Masks and vaccines: What would you do to save a child?

What would you do to save a child? Would you step into the street to pull a child out of traffic? Give your hard-earned money to feed a starving child? Raise funds for cancer research? 

Would you wear a mask?

As the prevalence of COVID-19 dropped and the number of fully vaccinated individuals climbed, we began to realize new-found freedoms. We gathered again with our friends, we spent time with others without masks on, and we re-experienced old loves, like indoor dining and movie theaters. This return to normal feels amazing, but it can also make us forget the ongoing COVID-19 threat that we face, especially for those too young to be protected by vaccination or with immune systems too weak to effectively fight this virus. 

Scientists and public health experts agree: Vaccines provide excellent protection against severe disease. While no vaccine can provide absolute protection against all infection, vaccination can turn a potentially fatal infection into an infection that is either entirely asymptomatic or one that has minimal symptoms. In addition, recent studies have shown that for those vaccinated people who do contract the disease, the amount of virus carried in the nose is low and therefore they are much less likely to infect others.

However, while the risk of infection for vaccinated individuals is lower than it is for unvaccinated individuals, vaccinated individuals can still contract and pass the virus to others. The more virus particles circulating in a group, the more likely someone will be infected, even someone who is fully vaccinated. 

This basic fact of virology has emerged as one of the central threats to our national recovery from COVID-19. The highly transmissible Delta variant is sweeping across the country, bringing many more viral particles to the noses of every person it infects. That means that each infected person is more likely to spread the virus to someone else, thus explaining why the Delta variant has now become the predominant strain in the United States. As of July 20, the Delta variant strain of SARS-CoV-2 accounted for 83 percent of new infections. And given its tendency to spread, we should expect this trend to continue unless we take action.

What can we do to stop this menacing virus from replicating the chaos we saw in the fall of 2020? Get vaccinated NOW if you have not already. And while being fully vaccinated is the single most powerful way we can protect ourselves and others, there are other simple steps we can take once vaccinated. Wearing a mask and cleaning our hands frequently in high-risk situations can decrease our risk of contracting the virus in the first place, as well as decrease our risk of spreading it if we are carrying it without realizing it. So, how can one identify a high-risk situation? By determining if key features are present that allow the virus to spread easily or put others most at risk:

• Crowded spaces without room for social distancing
• Indoor spaces
• Groups that include unvaccinated individuals or vaccination status is unknown
• Groups including individuals at high risk for severe disease such as the elderly and those with weak immune systems
• Activities where virus transmission occurs more easily such as singing and contact sports, and
• Areas where there is high prevalence of COVID-19 in the community

In some ways, we have attempted to move on as a country from this pandemic while leaving our children behind. All children 11 years old and under are still fully susceptible to COVID-19 and the disease it causes. This risk will persist until we have a vaccine that has been approved for their use. Early data from the UK suggests that the Delta variant might be more likely to cause severe disease than other variants. 

In the U.S., recent reports from states such as Alabama, Arkansas and Missouri have shown increasing numbers of children hospitalized with COVID-19, with many requiring intensive care. It is too early to say if this increased hospitalization is due to more severe illness from the Delta variant, or just because so many children are being infected, but regardless we know how to prevent this risk and suffering. We must prevent the spread of virus to children and protect them from becoming infected in the first place. And, since we are early in this most recent surge, we have yet to see the expected increase in cases of MIS-C (Multisystem Inflammatory Syndrome in Children). MIS-C typically develops in children 2 to 8 weeks after an initial COVID-19 infection and can cause severe organ damage and shock, including inflammation of the heart, leading many affected children to require intensive care monitoring and treatment.

As opposed to earlier in the pandemic, the current surge is coming at a time that pediatric hospitals across the country are full, not typical for this time of year. Last winter pediatric hospitals, including our own, were shocked by how few cases of any of the usual childhood viruses that can lead to hospitalization were seen. Most physicians did not see a single case of RSV or flu over the entire winter, both being viruses that are usually diagnosed multiple times a day by pediatric physicians during typical winters. With limited school attendance and loss of usual activities, children were relatively isolated from each other and viral transmission stopped. Now, however, those viruses are back with a vengeance combined with typical summer injuries and viruses that bring children into hospitals.

While it is true that the overall risk of severe disease in children is low, allowing even one child to become severely ill is too many if it can be prevented with simple measures. Children are at low risk of being killed in a car accident, yet we strap them into car seats and seatbelts because we can decrease that risk even further. Children are at low risk of poisoning from prescription medications, yet we endure prying off difficult child-proof caps because it can protect young children. Wearing a mask in high-risk situations is just the same — a minor inconvenience that is worth it if we can save even one child.

Dr. Sage Myers is an associate professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She serves as the medical director of Emergency Preparedness at the Children’s Hospital of Philadelphia (CHOP) and works clinically as a pediatric emergency medicine physician. She currently leads the CHOP Community COVID-19 Testing and Vaccination Programs focused on providing equitable access to testing and vaccination for children and their families in the region.

Dr. Susan Coffin is a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She practices as a pediatric infectious disease physician and epidemiologist at the Children’s Hospital of Philadelphia.