Peer-reviewed article
Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2
Erika Molteni, Carole H. Sudre, Liane S. Canas, Sunil Bhopal, Robert C Hughes et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined illness duration and symptoms in 1,734 UK school-aged children (aged 5-17) who tested positive for SARS-CoV-2 between March 2020 and February 2021. Most children had short illnesses lasting a median of six days, with headache and fatigue being the most common symptoms. A small proportion (4.4%) experienced prolonged illness lasting 28 days or more, though symptom burden decreased over time and almost all children recovered by eight weeks. Some children who tested negative for SARS-CoV-2 also had prolonged illnesses with similar or greater symptom burdens.
Key points
- Median illness duration was six days in SARS-CoV-2 positive children versus three days in negative children
- Only 4.4% (77 children) experienced illness duration of 28 days or more, with older children more likely to have prolonged illness than younger children
- The most common symptoms in prolonged cases were fatigue (84%), headache (80%) and anosmia (80%)
- By day 28, median symptom burden in prolonged cases was low (two symptoms)
- Only 1.8% of children experienced symptoms for 56 days or more
Limitations
The study relies on adult proxy reporting rather than direct clinical assessment, and symptom data were self-reported through a digital platform which may affect accuracy. The study compares COVID-19 illness to other respiratory illnesses in the same population but cannot establish causation or long-term developmental impacts.
Abstract
Abstract Background In children, SARS-CoV-2 is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, the largest UK citizen participatory epidemiological study to date. Methods Data from 258,790 children aged 5-17 years were reported by an adult proxy between 24 March 2020 and 22 February 2021. Illness duration and symptom profiles were analysed for all children testing positive for SARS-CoV-2 for whom illness duration could be determined, considered overall and within younger (5-11 years) and older (12-17 years) groups. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed. Findings 1,734 children (588 younger, 1,146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study time frame. The commonest symptoms were headache (62.2%) and fatigue (55.0%). Median illness duration was six days (vs. three days in children testing negative), and was positively associated with age ( r s 0.19, p<1.e-4) with median duration of seven days in older vs. five days in younger children. Seventy-seven (4.4%) children had illness duration ≥28 days (LC28), more commonly experienced by older vs. younger children (59 (5.1%) vs. 18 (3.1%), p=0.046). The commonest symptoms experienced by these children were fatigue (84%), headache (80%) and anosmia (80%); however, by day 28 the symptom burden was low (median, two). Only 25 (1.8%) of 1,379 children experienced symptoms for ≥56 days. Few children (15 children, 0.9%) in the negatively-tested cohort experienced prolonged symptom duration; however, these children experienced greater symptom burden (both throughout their illness and at day 28) than children positive for SARS-CoV-2. Interpretation Some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate. Research in context Evidence before this study SARS-CoV-2 in children is usually asymptomatic or manifests as a mild illness of short duration. Concerns have been raised regarding prolonged illness in children, with no clear resolution of symptoms several weeks after onset, as is observed in some adults. How common this might be in children, the clinical features of such prolonged illness in children, and how it might compare with illnesses from other respiratory viruses (and with general population prevalence of these symptoms) is unclear. Added value of this study We provide systematic description of COVID-19 in UK school-aged children. Our data, collected in a digital surveillance platform through one of the largest UK citizen science initiatives, show that long illness duration after SARS-CoV-2 infection in school-aged children does occur, but is uncommon, with only a small proportion of children experiencing illness duration beyond four weeks; and the symptom burden in these children usually decreases over time. Almost all children have symptom resolution by eight weeks, providing reassurance about long-term outcomes. Additionally, symptom burden in children with long COVID was not greater than symptom burden in children with long illnesses due to causes other than SARS-CoV-2 infection. Implications of all the available evidence Our data confirm that COVID-19 in UK school-aged children is usually of short duration and of low symptom burden. Some children do experience longer illness duration, validating their experience; however, most of these children usually recover with time. Our findings highlight that appropriate resources will be necessary for any child with prolonged illness, whether due to COVID-19 or other illness. Our study provides timely and critical data to inform discussions around the impact and implications of the pandemic on paediatric healthcare resource allocation.