of testing dates.
•
Extended time for test-taking or ability to take breaks during
Equity in caring for adolescents and young adults with Post-acute sequelae of SARS CoV-2 infection
Overwhelmingly, access to care for PASC has been limited to those who can navigate health care systems, afford to travel for care, afford off-label treatment, and/or have social capital to gain access to specialty clinics or knowledgeable providers. Reports in the media and medical literature call attention to PASC care being limited to mostly affluent, female, and White populations.73,81, 82, 83 It is possible to improve access to care for racially, ethnically, and socioeconomically diverse
Summary
There still is much to be discovered regarding PASC in AYAs. Acute respiratory symptoms and problems with taste and smell generally improve within 1 to 5 months after infection. Common persistent symptoms after COVID-19 infection in AYAs include fatigue, cognitive difficulties, PEM, headaches, and lightheadedness. A subset of AYAs develop more substantial impairments in function similar to those seen in ME/CFS. As we await data from observational and interventional studies in PASC, many of the