How Are My Kids Still Getting Sick In Lockdown?
Many infections come from within. Doctors explain what they are and what to do about them.
By Melinda Wenner Moyer
June 24, 2020, 5:00 a.m. ET
In April, about a month into a quarantine so careful I almost forgot how to drive, my 5-year-old came down with what I now refer to as “The Rash.” It started near her right eye, then spread down her right cheek — a red, menacing, puffy splotch. A few days later, it appeared on her left cheek, too. We arranged a telemedicine appointment with her pediatrician, who squinted at it and suggested it might be bacterial and ordered a round of topical and oral antibiotics. The medicines worked for as long as we had them: Exactly 48 hours after we stopped using them the splotches came back.
I’ve had a lot of questions about this rash, the most pressing being, Where could it have come from? I always thought that bacterial infections were spread by germy kids on the school playground, but my daughter’s rash showed up a month after her last day of school. It turns out I’m not the only parent who’s been shocked by seemingly impossible infections this spring. Months into isolation, parents have told me that their kids have come down with mystery fevers, strep throat, lice, pinworms and roseola.
“We were in total isolation, and Lucy woke up with a fever of 102 and was throwing up. Very lethargic,” said mother Maggie Gallant Isenberg of her 3-year-old daughter. “I took her to the pediatrician and he said she was, like, the fourth kid that day who was in his office with a virus that wasn’t Covid.” Isenberg, who lives in Atlanta, Ga., also has two stepchildren, aged 10 and 14.
As it turns out, kids are still getting sick at home for a variety of reasons — and quarantine-induced behaviors, as well as the coronavirus itself, might actually increase the risk for certain conditions, such as Lyme disease and diabetes. Still, pediatricians say they’re seeing fewer sick patients overall, and they’re especially seeing fewer patients with infectious diseases.
“Social distancing and quarantining work, broadly and effectively, for preventing many things that would otherwise happen when kids congregate,” said Dr. Brad Sobolewski, M.D., a pediatric emergency medicine physician at Cincinnati Children’s Hospital Medical Center.
Even so, doctors are probably not aware of the full spectrum of health issues kids are experiencing, because many families who would have taken their children to the doctor in the absence of a pandemic are, instead, staying home and crossing their fingers that their children will get better on their own.
“People just aren’t going in to see their health-care providers as often as they have been in the past,” said Dr. Yvonne Maldonado, M.D., a pediatric infectious diseases physician at Stanford University and chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. Even accounting for phone calls and telemedicine visits, which have certainly gone up, some pediatricians say that contact with parents during the pandemic has dropped overall.
Many infections come from within
If you’re wondering how your kid can get sick while isolating, keep in mind that many infections are caused by germs that naturally live inside our bodies and sometimes end up in the wrong place at the wrong time.
“For whatever reason, these organisms can reach the back of the throat, they can get into the bloodstream, they can enter breaks in your skin and you can become infected, even if you’re not around others,” Dr. Maldonado said.
When Karen Benavidez’s 3-year-old daughter developed scabs on her face two months into the coronavirus quarantine she didn’t think much of it, until a neighbor told her that the scabs looked like impetigo , a bacterial skin infection.
“I was expecting to have a healthier than normal spring since we were all at home and being so careful,” said Benavidez, who lives in Tallahassee, Florida, and also has an 8-year-old son. “I could not figure out how she could have been exposed.”
When she brought her daughter to the pediatrician, the doctor explained that the bacteria that cause impetigo — typically staphylococcal or streptococcal bacteria — can live in people’s noses and then inadvertently infect the skin through cuts or scratches. Ear infections, pneumonia , boils and urinary tract infections can also be caused by “normal” bacteria that have migrated to the wrong place.
Many infections and infestations also have long incubation periods, meaning it takes a while from the time a child is exposed until they start showing symptoms. The incubation period for scabies, for instance, can be as long as eight weeks . Lice, too, can take quite a while to populate a head; often it’s just one or two that migrate over, then they have to lay eggs, which incubate for 10 days before hatching and take another 10 to 15 days to grow into adults. Plus, kids may not even notice their lice for as long as six weeks , as it can take that long for them to become sensitized to the lice saliva and start to feel itchy. So if your child has just started scratching their scalp and you discover lice, it’s possible they’ve been there for some time.
