How Are My Kids Still Getting Sick in Lockdown

"As cities and states reopen slowly after coronavirus lockdowns, more people are stepping out, cautiously, into a changed world. If they are being careful not to spread disease, they are also in masks.

And that means many of us are missing a small but important social lubricant: the smile.

In anxious times, we may want to put neighbors, mail carriers, store clerks and others at ease with a casual smile. But if smiles can’t be seen, how do you greet people? How do you reassure them? How do you flirt? Are there workarounds — a squint, a head tilt, a raised eyebrow?

It’s a conundrum that is stumping many people who want to be both socially responsible and friendly. Coco Briscoe, 38, a comedian in Los Angeles, wears a mask to walk her dog, Daisy, and has been thinking about how to show friendliness to passing strangers.

“It’s like you’re both staring at each other, and you’re smiling, but they can’t see that you’re smiling,” she said. “So it’s just a very awkward interaction with people, and I think it’s going to be that way for a while.”

Dr. Josh Trebach, 30, an emergency medicine physician at Johns Hopkins Medicine in Baltimore, misses the nonverbal cues that used to make patients feel comfortable. “I would want to smile to assuage someone’s anxiety, show interest or convey warmth to let a patient know that they could trust me,” he said. “Suddenly, all of that was gone.”

“I’m almost a little bit over-expressive now,” Dr. Trebach added, “to try and compensate for the mask.” Of course, not everyone is an extroverted smiler, and some people find face coverings liberating — including women who are tired of being told to smile on the street. But masks not only hide grins; they can also make it harder for people to display a whole range of emotions including discomfort, dismay or disdain.

Facial expressions of all kinds are a very important component of human interaction, said David Matsumoto, a psychology professor at San Francisco State University and the director of Humintell, a research company that trains people to read nonverbal cues.

When we wear masks, “we’re missing a major piece of that entire communication package,” he said. But he added that people could adapt their body language. They can nod, for example. Or wave.

Jasmine Gregory, 29, of Winston-Salem, N.C., said that wearing a mask had prompted her to put in a little extra effort. “You just make more of an attempt to laugh, show your emotions and say what you’re thinking, rather than just listening and nodding,” she said.

Ms. Gregory, a lawyer focusing on family and juvenile law, feels the limitations of masks acutely when she is trying to put clients at ease as they testify in court, she said. That is already a scary experience for many people.

“There’s a lot of reassurance on my end,” she said. “I’ll be actively smiling so they can tell by my eyes that I’m encouraging them and telling them: ‘You’re doing just fine.’”

Not all smiles are the same, and some consider the so-called Duchenne smile to be the gold standard. Named after Guillaume Benjamin Amand Duchenne, a French neurologist who studied it, it’s the kind of smile that lights up the whole face, engaging not only the zygomaticus major muscle to lift the corners of the mouth, but also the orbicularis oculi to raise the cheeks and squint the eyes.

The typical social smile, by contrast, is a lips-only display given to strangers and acquaintances. But its importance should not be ignored, Dr. Matsumoto said. A genuine Duchenne smile can light up a room, but social smiles do a lot of work in daily interactions.

Because Duchenne smiles hit the eyes, they are often still discernible through masks. Social smiles are the ones we lose when our mouths are covered.

For many, masks can make life especially difficult. Many deaf people rely on visual cues, like the movement of another person’s lips, to communicate. Masks can hide that and muffle speech (but versions with a window of clear plastic can help). Racism can also make mask-wearing a fraught experience; some black men have voiced concerns about whether they will be harassed or profiled if they wear a face covering in public.

But masks are essential for slowing the spread of Covid-19, especially indoors or in large groups, experts say. So while some might struggle with this new glitch in communication, it’s worth getting creative about signifying warmth.

• Frequently Asked Questions and Advice Updated June 24, 2020
  

  • What’s the best material for a mask? Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.

  • Is it harder to exercise while wearing a mask? A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

  • I’ve heard about a treatment called dexamethasone. Does it work? The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

  • What is pandemic paid leave? The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

  • Does asymptomatic transmission of Covid-19 happen? So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

  • What’s the risk of catching coronavirus from a surface? Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

  • How does blood type influence coronavirus? A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

  • How many people have lost their jobs due to coronavirus in the U.S.? The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

  • What are the symptoms of coronavirus? Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

  • How can I protect myself while flying? If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • What should I do if I feel sick? If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

“Other nonverbal cues can compensate for the lack of a social smile,” Dr. Matsumoto said.

Ms. Gregory, for example, has been wearing her hair back so people can see her eyes. “When you make eye contact with someone and you feel happy or warm toward them on the inside,” she said, ”I think that creates the true, sincere smile that is more likely to spread across your face.”

Dr. Trebach has been sitting down with his patients more, to put them at eye level. He also takes more time to make small talk or share pictures of his cats, Mako and Bucket.

“Even though we’ve lost the bottom halves of our faces, other things, I’ve noticed, have become stronger in terms of communication,” he said. “So for the sake of my patients, I had to become attuned to those other things, like body language or eyes.”

Ms. Briscoe has been relying more on verbal cues, like saying “Hello!” or “How are you?” These days, she said, strangers seem much more willing to indulge in small talk, as if they are starved for human contact.

And she has considered other ways to get her message across. Recently, she went for a walk with Daisy and saw a cute neighbor. “I realized I raise my eyebrows and widen my eyes to signify a smile,” she said. “Next time, I’ll wink and see if he winks back.”" -The New York Times

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