Children under the mask: What is the solution to the hidden worries?

 　　During the three years of the COVID-19 epidemic, the living conditions of most people in the world have been affected to varying degrees. If there is any way of life that has become the common memory of the world under the epidemic, it is probably the masks. From being unable to bear the tightness of breathing, to adapting to this "shield" that is beneficial to block the virus, to gradually becoming "social etiquette" and "another piece of clothing", people's emotions towards masks have changed several times and have mixed flavors.

　　For adults who only started to wear masks as a daily "wear" in 2020, various emotions such as incomprehension, resentment, and reflection are all caused by "contrast"—in a kind of willing bondage, nostalgia for the past that can breathe freely years. But for children, especially those born during the epidemic, wearing a mask has become the only correct thing in cognition. Sometimes, social media and short video platforms will record some cute babies asking innocently: Why didn’t the parents in the photos in the past wear masks? Are masks clothes for the face? Funny and sad.

　　In addition to emotions, masks that lie between the real world and the sensory world, while trying to protect children from new coronary pneumonia or other respiratory diseases transmitted by droplets, have actually caused many new and unpredictable situations. trouble.

"like wildfire"

　　At the end of October, winter is approaching in the northern hemisphere. The new crown epidemic is still bouncing around the world from time to time, and more "old problems" are also wrapped in various butterfly effects of the "new crown era", sweeping in with the advent of winter.

　　These days, many children's hospitals in the United States are suffering. A childhood respiratory syncytial virus (RSV) is spreading like crazy. For a while, the embarrassment of running out of medical resources and the anxiety caused by the surge in the number of cases continued to spread.

　　RSV is not a novel infectious disease. Similar to the cold, an old friend of human beings, RSV is a relatively common respiratory disease that is prevalent every year. Under normal circumstances, it is also "non-toxic and harmless" like the common cold, and it will gradually recover after symptoms such as coughing, sneezing, runny nose, and fever last for one to two weeks.

　　But when the patient is a child or infant with a weakened immune system, RSV can sometimes cause dehydration, bronchitis or pneumonia. Because the airways of children and infants are more immature and narrow, the inflammation and sputum caused by RSV may cause airway blockage; if not treated in time, it will be life-threatening. Therefore, whenever a child has a high fever or symptoms are severe, even if the hospital does not have a special treatment for RSV or related vaccines, parents are more inclined to send them to the hospital to relieve the pain and seek peace of mind by relieving symptoms.

　　Masks are an important factor in isolating children from normal exposure to RSV.

On November 25, 2021, Stuttgart, Germany, a nurse is caring for a patient with respiratory syncytial virus

Electron micrograph of respiratory syncytial virus (RSV) from the US Centers for Disease Control and Prevention in 1981

　　Normally, the peak period of RSV epidemic is in January and February, and the time from late October to early November is far from the time when RSV is generally popular in winter in previous years. However, many children's hospitals in the United States have made it clear that because of the early arrival of the outbreak period, the hospitals "have been overwhelmed by patients" and "need support" very much. The chief physician of pediatrics with rich experience and more than 25 years of practice even said: In such a long career, there has never been a year, even in January and February when RSV is the most popular, I have seen so many patients who urgently need to be admitted to the hospital. Son.

　　Statistics confirm the doctor's feelings: according to the testing data of Children's Hospital of Los Angeles, the peak positive rate of RSV was only 24% last winter, but now, the traditional peak period has not yet arrived, and the positive rate has reached 31%-this seems to be just the beginning.

　　In the increasingly crowded medical environment, Children's Hospital of Connecticut, which has been severely affected by the disaster, has requested the National Guard to come to support through the governor and the Commissioner of Public Health, so as to improve the hospital's nursing capacity as much as possible to deal with the flock of children. Similar news came from children's hospitals in Los Angeles, South Carolina, Illinois, and Orange County in Southern California. Some critically ill patients have to wait at least 36 hours before they can be arranged in the ICU and receive appropriate medical equipment for assisted treatment.

　　"Like wildfire," an emergency room doctor in Orange County described the current scene of children's hospitals being overcrowded and patients surging. This urgent and heavy fire is licking people who are caught off guard uncontrollably.

Is it all to blame?

　　Why has RSV, which has always had a fixed outbreak cycle, a low rate of severe cases, and calm medical resources to deal with it, coming aggressively ahead of schedule this time?

