Jennifer Gershman, PharmD, CPh

Halloween will likely look different this year as the coronavirus disease 2019 (COVID-19) pandemic persists throughout the United States. Many families look forward to Halloween festivities, and there are a variety of creative and safe ways to celebrate while reducing the spread of COVID-19.

This is a great time for health care professionals to educate the public and remind everyone about the importance of masks, physical distancing (staying at least 6 feet apart), and frequent hand washing. Individuals should not let their guard down during Halloween, as it is critical to prevent the spread of COVID-19. It is also an important time to remind the community that everyone’s actions have a direct impact on the health of others.

Both the CDC and American Academy of Pediatrics (AAP) have issued guidance on Halloween activities, and health and safety measures.

 “The decisions we make on this 1 day can have a ripple effect on our family members.We can find safe ways to celebrate and create magical memories,” said Shelly Vaziri Flais, MD, FAAP, pediatrician and AAP spokesperson in a prepares statement.

Evidence demonstrates that even small family gatherings can lead to COVID-19 spread when appropriate safety measures are not followed.

Hosting a virtual costume party is a great way to stay connected with family and friends.2 Pumpkin carving, decorating, and a Halloween movie night with members of the same household can be fun for all ages. Creating a Halloween themed scavenger hunt by hiding treats around the house is also sure to be a big hit.

Outdoor activities with family and friends that are not in the same household should involve physical distancing, mask wearing, and frequent hand washing.

 Drive through events are being advertised on social media as a safe way to experience Halloween without getting out of the car, and may even have curbside treats and pumpkins. Attending an outdoor costume parade can be a fun way to celebrate Halloween, as long as all health and safety measures are followed.

 If visiting a pumpkin patch, it’s important to wash hands or use hand sanitizer with at least 60% alcohol after touching surfaces and pumpkins.

 Crowds should be avoided, and individuals should not attend indoor events such as haunted houses, as these can increase the spread of COVID-19.

Individuals should avoid traditional trick-or-treating, and residents should sit outdoors wearing face coverings if they would like to hand out individually packaged treats.

 Families should bring hand sanitizer and use frequently while trick-or-treating, and wash their hands after returning home. All individuals aged 2 years and older should wear adequate face coverings, as costume masks are not sufficient against COVID-19 transmission, if trick-or-treating.

It also is important to offer non-candy options for children with food allergies, and in doing so, households can participate in the Teal Pumpkin Project.

 All families should wipe down treat bags and keep candy in quarantine for a few days as an extra precaution.

CDC. Coronavirus disease 2019 (COVID-19): Trick or treating and other Halloween activities. Updated October 9, 2020. Accessed October 14, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/halloween.html

AAP. American Academy of Pediatrics offers tips for a safe Halloween during pandemic. Published September 22, 2020. Accessed October 14, 2020. 

https://services.aap.org/en/news-room/news-releases/health--safety-tips/american-academy-of-pediatrics-offers-tips-for-a-safe-halloween-during-pandemic/

Schwartz NG, Moorman AC, Makaretz A, et al. Adolescent with COVID-19 as the Source of an Outbreak at a 3-Week Family Gathering — Four States, June–July 2020. 

Articles

Many families look forward to Halloween festivities, and there are a variety of creative and safe ways to celebrate while reducing the spread of COVID-19. 

Halloween Activity Health Tips During the COVID-19 Pandemic

As the coronavirus disease 2019 (COVID-19) pandemic persists, families with substance abuse disorders face many challenges.

According to the CDC, stress during COVID-19 can lead to an increased incidence of substance abuse.

 Mental health and substance abuse can take a large toll on families, especially children as many school resources are not currently available. 

Sesame Street in Communities (SSIC), in partnership with DisposeRx, has expanded its parental addiction program with a new webinar series for the health care community including child and family therapists, first responders, community leaders, pharmacists, physicians, and other service providers.

 The goal of the webinar series is to provide new resources and tools for the health care community, and to serve as a support system for children affected by parental addiction.