Parents spread germs, too
Even though many families are isolating right now, that doesn’t mean they’re completely cut off from outside germs. If parents go to stores periodically, they could be exposed to viruses or bacteria that they then bring back to their kids — even if the parents themselves, who have more well-developed immune systems, never get sick.
“Dad runs to the grocery store and gets something on his hands and comes back in and gives the kid a hug right when he walks in, before he washes — and there’s a kid who hasn’t been around anyone but all of a sudden has a cold,” said Dr. Clay Jones, M.D., a pediatric and newborn hospitalist at Newton-Wellesley Hospital in Newton, Mass.
Frequently Asked Questions and Advice
Updated June 22, 2020
Is it harder to exercise while wearing a mask?
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise , says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals . But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19 , the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
My state is reopening. Is it safe to go out?
States are reopening bit by bit . This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Adults can also shed germs from previous infections and unwittingly make their children sick. Roseola , which commonly infects kids under the age of 2, causing a high fever and a distinctive pink rash, is caused by human herpesvirus 6 (HHV-6), a virus that can live dormant inside of our cells after we recover from it. The latent virus can then periodically get reactivated , particularly when we’re under stress — like, perhaps, when we find ourselves living through a global pandemic. When this happens, adults can shed the virus and infect their young children; research suggests that many babies actually become infected with roseola via their parents. This same scenario can also occur with coxsackieviruses , which can cause hand, foot and mouth disease, said Dr. Danielle Conley, M.D., a pediatrician in Buffalo, N.Y.
New behavior, new risks
Doctors are also seeing medical issues arise because of pandemic-induced changes in our behavior. In late May, the Centers for Disease Control and Prevention reported an outbreak of salmonella linked to backyard chickens, which have become more popular during the pandemic. “The case count is growing at a concerning rate,” a C.D.C. spokesperson said about the reports through mid-June.
With families taking more hikes than usual, it’s possible that doctors will see more cases of Lyme disease and other tick-borne infections this summer, too. “We presume that people are outside more, and it’s likely we will see higher numbers than usual, but that remains to be seen as we continue through the summer,” said Victoria McGahan, a public health educator for New York’s Columbia County Department of Health, a county that has among the highest rates of Lyme disease in the country.
Some pediatricians report that they have been seeing lots of rashes recently, too. “The week before heading into Memorial Day weekend, I saw a huge increase in rashes,” Dr. Conley said. Many, she noted, were eczema or atopic dermatitis, both of which flare up during allergy season, especially when kids spend lots of time outside. Dr. Conley has also seen a huge uptick in juvenile spring eruption , a sun-induced skin condition that can arise in kids in the springtime.
It’s also possible that some new medical issues are being directly caused by the coronavirus. Dr. Scott Krugman, M.D., a pediatrician at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Md., said that his hospital has recently treated a surprising number of kids with new-onset diabetes. “We have admitted a steady stream of children over the past few months,” he said.
Some new research suggests that Covid-19 could increase the risk for new-onset diabetes, so it’s possible these cases are coronavirus-related. As Dr. Sanjoy Dutta, Ph.D., the vice president of research for the JDRF (formerly the Juvenile Diabetes Research Foundation), explained, the cellular protein that is the primary docking site for the coronavirus is found on pancreatic beta cells and other cells involved in metabolism. If the coronavirus infects these tissues, sugar metabolism could be affected, he said, causing diabetes-like symptoms.
While there are plenty of ways kids can get sick right now — even if they’re not leaving the house — most of these illnesses, thankfully, aren’t medical mysteries. Doctors say they add up when considering the way people’s behaviors have changed in the pandemic, and the way common infections and other conditions develop in kids.
As for my family, we finally solved the enigma of “The Rash.” When my husband took our daughter to a pediatric dermatologist, she needed only one look at her face to make a diagnosis. “It’s eczema,” the doctor said. Go figure.