The role of children and adolescents in SARS-CoV-2 transmission and susceptibility to infection warrants further investigation

Abstract

Early investigations of severe acute respiratory syndrome coronavirus 2 infection revealed relatively low rates of infection and mild clinical outcomes among children and adolescents. The burden of disease on the pediatric population was thus determined to be relatively low, and their role in viral transmission likely insubstantial. However, our current understanding may be limited by the emphasis on identifying symptomatic cases and lack of widespread diagnostic testing. As such, children and adolescents, who are reportedly less likely to be symptomatic during infection may be under-represented. This paper aims to provide an updated summary of the manifestation of SARS-CoV-2 infection in children and adolescents, and their role in viral transmission as documented by previous studies. A comprehensive review of the existing literature will provide insight on the current status of our understanding of SARS-CoV-2 infection and post-infection outcomes within this subpopulation, identify limitations of early reports, and highlight the necessity for either further investigation or re-assessment of initial conclusions. Ultimately, recognizing and addressing the current gaps in our knowledge will better inform the development of public health policies to mitigate the spread of SARS-CoV-2 infection, assist clinical management of disease, and reduce the burden on our healthcare systems.