Medical Student The University of Western Ontario - Schulich School of Medicine & Dentistry London, Ontario, Canada
Background: This study aimed to elucidate the correlation between children’s social behaviors and susceptibility to SARS-CoV-2, which is pivotal for risk reduction strategies in future respiratory virus pandemics. Objective: To evaluate the association between social behaviors and SARS-CoV-2 test positivity across four pediatric age groups. Design/Methods: This multicenter cross-sectional study recruited children < 18 years old who had a SARS-CoV-2 nucleic acid test performed in fourteen Canadian pediatric emergency departments. We analyzed the association between self-reported social behaviors two weeks prior to testing and the likelihood of a positive SARS-CoV-2 test using multivariate logistic regression models categorized into four age groups. Causal mediation analysis quantified how factors such as mask-wearing and presence of a close contact mediated the SARS-CoV-2 risk associated with given behaviors. Results: 7272 children were enrolled, with a 20% SARS-CoV-2 positivity rate. A significant association was unveiled between attendance at social gatherings and increased odds of SARS-CoV-2 positivity in children aged 5- < 12 years, with an adjusted odds ratio (aOR) of 1.64 (95% CI: 1.05, 2.57). Conversely, attendance at in-person schools or daycares was associated with lower odds of positivity across all ages [aOR 0.27 (95% CI: 0.16, 0.45), 0.43 (95% CI: 0.35, 0.54), 0.66 (95% CI: 0.44, 0.99) and 0.57 (95% CI: 0.36, 0.89) for < 1, 1- < 5, 5- < 12, and 12– < 18-year age groups, respectively]. Attending childcare was associated with 16.3% (95% CI: -21.0%, -11.2%) and 9.0% (95% CI: -11.6%, -6.5%) reductions in the probability of SARS-CoV-2 positivity, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of these effects being mediated by the presence of a known positive close contact among < 1 year and 1- < 5 year age groups, respectively. Mask-wearing mediated the association between childcare attendance and SARS-CoV-2 positivity (-0.47% average causal mediated effect, 95% CI: -0.98%, -0.056%) in children aged < 1 year.
Conclusion(s): Attending social gatherings was associated with heightened risk of SARS-CoV-2 test positivity in children aged 5- < 12 years, but in-person daycare/school was associated with a reduced odds of testing positive in all age groups. These findings suggest that time in structured environments like schools and daycares, where there is more robust adherence to public health measures, may confer protection from SARS-CoV-2 infection. Our findings highlight the safety of keeping schools open during future respiratory virus outbreaks, with appropriate public health measures in place.
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