Last fall, 

SSIC introduced Parental Addiction resources

 for families featuring Karli, a 6-year-old 

 Muppet whose mother struggles with substance abuse and addiction.

 The new workshop for the health care community will feature 4 webinars with the first beginning July 29, 2020. Entitled “The Child’s Voice: How Parental Addiction Affects Young Children,” the first webinar presents Sis Wenger, president and chief executive officer, National Association for Children of Addiction, to discuss strategies to offer support and care.

Three additional webinars are planned and the series will be presented monthly. The webinars are free to viewers and available on any platform.

A version of this article was originally published by Pharmacy Times. Visit 

CDC. Coronavirus disease: Alcohol & substance use. CDC website. 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/stress-coping/alcohol-use.html

. Updated June 12, 2020. Accessed July 28, 2020.

Sesame Workshop Launches New Webinar Series on Substance Abuse and Parental Addiction to Help Providers Support Children and Families [news release]. New York, NY, and Sanford, NC; July 29, 2020: Sesame Street in Communities and DisposeRx. 

https://disposerx.com/press.show/42/Sesame-Workshop-Launches-New-Webinar-Series-on-Substance-Abuse-and-Parental-Addiction-to-Help-Providers-Support-Children-and-Families

Sesame Street in Communities (SSIC), in partnership with DisposeRx, has expanded its parental addiction program with a new webinar series for the health care community. 

Sesame Workshop Offers New Webinar Series for Health Care Community

Current evidence demonstrates that underlying health conditions can put people at risk for severe coronavirus disease 2019 (COVID-19). As more evidence becomes available, the list of underlying health conditions that are risk factors for COVID-19 complications (e.g. hospitalization, ICU admission, mechanical ventilation, death) continues to grow.

The CDC revised the list of conditions July 17, 2020 to include cancer as 1 of the risk factors for severe COVID-19.1 Individuals at any age with the following underlying medical conditions are at increased risk of severe COVID-19: cancer, chronic kidney disease, chronic obstructive pulmonary disease (COPD), immunocompromised state from solid organ transplant, obesity (body mass index of 30 or higher), serious cardiovascular conditions (e.g. heart failure, coronary artery disease, cardiomyopathies), sickle cell disease, and type 2 diabetes.

The CDC study estimated county-level prevalence of selected conditions (COPD, heart conditions, diabetes, chronic kidney disease, obesity) associated with severe COVID-19 illness among U.S. adults 18 years and older using survey information from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and U.S. Census population data among residents in 3142 counties in all 50 states and the District of Columbia.2A total of 437,500 individuals participated in the 2018 BRFSS telephone survey. The study revealed that 40.7% of US adults had at least 1 of 5 underlying medical conditions that would put them at risk for severe COVID-19. Among 3142 counties, the median estimated county prevalence of individuals having any underlying health condition was 47.2%, with a range of 22%-66.2%. Counties with the highest prevalences of any condition were mostly in the Southeastern states, especially Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, and West Virginia. Counties in Oklahoma, South Dakota, Texas, and northern Michigan also had high prevalences of underlying health conditions.

This study provides important data on the high prevalence of underlying health conditions in the US that can be risk factors for COVID-19 complications. Offering a break down by county can also provide critical information for public health outreach and COVID-19 prevention measures. Limitations include that there is the possibility of inaccurate disease state information being self-reported.

Sickle cell disease and solid organ transplant underlying medical conditions were not included in the BRFSS data, which may have underestimated the results.

 Cancer was added to the CDC list of health conditions that are risk factors for severe COVID-19 after this study was conducted, so it was not included in the analysis.

Health Care professionals can play an important role in educating patients about lifestyle modifications including diet, exercise, and smoking cessation to reduce the prevalence of underlying health conditions and COVID-19 complications.2 Individuals with underlying health conditions should try to stay home if possible and avoid cruises and non-essential air travel.1 Mask wearing, frequent hand washing, and social distancing are extremely important if individuals must go to public places. Home delivery of medications, groceries, and other supplies can also help to protect this vulnerable population against COVID-19.

