Following two years of lockdowns, medical professionals are noting that illnesses like Strep A, respiratory syncytial virus (RSV), colds and flu, which are usually much more prevalent in winter, are occurring more steadily throughout the year.
There are currently around 650 children under five in hospital with flu in England, which is 44 per cent more than at the same time in 2019-20, while there are more infections with RSV than usual.
The Royal College of GPs has reported increased rates of ‘influenza-like illnesses, respiratory conditions and the common cold’, with cases of strep, tonsillitis and upper respiratory infections ‘above the seasonal average’.
‘There has been more than a rise in infectious diseases, it's an epidemic,’ says Dr Jack Singer, consultant paediatrician and member of the Paediatrics and Child Health Section Council at the Royal Society of Medicine.
POST-LOCKDOWN
While it is normal for a child to have eight or more colds a year, Dr Singer says rates during lockdowns were significantly reduced.
‘We hardly saw any. It was amazing. Common colds, diarrhoea, fever, ear infections, throat infections, coughing and vomiting were as rare as hen's teeth.
‘But when children all went back to school together, it was like when a child moves to a new school or changes classes and are sick for the first six months because they’re exposed to everyone else's bugs for the first time,’ he says.
This may account for the rise in seasonal illnesses outside their usual time periods.
‘The seasonal viruses that we normally see have all been mixed together, and we’re seeing compressed what would ordinarily have been spread out over a year,’ Dr Singer explains. He adds that following Covid-linked border controls, another contributing factor to the spike in infectious diseases could be renewed air travel. ‘People are flying off to places where it is the opposite time of year, so they are exposed to the opposite seasonal viruses, and bring them back.’
STOPPING THE SPREAD
Early years practitioners will be no strangers to ensuring high levels of hygiene, and Dr Singer says this is the most efficient way of protecting children from germs.
‘Washing your hands thoroughly, standard hygiene really, in nursery settings and primary schools is important. Everyone knows that. You can't really over-sanitise,’ he says. Ultimately, though, ensuring children stay bug-free isn't desirable or realistic. ‘They’re all sitting next to each other and coughing in each other's faces. There's not much you can do except expose them, so they build up their own antibodies against everybody else's germs. We have to realise how important it is to develop immunity, and it's best to do that gradually, at school or nursery.’
BOOSTING IMMUNITY
Sleep, exercise and diet are generally cited as the best ways to support the immune system.
Dr Singer says good sleep is certainly important. ‘That's why there is a term for it. People say they are “run down”, which makes them more susceptible. It's kind of non-scientific terminology, but if it weren't true, it would have died out long ago. It's very hard to quantify, but it's largely common sense.’
Encouraging children to get outside is also vital, regardless of the time of year.
Although exposure to cold air reduces the immune defences in our noses, making it easier for us to be infected by airborne viruses, spending long periods indoors with others will also increase the spread of germs, as Covid proved.
Furthermore, the role of Vitamin D, which our bodies create from sunlight, as an immune function regulator means increased time outside will help bolster immunity.
Xanthi Maragkoudaki, a registered nutritionist working with the Early Years Alliance, says many vitamins and minerals which support the immune system can be easily acquired through diet.
‘For childcare providers, nutrition plays a big role when it comes to immunity,’ she explains.
‘I always advise five different colours in a lunch. It's not as difficult as it sounds. Zinc is very important for immunity. You find it a lot in red meat and in poultry, and in some nuts, but as we can't have them in nursery, including protein sources in the menu is important. For vegetarians, you provide pulses like beans and lentils. Iron can also help. It's not that we need a lot of iron all the time, but good stores help fight viruses and bacteria. Again that is red meat, even just once a week would be sufficient, and then some lentils, eggs, beans, and Vitamin C like tomatoes, peppers or lemon to help with absorption.
‘Some studies have shown that even after getting a cold, Vitamin C and zinc will shorten its duration. I prefer talking about potential food sources to supplementation with children, but there were even studies that showed Vitamin C and zinc supplements stopped Covid-19 spreading to the lower respiratory tract.’
FUTURE PROTECTION
There is some light at the end of the tunnel.
Dr Singer says while rates of seasonal bugs remain high, there is every reason to assume immune levels will return, and children will not be unduly affected in the long term. He adds, ‘It's starting to taper off, and we’re starting to see the usual cough, cold and ear infection rates creep back. RSV has been a big headache and continues to be, but overall we’re gradually coming back to normal.’
CASE STUDY: Little Adventurers
Ginny Andreas, manager at Little Adventurers Nursery in Upminster, says staff have been particularly cautious about the spread of germs this winter after the rise in Strep A cases.
In general, she says, the nursery works hard to limit the spread of bugs. Hand sanitiser and handwashing sinks are provided in all rooms, with a sink outside and sanitiser in the reception area for parents. Pictures of good handwashing practice are up in all rooms.
‘Since Covid, we don't just ask children to wash their hands, we go with them and talk to them while they do it, make sure they use soap and teach them the routine of wet bubbles, rinsing and drying,’ Andreas says.
‘If children have runny noses, we have been very clear with staff that they need to wipe them immediately and then wash their hands, particularly in the baby room, or you end up with runny noses all over the place.’
No shoes or buggies are allowed in the baby room, and staff sanitise all surfaces on a daily basis, and tables and chairs after each meal.
Staff are also committed to helping children's developing immune systems.
‘We closely monitor sleep time, and ensure a balanced diet, with meals prepared on site by a cook and analysed by a nutritionist, so we all know what foods groups children need,’ Andreas explains. ‘We do something called “wake and shake”, with exercise before nine o’clock, and encourage a lot of outside play to get fresh air into the lungs and adhere to the guidance of 180 minutes of physical exercise a day. I also encourage staff to have windows open. We have underfloor heating, so the rooms maintain their temperature, and it's nice to have that air circulating.’
Antibiotics
Antibiotics are used to treat or prevent bacterial infections that:
- are unlikely to clear up without antibiotics
- could infect others
- could take too long to clear without treatment
- carry a risk of more serious complications.
Antibiotics work by killing bacteria or preventing them from spreading, but they are not effective against viral infections, such as colds, flu, or most coughs.
Antibiotics are no longer routinely used to treat:
- chest infections
- ear infections in children
- sore throats.
- This is because:
- many infections are caused by viruses, so antibiotics are not effective
- antibiotics are often unlikely to speed up healing and can cause side effects
- overuse on mild conditions may make them become ineffective for serious illnesses.