How to Help Kids Embrace Mask-Wearing

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What a beautiful thing is a face mask if it gives us back our world.

With states in various stages of reopening, the challenge we face right now is to hold on to the hard-won gains from staying home and shutting down, and to avoid increased transmission. Masks are a big part of the solution.

Older children can be a little cranky about adapting to life with masks, but younger children are perfectly placed to learn a new drill. They can be the family monitors, reminding their parents not to forget their face coverings when they leave the house, nudging them to pull up face coverings that slide down off their noses, sitting in disapproving judgment on naked-faced runners or puffing smokers who come too close.

Most children enjoy the chance to feel morally superior to adults (and adults often make this all too easy); go ahead and encourage a little righteousness. Remind them that they’re smarter than these grown-ups who are not protecting others and not protecting themselves; masks do both.

Going back to school in the fall may well mean masks; the more kids have come to take them for granted by then, the better. I’ve taught in China, where many people — including children — have long been in the habit of wearing face masks to prevent transmitting or catching respiratory illnesses. Masks also come out when pollution counts are high; everyone understands that a face mask protects children from breathing in bad stuff.

As a medical student, you learn how to scrub for surgery, and after you’ve scrubbed, how to put on sterile gloves without contaminating them. You’re already wearing your surgical mask before you put the gloves on, because (does this sound familiar?) you don’t want to touch your face and contaminate your gloves. And of course, in the operating room you also wear shoe covers and head covers and sterile gowns, and there is a very organized and very rigid choreography of what is sterile and who is sterile and who is not. (Mind you, the mask itself is not sterile — you would not touch it once you have your sterile gloves on.)

And then you spend a little time, as a medical student in the operating room, terrified that you’re going to contaminate that sterile field; that in a room full of highly expert people (scrub nurses, circulating nurses, surgeons, anesthesiologists), all of whom have come to understand what is sterile and what is not, you are the trainee who will screw things up — and then you learn the rules, and you internalize them, and you come to feel a little more at home, a little more sure that you can help keep everyone safe — especially the vulnerable patient, who is the reason you are all there in the first place.

At the end of the 19th century, as surgeons understood the role of microorganisms in infection, they began wearing cloth masks in the operating room so that they would not infect their patients. By 1918, gauze masks were being used in hospitals to reduce the likelihood that infections would spread among the patients, and to protect the doctors and nurses.

Surgeons and scrub nurses and their operating room colleagues do incredibly precise and high pressure work for hours and hours while wearing masks. And when we watch them doing that — on videotape, in movie scenes — we probably all feel subliminally reassured by their masks. They’re concentrating, they’re following the rules, they’re working. When we say of any activity, well, it’s not brain surgery, we’re comparing that activity deprecatingly to something which is only ever done by people wearing face masks. We look at that masked neurosurgeon’s face, and we think, well, that’s brain surgery.

Like pretty much everyone else — including most doctors — I can’t claim any kind of prescience about the coronavirus epidemic. But as a pediatrician, I knew that masks were a good idea, even when the authorities were telling us not to wear them. Hospital-grade face masks help protect health care workers from infections — not perfectly, but they improve the odds. When a sick child in a clinic or a hospital is known to have a respiratory infection — let’s say, a baby hospitalized with respiratory syncytial virus, or R.S.V. — there will be signs all over the place telling everyone who comes into the room to wear a mask and gown and gloves. You don’t do this because R.S.V. is dangerous to medical personnel or family members — in adults, it usually causes mild common cold symptoms.

But it can be very dangerous in babies, especially premature babies, so the last thing you want is infected medical workers, asymptomatic or very mildly affected themselves, but possibly carrying the virus, to infect other vulnerable infants. And even when they’re in the room taking care of the sick baby, the face mask helps prevent that transmission along with careful hand hygiene and other contact precautions.

And when you have a health care worker who might have an infection — say, the occasional health care worker who won’t or can’t get a flu shot and therefore constitutes a danger to patients — that worker wears a face mask at work all winter long because the face mask protects the patients.

For months now, the Centers for Disease Control and Prevention has been recommending cloth face coverings, pointing to information about how asymptomatic and presymptomatic people can spread coronavirus. In other words, face coverings reduce the chance that we’ll inadvertently spread virus when we don’t know we’re infected. They also remind us not to touch our mouths and noses, so they protect us from inadvertently infecting ourselves — and they probably offer a certain amount of protection against large droplets. Again, that’s not guaranteed, so keep washing your hands, keep up the physical distancing, and cover your face when you might be around other people — or they might be around you.

The American Academy of Pediatrics reminds parents that staying home and social distancing are still most effective in preventing the spread of the virus, but it offers advice about helping children get accustomed to masks. They are not recommended for those under 2, and there may be some children who can’t wear them — the A.A.P. mentions those with “severe cognitive or respiratory impairments.” On the other hand, immunocompromised children might need more protection than cloth face coverings offer, and N95 masks are recommended.

The A.A.P.’s suggestions include putting a cloth face covering on a child’s favorite stuffed animal, decorating masks so they’re more personalized and drawing a mask on your child’s favorite book character.

  • Frequently Asked Questions and Advice

    Updated June 22, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

There will be more information coming out about the relative efficacy of different kinds of face coverings, and there is increasing interest in the possibility of face shields, which might be especially helpful for children with neurodevelopmental issues who have trouble reading social cues.

I understand it’s not always pleasant to feel a little hot and sweaty under the mask on a hot, humid day, but let’s be honest, you can feel a little hot and sweaty under your underwear on a hot, humid day. I understand being sorry not to see people’s full faces, out in public, but I can deal with it. We’ll always have Zoom.

Doctors and nurses tend to feel safe and at home in their masks. Medical Twitter is rife with TikToks about masks, and by and large they are made with affection. Let’s help our children learn that affection — they can smile from behind their masks at the other people who are also doing the right thing.

You should feel a little safer in your mask, because you are. And you should feel like a good and generous citizen in your mask, because you are. And you should teach your children to feel safe and proud when they wear their masks, because they deserve to. They will be helping make a safer world.

Believe me, they will understand. It’s not brain surgery.