CDC. Coronavirus disease 2019 (COVID-19): People with certain medical conditions.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

. Updated July 17, 2020. Accessed July 23, 2020.

Razzaghi H, Wang Y, Lu H, et al. Estimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe COVID-19 Illness — United States, 2018. 

The CDC revised the list of conditions July 17, 2020 to include cancer as 1 of the risk factors for severe COVID-19.

CDC Study: Underlying Health Conditions Can Increase Risk of Severe COVID-19 

Current evidence shows face coverings and masks can prevent the spread of the coronavirus disease 2019 (COVID-19), according to the CDC. The agency has publicly recommended cloth face coverings to be worn.

“Cloth face coverings are 1 of the most powerful weapons we have to slow and stop the spread of the virus, particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities,” stated CDC Director Dr. Robert R. Redfield, in a press release.

The CDC also emphasized the importance of masks and face coverings in a recent 

 editorial that discussed protecting others as well as personal protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

Evidence Demonstrating Masks and Cloth Face Coverings Reduce Transmission

With emerging evidence showing that asymptomatic individuals can spread SARS-CoV-2, universal mask wearing is crucial to slow the pandemic especially as more businesses have reopened.

 Since there are no federal laws enforcing universal mask wearing, some states have enacted laws that mandate them. Without an FDA approved treatment or vaccine for COVID-19, masks are the best form of protection.

Evidence of transmission prevention was shown in the largest health care system in Massachusetts after universal masking of all health care employees and patients was implemented.

 One CDC report further demonstrated the importance of face covering mandates in the community setting for reducing the spread of SARS-CoV-2.

 The report revealed that 2 hair stylists in Missouri who were symptomatic and tested positive for COVID-19 were wearing face coverings, along with the clients at the hair salon.

 None of the 139 clients became symptomatic, and 67 of the patrons who were tested for SARS-CoV-2 were negative.

 These studies further showcase the importance of universal mask wearing.

The CDC recommends that individuals wear cloth face coverings in public settings and when around those who do not live in the same household to reduce the spray of respiratory droplets.

 Cloth face coverings should not be worn by children under the age of 2 years or anyone who has trouble breathing, is unconscious, incapacitated, or unable to remove the mask without assistance. Face coverings should be used in combination with social distancing measures, or staying at least 6 feet away from other individuals.

Health care professionals can play an important role in educating the public about the proper use of face coverings to ensure they are being used appropriately.

Individuals should wash their hands before putting on face coverings, and they should cover the nose and mouth and be secured under the chin. Before removing the face covering, individuals should wash their hands and untie the strings behind the head or stretch the ear loops. Then, the outside corners should be folded together, and the face covering should be placed in the washing machine. Face coverings can be washed with the laundry and regular detergent on the warmest appropriate water setting and dried using the highest heat setting.

CDC Calls on Americans to Wear Masks to Prevent COVID-19 Spread [news release].Atlanta, GA: CDC; July 14, 2020. 

https://www.cdc.gov/media/releases/2020/p0714-americans-to-wear-masks.html

Brooks JT, Butler JC, Redfield RR. Time for universal masking and prevention of transmission of SARS-CoV-2- The time is now. 

. Published online July 14, 2020.doi: 10.1001/jama.2020.13107.

Wang X, Ferro EG, Zhou G, Hashimoto D, Bhatt DL. Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers.

. Published online July 14, 2020. doi:10.1001/jama.2020.12897.

Hendrix MJ, Walde C, Findley K, Trotman R. Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020. 

CDC. Considerations for wearing cloth face coverings. 

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

. Updated July 16, 2020. Accessed July 18, 2020.

Author | Jennifer Gershman, PharmD, CPh

Articles

Halloween Activity Health Tips During the COVID-19 Pandemic

Sesame Workshop Offers New Webinar Series for Health Care Community

CDC Study: Underlying Health Conditions Can Increase Risk of Severe COVID-19

CDC Recommends Universal Mask Wearing to Slow COVID-19 Spread