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Because there is significant interest but little rigorous data on the association between COVID-19 infection and health outcomes in children, Elevance Health researchers studied the impact of COVID infection in unvaccinated children. The goal was to understand whether infection can have longer-lasting (after the infection period) health effects on children.

Findings: The study suggests that adverse events and diagnosis of new cardiovascular conditions are rare but slightly more common after COVID infection than in children who had not been diagnosed with COVID. Meanwhile, behavioral health disorders were somewhat less common in children who had COVID.

Uncommon acute adverse events such as sepsis, acute heart failure, and viral pneumonia were twice as common in children with COVID than their matched comparison group. Myocarditis (inflammation of the heart) and MIS-C (multisystem inflammatory system in children, a rare but serious and sometimes fatal condition) were 10 and 45 times more common, respectively.

The COVID group also had a higher chance of development of a new potentially chronic cardiovascular diagnosis. In particular, development of arrhythmias and atherosclerotic cardiovascular disease were 1.2 and 1.4 times more common, respectively.

However, children with COVID were somewhat less likely to develop behavioral health disorders (6% less) or have visits with a psychologist (20% less), possibly due to less anxiety around the disease after having recovered from it. “While we can’t explain this difference from our data, we might speculate that kids who contracted the disease but then recovered were less anxious than those who might still be worried about contracting it.  Alternatively, behavior differences may factor into the findings, where greater levels of social isolation decreased risk of COVID but came with a trade-off in mental health outcomes,” said Aliza Gordon, director of Health Services Research at Elevance Health’s Public Policy Institute.

Six-month healthcare utilization was similar between cohorts, though lab testing and imaging were slightly higher in the COVID group, and total medical costs did not increase for the COVID group. 

What’s Next: While significant adverse outcomes are rare, they occurred more frequently than prior reports on similar outcomes for vaccinated children. For example, myocarditis has been reported as a rare side effect of COVID vaccination, but the study found that that myocarditis rates following COVID infection were 10 times higher than the reported rates following COVID vaccinations.

The findings underscore the importance of prioritizing vaccination efforts, implementing preventive measures in schools and continuously monitoring the health of children who have recovered from COVID.

Elevance Health offers direct virtual urgent care services directly on its Sydney app, which can be accessed by insured members. This includes the ability to directly access a physician for chat and telehealth access. Last year Elevance Health launched a series of “Concierge Care” disease management programs, including modules in the Sydney app specifically geared toward the management of COVID and respiratory illnesses.

Methodology: This analysis used claims data from children aged 0-17 with commercial or Medicaid insurance. 223,842 children with a COVID diagnosis in May 2020 to March 2021 were compared to a matched group of 223,842 children who had a COVID test but were not diagnosed with the disease. Outcomes were measured during the six months after infection/test, and included acute adverse events, the development of new chronic conditions, long-lasting symptoms, healthcare utilization, and healthcare cost. Statistical tests were used to determine if there was a difference in outcomes between groups. The study also analyzed outcomes in subsets of the population, including by age category and among the subgroup of children with preexisting conditions. The role of vaccines for this cohort was outside the scope of the analysis as the study period took place prior to vaccine eligibility for children under 17.

Read the Study:

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