A year has passed since the pandemic has become a part of our lives and vernacular. Social distancing, new normal, gaiters and face wear are terms that we do not go more than an hour without hearing. As pediatricians, we seek to protect our patients by informing parents of the “rules” that have been changing with the advents of scientific discovery and increasing data. With children it seems as though the rules have been changing almost monthly. To help you navigate through the muddle of information, we are going to look at five areas.
How can we Effectively Avoid COVID-19?
First let’s take a look at the defense strategies for COVID-19. As described by Dr. Ian MacKay in the New York Times, each of the defensive strategies against COVID-19 (social distancing, hand washing, masking) are imperfect. They have holes like a piece of Swiss cheese. With every piece of Swiss cheese you layer, some of the holes of one method are covered by another. This is why it’s effective to use all of the defense strategies available to you.
Can Children Get Sick?
Yes. As of January 28th, approximately 2.82 million children have tested positive representing 12.8 percent of all positive tests. There is no question children can be infected, and they are not immune to the virus. Fortunately, they typically have much milder disease than their adult counterparts. So, parents and pediatricians can take a deep breath as our kids are superheroes and they battle this disease much better than we do.
It’s important to note though if children are infected, they can still infect others. This is why we must teach our kids to follow the rules to protect their families and friends. As a pediatrician I have found it effective to ask kids why Spiderman wears a mask. They generally know it is to hide his identity. But why? It is because if I am a supervillain, I do not attack Spiderman, he’s too strong, I go after his family and friends (poor Aunt May or Mary Jane Watson). We wear a mask so the villain cannot get our family and friends.
Should Children Go to School?
Early on European studies suggested that a rapid closing of schools would greatly decrease spread and save thousands of lives. There were NY Times articles in March saying early closure of schools saved thousands of lives. As the pandemic moved on, we have seen that schools have done a fantastic job and our kids are excellent at following rules. Wearing masks, distancing and co-horting have worked in limiting spread but again it does not completely eliminate risk. Meanwhile, our stay-at-home kids are increasingly suffering from anxiety, depression and PTSD. So where does the answer lie?
To answer this, you need to look at your own individual situation and weigh your own risks. Do both parents work and are they essential workers? Then yes, your child will probably go to school. Does your child have learning concerns such as Autistic Spectrum Disorder or Attention Deficit Hyperactivity Disorder? Then yes, they will go so they can get the support they need in a structured setting. But what if the parent takes care of a fragile grandparent and needs to reduce the risk? Then you have the option to do virtual learning – which is a good thing right now.
Should you Vaccinate?
A vaccine will prepare our body for battle before exposure, giving our bodies a head start in the race to fight the virus. At present we do not have a vaccine for anyone under the age of 16, but there are trials going on at Pfizer, Moderna and AstraZeneca. As a community, the more that people get vaccinated, the less you are likely to be exposed to the virus. Even more importantly, reducing the time a virus stays within a body also reduces the copies it makes thereby decreasing the risk for mutations. When millions of people get a vaccine, you will hear of side effects because they will be closely monitored.
BUT – Keep this statistic in mind: for every million vaccines distributed, there have been 2-6 cases of anaphylaxis that were treated; for every million cases of COVID-19 approximately 16,500 people die.
Are there long-term Consequences from COVID-19?
There are some things we cannot presently predict. We are learning about potential cardiac consequences in those who have had moderate to severe disease. At present we are looking at screening any children with moderate/severe illness with an EKG and potentially a cardiology visit before returning to strenuous activity or sports. Moderate disease is considered more than 4 days of fever or prolonged illness.
The burden on our children’s mental health is more predictable. In an already overwhelmed and difficult to access system we will assuredly have large number of children dealing with anxieties in a world that has no recent comparative model. Pediatricians are being moved into the role of mental health providers and we all need to be prepared to work together to help hold our children’s hands as they walk forward into this new world.
With the addition of the vaccines, rapid testing routes, and better therapies there should be optimism for the spring and summer to come. However, our Swiss cheese defense is bound to have some holes and we as a community need to use as many layers as we have available if we want to succeed. Remember that your kids are superheroes when they wear their masks and you and your children serve the community by doing everything you can do fight this pandemic.