ABSTRACT
Post-COVID syndrome (or long COVID) is a set of multiple symptoms oc-curring after a documented SARS-CoV-2 infection and persisting for more than 2 months. The pediatric population is also affected, especially pre-adolescents and adolescents, even if data about this age group are still scarce. Persistent symptoms can have a strong impact on quality of life and schooling, school absenteeism and social withdrawal being of major concern. For this reason, the Division of General Pediatrics at the Univer-sity Hospital of Geneva has set up in May 2021 a specific consultation for adolescents with post-COVID syndrome, offering global and multidiscipli-nary care. To date 50 patients have been addressed to our consultation by their gen-eral practitioner. The mean age is 14 years, two thirds are girls. The symp-toms are multiple and non-specific, and are similar to those described in adults. The most frequent ones are fatigue, dizziness, headaches, dysp-nea, loss of smell, brain fog, sleep disorders, mood disorders. The Peds-QL questionnaire (assessing 4 aspects of teenagers' daily life), shows an impact of these symptoms on the quality of life, schooling and daily activities being the most affected. Reassuringly, peer relationships seem preserved. Impact on schooling is important, with two thirds of pa-tients reporting an impact on school performance, and one fourth having extended school absenteeism. The Adolescent Depression Rating Scale shows that 44% of our patients are at risk for depression. One third needs a psychological support. If necessary, patients can be referred to specialized consultations in our multidisciplinary group (ENT, pulmonology, neurology, cardiology, etc.) or to complementary examinations (Tilt-Test, stress test). Patients having symptoms due to physical activity (fatigability, shortness of breath, dysau-tonomia with standing position intolerance) can benefit from a progres-sive and individualized reconditioning program with an adapted sport coach. We offer a global follow-up to patients and families. School attendance is supported by making individual arrangements if required, through close collaboration with the education system. Repetition of the questionnaires 3-6 months after the beginning of the follow-up shows a trend towards clear improvement, however a longer follow-up period would be necessary to confirm these observations. (To allow fully up-to-date informations, numbers are susceptible to change until June).
ABSTRACT
Post-Covid condition (or long covid) describes the persistence of symp-toms several months to years after SARS-CoV-2 infection. It has been in-creasingly described in children as well, particularly in preteens and teen-agers. Most commonly reported symptoms include fatigue, difficulty con-centrating, sleeping disorders, shortness of breath, and mood disorders. Treatment of these symptoms is limited and consists mostly of adaptation of physical and mental activities, reconditioning and motivational sup-port. Improving information and awareness of this condition are priorities to properly evaluate and treat these children. The Department of General Pediatrics in Geneva has set up a specific consultation for children and adolescents in spring 2021. In addition, in collaboration with the Depart-ment of Community Medicine and Primary Care and Emergency Medicine, we developed an academic digital citizen platform (RAFAEL), which com-bines an information site, a chatbot, and webinars/workshops for both children and adults. We report here our experience with the use of the pediatric chatbot which was launched on February 1st 2022. The chatbot is a conversational agent that can answer questions in real-time and reorient people to a special-ist/advisor if needed. Chatbot technology is useful in providing verified information and prompting communication and interaction with a large number of people simultaneously and can be adapted to all age groups. It is particularly appealing to teenagers who are very familiar with the con-cept of chatbot technology and may find this way to communicate more appealing than regular website information or traditional literature. We will report the initial frequently asked questions and their evolution over time within this chatbot. We will also report the number of users of the pediatric chatbot, the overall and individual match rates, and users' satis-faction. A platform, such as RAFAEL, could become a new way to interact with young patients regarding non urgent subjects, prevention, chronic dis-eases, as well as a way to use their regular feed-back to be as close as possible to the patients' needs.
ABSTRACT
OBJECTIVES: To evaluate longitudinally the persistence of humoral immunity for up to 6 months in a cohort of hospital employees with mild coronavirus disease 2019 (COVID-19). METHODS: We measured anti-RBD (receptor binding domain of viral spike protein), anti-N (viral nucleoprotein) and neutralizing antibodies at 1, 3 and 6 months after mostly mild COVID-19 in 200 hospital workers using commercial ELISAs and a surrogate virus neutralization assay. RESULTS: Antibodies specific for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persisted in all participants for up to 6 months. Anti-RBD geometric mean concentrations (GMCs) progressively increased between months 1 (74.2 U/mL, 95%CI: 62.7-87.8), 3 (103.2 U/mL, 95%CI: 87.9-121.2;p < 0.001), and 6 (123.3 U/mL, 95%CI: 103.4-147.0;p < 0.001) in the whole cohort. Anti-N antibodies were detectable in >97% at all times. Neutralizing antibodies were detectable in 99.5% of participants (195/196) at 6 months post infection. Their GMC progressively decreased between months 1 (20.1 AU/mL, 95%CI: 16.9-24.0), 3 (15.2 AU/mL, 95%CI: 13.2-17.6;p < 0.001) and 6 (9.4 AU/mL, 95%CI: 7.7-11.4;p < 0.001). RBD-ACE2-inhibiting antibody titres and anti-RBD antibody concentrations strongly correlated at each timepoint (all r > 0.86, p < 0.001). Disease severity was associated with higher initial anti-RBD and RBD-ACE2-inhibiting antibody titres, but not with their kinetics. CONCLUSIONS: Neutralizing antibodies persisted at 6 months in almost all participants, indicating more durability than initially feared. Anti-RBD antibodies persisted better and even increased over time, possibly related to the preferential detection of progressively higher-affinity antibodies.