In early April, everyone at our clinic here in Nashua, New Hampshire received an email saying, “Effective immediately, masking is optional.” This was cheered, and they all took off their masks. We were teary eyed, and commented on how wonderful it was to see smiling faces after 3 long years of wearing masks throughout our careers.
CDC declares Covid-19 a “public health emergency”. May 11, 2023Along with many policies related to the pandemic. How will this play out in terms of who still wears masks, how many children and adolescents continue to receive the required boosters for Covid-19 vaccines, and how often doctors recommend getting tested for Covid-19?
A brief look back
In the year On January 31, 2020, US Health and Human Services Secretary Alex Azar declared the COVID-19 virus (coronavirus disease 2019) a public health emergency and ordered all US citizens returning from Wuhan, China, to self-quarantine for 2 weeks. In the year On March 11, 2020, the World Health Organization declared the Covid-19 outbreak a global pandemic.
We all remember what followed. Many people have been hospitalized, intensive care units are fully booked, and far too many patients have died (table).
Our response to the outbreak was heroic: rapid diagnostic tests were distributed quickly, personal protective equipment (PPE) was maintained and vaccines were developed in record time.
Over the past 3 years, pediatricians have done their best to help patients and parents through the pandemic. We eagerly wanted to wear masks and vaccinate to protect ourselves and the sick from this terrible disease – after all, we hope that the epidemic will end soon. Unlike the 1918 influenza pandemic, which lasted for 2 years, the Covid-19 pandemic is now winding down after 3 very long years. We’re all excited about the effects of unmasking and the CDC’s relaxation of Covid-19 policies.
We have now revealed it officially. I made several observations. First, it took some time to get used to the “uncovered” experience. I find myself emotionally reaching for the inevitable mask. The bridge of the nose is slowly getting rid of the chronic reddening from wearing the mask every day. I am so happy to see the faces of my patients (and their parents) again. Despite hearing aids, I continued to have difficulty hearing responses to my questions during the outbreak, as voices were muffled by masks and I could not rely on reading lips to aid my understanding. Now I rarely need patients or parents to repeat themselves.
After that office email, large numbers of employees continued to wear masks. When asked, many said that the medical office is a high-risk environment, and that wearing masks has prevented most respiratory infections in the past 3 years. Many of our patients also continue to wear masks. Ironically, one of our employees, who was fully vaccinated and boosted, contracted Covid-19 2 days after we issued masks. Was this a coincidence or the result of masking being optional?
Although we would all like to return to “normal” pre-pandemic pediatrics, in reality, I fear that COVID-19 has changed pediatrics forever. The post-pandemic includes many precautions to protect pediatric office workers from covid-19 and other respiratory infections, many of which seem very dangerous (we’ve had a bad flu season, and there’s currently an outbreak of strep pharyngitis here in New Hampshire). Wearing a mask when caring for children with acute respiratory illness is prudent, and it’s a practice I expect many providers and staff to continue for a long time. And we will never run out of PPE again.
In general, we are fortunate that pediatric patients do not experience serious illness when they contract Covid-19. This was certainly not the case with the children’s parents and grandparents, and all too many families experienced epidemic-related deaths. A recent study suggests that young children undergo T-cell activation when exposed to seasonal coronavirus infections other than Covid-19.2
Additionally, despite the support of the American Academy of Pediatrics (AAP) and the CDC, many young children were not vaccinated against Covid-19 after the FDA approved the vaccine for use in children, ultimately allowing it to be given to younger people. Like 6 months. In the year As of March 1, 2023, according to the CDC, 68% of children aged 12 to 17 had received at least 1 Covid-19 vaccine, compared to 39% of children aged 5 to 11 and only 12%. Children aged 6 months to 4 years (Fig).3 This vaccine hesitancy is no doubt related to the perception among many parents that the COVID-19 vaccine was rushed to market and has not been fully tested like the regular vaccines that children receive.
After the Covid-19 public health emergency, there will be no government-distributed free Covid-19 test kits, and antiviral drugs may require insurance approval. Hopefully, now that virtual medical visits have been embraced by patients and providers, insurance companies will continue to pay for these visits on par with office visits. We’ll just have to wait and see.
1. Interim mortality from Covid-19: focus on 0-18 years. CDC. April 12, 2023. Updated April 19, 2023. Accessed April 19, 2023. https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Focus-on-Ages-0-18-Yea/nr4s-judge3
2. Humbert M, Olofsson A, Wullimann D, et al. Functional SARS-CoV-2 cross-reactive CD4+ T cells established in early childhood decline with age. Proc Natl Acad Sci US A . 2023;120(12):e2220320120. doi: 10.1073/pnas.2220320120
3. American Academy of Pediatrics. Trends in pediatric and covid-19 vaccines. March 1, 2023. Accessed April 19, 2023. https://downloads.aap.org/AAP/PDF/Child%20Vacinations%20Report%20US%20Cumulative%20and%20Weekly%203.1.2023.pdf