Background: The epidemiology of SARS-CoV-2 infection in the pediatric population, with a focus on racial and ethnic disparities and impact of societal public health measures, remains poorly understood. Methods: This large observational study used electronically abstracted data from pediatric (≤ 19 years of age) patients who received a molecular test for SARS-CoV-2 at a UMass Memorial Health Care (UMMHC) site between March 8, 2020 and April 3, 2021 which was further supplemented by manual chart review of a subset of pediatric SARS-CoV-2 cases. Multivariable logistic regression models with interaction terms were used to identify risk factors for SARS-CoV-2 infection. Segmented regression analysis using Poisson models was used to estimate the effect of public health measures on the weekly incidence of SARS-CoV-2 infection. Results: A total of 25,426 unique pediatric patients were tested for SARS-CoV-2 among whom 2,920 (11.5%) tested positive. The average age of those who tested positive was 10.8 years (SD: 5.8) and 48.1% were female. In the subset analysis, nearly three-quarters (75.9%) of SARS-CoV-2 diagnoses occurred through a telephone encounter, meaning that the child was not physically examined by a provider prior diagnosis and only 2.0% were admitted for inpatient care at diagnosis. Results of multivariable regression revealed that children or parents who self-reported Black race, Hispanic ethnicity, and non-English primary language were associated with approximately twice the odds of testing positive in comparison with White or English-speaking patients. Furthermore, increasing age was associated with increased odds of testing positive for SARS-CoV-2 (aOR: 1.1 (1-4 years), 1.2 (5-9 years), 1.4 (10-14 years), 1.6 (15-17 years), 1.7 (18-19 years)). However, this association between age and positivity rate, varies by race/ethnicity and primary language such that Non-Hispanic Black, Hispanic, and non-English speaking children had markedly greater odds of testing positive during adolescence in comparison to Non-Hispanic White and English-speaking counterparts. Results from segmented regression analysis demonstrated a decline in weekly incidence of cases 9.9% (95% CI: 7.8 – 11.9) after the Massachusetts state mask mandate was implemented. During the winter holidays, the rate of increase in the weekly incidence of cases was 12.1% (95% CI: 11.9 – 12.3) in this pediatric population. Conclusions: Many SARS-CoV-2 cases have been diagnosed at UMMHC sites and notable racial/ethnic disparities exist that vary based on patient age. Public health measures are effective at preventing transmission of SARS-CoV-2 among children.

The needs of the free trade regime and governments' legitimate regulatory aims in the area of public health protection conflict. Government health measures create barriers to free trade and are thus disciplined by the trade regime. This conflict is addressed in the rules of the World Trade Organization, in the Agreement on the Application of Sanitary and Phytosanitary Measures. This Agreement uses science to mediate the conflict. The reason for the reliance on science is the view that it provides a neutral, universally-valid discipline and that thus the results of testing health measures for scientific validity would be acceptable to both parties in a dispute. This uncritical approach towards science is called into question. An analysis of the relevant science-based disciplines of the SPS Agreement and their interpretation in WTO dispute settlement shows the flaws in this system. A re-evaluation of the WTO rules governing health regulation is called for. / Law / LL.M.

The needs of the free trade regime and governments' legitimate regulatory aims in the area of public health protection conflict. Government health measures create barriers to free trade and are thus disciplined by the trade regime. This conflict is addressed in the rules of the World Trade Organization, in the Agreement on the Application of Sanitary and Phytosanitary Measures. This Agreement uses science to mediate the conflict. The reason for the reliance on science is the view that it provides a neutral, universally-valid discipline and that thus the results of testing health measures for scientific validity would be acceptable to both parties in a dispute. This uncritical approach towards science is called into question. An analysis of the relevant science-based disciplines of the SPS Agreement and their interpretation in WTO dispute settlement shows the flaws in this system. A re-evaluation of the WTO rules governing health regulation is called for. / Law / LL.M.