Dr. Handy’s Corner — Viruses: Home for the Holidays

As the country is experiencing an unprecedented surge in viral infections, including early starts to RSV and influenza seasons, I’m often asked how to keep young children healthy, especially with the approaching holiday season. Viruses thrive when families are traveling, gathering in groups, and spending a significant amount of time in close quarters, like in each other’s homes and around shared dinner tables. The holidays provide the perfect opportunity for viruses to move between individuals and homes, spreading from grandchild to grandparent and cousin to cousin.

Luckily, during the height of the COVID-19 pandemic while we waited for the arrival of vaccines and treatments, we all “leaned into” practices that infection prevention providers know work to decrease the spread of viruses. During the holidays, these practices are key to preventing transmission of all types of infections and controlling their spread among household members if someone does get sick. As you prepare for the holidays, it is worth considering how to use these key practices in your home.

Prevention: 3 keys to keeping the viruses out of your home

1. Handwashing: The most important factor in reducing the spread of infections is handwashing. Handwashing accomplishes two things. First, the soap or alcohol-containing hand sanitizer physically kills many types of viruses by destroying their outer membrane, called the viral envelope. Second, rubbing the hands together and drying them on a clean towel decreases the number of viruses that remain on the hands, resulting in fewer viruses to leave on other objects that are touched, like doorknobs, refrigerator handles, and television remotes.
   
   One fun way to encourage kids to wash their hands is by using the “glitter experiment.” Have them put some glitter on their hands and do an activity, like leave the room or play with a toy, without washing their hands. Then repeat the process but have them wash their hands before completing the activity. After explaining that viruses are like the glitter, they will quickly understand why washing their hands is important. As they become handwashing “ambassadors” in your home, they can be assigned the task of ensuring that all dinner guests have washed their hands before being seated at the table. 
2. Vaccines: Before traveling or visiting for the holidays, ensure that everyone in your household is up to date on vaccines, including influenza and COVID-19. Many children missed routine childhood vaccines during the pandemic because of hesitation to go to the doctor’s office, shutdowns of healthcare centers, worker shortages, supply chain delays or lack of clear guidance on which routine care to continue. Unfortunately, these lapses in routine vaccination can lead to increases in infections that we are no longer used to seeing much of, like rotavirus and measles.
   
   Kids may not want to get vaccinated, but it’s important not to frame vaccinations as a condition of attendance at an anticipated event. Instead talk to them about how being vaccinated will help shield them from viruses that might also be at the event. Consider using the VEC’s “My Vaccine Activity” book or “Vax Pack Hero” game to help kids learn about vaccines.
3. Masking: We’re all eager to gather again in so many ways — religious services, concerts, office parties, and more. If you are in a particularly crowded place and have concerns that others around you are sick, you can fall back on use of a mask for that interaction as an extra layer of protection. The pandemic has demonstrated that mask use helps reduce the spread of COVID-19, as well as many other common respiratory infections. Masks can physically contain respiratory droplets when someone who is sick is speaking or coughing, and they can also keep some of those droplets from finding their way into your nose or mouth if you have a mask on as well.
   
   The most important principle in selecting a mask is that it fits snuggly over the nose and under the chin and comes close to the sides of the face. A medical-grade or surgical mask functions better than a cotton mask because the fibers are typically closer together, making it more difficult for viruses to get through the fibers. But if a cotton mask is all that is tolerated, especially in a young child, that is better than no mask. N95 masks, which were the topic of many conversations and articles throughout the COVID-19 pandemic, should be reserved for situations in which the person wearing the mask requires the high level of protection provided by the filtration of an N95 mask, such as healthcare workers caring for patients with infections like COVID-19 or measles, or immune-compromised individuals in a crowded indoor space during viral season. Because N95 masks are more challenging to wear for prolonged periods of time, they often lead the individual to remove them, thereby limiting their day-to-day usefulness in most public settings. 

Controlling spread: 3 keys to stopping a virus that has taken up residence in your home

1. Isolation: While the idea of isolation may make you cringe because of COVID-19 measures, your family can benefit from a more relaxed form of isolation when someone is ill. This can be particularly important if your family includes very young babies, elderly individuals, people with complex medical conditions, or people with compromised immune systems. Remember that a mild cold for a healthy child can be quite dangerous to someone else. For example, respiratory syncytial virus (RSV), which is circulating at high levels in the United States right now, can cause a runny nose in a school-aged child, but bronchiolitis in babies. Bronchiolitis is an infection of the lungs that leads to inflammation and congestion of the small airways. Because a baby’s airways are so small, inflammation caused when the virus replicates in those airways can cause limited efficiency in oxygenation, causing shortness of breath and pauses in breathing, called apnea (Find out more about RSV in the “Feature Article” section of the newsletter). This type of situation can quickly require hospitalization. For an older family member or someone with underlying medical conditions, RSV can cause viral pneumonia and significant respiratory distress. 
   
   "Isolation” can mean staying away from others in the home, but it also means staying home until one has recovered:

• “At home” isolation: When someone is ill in the home, simple actions can make a big difference in whether others get infected. For example, if you have space in your home for the person who is sick to have their own bedroom, take advantage of that. If a healthy individual can prepare their meals and keep them out of the kitchen, this will reduce opportunities for the spread of viruses on frequently touched areas of the house, like sink handles, countertops, and the refrigerator door. Finally, if someone has a gastrointestinal illness with vomiting and diarrhea, dedicating a bathroom to that person, if possible, will reduce the opportunity for spread to others until you can thoroughly clean the space. 
• “Community” isolation: Someone should be fever free for 24 hours without the help of medications that reduce fever, like acetaminophen or ibuprofen, before heading back into the community or to another family’s home. Likewise, people with infections should feel better before they go out, meaning their symptoms have significantly improved. This approach is critical for preventing spread of the virus to other homes.

2. Handwashing: This action becomes even more important when someone in the home is ill, especially for the person who is infected. The sick individual, as well as anyone taking care of them, should keep up with good handwashing, particularly after coughing or sneezing and before touching items that other people in the house will be touching. This will ensure that viral particles end up down the drain instead of on doorknobs and television remotes where other family members might pick them up, starting a second round of sick people in the home. 
3. Disinfection: When someone in the home is sick, go beyond your standard cleaning routine and ensure that you are choosing a household cleaner labeled as a disinfectant. Cleaning products, like soap, work to physically remove germs and dirt from your household surfaces; however, disinfectants have been specifically designed to kill viruses and bacteria, typically by causing physical disruption of their structures, thereby preventing them from reproducing. 
   
   When using disinfectants:

• Review the label to make sure the disinfectant you have chosen works against the germs circulating in your home.
• Follow the instructions so that you leave the disinfectant on surfaces for enough time to be effective.
• Take care to wear gloves.
• Don’t mix disinfectants. 
• Store these and other household chemicals out of the reach of children and pets.
• Once you are finished cleaning, remove your gloves and wash your hands with soap and water before moving to your next activity. 

While it is true that viruses and bacteria seek opportunities to make your home their own over the holidays, you and your family can make it harder for them to do so! Happy holidays!

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