Is everyone sick right now? The past couple of months have been a doozy for our family. First, despite our hermit-like efforts, we all got COVID-19. A couple of weeks later, barely out of quarantine, we somehow picked up the gnarliest, most disgusting cold I’ve had since my mental records began. Last week our 18-month old daughter suffered a bout of croup so bad we ended up in the ER. And it’s not just my family. Everyone I’ve talked to lately — friends, colleagues — is dealing with some real nasty germs. So, what’s going on? Have we, as some anxiety-inducing headlines suggested, weakened our and our kids’ immune systems by limiting their exposure over the last two years? Bluntly, is immunity “use it, or lose it?”
In short: not really, thankfully, but — like everything with the human body — it’s complicated.
“Lockdown affected viruses — rather than our immune systems,” reassures Dr. Jennifer Dowd, an epidemiologist, aka a disease detective, at the University of Oxford, and the editor-in-chief of the all-female science site Dear Pandemic.
As Dowd explains it, the whole world has been actively and somewhat collectively trying to prevent illnesses in a way that we’ve never done before. In trying to stop the spread of a specific respiratory infection — SARS-CoV-2 — governments implemented prevention measures like hand washing, masking, and social distancing that, as it turns out, worked pretty well at keeping other respiratory illnesses at bay too.
“We reduced social contact [over the last two years] and the flu went to almost next to nothing,” continues Dowd. “That we actually had control over that was shocking to a lot of people.”
But after two years of being as close to hermetically sealed as we could be, we’re all heading into the wild again. After not having set foot in a restaurant since March 2020, our family has been out to eat in a couple of well-ventilated restaurants. Our little girl had her first indoor daycare experience this spring, a full 17 months after she was born.
And as we and other families change their behaviors — in tandem with a nationwide lifting of many of these pandemic restrictions — it’s leading to more illness circulating. Now, importantly, these viruses we’re coming into contact with aren’t necessarily worse versions than we’ve experienced before. Instead, our bodies are just a bit out of practice at fighting them.
Here’s a brief, hopefully helpful, primer on our immune system.
We’ve heard a lot about antibodies the last couple of years, and more recently phrases like “T cells” and “B cells” have been cropping up. We know intuitively that babies' immune systems are less developed (or “educated”) than adult ones, but also weirdly babies seem to be better at bouncing back from illnesses faster than us grownups. It’s frankly confusing. So I asked Dr. E. John Wherry, the director of the Institute for Immunology at the University of Pennsylvania, to break it all down.
“Your immune system has layers to it,” Wherry explains. “Think about it a bit like LEGO blocks.”
Every person is born with a LEGO box. The basic set of blocks are there, and these blocks are the components of our immune system. The blocks have different names, and do different things, just like LEGO pieces. Our bodies have B cells, T cells, the capacity to make antibodies, as well as innate immunity, which is the immunity handed down over the millennia from our ancient human ancestors. (Immunocompromised children still have a LEGO box, they just have some missing blocks, and depending on which blocks are absent it can cause varying severities of illness).
If you put a LEGO box in front of a grown up, chances are they’re going to be pretty good at building some complex models. But a child needs to be taught how to use the blocks they have in their set, and acquire more pieces — and that is what being exposed to illnesses does, and vaccinations. It helps teach our immune system how to use the LEGO blocks that it has. All of these LEGO building-blocks play an important role in neutralizing and killing pathogens, which are the organisms that produce diseases.
So, why do kids seem to bounce back better than us suffering parents if they start out with fewer LEGO blocks? Well, this is where our immune systems are something of a black box. There are plenty of hypotheses, ranging from a combination of physiological resilience and kinetics in inflammatory responses, to psychology (parents/adults are more capable of wallowing in our misery than kids). Truthfully, we may never know why.
So how does all the science we do know apply to our lives right now?
Well, for one thing, we should all breathe a sigh of relief. Our kids' immune systems didn’t get weakened by the pandemic measures, we just shifted their exposure time frame to various bugs and germs. Basically, we’re all just playing catch up.
“Have our kids had less exposure to certain pathogens and missing initial stimuli they may have gotten a year earlier because we were masked and physically distanced? Probably,” says Dr. Michael Chang, pediatric infectious disease physician at UTHealth Houston and Children's Memorial Hermann Hospital. “But that just means that instead of having RSV, for instance, when they were 1 years old, they’ll get it when they’re 2 years old. Their bodies are still going to fight the RSV.”
Father-of-two Chang says he relates to the general frustration of parents who are in the thick of yet another cold or flu right now. His own family has been relatively cautious throughout the pandemic, but have recently relaxed their mask-wearing and have put their kids back in a lot of in-person activities over the last few weeks. And that bit of freedom has led to an uptick in household chaos and disruption.
“My daughter had a cough a couple of weeks ago, my wife lost her voice, and we’ve had congestion, sore throats, and general fatigue. Everyone has been dealing with that,” Chang continues. “And it’s not just me. I know so many people going through the same thing.”
Frankly, we’ve all kind of forgotten how much it sucks to be ill. And picking up our kids’ sicknesses is one of the million undisclosed job requirements of being a mom. A girlfriend of mine shared that her OBGYN matter-of-factly informed her during her first-ever sonogram that she was going to be more sick in the first few years of her baby’s life than she ever had been. Welcome to parenting!
But it’s insanely disruptive when our kids get sick, and you can’t find childcare, but you still have to work, because the pandemic brought our work lives home, and now we don't stop… Don’t mind me, just having an existential crisis over here, you?
Yet, and I write this somewhat bitterly with a stuffy nose and a Kleenex in hand, we’re actually pretty lucky.
“I would argue the immune system is so effective that it’s actually remarkable that we’re not sick more often,” Dr. Chang reasons. “Viruses, bacteria, mold — they're around all the time. And yet, we’re pretty healthy most of the year.”
So, how should we think about illness going forward, especially as we’re still in the middle of a pandemic?
States and cities are pushing towards removing almost all of the measures that were put in place at the height of the pandemic. Judges are overturning mask-mandates on flights. And unless we see another dramatic spike in case counts or — shudder — another more aggressive, vaccine-evasive variant, the idea of going back to 2020 height-of-the-pandemic living is undesirable to most of us. Perhaps one way to think about it is simply that we should continue to be super vigilant about pathogens (the really nasty bugs) versus friendly microbes (like dirt).
“Friendly microbes are one thing, but there is just no evidence that getting RSV, which is a nasty pathogen, will help you,” Dowd says. “But letting your kid play with the dirt is a much better idea. Then they’re [your kids] more likely to be interacting with friendly microbes that have been around with us for millions of years and they help educate the immune system to identify what’s good and what’s bad, because they’re not pathogenic.”
The answer might be somewhere in between, thinks Dowd, who advocates for a new hygiene movement.
“We used to be really pretty cavalier about all kinds of things like going to work unless you felt really bad. Giving kids a little Tylenol and sending them into daycare or school was not uncommon,” Dowd says. “I'm wondering if those norms have changed enough and working from home we can be more flexible in ways we weren’t before.”
Still, she adds, as a society we need permanent strategies to reduce disease burden — whether that’s mask-wearing during COVID spikes, or even plain staying home when you feel lousy. “I think they’d be pretty big wins for preventing all sorts of infections,” Dowd concludes.
Caroline Modarressy-Tehrani lives in New York City with her 18 month-old baby and husband. She is a writer and Emmy-nominated television correspondent. You can follow her on instagram @caro_mt.