　　Many epidemiologists associate this "accident" with the COVID-19 pandemic and a series of changes in living habits triggered by it. In past experience, RSV is relatively "easy to get" in life: if a mother is infected with RSV during pregnancy, she can easily get through this "little cold" with the resistance of an adult, and the baby in the womb will also have some Immunity; after birth, babies will always experience a winter of RSV in January and February, and gradually build up immunity; after 2 years old, with the improvement of their own resistance, they have "handled with RSV" in the past Most children will build up immunity to RSV and other common common epidemic diseases; even if they are infected again in a certain winter, they can recover by drinking plenty of water and resting more, without seeking help from the hospital.

　　The usual way of learning language by imitating lip and tongue movements is not working.

　　However, the epidemic of the new crown pneumonia virus has broken the relatively friendly and relaxed temptation between the virus and the human body. During the epidemic, no matter how many times the epidemic prevention policy has been revised, one indisputable fact is that people are keeping social distance as much as possible. Whether it is actively or passively choosing to stay at home as much as possible, or having concerns or screening for intimate social activities after gradually letting go, the scene of children playing together in those communities almost disappeared in the first two years of the new crown pneumonia virus epidemic , which makes children—especially young children born after January 2020—completely lose their natural contact and gradually adapt to RSV.

　　Masks are an important factor in isolating children from normal exposure to RSV. As the most daily way of epidemic prevention, at the beginning of the new crown pneumonia virus epidemic, whether it was the initiative of the people to wear masks for children to prevent them from being exposed to respiratory viruses, or the "two-year-old and above" proposed by professional organizations such as the American Academy of Pediatrics when schools reopened Health guidelines such as "Every child should wear a mask" allow masks to block not only the "target virus" but also other respiratory viruses.

　　Now, for the United States, the various measures taken against the new crown pneumonia virus are coming to an end. The "pandemic" has exited, children have returned to school, and restarted intimate play, but the immune protection that should have been subtle cannot be recovered. Therefore, although these children in the "new crown era" have grown up, their immune system against RSV is still a blank slate. After everything "restarts" this winter, they have to collectively make up this lesson.

Various signs are posted outside the entrance to the emergency room at Providence St. Joseph Hospital in Orange County, California, U.S., on November 1, 2022

disappearing feedback

　　"There are more (RSV) patients than before the pandemic." Today, while major children's hospitals in the United States are struggling with RSV, they are also preparing for the expected upcoming wave of influenza. It is self-evident that the "triple epidemic" of new coronary pneumonia, RSV and influenza has brought enormous pressure to the medical system.

　　Getting vaccinated might be a good way. Even if there is no specific vaccine for RSV, both the new crown vaccine and the flu vaccine have the function of stimulating autoimmunity and protecting children to a certain extent. Avoiding large-scale outbreaks of infection through vaccination has eased the pressure on medical resources under the "triple epidemic", which has become the best choice at present.

　　This extremely busy winter will eventually pass. But for three years or more under the epidemic and masks, for children who have just begun their long lives, some secondary effects more subtle than infection are slowly emerging: According to reports from the pediatric departments of many hospitals, about 3— The number of consultations on language development issues for 5-year-old children generally increased by about 20%.

　　One reason is that teachers wear masks, making language learning difficult for children. The sound made through the mask is more likely to be blurred, and there are deviations. After covering the face, the "heard sound" and "lip movement" are completely separated. The usual method of learning language by imitating lip and tongue movements fails. Yes, many children develop language delays. In addition to masks, social distance reduces the interaction between people. Children can only be confined to small families and lack socialization during the critical growth period, which is not conducive to language learning.

　　Even if children have passed the language barrier and can understand and communicate through pronunciation like adults, the facial expressions of the other party covered by masks will also allow children to face new crises in understanding and recognizing emotions. Under the cover of the mask, it is difficult to see a smile, and it is difficult to recognize various emotions such as anger and sadness, and it is impossible to understand and process these emotions. In the view of psychologists, the loss of this "implicit feedback" blocks the important communication channels between children and teachers, parents and peers. In the more critical period of growth, it is still unknown what changes this loss will bring to personal life and group relationships in the future.

　　The new crown pneumonia virus and its chain reaction are continuously affecting the study and life of one generation or even several generations. The protection of masks is a double-edged sword, and the efficacy of vaccines often has hidden concerns... In the new winter and many unpredictable challenges, in addition to guaranteeing the right to breathe freely, human beings have to think about more propositions of harmonious coexistence with nature.