A Prospective Pan-Canadian Cohort Assessment of SARS-CoV-2 Variant of Concern Disease Severity and Association with Long-Term Symptoms in Children

Over 160,000 children in Canada have been infected by SARS-CoV-2 and although, in general infection in children is milder than what occurs in adults, nearly 1,000 children have been hospitalized and 125 admitted to the intensive care unit. In December 2020, a SARS CoV-2 variant of concern (VOC), strain B.1.1.71, was identified. Data suggest that this VOC has increased transmissibility and is associated with increased mortality. Other VOC have been identified and some of these have the ability to decrease the effectiveness of natural and vaccine-induced immune responses. These VOC are present and spreading rapidly in Canada and there is an urgent need to understand their short and long-term impacts on children, particularly as this group of Canadians will be the last to be vaccinated and thus most likely to be exposed to natural infection. While data are scarce, a substantial proportion of individuals with COVID-19 develop persistent symptoms that are characteristic of long-term COVID symptoms (i.e. Long-Haulers). Symptoms in adults include fatigue, headache, shortness of breath, cognitive impairment, depression, skin rashes and gastrointestinal complaints. While there is a growing body of literature on long COVID in adults, the data on children are scarce. To address these knowledge gaps we will extend and expand two ongoing studies to enable: 1) The collection of acute and long-term data on both SARS-CoV-2 positive (VOC and non-VOC) and negative children thereby permitting an assessment of chronic symptoms and to compare those reported by these three otherwise similar groups of children. 2) Testing for VOC on specimens collected from asymptomatic SARS-CoV-2 test positive children to quantify and compare the secondary clinical attack rate between those positive for a VOC vs. those with non-VOC. 3) Quantify development of long-term symptoms in children with COVID and to extend follow-up from our current plan of 90 days out to a full 12 months.