Masks, distancing and hand hygiene: Doctor’s recommendations as school starts

August 13, 2021
a young girl sits cross legged with a picture book open on her lap while wearing a mask
Masks are not required in school, but doctors are strongly recommending them. Photo by Kelly Sikkema via Unsplash.

Children can and do get COVID, pediatric infectious disease specialist Allison Eckard, M.D., emphasized this week ahead of the start of school for most of South Carolina.

While it’s true that children generally have much less severe cases than adults, there are children, including healthy children, who become sick enough to be hospitalized – and as more people become infected, it follows that more people, including children, will become seriously ill.

“Somebody very wise once said to me, ‘A small percentage of a large number is a large number,’ and that’s exactly what you’re seeing with Delta,” said Eckard, who serves as director of the Division of Pediatric Infectious Diseases. “The more spread, the more cases you have, and subsequently, the more sick people you’re going to have and the more deaths.”

Dr. Allison Eckard 
Dr. Allison Eckard

The Delta variant, which has quickly become the predominant strain in South Carolina, is more easily transmissible than the original virus. With the original strain, an infected person could be expected to spread COVID-19 to two to three people, she said. With Delta, an infected person is expected to spread the virus to five to eight people.

“That has huge implications in the current setting we’re in, particularly for children in school and the more than half of South Carolinians who have not yet been vaccinated,” Eckard said.  

That includes most teenagers. Although everyone age 12 and up is eligible for the vaccine, only 20% of South Carolina children aged 12 to 17 years old have been fully vaccinated, Eckard said.

“I think time will tell whether the Delta variant is more severe in children, but part of what we’re seeing right now is that there are more children who are acquiring COVID, and by default we’ve started to see more sick children admitted to our children’s hospital,” she said.

Kershaw County School District, which returned Aug. 5, is already reporting more than 120 students and more than 20 staff with COVID-19, resulting in the quarantine of more than 600 students.

Eckard recommends what she calls the “COVID trifecta” to reduce the spread of the virus: hand hygiene, physical distancing and masks.

Masks are effective and safe – in fact, they’re one of the most important mitigation tools we have, she said.

“I know it’s become a very contentious issue, and I wish it weren’t that way. We've been wearing masks in medicine and putting masks on immunocompromised children for many decades,” she said.

Masks do not cause a buildup of carbon dioxide. Even people with pulmonary disease can wear cloth or surgical masks, and studies show no difference in the amount of carbon dioxide in their bodies, she added.

“I continually look at all of the data, every study that comes out, and masks in general are extremely safe for the majority of people, including children, and they are highly effective in preventing respiratory droplet spread,” Eckard said.

“You're not trying to prevent single viral particles from going through; you’re trying to prevent the escape of large respiratory droplets that contain millions of copies of the virus in them."

Allison Eckard, M.D.

Viruses ride along inside these respiratory droplets, which are expelled when people cough, sneeze, talk, shout or sing. Data have shown that after one minute of speaking loudly, respiratory droplets – with virus inside – can linger in the air for another eight minutes, she said. Thus, it’s important that an infected person keep those respiratory droplets contained within his or her own mask as much as possible and that uninfected people wear masks to try to block entry to their noses and mouths.

“You're not trying to prevent single viral particles from going through; you’re trying to prevent the escape of large respiratory droplets that contain millions of copies of the virus in them,” she explained.

Even cloth masks are effective, although two or three layers is better, she said.

“I really encourage everybody to put them on. I know they’re not fun. Hopefully we can move past this and get to a better place,” she said.

It is very important for kids to be in school, she said, and some of the children who are most vulnerable to this disease are also the same ones who need to be in school because of the services they receive there, like meals or speech therapy, or because they didn’t fare well with virtual learning.

Eckard noted that of the almost 100 children admitted to MUSC Shawn Jenkins Children’s Hospital because of COVID-19 since the beginning of the pandemic, many had underlying conditions like diabetes, sickle cell disease, obesity or an immune system condition. However, the hospital has also treated otherwise healthy children, and of that group, the most vulnerable have been those less than 2 years old, she said.

Nearly all of the hospital’s cases of MIS-C, a rare but serious, often life-threatening, inflammatory condition that occurs post-infection, have occurred in healthy children, and most didn’t even know they had been infected with COVID, she said.

Eckard hopes that people will take this surge seriously and take proper precautions to reduce the spread of the disease and therefore hospitalizations and deaths.

“It’s not about fearmongering,” she said. “It’s about being realistic that the more kids who have COVID, the more kids who will have severe COVID and will have to be admitted to the hospital.”