P3C115: Estimating the Burden of Long COVID Among Children and Adolescents in San Diego County

Background: Although Long COVID (LC) has been known to affect children, little is known about the prevalence among this population. Understanding Long COVID in children and adolescents is critical to inform case management and the development of preventative strategies. We aim to evaluate the burden of LC among San Diego County (SDC) residents < 18 years of age.

Methods: SDC residents < 18 years old infected with a SARS-CoV2 virus reported to SDC Public Health from June 2021 to January 2022 were identified. Those with a completed COVID-19 case-report form were re-contacted >90 days from infection and asked standardized questions about their COVID-19 symptoms. Chi-square tests were used to compare respondents reporting LC, defined as persistent symptoms for >4 weeks following acute SARS-CoV-2 infection, to those without. Health disparities were assessed using the Healthy Places Index (HPI) 3.0.

Results: Staff identified 3,242 persons < 18 years-of-age; and completed 1,686 (52%) interviews from caregivers or adolescents. Ages ranged from 0 to 17 with a median age of 10 years (IQR 7) and 22% of the participants were 5 years old or younger. Demographics of included participants were representative of race/ethnicity distribution in San Diego County. Majority of the cohort were Hispanic (49.8%) with smaller proportions of White (26.8%), African American/Black (4.8%), Asian (4.9%), American Indian/Alaska Native (0.4%) and Native Hawaiian/Pacific Islander (0.7%). Of the interviewed participants,154 (9%) experienced LC. Children with LC were more likely to be Hispanic (P < 0.001) and older (median age 11 years) than those without LC (median age 9 years) (P = 0.011). Unlike observations among adult populations, there were no differences in rate of Long COVID between sexes. Children in HPI quartiles with more health disparities were more likely to report symptoms (10–11%) than in the quartile with the least disparities (4%) (P < 0.001). Commonly reported symptoms were fatigue (38%), headache (31%), cough (29%), and anxiety (18%). Only 1% (n=17) of participants were hospitalized for their infection, with a median length of stay of 1.5 days (1-21 days). There were no observed differences in rates of Long COVID by hospitalization status. Persisting symptoms prompted 32% of the participants to seek medical attention for Long COVID and 6% of those visits were for emergency/urgent care services. During the time of initial infection, only 5% had received any dose of the COVID-19 vaccine and 4% were fully vaccinated.

Conclusion: Nine percent of SDC residents < 18 years-of-age have persisting symptoms. Living in HPI quartiles with greater health disparities was associated with having LC. Our findings confirm LC is a significant public health issue in children and adolescents requiring adaptation of interventions to this population. Measures that reduce risk of SARS-CoV-2 infection, such as vaccination, may reduce risk of Long COVID.