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Published on August 24, 2021

When masks came off, common viruses returned

Mask Children

The COVID-19 pandemic did not have many silver linings, but one positive trend that stood out was there was a dramatic drop in the cases of common colds, RSV and flu last winter. For medical professionals, it was proof-positive that masks do, in fact, work.

Once people were vaccinated and abandoned face coverings, all of the typical winter viruses have returned, especially in children.

“I think it was a combination of masking, daycares being closed, and the fact that children weren’t out and about as much,” said Pediatric Hospitalist Christopher Lops, MD, who practices at Cape Cod Hospital as part of its pediatric hospitalist program with Boston Children’s Hospital. “During the pandemic, people weren’t exposed to as many viruses as they typically are. Just because we were focused on COVID, doesn’t mean that the flu, RSV and all the other respiratory viruses went away. They are still out there.”

Dr. Lops is currently seeing a lot of cases of viruses that he typically sees in the winter, but COVID has changed the equation. Normally it didn’t really matter whether a patient had the rhinovirus or RSV. The treatment was generally the same: symptom management and waiting it out with plenty of rest and fluids.

“Now we really focus on specific symptoms and diagnostics, for obvious reasons,” he said. “We have to think about quarantining. We have to think about the prognosis and other medications we might give to patients with COVID-19 as well as long term impacts of COVID and the potential for children to develop autoimmune conditions as a result of COVID. Now there is a lot more that goes into the decision to test for respiratory viruses.”

The pandemic has also made parents more attentive to symptoms and whether they could be an indication of COVID-19. That might make parents more apt to head to an Urgent Care facility or the Emergency Department, but Dr. Lops discourages that as a first response. Instead, he recommends calling your pediatrician and going over the symptoms. Your pediatrician will be able to advise you on the best course of action.

“It’s best to avoid places where you could potentially get exposed to something,” he said, explaining that urgent care and emergency department waiting rooms have been crowded with people experiencing fevers and coughs. “It’s challenging because the first instinct is often to head to the emergency room, but talking to your pediatrician first is often the safer option.”

All of the local pediatricians have a doctor on call 24 hours a day, so concerned parents should call even if the office is closed. A pediatrician may recommend that someone see your child quickly or they may say it’s okay to watch symptoms and wait until the next day to come in. They will also inform you of what symptoms to look out for and offer tips for alleviating discomfort.

“That anticipatory guidance is really what parents need right now so they don’t end up seeing me in the hospital,” Dr. Lops said. “I’m happy to see anyone who comes in, but if we can avoid a visit to the emergency room, that’s really the most important thing.”

The exception is if a child is having difficulty breathing, isn’t eating or drinking, or has symptoms of dehydration. Those children probably need to be seen as soon as possible in the Emergency Department, he advised, but check with your pediatrician first.

Pediatricians can do COVID tests, but if your child tests positive it isn’t a reason to panic. Kids have a wide variety of symptoms just like adults do and many times they are asymptomatic. Sometimes kids will get a dry cough or some gastrointestinal symptoms like vomiting or diarrhea. Only a portion of kids will get the more serious symptoms we associate with COVID, like a bad cough and trouble breathing, according to Dr. Lops.

Testing offers parents the peace of mind of knowing what to watch for, even if it is COVID. It also indicates whether it is imperative to quarantine, he said. But even if your child has the common cold, they should still stay home, rest and take a break from beaches and playgrounds.

It’s impossible to forecast whether the upcoming fall and winter months will be worse than usual for colds, respiratory illnesses and the flu, said Dr. Lops. Right now, it feels worse because we haven’t seen a lot of these viruses for the past two years. Plus, the pandemic has made parents pay more attention to symptoms and raised more concerns when children do get sick.

A lot of parents are anxious about sending their kids back to school, especially since (at this time) some school districts have mask mandates and others are letting parents decide. Dr. Lops said that each parent has to assess their own risk tolerance when making that decision. That said, it certainly isn’t a bad idea to have your child wear a mask, he said. While not perfect, they do reduce the rate of transmission and are a low risk intervention.

“I think about it when going into crowded stores, like the supermarket,” he said. “When I go into the supermarket, even though I’m vaccinated, I still wear my mask because it’s a risky environment. There are a lot of people, many of whom are not wearing masks, in an area that is not well-ventilated and often difficult to physically distance. Putting on a mask takes minimal effort and is an effective way to reduce transmission. That’s the way I think about it and I would advise parents to think about it that way.”