Perhaps the only respite pandemic closures brought to my family — which includes two kids under age 6 — was freedom from the constant misery of dripping noses, sneezes and coughs. And statistics suggest we weren't the only ones who had fewer colds last year: With daycares and in-person schools closed and widespread use of masks and hand sanitizer in most communities, cases of many seasonal respiratory infections went down, and flu cases dropped off a cliff.
That reprieve might be ending. Social mixing has been starting up again in much of the U.S. and so have cases of garden-variety sniffles. The Centers for Disease Control and Prevention just warned physicians that RSV, a unpleasant respiratory virus, is surging right now in southern states. And it's not just happening in the U.S. — researchers in the U.K. and Hong Kong found that rhinovirus outbreaks spiked there, too, when COVID-19 lockdowns ended.
My family is at the vanguard of this trend. Right after Washington D.C. lifted its mask mandate a few weeks ago, both my kids got runny noses and coughs, and as soon as they tested negative for COVID-19, my pandemic fears were replaced by a familiar dread. I had visions of sleepless, cough-filled nights, dirty tissues everywhere, and — in short order — my own miserable cold.
"If someone in your house is sick, you're not only breathing in their sick air, you're touching those contaminated surfaces. You're having closer contact, you're having longer exposures," says Seema Lakdawala, a researcher at the University of Pittsburgh School of Medicine, who studies how influenza viruses transmit between people. It can start to feel inevitable that the whole family will get sick.
Take heart, my fellow parents-of-adorable-little-germ-machines! Lakdawala says many strategies we all picked up to fight COVID-19 can also stop the spread of many routine respiratory viruses. In fact, they may be even more effective against run-of-the-mill germs, since, unlike the viruses behind most colds, SARS-CoV2 was new to the human immune system.
Those strategies start with everyone keeping their children home from school, camp and playdates when they're sick and keeping up with any and all vaccinations against childhood illnesses. Beyond that, specialists in infectious disease transmission I consulted offer five more tips for keeping my family and yours healthier this summer.
Tip 1: Hang on to those masks
In pre-pandemic times, it might have seemed like a weird move to put on a mask during storytime with your drippy-nosed kid, but Dr. Tina Tan says that's her top tip. She's a professor of pediatrics at the Feinberg School of Medicine at Northwestern University and a pediatric infectious disease physician at Lurie Children's Hospital in Chicago.
When it comes to influenza, a rhinovirus, or any of the other respiratory bugs constantly circulating, "once these viruses touch your mucous membranes, whether it's your eyes, your nose or your mouth, you do have a chance of contracting it," says Tan. Masks help stop infectious particles and virus-filled droplets from getting into your body.
"You don't need a N95," Tan says. A light-weight surgical mask or homemade cloth mask can work as long as it has two or more layers. The mask-wearing also doesn't have to be constant. "If you're going to be face to face with them — they're sitting in your lap, you're reading to them, you're feeding them, etc. — then I would say wear a mask," Tan advises.
Even better, if it's not too uncomfortable for your sick child, have them wear a mask, Lakdawala says. "If your kids are old enough to wear a mask, that would probably be the best strategy, because then you're reducing the amount of virus-laden aerosols in the environment."
How long should you stay masked-up?
For most respiratory viruses, "the infectious period is probably similar to that of COVID," says Dr. Jennifer Shu, a pediatrician in Atlanta and medical editor of the American Academy of Pediatrics' site HealthyChildren.org. It might technically start a few days before symptoms begin and last for up to two weeks, but your sniffly kids are likely most contagious during those first runny-nosed days Shu says. "You could have kids over [age] 2 wear a mask for the first three or four days of symptoms," she suggests.
And if you can't bring yourself to wear a mask or put one on your child inside your own home to fight a cold, don't worry. Lakdawala has a few more ideas.
Tip 2: Air it out, space it out
When Lakdawala's 5- and 8-year-old kids get sick, "I open the windows, I turn on the fans, I get a lot more air circulation going on in the house," she says — that is, weather and allergies permitting, of course.
"A lot of these viruses tend to circulate more during the colder weather, so where you live is going to determine how much you can open your windows," Tan points out. But certainly, she says, "the better the ventilation, the less likely the viruses are going to get transmitted from one person to another."
What about buying HEPA filter air purifiers, or changing the filter in your heating and air conditioning system? "I would not suggest going out to purchase extra HEPA filters just for this purpose," says Dr. Ibukun Kalu, a pediatric infectious disease physician at Duke University. For hospitals that are treating very contagious and serious pathogens like tuberculosis or SARS-CoV2, those upgrades may be important, she says. "But for all of the other routine viruses, it's routine ventilation."
