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expert reaction to COVID-19 Schools Infection Survey, England: long COVID and mental health, November to December 2021

The Office for National Statistics (ONS)London School of Hygiene & Tropical Medicine (LSHTM), and UK Health Security Agency (UKHSA) have published the latest analysis of COVID-19 findings on mental health and long COVID from the Schools Infection Survey.


Prof Russell Viner, Professor of Child and Adolescent Health, UCL

“These are important data for a number of reasons, but particularly because they go past simple symptom-counting to look at whether the everyday lives of children and young people have been affected by having COVID-19 infections. 

“First, these data emphasise just how common symptoms such as tiredness or headaches are in children and teenagers, regardless of whether they had COVID-19 or not. They found that almost all these symptoms occurred as frequently in those who had never had a positive test compared with those who ad. Indeed, the only symptom more common in those who had a positive test was loss of smell/taste .

“Second, they estimated that around 1% of primary and just under 3% of secondary students fulfil suggested criteria for diagnosing post-COVID syndromes in children and young people. The key criterion here was whether ongoing covid symptoms affected their daily life, providing a measure of severity rather than just a count of symptoms. These findings make it clear that research that simply counts issues or symptoms in those who have had covid or those who haven’t overstates the extent of major problems after infection.

“We have always known that there is a small group of children and teenagers in whom persistent problems after COVID-19 affect them considerably, although there’s been a lot of debate about the size of this group. These data are very helpful in confirming this appears to be a reassuringly small group. It was also reassuring to see that post-COVID problems (e.g. long COVID) did not appear to be more common amongst children and young people from deprived families.

“The mental health data provided confirm the concerns about rising rates of mental health problems amongst our children and young people. While there appears to be a link with long COVID, we cannot determine whether this is cause or effect.

“There are a number of limitations to these otherwise excellent data. School studies will inevitably miss those who aren’t at school, and some who were unable to attend school due to long covid may have been missed. The pupil response rate was only 62% although the parent response rate was better at 85%, suggesting that the primary school data maybe more reliable. Can we be certain that the problems in these 1 to 3% of children and young people after COVID were actually due to infection? We can’t actually make this assumption because of the design of the study. It would be very interesting to know what proportion of those who did not have covid-19 also had persistent symptoms that affected their daily life. This would be important as it is very likely that at least some of the covid-negative group with persisting symptoms had problems affecting their daily life, and comparing these with the post-COVID group would give us a better idea of the effects attributable to COVID. 

“Overall these data are reassuring that relatively few children and young people suffer problems sufficient to be categorised as ‘long COVID’ after infection. However there is undoubtedly a small group who have much more significant problems due to infection and it is essential that that clinical services and referral pathways ensure these children receive treatment in specialist settings as soon as possible.”


Dr Michael Absoud, Honorary Reader, Dept of Women and Children’s Health, King’s College London

“The jointly led England representative study by the Office for National Statistics (ONS), London School of Hygiene & Tropical Medicine (LSHTM), and UK Health Security Agency (UKHSA) have released the latest results from the COVID-19 Schools Infection Survey. This release includes analysis of persistent symptoms (long Covid) and mental health from head teacher, parent and pupil questionnaires (November to December 2021). The recent CloCK study childhood long Covid Delphi consensus criteria were used, in which a child or young person has symptoms (at least one of which is a physical symptom) that:

  • have continued or developed after a diagnosis of COVID-19 (confirmed with one or more positive COVID tests);
  • impact their physical, mental or social wellbeing;
  • are interfering with some aspect of daily living (eg, school, work, home or relationships) and;
  • persist for a minimum duration of 12 weeks after initial testing for COVID-19 (even if symptoms have waxed and waned over that period).

“The study provides reassuring findings for children and their families, consistent with recent studies by the ONS and others (refs [1], [2]) which showed the vast majority of children recover well post Covid. 

“Less than 1% of primary school pupils and 2.7% of secondary school pupils met the Delphi criteria for having experienced long COVID since March 2020. The only symptom where the prevalence was significantly higher for those with a positive Covid-19 test since March 2020 (compared to those who hadn’t) was ‘loss of taste or smell.’ 

“There were also no significant difference in the numbers presenting with a ‘probable mental disorder’ between both groups (test positive and negative). This likely reflects the high burden of difficulties with emotional wellbeing of children, regardless of SARS-CoV-2 test positivity (1).This finding is on a background of even more stretched neurodevelopmental and mental health services, reduced access to in-person therapies in schools, and long ‘hidden’ waiting lists as highlighted in the recent Nuffield report (3).

“An ambitious vision of recovery for children is hence needed, where there is consideration of integration of mental health professionals in multidisciplinary teams.”


  1. Assessing the impact of the pandemic in children and adolescents: SARS-CoV-2 infection and beyond. Molteni E, Absoud M, Duncan EL. The Lancet Child & Adolescent Health. Published: February 7, 2022.
  2. Long Covid in Children: ONS Prevalence estimates have been radically revised downwards. Bhopal S, Absoud M.
  3. Growing problems. What has been the impact of Covid-19 on health care for children and young people in England? Nuffield Watch and Quality Watch, 18 Feb 2022.



All our previous output on this subject can be seen at this weblink:



Declared interests

Prof Russell Viner: “No conflicts.  Member of the Science Media Centre’s Advisory Committee.”

Dr Michael Absoud: No conflicts of interest



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