Halloween is a favorite fall celebration in the United States and elsewhere in the world. This year, however, the COVID-19 pandemic poses some challenges for enthusiasts of this holiday. How can you have fun and still stay safe this Halloween?

Halloween is the time of the year when many fall enthusiasts drink pumpkin spice lattes, watch favorite horror flicks, and go trick-or-treating. Every year, people around the U.S. and the world throw costume parties to celebrate this holiday, taking the opportunity to spend some quality time with friends and family.

This year, however, the COVID-19 pandemic has made celebrating Halloween more complicated, as social gatherings can facilitate the spread of SARS-CoV-2, the virus that causes the disease.

Despite this, some data suggest that many people in the U.S. have not let the pandemic deter them from their yearly Halloween preparations.

According to a Statista projection from September 2021, planned nationwide expenses for Halloween costumes amount to $3.3 billion. Estimates also indicate another $3.2 billion on Halloween decorations and $3 billion on candy.

So how can people stay safe while still enjoying this favorite fall holiday? In this Special Feature, we look at some best practices and offer tips for health, safety, and fun.

We have based our suggestions on official guidelines from the Centers for Disease Control and Prevention (CDC).

Article highlights:

Handling and offering treats

Trick-or-treating and costume parties may be the best-loved Halloween activities, but they typically involve close contact with many people from different households. This can facilitate the transmission of the coronavirus.

For example, if someone who has unknowingly contracted SARS-CoV and has not experienced any symptoms engages in regular social activities, they might be putting others at risk.

The first and most important step to protect yourself and others against COVID-19 is by getting vaccinated, and the CDC advises everyone who is able to receive a COVID-19 vaccine to do so.

The best way to stay safe this Halloween is to avoid contact with people from other households, which might mean avoiding trick-or-treating and attending parties with individuals you do not share a living space with.

However, there are some ways people who want to make the most of this fall festivity can mitigate the risks.

If children go treat-or-tricking, they must avoid coming into direct contact with other treat-or-trickers or with any adults offering them treats.

They must also try to keep at least 6 feet away from other children and adults who do not live with them and carry hand sanitizer with at least 60% alcohol content to use frequently.

Adults may want to supervise children as they use hand sanitizer and use it frequently themselves.

Additionally, always wash hands before and after handling any treats or treat bags destined for children from other households.

Children must also wash their hands thoroughly before they eat any candy received while treat-or-tricking.

Costumes and face coverings

One of the most important aspects of Halloween is, of course, wearing costumes.

Both adults and children may want to incorporate a face covering — covering the nose and mouth — into their outfit during any treat-or-tricking activities or any other activities where they might encounter people who do not form part of their household, particularly in areas where the risk of viral transmission remains high.

Healthline’s former chief medical officer, Dr. Hanh Le, advises that: “For this Halloween, amidst the COVID-19 pandemic, costumes that have a mask that covers the mouth and nose area are likely the safest, and costumes that are either disposable or washable will most likely decrease your risk of contamination in the future.”

However, a regular costume mask may not provide the necessary protection against the transmission of SARS-CoV-2, so it is best to follow CDC guidelines on choosing an appropriate mask.

You may also want to avoid wearing a cloth face covering under a costume mask, because it could get in the way of breathing freely.

Organizing or attending festivities

The safest way to celebrate this Halloween is with people from your own household.

Pumpkin carving, wearing fun costumes, and participating in traditional Halloween games can be just as fun in smaller, more intimate circles as they are in larger social gatherings.

However, for those choosing to celebrate with individuals outside their households, here is some advice on staying safe and minimizing the risk of transmitting the virus.

According to medical experts, one way of minimizing transmission during a social gathering is by holding it in an outdoor space.

Dr. Hanh Le explains why:

“When organizing Halloween get-togethers, it is advisable to plan them outdoors if possible, because [spacing] people out in an open outdoor setting is the best way to prevent person-to-person transmission. Gathering a lot of people together in small confined spaces — especially if it’s loud and people [need] to lean in to hear each other — is a recipe for disaster for widespread [SARS-CoV-2] transmission among all your guests.”

Additionally, make sure to ventilate any indoor spaces used during a holiday gathering.

Hosts who wish to organize a get-together should limit the number of guests and ensure that everyone is familiar with and willing to follow current safety guidelines.

Some hosts may choose to provide disposable face masks, hand sanitizer, and tissues to their guests if they cannot bring their own.

For extra safety, you may want to place tables and chairs to allow for physical distancing between guests from different households. When it comes to cutlery, plates, and drinking cups, using disposable ones may be the safest option.

Providing individual sachets or pots of sauce, condiments, and salad dressings is also safer than passing around one container that everyone will handle.

Some hosts may suggest that guests bring their own food and drink to avoid sharing with others. Where this is not possible, limit contact with shared items or surfaces.

If people from different households cannot keep at least 6 feet apart from others, they should wear face coverings.

Hosts and guests alike must remember to wash their hands thoroughly before handling shared items or serving or eating food.

Finally, and most importantly, if you feel unwell or think you may have had exposure to a virus, please avoid all social gatherings to keep your friends and family safe.

In 2020, 685,000 people died from breast cancer, and 2.3 million received a diagnosis. It reported:

“As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer.”

Its prevalence might help explain why there is a wide range of myths attached to it. Here, we will tackle 15 of the most common misunderstandings.

To help us reach the truth, we enlisted the help of three experts:

• Dr. Michael Zeidman: an assistant professor of breast surgery at Icahn School of Medicine at Mount Sinai in New York City.
• Dr. Crystal Fancher: a surgical breast oncologist at the Margie Petersen Breast Center at Providence Saint John’s Health Center and assistant professor of surgery at the Saint John’s Cancer Institute in Santa Monica, CA.
• Dr. Richard Reitherman, Ph.D.: the medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center in Fountain Valley, CA.

