With three preschool-age kids, Corinne McDaniels-Davidson is very familiar with illness.
In past years, she’s seen regular outbreaks of hand, foot, and mouth disease; croup; pink eye; and even scabies—not to mention constant colds, coughs, and flus. “It was just rampant and constant,” she says of the revolving door of disease that’s simply a given when kids attend school together.
Then the family locked down in March 2020. In the fall, McDaniels-Davidson, who’s also the director of the Institute for Public Health at San Diego State University, sent her kids back to the preschool, which had adopted smaller class sizes, better air filtration, a strict no-illness policy, and masks for teachers and kids two and up.
The result? A mostly illness-free winter.
Many of us have likely noticed what the data is bearing out: Strict social distancing and masking protocols not only kept us from getting COVID-19—we've barely had the sniffles since the pandemic began. For example, the United States usually sees 45 million cases of the flu each year; this year, it was under 2,000. Other common respiratory viruses, including the rhinovirus that causes the common cold, were also way down. And experts say that could have a real impact on the future of disease and how our kids experience the world.
The COVID-19 pandemic has forced both personal and foundational behavior changes onto kids and families, everything from mask-wearing and social distancing to strict illness policies at schools and workplaces. Health experts say if they’re maintained, those measures could mean more winter seasons without those common childhood illnesses.
“A lot of positive changes came out of this whole experience,” says Susan Little, an infectious disease expert with the University of California—San Diego. “We do a lot of things differently, and that could change everything.”
What history says
To understand how infection rates—as well as our own behavior—might change because of the COVID-19 pandemic, experts will likely look to how past health emergencies radically affected people’s behavior.
For instance, after the bubonic plague—also known as the “Black Death”—killed about 20 million Europeans and 25 million people in Asia and North Africa in the mid-1300s, the practice of quarantining became law in many places to prevent the disease from spreading.
“Efforts to address issues of public health and sanitation became more urgent when it was realized that the plague would be a recurring phenomenon,” says David Routt, a history research associate at the University of Richmond. “The Venetians very famously in 1377 produced legislation to impose quarantines when the plague struck, first for 30 days and then later for the canonical 40 days.” (That’s actually where the word “quarantine” comes from, he notes; quaranta means 40 in Italian.)
The 1918 flu killed about 50 million people worldwide but led to better understanding about how to stop the spread of a virus, including exposure alerts, contract tracing, and quarantining procedures, all of which helped stop future viruses from spreading as rapidly.
That pandemic also launched significant scientific research that contributed to the modern-day understanding of what a virus is, which is a tiny infectious agent that replicates inside living cells, says John Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History. Previously, scientists didn’t know whether viruses were just tiny bacteria or a different kind of organism.
“They didn’t know what a virus was back then, they just knew it was a really small thing that could pass through a porcelain filter,” Barry says.
But advances made after 1918 led to better understanding of other diseases, such as streptococcal pneumonia and other strains of influenza, and how to avoid them, he says.
And after the SARS and swine flu epidemics of the 2000s killed more than 300,000 people worldwide, mask-wearing became normalized in the Asian countries where the disease was most prevalent, after people realized how effective it was in preventing the spread of these diseases.
“[Today] people wear masks in crowded places, such as public transportation and crowded intersections, to protect themselves,” says Stacey Knobler, director of Influenza Vaccine Innovation at the Sabin Vaccine Institute.
How disease will spread in the future
The COVID-19 measures most people took over the past year and half resulted in the almost complete elimination of many different kinds of infections, including non-COVID-19 colds and influenza. And according to Alessandro Sette, an immunologist at the La Jolla Institute for Immunology, whether we maintain those measures will impact how disease spreads among kids in the future.
First, Sette and other medical experts do not expect COVID-19 to completely disappear. “In general, viruses do not go away,” he says. “If we look at history, we’ve been able to eradicate only smallpox.”
But what will likely happen, he says, is that as society achieves herd immunity—which includes the ability to vaccinate children—COVID-19 could become more like a “common cold coronavirus” that won’t be very dangerous to most people who get it. After that, it’s up to parents.
For instance, Davey Smith, a virologist at UC San Diego, says that childhood illnesses that are spread through breathing in viruses from coughs and sneezes, like the flu, would likely decrease if kids continue to wear masks indoors or socially distance in school. But for diseases such as norovirus—more commonly spread by touching things like doorknobs and countertops—parents would need to revert to the old days of COVID-19, back when we were sterilizing every single surface.
“When we stop wiping everything down all the time, then those infections come back, especially for young children who like to taste everything,” he says.
Other health professionals like Maria Sundaram, an epidemiologist at the health research nonprofit ICES Ontario, agree that it will take better health practices—not just vaccines—to help reduce childhood infections in the future. Though the changing nature of viruses makes it impossible to predict exactly how much protective measures will help, she says they will have some impact. And the more measures you take, the more effective they are.
“The effect of mask-wearing, hand-washing, and physical distancing is additive,” she says. “This means that mask-wearing solves problems and prevents transmissions that hand-washing can’t, and physical distancing prevents transmissions that might not be prevented by mask-wearing. So it’s best to use every tool in our toolbox if we can.”
As for worries that fewer infections could weaken children’s immune systems, Little isn’t concerned. They’ll have plenty of opportunities to expose themselves to viruses—playing in the dirt, going to school—so that their immune systems can develop antibodies to prevent future infections. They won’t be exposed as often—but it’ll likely be exposure enough.
“It’s good for kids to develop antibodies, to be exposed to various pathogens they see along the way in life, so they do have protective immunity,” she says.
But will changes last?
Athena Aktipis, a psychology professor at Arizona State University, says even as people relax their pandemic behavior, the realization that a similar health crisis could happen again has forced people to create lasting changes in their thinking.
“It’s opened our minds a little bit to the fact that pandemics are potentially an issue that we'll be facing in the future,” she says. “So I think a lot of people are going to continue to be more cautious when they're traveling internationally or interacting with strangers.”
Aktipis has studied how our thinking has changed over the course of the pandemic and found that people have actually grown more community-minded, which can also extend to thinking about others when taking precautions to not spread disease.
“Our ability to collectively navigate this and agree on norms is going to be a big transition,” she says. “But if we're able to do it effectively, I think we'll both be able to recover better from all of the social and economic fallout from the last year and weather whatever comes next.”
That might be why some surveys have shown a large majority of Americans say they’ll continue to wear masks in public, even after the pandemic. But even if they don’t, Knobler says other changes such as avoiding crowded theme parks could still make a big difference in whether viruses are as easily passed around among children.
And even if your kid does go to a crowded Taylor Swift concert—but still wears a mask—“we’d anticipate still seeing a major change in influenza outbreaks in the future,” she says.
COVID-19 might become less infectious and dangerous, but it likely isn’t going anywhere. That’s why the biggest hope for the future of disease might be children themselves.
“I think this is going to spark a new generation of epidemiologists and doctors,” says Benjamin Seitz, a psychology researcher at UCLA. “Research has shown that major life events and significant societal moments can shape the career trajectories of children and young adults.”
So in the end, the future of infection might not be influenced by mask-wearing and social distancing. The biggest impact might come from all those children who’ve been inspired to become future health heroes.