The Boy in the Bubble

This started as a reply to the comment for a post earlier today, but became quite long, so I thought I’d post it on the front page…

Shelby asks

The question I have (and I honestly don’t know) is when is a virus no longer contagious? Johnny should not be allowed in school until he’s not going to spread his nasty little germs to every kid in a 10 mile radius. I think schools are vigilant about fevers because a fever means that a kid is really sick and not faking it, and one sick kid means a lot of sick kids in a school environment.

I think there are a number of issues to consider. The first is the issue of public health. Certainly, none of us can afford either economically or socially, to be “the boy in the bubble”. Colds & illness are facts of life. Schools might be much less infectious environments if all sick children stayed home during the time of being infectious, but a direct quote from emedicine.com shows that it’s just not practical to be out of school for a month at a time for each cold:

“RV is shed in large amounts, with as many as 1 million infectious virions per milliliter of nasal washings. Viral shedding can occur a few days before cold symptoms are recognized by the patient, peaks on days 2-7 of the illness, and may last for as many as 3-4 weeks. “

The second issue is one of practicing good medicine. It is not good medicine to prescribe antibiotics for viral infections, which are the majority of febrile illnesses particularly for school aged children.

The policies of the school put issues 1 & 2 in opposition with one another by encouraging parents to pressure physicians for treatment so that their kids can go back to school, and the parents can go back to work.

In the meantime, the best way to prevent the spread of colds and flu (and smallpox for that matter) is to practice not only good handwashing, but TEACHING KIDS TO COVER THEIR NOSES AND MOUTHS when they sneeze and cough. I had a nine year old girl coughing and hacking on me today making no effort at all to cover her mouth and her mom not seeming to care or even notice, while on the other hand I see well taught 18 and 24 month old kids doing by habit.

In the real world, people need to balance personal needs and staying healthy with the need to attend work and school. I am still going to practice good, scientific medicine regardless. Asking me to prescribe antibiotics because Johnny is missing out on his education will neither reduce the impact nor duration of his viral shedding.

Leave a Reply

Your email address will not be published. Required fields are marked *