In April, about a month into a quarantine so careful I almost forgot how to drive, my 5-year-old came down with what I now refer to as “The Rash.” It started near her right eye, then spread down her right cheek — a red, menacing, puffy splotch. A few days later, it appeared on her left cheek, too. We arranged a telemedicine appointment with her pediatrician, who squinted at it and suggested it might be bacterial and ordered a round of topical and oral antibiotics. The medicines worked for as long as we had them: Exactly 48 hours after we stopped using them the splotches came back.
I’ve had a lot of questions about this rash, the most pressing being, Where could it have come from? I always thought that bacterial infections were spread by germy kids on the school playground, but my daughter’s rash showed up a month after her last day of school. It turns out I’m not the only parent who’s been shocked by seemingly impossible infections this spring. Months into isolation, parents have told me that their kids have come down with mystery fevers, strep throat, lice, pinworms and roseola.
“We were in total isolation, and Lucy woke up with a fever of 102 and was throwing up. Very lethargic,” said Maggie Gallant Isenberg of her 3-year-old daughter. “I took her to the pediatrician and he said she was, like, the fourth kid that day who was in his office with a virus that wasn’t COVID.” Isenberg, who lives in Atlanta, also has two stepchildren, ages 10 and 14.
As it turns out, kids are still getting sick at home for a variety of reasons — and quarantine-induced behaviors, as well as the coronavirus itself, might actually increase the risk for certain conditions, such as Lyme disease and diabetes. Still, pediatricians say they’re seeing fewer sick patients overall, and they’re especially seeing fewer patients with infectious diseases.
“Social distancing and quarantining work, broadly and effectively, for preventing many things that would otherwise happen when kids congregate,” said Dr. Brad Sobolewski, a pediatric emergency medicine physician at Cincinnati Children’s Hospital Medical Center.
Even so, doctors are probably not aware of the full spectrum of health issues kids are experiencing, because many families who would have taken their children to the doctor in the absence of a pandemic are, instead, staying home and crossing their fingers that their children will get better on their own.
“People just aren’t going in to see their health-care providers as often as they have been in the past,” said Dr. Yvonne Maldonado, a pediatric infectious diseases physician at Stanford University and chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. Even accounting for phone calls and telemedicine visits, which have certainly gone up, some pediatricians say that contact with parents during the pandemic has dropped overall.
MANY INFECTIONS COME FROM WITHIN
If you’re wondering how your kid can get sick while isolating, keep in mind that many infections are caused by germs that naturally live inside our bodies and sometimes end up in the wrong place at the wrong time.
“For whatever reason, these organisms can reach the back of the throat, they can get into the bloodstream, they can enter breaks in your skin and you can become infected, even if you’re not around others,” Maldonado said.
When Karen Benavidez’s 3-year-old daughter developed scabs on her face two months into the coronavirus quarantine she didn’t think much of it, until a neighbor told her that the scabs looked like impetigo, a bacterial skin infection.
“I was expecting to have a healthier than normal spring since we were all at home and being so careful,” said Benavidez, who lives in Tallahassee, Florida, and also has an 8-year-old son. “I could not figure out how she could have been exposed.”
When she brought her daughter to the pediatrician, the doctor explained that the bacteria that cause impetigo — typically staphylococcal or streptococcal bacteria — can live in people’s noses and then inadvertently infect the skin through cuts or scratches. Ear infections, pneumonia, boils and urinary tract infections can also be caused by “normal” bacteria that have migrated to the wrong place.
Many infections and infestations also have long incubation periods, meaning it takes a while from the time a child is exposed until they start showing symptoms.
The incubation period for scabies, for instance, can be as long as eight weeks. Lice, too, can take quite a while to populate a head; often it’s just one or two that migrate over, then they have to lay eggs, which incubate for 10 days before hatching and take another 10 to 15 days to grow into adults. Plus, kids may not even notice their lice for as long as six weeks, as it can take that long for them to become sensitized to the lice saliva and start to feel itchy. So if your child has just started scratching their scalp and you discover lice, it’s possible they’ve been there for some time.
PARENTS SPREAD GERMS, TOO
Even though many families are isolating right now, that doesn’t mean they’re completely cut off from outside germs. If parents go to stores periodically, they could be exposed to viruses or bacteria that they then bring back to their kids — even if the parents themselves, who have more well-developed immune systems, never get sick.
“Dad runs to the grocery store and gets something on his hands and comes back in and gives the kid a hug right when he walks in, before he washes — and there’s a kid who hasn’t been around anyone but all of a sudden has a cold,” said Dr. Clay Jones, a pediatric and newborn hospitalist at Newton-Wellesley Hospital in Newton, Massachusetts.
Adults can also shed germs from previous infections and unwittingly make their children sick. Roseola, which commonly infects kids under age 2, causing a high fever and a distinctive pink rash, is caused by human herpesvirus 6 (HHV-6), a virus that can live dormant inside our cells after we recover from it.
The latent virus can then periodically get reactivated, particularly when we’re under stress — like, perhaps, when we find ourselves living through a global pandemic. When this happens, adults can shed the virus and infect their young children; research suggests that many babies actually become infected with roseola via their parents. This same scenario can also occur with coxsackieviruses, which can cause hand, foot and mouth disease, said Dr. Danielle Conley, a pediatrician in Buffalo, New York.
NEW BEHAVIOR, NEW RISKS
Doctors are also seeing medical issues arise because of pandemic-induced changes in our behavior. In late May, the Centers for Disease Control and Prevention reported an outbreak of salmonella linked to backyard chickens, which have become more popular during the pandemic.
“The case count is growing at a concerning rate,” a CDC spokesperson said about the reports through mid-June.
With families taking more hikes than usual, it’s possible that doctors will see more cases of Lyme disease and other tick-borne infections this summer, too.
“We presume that people are outside more, and it’s likely we will see higher numbers than usual, but that remains to be seen as we continue through the summer,” said Victoria McGahan, a public health educator for New York’s Columbia County Department of Health, a county that has among the highest rates of Lyme disease in the country.
Some pediatricians report that they have been seeing lots of rashes recently, too.
“The week before heading into Memorial Day weekend, I saw a huge increase in rashes,” Conley said. Many, she noted, were eczema or atopic dermatitis, both of which flare up during allergy season, especially when kids spend lots of time outside. Conley has also seen a huge uptick in juvenile spring eruption, a sun-induced skin condition that can arise in kids in the springtime.
It’s also possible that some new medical issues are being directly caused by the coronavirus. Dr. Scott Krugman, a pediatrician at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Maryland, said that his hospital has recently treated a surprising number of kids with new-onset diabetes.
“We have admitted a steady stream of children over the past few months,” he said.
Some new research suggests that COVID-19 could increase the risk for new-onset diabetes, so it’s possible these cases are coronavirus-related. As Dr. Sanjoy Dutta, the vice president of research for the JDRF (formerly the Juvenile Diabetes Research Foundation), explained, the cellular protein that is the primary docking site for the coronavirus is found on pancreatic beta cells and other cells involved in metabolism. If the coronavirus infects these tissues, sugar metabolism could be affected, he said, causing diabetes-like symptoms.
While there are plenty of ways kids can get sick right now — even if they’re not leaving the house — most of these illnesses, thankfully, aren’t medical mysteries. Doctors say they add up when considering the way people’s behaviors have changed in the pandemic, and the way common infections and other conditions develop in kids.
As for my family, we finally solved the enigma of “The Rash.” When my husband took our daughter to a pediatric dermatologist, she needed only one look at her face to make a diagnosis. “It’s eczema,” the doctor said. Go figure.
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