Persistent physical and mental health effects of COVID-19 hospitalization

The long-term health effects of the COVID pandemic on children remain an area of active investigation. Viral infection, immune responses, and societal disruption have been implicated as contributing factors.

We conducted a retrospective survey-based study of children infected with SARS-CoV-2 and uninfected controls admitted to a single urban children's hospital in the Bronx, NY, USA, during the Original/Alpha variant wave (1 March 2020 to 1 March 2021) or Omicron wave (2 December 2021 to 21 December 2022). Persistent symptoms, time to recovery, family stress, and psychiatric outcomes were assessed. A psychometric assessment using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) (n = 48) and Pediatric Symptom Checklist (PSC-17) (n = 64) was completed.

A total of 176 children and families completed surveys. Approximately 31.9% of children admitted during the Original/Alpha wave and 8.8% during the Omicron wave reported that their illness took several months or more to resolve. The most common symptoms after hospitalization were fatigue, shortness of breath, and difficulty sleeping, and these were similar to those experienced by uninfected controls. PHQ-9 and GAD-7 scores did not differ by infection status. However, PHQ-9 scores were significantly higher during the Original/Alpha wave than during the Omicron wave (median 5 vs. 1; p = 0.04; r = 0.62), with GAD-7 trending similarly (p = 0.05). Overall, 43.8% of children screened positive for depressive symptoms on PHQ-9, including 20.9% in the moderate-to-severe range. PSC-17 scores did not differ significantly by wave or infection status. High levels of pandemic-related stress, including job loss, childcare disruption, and food insecurity, were reported across both COVID-positive and uninfected families.

Children hospitalized during the Original/Alpha wave experienced a significantly greater burden of prolonged recovery than those during the Omicron wave, implicating virologic and immunologic factors in postacute physical outcomes. Notably, posthospitalization symptoms were similar between COVID-positive children and uninfected controls, underscoring the importance of contemporaneous control groups in studies of postacute sequelae. Mental health outcomes were more strongly associated with the pandemic phase than infection status, suggesting societal disruption rather than direct viral effects as a key contributor. These findings highlight the need for routine mental health screening in hospitalized children during public health emergencies.