In November, the American Academy of Pediatrics announced that more than 1 million children in the United States have been diagnosed with COVID-19. Politicians are calling for closures and lockdowns in response to this crisis, but often they are focusing on shutting down sporting events and schools for our nation's children.
What's wrong with this approach? Data strongly suggest that indoor restaurants and bars, along with private indoor social gatherings, are the primary driver of the increase in infections. Importantly, studies tell us that COVID-19 is not spread easily outdoors and that children are not spreaders of this disease.
It is understandable that leaders making health decisions for our communities need to do so quickly and prefer not have people getting sick or worse on their watch. But there are details about the spread of this virus that need to be made clear to the public.
First, COVID-19 is not spread by larger droplets, but by tiny aerosols, according to the National Academies of Science, Engineering and Medicine, and others. Numerous studies have shown that COVID-19 infection occurs through these airborne aerosols, with most particles around 5 microns in size, just larger than your typical bacterial cell. The Centers for Disease Control still claims droplets are more responsible for infections, although they recently changed their guidelines to include aerosols. Droplets fall to the ground quickly if not intercepted, and it is difficult to get infected from inanimate surfaces or objects, known as fomites, with COVID-19. Washing hands and the disinfection of surfaces does little to mitigate the spread of this virus. Again, this is why masks should be focused on and are so critical for COVID-19 and, likely, influenza (the flu).
It is difficult to find documented cases of people catching COVID-19 outside. Protests this summer appear to have had no effect on transmission, and it has been the large indoor political gatherings that have led to outbreaks. Centers for Disease Control guidance suggests at least 15 minutes of exposure to become infected, which is based on being indoors. However, the Centers for Disease Control guidelines should be clearer on this point. Importantly, because an aerosol can travel long distances within a room, you may be further than 6 feet from someone indoors and still become infected. Grandma and grandpa are not safe at Thanksgiving if they are sitting on the opposite side of the room without a mask! When outside, the probability of inhaling a viral dosage leading to infection is low, since the virus quickly disperses into the surrounding air. It is very safe at the beach or park.
Given our understanding of transmission, focus should be on stopping the spread indoors in restaurants, bars and social gatherings. People need to support our restaurants, but do it through outdoor seating or ordering carryout. Citizens should feel safe to go to businesses where masks are mandated, which should be all indoor businesses where eating and drinking are not part of the visit. Masks should also be mandated in indoor gyms. It will be a travesty if gyms are closed since exercise boosts your immune response.
Additionally, the data is telling us that preadolescents are not infectious. If children aren't infectious and hardly ever show symptoms, then maybe we shouldn't be preventing them from attending school or indoor winter sports. We would expect to be able to find unequivocal examples where a preadolescent child brought the virus home and spread it to other household members who never left the house. There just aren't examples of this, suggesting it rarely happens. This means teachers should not be afraid of preadolescent children infecting them.
Lastly, several studies this month show that children and adolescents have very different immune responses to COVID-19, which likely contributes to them being resistant to infection, and if infected, being less ill and eliminating the virus quickly. This may also lower their chance of being infectious and needs to be determined, as it also has implications for immunizations, which are critical to preventing the pandemic. We may find that children won't benefit from vaccinations, unless belonging to a group that is high risk for illness and complications, and these considerations need to go into clinical trials.
These decisions are taking a tremendous toll on kids and their families and it is not good for the country or the economy. As a scientist, parent, coach and now someone that has a ton of Girl Scout cookies that I am going to end up eating because outdoor booths were closed, I would like to see further reasonable and data driven debate on outdoor activities and locking down our children.(c)2020 The Baltimore Sun Distributed by Tribune Content Agency, LLC