Kalu says you might also want to think strategically about creating some social distance — when it's possible — like strategically having the parent who tends not to get as sick provide the one-on-one care for the sick kid.
Obviously, you can't isolate a sick child in a room by themselves until they recover, but Lakdawala says not getting too close or for too long can help. When her kids are sick, "I do try to just not snuggle them — keep them a little bit at a distance."
Tip 3: Don't try to be a HAZMAT team
There's good news on the house-cleaning front. "Most of these viruses don't live on surfaces for very long periods of time," says Tan.
The research on exactly how long cold-causing rhinoviruses can survive on surfaces — and how likely they are to remain infectious — isn't definitive. As Dr. Donald Goldmann of Boston Children's Hospital poetically put it in The Pediatric Infectious Disease Journal a couple decades ago, "Despite many years of study, from the plains of Salisbury, to the hills of Virginia, to the collegiate environment of Madison, WI, the precise routes rhinovirus takes to inflict the misery of the common cold on a susceptible population remain controversial." That's still true today, doctors say.
There's some evidence that contaminated surfaces are not very important in the spread of colds. In one little study from the 1980s, a dozen healthy men played poker with cards and chips that "were literally gummy" from the secretions of eight other men who had been infected with a rhinovirus as part of the study. Even after 12 hours of poker, none of the healthy volunteers caught colds.
Shu's take home advice? Be methodical in your cleaning of often-touched surfaces (kitchen table, countertops and the like) with soap and water when everybody's healthy, and maybe add bleach wipes or other disinfectant when someone in your household has a cold. But don't panic.
Tan agrees. "Wipe down frequently-touched surfaces multiple times a day," she says. "But you don't have to go crazy and, like, scour everything down with bleach."
You also don't need to do a lot of extra laundry in hopes of eliminating germs on clothes, towels, dishtowels and the like — that can be exhausting and futile. Instead, just try to encourage kids who are sick to use their own towel — and do what you can to give towels a chance to dry out between uses. "Having some common sense and doing laundry every few days — washing your towels every few days and washing your sheets every couple of weeks — is probably good enough," Shu says. "You don't need to go overboard for run-of-the-mill viruses."
Don't fret that there are germs everywhere and you can't touch anything, says Lakdawala. "If I touch something, that -- in itself — is not infecting me," she notes. Instead, it's getting a certain amount of virus on our hands and then touching our own nose, eyes or mouth that can infect us. "If I just go wash my hands, that risk is gone," Lakdawala says.
You can also skip wearing gloves around the house. "People think that they are safe when they're wearing the gloves — and then they touch their face with their gloves [on]" and infect themselves, she says.
Instead, just make it a habit to wash your hands frequently.
Tip 4: Seriously, just wash your hands
"The same handwashing guidelines for COVID also apply for common respiratory illnesses," Shu says. That is: regular soap with warm water, lathered for about 20 seconds.
"The reason why 20 seconds is recommended is because some studies show that washing your hands shorter than that doesn't really get rid of germs." She warns that there hasn't been a whole lot of research on this, and 20 seconds is not a magic number. "But it is thought that anywhere from 15 to 30 seconds is probably good enough to get rid of most of the germs," she says. (Note: No need to drive your family crazy singing the birthday song twice — y'all have options.)
"Wash your hands before you eat, after you eat, after you go to the bathroom ... if you're changing your child's diaper, et cetera.," says Tan. "And if you're going to use hand sanitizer, it has to be at least 60% alcohol."
"Your hands are probably the most important source of transmission outside of someone really coughing or sneezing in your face," Kalu adds.
Tip 5: Don't give up, but do keep perspective
So, what if your beloved child does cough or sneeze in your face? Should you then forget all this stuff and just give in to the inevitable?
Don't give up, says Lakdawala. "Just because you got one large exposure in your mouth and in close range, it doesn't mean that that was sufficient to initiate an infection," she says. Whether you get sick from that germy onslaught is going to depend on a lot of things — the particular virus, whether the sneeze landed in your mouth or nose, whether you've been exposed to some version of that virus before and more.
One tiny positive side effect of the coronavirus pandemic for Lakdawala has been a broader public understanding of "dose-response" in viral transmission. "Just because somebody breathed on you once doesn't necessarily mean that that's what's going to get you infected," she says.
Consider practicing the swiss cheese model of transmission control, Shu says. "Every layer of protection helps — if you find that wearing a face shield is too much, but you do everything else, you're still going to limit your exposure," she says. Just do what works for you and your family.
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