If there’s one thing we can say for certain more than a year after the arrival of the COVID-19 pandemic, it’s that masks work. Thanks to face coverings, the flu nearly vanished this year, saving the lives of roughly 500 children who die annually from the virus, according to the CDC. Other respiratory infections like RSV also dropped significantly, but with the loosening of social distancing and masking, pediatricians expect an uptick in childhood illnesses from RSV to strep throat to the common cold.
One need only look to Australia for proof of this oncoming phenomenon. Public health measures changed up the seasonal respiratory illness pattern there with a delayed spike. Australia saw a significant uptick in RSV — Respiratory Syncytial Virus, which can cause inflammation of the small airways of the lungs — higher than their seasonal average following a lift on restrictions, and now the same is being reported in places like Atlanta.
A Brooklyn mom of two tells Romper that her own kids caught some crud right before summer started. “They hadn't been sick since February 2020, which was a brutal winter for colds. They have been fully masked on in-person school days and we haven't been socializing indoors with anyone. At the very last minute, we went away with some friends for Memorial Day and their kid had a sniffle. By the time we were in the car on the way home, my daughter began to complain of a sore throat. By the next day both of them had fevers and a cough.”
Dr. Elizabeth Mack, division director of pediatric critical care at Medical University of South Carolina, tells Romper she’s seeing a similar increase in respiratory viruses and common colds and expects more of the same as restrictions on social distancing continue to decrease across the country.
Why are respiratory infections in kids expected to rise?
For months, parents have been reminding children to wash their hands, wear a mask, keep space between friends, etc. and guess what? Dr. Mack says those efforts really paid off significantly decreasing illnesses like RSV and colds. “We’re confident that the major reasons were masking, social distancing, and hygiene,” Dr. Mack says.
Now states across the country are following federal recommendations to ease up on social distancing restrictions, but children remain vulnerable both to COVID, because there is no vaccine available for infants to 12-year-olds, and common illnesses. So while it might seem safe to ease up on restrictions for them as well, doing so could expose them to not just COVID, but all the other yucky bugs they’ve been protected from this past year thanks to masks.
Which adds some stress to the situation, says the Brooklyn mom. “I hadn't been particularly worried — every adult was vaccinated and there was no known COVID exposure — but it does add a real layer of drama to have to take them to a COVID testing center when they feel like junk and then wait for the results to send to school. My son turned 12 about a week later, and we went for his first dose of the COVID vaccine right away. At least next time he has the sniffles, he'll be able to say ‘I've been vaccinated.’”
Is unmasking good for children’s immune system?
But there are some parents who wonder if unmasking is just a natural way of helping their child’s immune system. Maybe they’re catching more colds because they’ve been masked for over a year? Should children be unmasked in order to help their immune system? Dr. Mack has a quick response: “No. If pediatricians had it our way, we'd mask every respiratory viral season.”
Mack says the idea that kids need to build up their immune systems by being exposed to viruses just doesn’t hold a lot of water. “I think parents get that idea from the old pox parties when we were little when people would say, ‘You need to be out there and get it all,’” she says. In this case, kids aren’t more susceptible to these common childhood illnesses, they’re just being exposed to them later than usual in the year. “Our hospitals are full of flu and RSV in the winters,” says Dr. Mack. “We're flooded every year.” Which is why Dr. Mack says you can expect to see more bugs going around this summer instead. But continuing to keep up with good hygiene can help mitigate kids’ illnesses.
Even with an easing of restrictions, Dr. Mack says now is not a time to get complacent about prevention. “RSV leads to on average approximately 58,000 hospitalizations with 100 to 500 deaths among children younger than 5 years old,” according to the CDC. So making sure kids are masked can make all the difference.
“It was just a textbook cold: sore throat and fever, cough, then stuffy nose for days,” the Brooklyn mom of two tells Romper. “I felt a little rundown, but my husband and I were both spared the worst of it. I am so excited for the world to go back to normal but I definitely did not miss this part of life with kids. We're going to seriously think about wearing masks in crowded places next year and if their school decides to keep its mask policy, I won't be entirely sad about that.”
Dr. Elizabeth Mack, division director of Pediatric critical care and professor of Pediatrics at the Medical University of South Carolina