Insights into SARS-CoV-2 evolution, treatment, and prevalence in children.

This review article explores the mechanisms that generate genetic variation in SARS-CoV-2, underlying the within-host and population-level processes that underpin these events. The article examines the selective forces that likely drove the evolution of higher transmissibility and, in some cases, higher severity during the first year of the pandemic and the role of antigenic evolution during the second and third years, together with the implications of immune escape and reinfections, and the increasing evidence for and potential relevance of recombination. The article also evaluates uncertainties and outlines scenarios for the possible future evolutionary trajectories of SARS-CoV-2.