Young people’s physical health during the COVID-19 pandemic

Jake Anders is Principal Investigator of the COVID Social Mobility & Opportunities study (COSMO), and an Associate Professor and Deputy Director at UCL Centre for Education Policy & Equalising Opportunities.

Although young people were among those least likely to be directly affected by severe effects of COVID-19, they were not immune from its immediate effects on health. We are better able to understand implications of this using data from the COVID Social Mobility & Opportunities study (COSMO). The study includes a representative sample of over 13,000 young people across England, who were aged 14–15 at the onset of the pandemic, and 16–17 during the academic year 2020/21 when our first data were collected.

COSMO’s purpose is also wider than the direct health impacts of COVID-19. As such, this blog post — drawing on our latest COSMO briefing published today — also takes a wider look at young people’s health behaviours during this period.

Young people’s experiences of COVID-19

When first taking part in COSMO (between October 2021 and March 2022) almost half of the cohort reported having had COVID-19 (of whom 28% had had this confirmed by a test, likely with many having been affected before widespread testing was available).

Many of these young people will have experienced relative mild — or at least, transient — symptoms. But this was not the case for all. 1 in 5 of young people who reported having had COVID-19 (just under 10% of the cohort as a whole) reported that they continued to experience symptoms more than 4 weeks after first catching the virus: the accepted definition of Long COVID. Among this group, a quarter described their case of Long COVID as limiting their ability to carry out daily activities a lot.

Figure 1: Proportion reporting a case of severe long COVID by deprivation quintile group

Furthermore, there were inequalities in young people’s chances of experiencing long COVID. Among those who reported having caught COVID-19, those from less socio-economically advantaged backgrounds were more likely to report that this had persisted into a case of long COVID. This is despite no difference in reporting having contracted COVID-19 between these groups. What, then, explains differences in this persistence? Reasons for these inequalities are rather uncertain. One hypothesis is that getting sufficient rest is important for COVID-19 recovery, and this may be easier to achieve for some groups than others. Another is that pre-existing differences in overall health levels associated with socio-economic status pre-infection explain risk of prolonged disease.

Educational consequences of physical health during the pandemic

Young people who reported having experienced severe Long COVID received lower teacher-assessed GCSEs than their peers who had never had COVID-19. Given the differences discussed above between young people who experienced severe Long COVID, we wanted to ensure that this was not simply an artefact of these differences. After adjusting statistically for differences in demographics, socio-economic status, and prior attainment, it was still the case that young people who had experienced severe long COVID performed worse than comparable peers. The size of this difference is very roughly equivalent to two months of learning.

Figure 2: Differences in GCSE teacher assessed grades by shielding status and severe long COVID

Notes: Differences reported have been standardised. Severe long COVID analysis is compared to those who reported not having had COVID at all.

Those who were asked to shield during the pandemic — because pre-existing medical conditions meant that they were at the highest risk of severe illness if they caught COVID-19 — also received lower grades in their teacher assessed GCSEs than their peers. 8% of the COSMO cohort reported being asked to shield and — after adjusting for demographics, socio-economic status, and prior attainment — had lower GCSE grades very roughly equivalent to four months of learning.

Young people’s wider health

COSMO also allows us to shine a light more broadly on the health of this generation of young people.

Continuing a trend seen across successive cohorts, this cohort of 16–17 year olds are less likely to drink alcohol than those who came before them. 63% say they have ever done so, compared to 85% of a comparable group of 16–17 year olds in 2007. Across various measures, pupils from advantaged backgrounds (such as those attending private schools, or in state schools with more advantaged intakes) are more likely to report ever having drunk alcohol, and reported drinking more frequently.

This group of young people are more likely to have ever used an e-cigarette (33%) than to have ever smoked a cigarette (23%). However, regular e-cigarette use is much lower than this might imply. Just 6% report using e-cigarettes once a day or more. In contrast to alcohol use, those from less advantaged backgrounds are more likely to use e-cigarettes than their more advantaged peers.

Just under 1 in 6 of this cohort of young people report having ever tried any illegal drugs. Among those who have, almost all had tried cannabis. Just 4% of the sample reported having tried any other illegal substance. And similar to the patterning seen with alcohol, those in more advantaged circumstances were more likely to have taken an illegal drug. Those identifying as White or Mixed ethnic background are far more likely to report having tried illegal drugs than any other ethnic groups.

Conclusions

With attention on issues around COVID-19 fading, we should not forget its continuing effect on those for whom it was a particularly debilitating illness to experience. Some continue to suffer from long COVID. Even those who have recovered have seen implications for their wider lives and life chances, such as lower academic attainment scores for those who experienced severe long COVID. These impacts also seem to have reinforced existing health and socioeconomic inequalities.

COSMO also helps us shine a wider light on the experiences of this cohort of young people, and quite how much this has changed compared to earlier generations. Substantially reduced drinking of alcohol compared to earlier generations, low rates of drug use, and the emergence of e-cigarette use all raise questions about implications for future health, too.

There is more detail on these findings, as well as a wider range of health impacts and behaviour of the COSMO cohort, in our latest briefing note. You can also find our earlier briefing notes on the study website.