How are kids affected by COVID-19?

April 20, 2020

Dr. Stephen Freedman

While it is clear that COVID-19 infection can have severe impacts on older adults and those with pre-existing respiratory and other conditions, little is known so far about how the virus impacts children. One of CIHR's 99 recently funded Novel Coronavirus (COVID-19) Rapid Research projects aims to change that, with a rapidly-launched and intense prospective study that plans to enroll and follow 12,500 children over the coming months with suspected COVID-19 who present to 58 participating emergency departments (ED) in 14 countries.

Lead Principal Investigator Dr. Stephen Freedman is a pediatric emergency medicine physician at the Alberta Children's Hospital in Calgary and clinician-scientist in the Cumming School of Medicine's (CSM) Alberta Children's Hospital Research Institute (ACHRI) and O'Brien Institute for Public Health. The funded project, Clinical Characteristics and Outcomes of Children Potentially Infected by SARS-CoV-2 Presenting to Pediatric Emergency Departments, is one of several in the rapid response round that focuses on outcomes in the pediatric population.

Recruitment has already launched across Canada at five sites, with three more approved to participate, and more than 100 participants have been enrolled. Numerous other sites around the world have also launched recruitment already this week and the research team hopes to have over 50 sites recruiting within the next 2 weeks. To get off the ground quickly, Dr. Freedman's study is operating as a parallel study, leveraging the infrastructure from an ongoing study called the Pediatric Emergency Research Network (PERN)-Pneumonia study.

Children who test positive for COVID-19 as well as those who test negative will be enrolled, so that researchers can compare exposures, interventions, and collect outcome data from children with other respiratory illnesses as well as SARS-CoV-2 infection.

One of the major goals of this project is to share data with policy makers in real time. To enable this, Dr. Freedman stated, "We will use an electronic database to build tableaus that can portray our data as it comes in using scripts and code that are written to enable data to be analyzed daily to lead to updated information in our tableaus that can be viewed by the public, academics, and policy makers."

Children will be followed by researchers for 90 days after they visit a pediatric emergency department, and Dr. Freedman explains that the "90 day window is to look at chronic symptoms that develop – either as consequence of SARS-CoV-2 infection itself or even related to the stress that children are experiencing. This can sometimes manifest in children as non-specific or what we call somatic symptoms." Planned documentation and follow up monitoring will include the children's travel history, exposures and symptoms, and reviewing lab tests, X-rays, treatment and outcomes.

As the study is just getting underway, Dr. Freedman's team is currently building their electronic data capture tool, and then he expects they will be able to begin analyzing the data collected so far within a week or two and they will begin to be able to look for trends in outcomes among children, specifically hoping to identify the high-risk period, which for adults appears to be 7-10 days after the onset of initial symptoms.

For more conversation on the impacts of COVID-19 on children, listen to UCalgary's podcast with guest Dr. Freedman, "The Kids are Alright."

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