Protecting Canada's children from the consequences of the fourth wave of the COVID-19 pandemic.

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Date: Sept. 27, 2021
From: CMAJ: Canadian Medical Association Journal(Vol. 193, Issue 38)
Publisher: CMA Joule Inc.
Document Type: Article
Length: 1,942 words
Lexile Measure: 1720L

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Understanding and responding to the impact of SARS-CoV-2 infections on children is a high priority as the fourth wave of the COVID-19 pandemic sweeps across Canada. Although highly effective vaccines are available to prevent infections in people 12 years of age and older, none are yet approved for use in younger children, the timelines to approval remain uncertain and uptake is unpredictable. In this context, a related study using data (1) from the Canadian Paediatric Surveillance Program (CPSP) provides information on the frequency and characteristics of children admitted to hospital with COVID-19, a key indicator of the pediatric burden of disease. However, public policy must integrate other considerations including the impact of new SARS-CoV-2 variants (e.g., delta variant), incidence of multisystem inflammatory syndrome in children (MIS-C) and post-COVID conditions, and availability and uptake of COVID-19 vaccines.

The related study (1) clearly shows that children were relatively spared during the first 2 waves of the pandemic. Drouin and colleagues note that 308 cases of children admitted to hospital with SARS-CoV-2 infections were reported to the Public Health Agency of Canada by Dec. 31, 2020. Through the CPSP reporting system, the authors analyzed records for 264 children who were admitted to hospital with acute SARS-CoV-2 infection for which detailed chart review information was submitted. Of these cases, just 150 (57%) were categorized as admitted to hospital because of COVID-19. This low number reflects the mild nature of SARS-CoV-2 infection in children and that public health measures effectively prevented widespread disease in children.

An analysis of data from electronic health records performed in September 2020, which included more than 135 000 people in the United States who were younger than 25 years of age, reported that 7% of those infected with SARS-CoV-2 were admitted to hospital, with 28% being admitted to an intensive care unit (ICU). (2) Although the related study (1) does not describe the proportion of children with SARS-CoV-2 infection who required hospital admission, the authors do report that among those children who were admitted to hospital with COVID-19, 21% were admitted to an ICU and 6% required mechanical ventilation. According to the latest Canadian data (as of Aug. 29, 2021), the overall proportion of children with SARS-CoV-2 infection who required hospital admission is low (0.5%); however, 11% required ICU admission. (3) These relative proportions of children in hospital with severe disease are concerning. When compared with other pediatric respiratory illnesses, these proportions of admitted children requiring ICU care exceed those reported for children with bronchiolitis, (4) and seasonal and pandemic H1N1 influenza. (5)

The cases reported in the related study (1) occurred before emergence of the SARS-CoV-2 delta variant. This new variant requires that we reconsider risk. The delta variant is more transmissible than previous strains, and emerging evidence describes higher morbidity at all ages, including in children. A cohort study that included all patients (30% were younger than 20 yr of age) with COVID-19...

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Gale Document Number: GALE|A677132932