Household Transmission Dynamics and Vial Load among Asymptomatic SARS-CoV-2 Infected Children [Added supplement: COVID-19 Variant Supplement]

Children have milder disease than adults and many have no symptoms even when infected by SARS-CoV-2. At present, we do not know how likely asymptomatic-infected children are to transmit the infection. Gaining an understanding of this issue is crucial to determining the role children play in transmission and what the risks will be to other children and adults when children return to school. To answer these questions we will enroll children who are brought for care due to non-infectious reasons (e.g. fall, cut, injury, pain) to 20 emergency departments across Canada and the United States. These sites are participating in the CIHR-funded, 57-site, Pediatric Emergency Research Network (PERN)-COVID-19 study, and currently perform screening of select asymptomatic children for SARS-CoV-2. Participating sites will enroll 400 asymptomatic SARS-CoV-2 positive children and 1,200 uninfected children (3:1 ratio of uninfected to infected child). Study aims: 1) Household Transmission Dynamics: Data will be collected regarding exposures and symptoms at baseline and again at 14 days for enrolled children (infected and uninfected) and their household members. Household members who develop symptoms of COVID-19 will be encouraged to have SARS-CoV-2 testing done (if not already) and the results will be obtained. Analyzing and modeling this information, comparing households with transmission versus those without, will help us understand the transmission risk posed by asymptomatic SARS-CoV-2 infected children. In particular this information will inform social distancing policies (e.g. school re-opening) 2) Viral Load Quantification: All SARS-CoV-2 positive specimens will have viral load quantification performed. These results will be analyzed alongside those from aim #1 to determine the relationship with household transmission. Viral load quantification data will also be analyzed alongside symptom evolution data to inform our understanding of the presymptomatic state.