Incidence of asymptomatic SARS‐CoV‐2 infection in children undergoing elective otolaryngologic surgery throughout the COVID‐19 pandemic

OBJECTIVE: Children infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are less clinically affected than adults, with most cases presenting as asymptomatic or mildly symptomatic. However, true rates of asymptomatic SARS‐CoV‐2 infection in children remain unclear. We sought to examine rates of SARS‐CoV‐2 in asymptomatic children and the role of children in transmission. METHODS: We performed a retrospective review of patients between 6 months and 17 years of age who underwent elective or semi‐elective otolaryngologic surgery with physicians affiliated with Weill Cornell Medicine between May 15, 2020 and March 31, 2022. Patients were included if they received molecular assay testing for SARS‐CoV‐2 without SARS‐CoV‐2 symptoms within 5 days of scheduled surgery. SARS‐CoV‐2 infection status, exposure, clinical symptoms, demographic data, and insurance status were recorded. RESULTS: 1047 patients met inclusion criteria. Thirteen positive cases (1.24%) were identified in the study population. Six cases occurred between December 2021 and February 2022 following the classification of the omicron variant as a variant of concern in November 2021. Five of the 13 cases occurred in children under 2 years of age. Seven patients were male, and five were female. Residences spanned all five boroughs of New York City and the surrounding metropolitan area. CONCLUSION: Throughout the pandemic, children have had a low rate of asymptomatic disease and likely pose a low risk of transmission of SARS‐CoV‐2 to the general population. Our results suggest that testing of asymptomatic children is a low‐yield practice that is unlikely to influence rates of SARS‐CoV‐2 in the general population. LEVEL OF EVIDENCE: 3.