The outbreak of a viral infection known as COVID-19, caused by a newly discovered coronavirus, is dominating the news, and governments, public health experts, and doctors are preparing for a growing number of cases around the world and in the United States.
The possibility of a coronavirus outbreak in the New York region, as well as the seasonal outbreak of the flu, pose special concerns for children. “There is a lot of anxiety out there and a lot we don’t know,” says Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and an Associate Professor of Infectious Diseases, and Medical Education, at the Icahn School of Medicine at Mount Sinai. “Fortunately we are learning from cases in China that most children don’t seem to get very sick from the coronavirus. But we also know that youngsters are one of the ways that viruses travel from one household to another.”
In this Q&A, Dr. Posada offers some basic advice for parents in the New York area.
What general advice do you have for parents who may be worried about their children?
The most important prevention strategy is to get your flu vaccinations. It’s not too late, and every child should be vaccinated every year. We are still seeing a lot of cases of the flu in the community, and some of these children need to be hospitalized. With all viruses in general and with respiratory-borne illnesses, everyone should wash hands frequently, with soap and water or with an alcohol-based sanitizer—especially before eating, after blowing your nose, and after entering your home from the outside. There is no difference between soap and water and a hand sanitizer when it comes to most viruses. Soap and water is preferable for eliminating gastrointestinal pathogens—infectious agents like viruses and bacteria that cause disease in your digestive tract—so that’s best after using the bathroom.
Also, teach children the proper etiquette for coughing or sneezing. They should use the inside of their elbow or blow into a tissue, and then wash their hands.
Are kids more at risk from viral outbreaks generally?
Kids tend to get more viral infections than adults, partly because their immune systems are not fully developed. How sick they can get depends on their age. Kids less than two years old are at higher risk for many infections like the flu.
How much of a risk does the coronavirus present for children?
We know from the data so far that the coronavirus seems to result in a very mild infection for children. Most of the patients that have been hospitalized or have died are older adults. Also, it is important to note that about 80 percent of people who have gotten the coronavirus experienced a very mild illness and did not need to be hospitalized. Unfortunately, about 20 percent of infected people develop more significant disease, and about 1 to 2 percent of all of those infected have died, again most of them older adults.
Should parents keep children out of public spaces, maybe off the subway?
At this time, I would suggest people in the United States go about life as normal, so long as they are washing their hands frequently. For example, if you take the subway or public transportation, or if you have been around people who are coughing or sneezing, it’s a good idea to wash your hands. Avoid as much as practical being in close proximity to people who are sick. You should also follow the news, as the recommendations from public health officials may change rapidly depending upon the cases we see. As always, the Centers for Disease Control and Prevention (CDC) and your local health department are the best sources of information.
The CDC recently said that if a widespread outbreak occurred in the United States, schools could be closed. Why is that an effective step?
If public health officials see the virus is spreading fast, and believe schools may be playing a role in facilitating the spread of the illness from household to household, closing of schools may be warranted.
How do children help transmit viral infections?
What happens with the flu or any virus is that young children pass them to their classmates. Young people are in such close contact with each other, especially if they are at day care, and it’s not uncommon for their saliva or mucus to mingle. They share toys, maybe even eating utensils. When kids get sick with an infection, they can pass the causative virus or bacteria along to other kids, and those kids then can bring it to their parents. That is how an illness crosses from one household to another and contributes to the spread of the viral infection.
Should we wear face masks?
At this point we are not recommending you or your children wear face masks to avoid getting sick. Face masks are mostly for health care workers who are in close proximity with people who are sick. And it can be helpful if someone who is already sick wears a face mask when in public spaces to prevent infecting others.
When should parents call the pediatrician if their child is sick?
My recommendations for the flu and other viral infections is the same as for illnesses in general. If your child’s symptoms are mild and in the respiratory tract, like a runny nose and sneezing, and if they are continuing with their other normal activities and these symptoms have lasted less than 24 hours, I would not worry or call. But if symptoms last more than 24 hours, if children also have a cough and fever, if they are not eating or drinking enough, and if they are disinterested in normal activities and look tired or sleepy, I would call your pediatrician. And let your pediatrician know if there is any history of travel or interactions with people who have been sick.