Parents wondering if it's OK to take their kids to the playground as the world implements increasingly strict measures to slow the spread of coronavirus will get this unequivocal answer from Dr. Gregory Cain, a pediatrician in Port Orchard, Washington.
How about a pick-up game of basketball or baseball at the park?
"That's a big no," Cain said.
Walking on sidewalks or trails?
"I think if one is really, really careful and adheres to strict social distancing, I think you can make a case that those are reasonable things to do," Cain said.
But he advises walkers to give others a wide berth, even friends and other families from the neighborhood.
At this time, children's interactions should be limited to siblings and others who are part of the immediate household, according to Cain.
Dr. Niran Al-Agba, a pediatrician in Silverdale, Washington, said her advice is to limit contact to small groups who are part of an immediate circle of family or other contacts. She thinks play around the neighborhood close to home is OK with social-distancing precautions.
"I don't think we should be doing informal gatherings. I don't think people should be going out on play dates," Al-Agba said.
For parents who must continue working outside the home, isolating children from most or all of their peers is not an option, Al-Agba acknowledges. But for families who do have the option, her advice is clear.
"I would never dare judge anyone else's situation, but if you can stay home, stay home," she said. "I'm concerned about our elderly folks. The more the kids interact, the more they're going to spread it."
That's because children who have the disease may not seem sick.
Cain cites data out of South Korea, which has an aggressive coronavirus testing program, that shows 5% of children tested were infected, and of those kids, the majority were asymptomatic. That's highly troubling news, Cain said, considering they could be spreading the illness to grandparents or other older adults who are far more vulnerable to becoming severely ill or dying from COVID-19.
The positive news is that South Korea has a relatively low incidence rate of infection compared with other countries, like Italy, where the disease is rampant.
Data from China suggests that a majority of COVID-19 deaths have occurred among adults aged 60 years and older and among people with serious underlying health conditions, according to the Centers for Disease Control and Prevention.
Early data from the United States indicates the fatality rate in people 65 to 84 years old ranging from 3% to 11%, the CDC reported Wednesday. The rate in people 85 and older ranges from 10% to 27%.Playgrounds as sources of infection
Coronavirus can be transmitted when mucus droplets from a sneeze or cough go airborne and from droplets that land on surfaces. Studies show that without disinfection, the virus persists on some surfaces for days, meaning the neighborhood jungle gym or basketball hoop is a potential source of infection.
Coronavirus in the air remains viable for up to three hours, according to research by a consortium of infectious disease experts recently published in the New England Journal of Medicine. Another source Al-Agba cites indicates the virus can live on plastic and stainless steel for up to three days, and it lingers on wood, glass and paper for four to five days.National 'gut check' needed
For Cain, who is 65 with underlying health conditions, the threat of coronavirus is personal. He also worries about his 88-year-old mother in assisted living, who was a nurse during the polio outbreak of the 1950s. During the epidemic of the disease that causes paralysis, as now, the only way to prevent the spread before a vaccine was developed was to self-quarantine.
Cain became emotional talking about his mom, who was on the front lines of caring for patients in iron lungs (a precursor to ventilators).
"That was a time that Americans really, really pulled together, and yes, people were scared but they did listen to public health and they did isolate themselves because it was the only thing they could do," Cain said.
"I just only hope, she having risked her life for us, we don't kill her. As Americans we have to have a real gut check right now. We are a strong country. We are a great people, but we have to really sacrifice now for one another."
"This is real," Al-Agba said. "We are losing more and more time every day."
That said, Al-Agba urges parents to be kind to themselves as they work to protect their children and others.
"I don't want people afraid to live," she said. "This is about 'good enough' not 'perfect.'"
Cain and Al-Agba offered more guidance for daily living as coronavirus mitigation measures continue.
Are play dates and sleepovers OK?
Cain (laughing): "I'm trying to say something without using profanity. No, absolutely, not at all."
Can my kids bike around the neighborhood?
Cain: Yes, as long as children don't stop to chit-chat with friends, which carries the potential to "exchange touches," Cain said. "I don't know how you draw that line." Depending on the age of your child and their ability to understand and comply with precautions, parental supervision may be required."
Should we stop visiting the grandparents?
Cain: Unless your grandparents, aunties and uncles, and other older relatives already live in the home, skip the in-person visits. Instead, make phone calls, and if the technology is available, schedule virtual visits online. If your relative lives in assisted living or a nursing home, you won't be allowed to visit under current statewide restrictions.
I rely on grandparents for childcare. What about that?
Al-Agba: That's fine as long as grandma is caring for the same few kids she has been caring for. The goal is no new exposures.
Can we still walk my dog? What about dog parks?
Cain: Because dogs snuggle, lick and drool on their human companions, their fur and saliva could be a source of coronavirus transmission. When walking your dog, don't let him interact with dogs that aren't part of the immediate family. Cain advises against bringing your dog to the dog park at this time.
The CDC has not received any reports of pets or other animals becoming sick with COVID-19. "Further studies are needed to understand if and how different animals could be affected by COVID-19," the CDC states.
Should I bring my kids to the grocery store?
Al-Agba: Not unless you have no other option. "The whole family should not be in the grocery store right now."
What if my child is showing symptoms?
Cain: His office is doing almost 100% virtual visits. If your child (or another family member) is showing flu-like symptoms, call your doctor. Do not go to the emergency room or other clinic. Cain said he's been able to give families guidance about treating and monitoring symptoms at home. The goal is to prevent unnecessary trips to the ER and to curtail spreading the disease.
Reach reporter Chris Henry at firstname.lastname@example.org.