As schools close around the world, families are spending more time in close quarters. Three experts weigh in on how kids, and everyone else, can stay safe.
What do we understand about Covid-19’s risks to children?
Dr Akiko Iwasaki: Kids are definitely exposed and infected with this virus … They have to be hospitalized and some of them have to be intubated. So it’s not that kids are completely resistant, but the lethality is much lower than in other age groups. [Editor’s note: A report found that of over 2,000 confirmed and suspected cases among children in China, nearly 6% became seriously ill and one 14-year-old boy with a confirmed case died.]
Do we have to worry about kids spreading Covid-19 to others?
Dr John Carl: The probability probably is higher because for toddler-age kids, there’s more need to have direct contact to control where they are. So social distancing becomes a little bit more difficult.
Is it possible to become infected by changing diapers?
Dr Gregory Poland: In adults, 3-5% of the people affected do excrete the virus in their stool. I don’t have any data, but there’s no reason to think that wouldn’t also happen in kids. So I would err on the side of caution and handle diapers as if they might be [contaminated]. Throw them into a plastic bag and wash your hands.
For older kids, in addition to hand hygiene and respiratory etiquette, teach them about bathroom habits. One thing people don’t know about is the “toilet cloud plume”. When you flush the toilet with the lid open, you spray virus over every surface in that bathroom.
Should we be keeping kids away from grandparents? What if a grandparent is a primary caregiver?
Carl: If they’re showing symptoms, yes. The issue, of course, is that if they’re having much milder symptoms than the standard adult would then it’s less obvious that they themselves may be infected.
Iwasaki: That’s why public health measures to close down schools and daycares need to happen immediately. That way, kids aren’t going to be exposed to the virus so they can live and be cared for by grandparents without the risk of them bringing the virus home. The earlier that can be done, the less risk the grandparents will be exposed to.
Should I take my kid out of daycare if it isn’t closed already?
Iwasaki: If you have a choice. I would not put my children in daycare right now. Some people have no choice if they’re earning daily wages and need to go to work to even survive.
Is it safe to go to playgrounds?
Carl: It’s absolutely helpful both for the parent and child’s mental health, in limited amounts, to go outdoors. Go for a walk, walk the dog, but monkey bars, playsets and gyms? That’s a time when you’d have to use extraordinarily good hand-washing and I’m not sure how you do this effectively.
What about playdates? Or if a friend or neighbor asks you to babysit?
Iwasaki: Playdates are a bad idea right now. And of course, in any other time, it would be a very nice gesture to watch a friend or neighbor’s kids, but right now I’m not even allowing my children to play with friends’ or neighbors’ kids.
How can you isolate yourself from your own children if one of you has been exposed?
Carl: If there’s another parent in the household that can carry the ball, then that person becomes the primary caregiver, at least for a while. But, wash your hands, try to not cough if you’re cooking over the stove – you’re going to do things that you need to do to get through the day, but remove yourself as much as possible. Isolate yourself in your bedroom.
Probably the greatest issue, which is something the [American] Academy of Pediatrics would probably frown on anyway, is co-sleeping. That’s probably a huge likely risk factor.
It’s much easier when the kids are older. I have a 20-year-old who came home from college four or five days ago with a viral respiratory infection and a low-grade fever. We’re insisting pretty strictly that he maintain isolation in his room as much as possible. I’m checking in with occupational health, monitoring my temperature pretty regularly, so I can maintain my activity and see patients. I have no symptoms whatsoever at the present time, and sure as heck don’t want to and I want to protect my own patients.
Poland: One thing that’s really, really important is you got to teach people how to wash their hands. Everybody thinks they know how. I have never, ever – and in case I’m not being clear – never, ever seen a layperson wash their hands properly.