Doctors and nurses expect surge in non-COVID infections at school

BOSTON — Stomach bugs, coughs, colds, and the flu: Doctors say it’s highly likely that schools will once again become breeding grounds for common childhood infections if districts opt to make masks optional beginning next week.

“The various viruses that cause the common cold and also the kind of bugs that cause diarrheal disease and stomach flu are all going to increase with the decreased use of masks and more congregating in schools,” said Paul Sax, MD, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital. “It’s almost inevitable.”

“If everyone wore a mask indoors we would prevent 30,000 influenza deaths a year in the United States,” said William Raszka, MD, a pediatric infectious disease specialist at the University of Vermont Medical Center .”We’d prevent an enormous number of hospitalizations of children. It’s just amazing as a public health measure.”

In the absence of that public health measure, Raszka also expects more infections -- in part because masking has created a cohort of children minimally exposed to common bugs.

Among the more serious pathogens, some kids may not have been exposed to RSV -- or Respiratory Syncytial Virus. Raszka said it’s possible some states could see a surge in those infections.

“We used to assume that almost everyone had been infected with RSV by two years of age,” he said.

Widespread masking means that can no longer be assumed.

“Once this virus gains traction in the community, it will spread through various members and the three-year-olds and four years olds will just have the sniffles but an 18-month-old, a 6-month-old might be much more ill.”

Younger children tend to get sicker with RSV, Raszka said, because their airways are smaller -- and that causes more resistance to airflow.

But will infections be more severe as a result of limited immune system exposure?

Probably not, said Sax.

“The childhood immune system is actually excellent, very strong, very adaptable,” Sax said.  “Children who get these bugs, they recover much more quickly than adults do and I feel like that’s what’s going to happen again.”

One thing Raszka and Sax agree on: Sick kids shouldn’t come to school.

“I think we have to have much tougher standards about sending children to school when they’re sick,” Sax said. “And much tougher standards about ourselves when we go to work while sick. We shouldn’t do that .”

“I’ve always said that you shouldn’t go to school sick,” Raszka said. “I actually think that it’s a reasonable thing to make masking an individual decision. But I still think if you’re ill you shouldn’t go to school.”

The problem, Raszka said, is defining what it means to be ill -- both for parents and school nurses.

“Parents need to work -- they need to get to their job,” he said. “The school nurse is worried I’ve got influenza, I’ve got SARS-CoV2, I’ve got all these different things. How do I decide the child can stay there?”

Rebecca Jackson is a school nurse in Providence. She’s expecting that once the masks come off, business in her office will boom.

“I think some teachers get anxious when they see symptoms, so they’ll send the kids right away and I may have to do more rapid testing in the school,” Jackson said.

That will help keep the most serious threat under control -- but some parents are concerned about the others, as well.

I don’t think we should just take all the masks off. I know their children maybe the masks can come off but they should be a little distanced.

“I’m concerned for my friends I know that have children that are immunocompromised,” said Sara Libert.

“I don’t think we should just take all the masks off,” said Amanda Quiles. “I know they’re children. Maybe the masks can come off but they should be a little distanced.”