1. A breast injury can cause breast cancer

“Injury to the breast cannot cause breast cancer,” explained Dr. Zeidman, “however, it can cause changes in the breast that may mimic breast cancer on imaging.”

“This process is called ‘fat necrosis,” he continued, “and it can look like an irregular mass with jagged edges on a mammogram, much like the appearance of a new breast cancer. The best way to distinguish cancer from fat necrosis is with a needle biopsy.”

2. Underwire bras increase the risk of breast cancer

Although underwire bras do not increase breast cancer risk, Dr. Zeidman always recommends bras without a wire. He explains:

“The wire can irritate the skin under the breast, which can lead to skin breakdown. This breakdown may allow bacteria to enter the breast causing infection, [an] abscess, [or both].”

3. IVF increases the risk of breast cancer

As part of the in vitro fertilization (IVF) procedure, doctors often prescribe drugs that stimulate the ovaries to produce eggs. These drugs mimic the activity of estrogen.

Because of this, some experts wondered whether they might encourage the growth of estrogen receptor-positive breast cancer. As the name suggests, these cancer cells have estrogen receptors on their membranes.

“While there are no randomized controlled trials looking to answer this question,” explained Dr. Zeidman, “a recent meta-analysis of all observational studies over the past 30 years concluded that there is no increase in breast cancer risk for women who received ovarian stimulation drugs compared with the general population.”

4. No one in my family had breast cancer, so I won’t develop it

This is a myth that Dr. Zeidman is familiar with, he told Medical News Today: “It is very common for [people] with a new breast cancer diagnosis to tell me how shocked they are considering that they have no family history.”

“I then respond by stating that the vast majority of [people who] I see with a new breast cancer have no risk factors. In fact, the most significant risk factor for developing breast cancer is being a woman. In the United States, 1 in 8 women will develop breast cancer over their lifetime.”

As Dr. Fancher explained to us, “only about 5–10% of breast cancers are caused by a genetic mutation that is passed between family members. This means that the majority of breast cancers are sporadic or have no hereditary cause.”

Because family history is only one factor in the risk of breast cancer, screening is important. As Dr. Reitherman explained:

“The message is that every woman starting at 40 years of age should have a yearly mammogram regardless of a family history of breast cancer. Those women with a family history of breast or ovarian cancer should be evaluated by a genetics counselor by the age of 30. This group of women may need to begin breast cancer screening prior to the age of 40.”

Dr. Zeidman takes the opportunity to stress the importance of checkups:

“If you are a woman and at least 40 years old, please get your screening mammograms!”

5. Being stressed can cause breast cancer

With the ever-present stresses of modern life, it is no surprise that people are concerned about how stress might impact health.

However, as Dr. Zeidman told us, “There is absolutely no evidence to support a link between stress and breast cancer. In fact, there is evidence to support that stress does not increase breast cancer risk.”

That is not to say that stress cannot impact health at all, however. He goes on: “Part of being human is finding effective ways to deal with the stress we all will inevitably face. This can have profound health benefits both mentally and physically, but will do nothing to mitigate breast cancer risk.”

6. A healthy lifestyle eliminates breast cancer risk

“While it is true that postmenopausal women who are overweight are at an increased risk of developing breast cancer, there is nothing that a woman can do to eliminate breast cancer risk,” explained Dr. Zeidman.

“Even women who undergo bilateral mastectomy are still at risk of developing a new breast cancer.”

However, he is not suggesting anyone starts “smoking and eating fast food every day.”

More generally, he believes that “it is of the utmost importance to take care of your body because you only get one. But even world class athletes have been diagnosed with breast cancer.”

7. Breast cancer only happens to older adults

“While it is true that breast cancer risk increases as women age, and the average age of a new breast cancer diagnosis is 61 years, breast cancer can occur much earlier,” Dr. Zeidman told MNT.

“About 5% of new breast cancer diagnoses are in women under the age of 40 years. There, unfortunately, have been reports of women in their early 20s and even teens who were diagnosed. There is typically a strong family history in these young women.”

“If you have a significant lifetime breast cancer risk based on a strong family history, then you may qualify for genetic testing and early screening starting at age 25.”

Dr. Fancher explains that, although breast cancer is rarer in younger people, she encourages people to “bring any concerning findings in your breast to your doctor’s attention and follow their recommended screening guidelines.”

8. All lumps in the breast signal breast cancer

This is a myth — not all lumps in the breast are cancer. Dr. Zeidman explained that the majority

“of new breast lumps are benign. And, if you had a recent mammogram that was normal, then that percentage is likely even higher.”

However, Dr. Zeidman made it clear that any new lump should be “evaluated by a healthcare professional.”

9. Having an abortion increases the risk of breast cancer

“The reason this question comes up is because we know that breast cancer risk is directly related to estrogen exposure,” Dr. Zeidman told us, “and abortion interrupts the normal hormonal cycle of pregnancy.”

“While we can never perform a randomized controlled trial to address this question, there was a very large observational study

in Denmark that included 1.5 million women and found no link between abortion and breast cancer.”

Aside from this analysis, he explained that there have also “been several other large-scale studies that came to the same conclusion.”

10. Carrying a phone in your bra can cause cancer

According to Dr. Zeidman: “There is no evidence to support that cell phones cause cancer, period.”

“However, we do not have any long-term studies, so we may find this to be the case in the future. For now, why can’t you just put your phone in your pocket or bag?”

11. Nipple piercings increase breast cancer risk

Dr. Zeidman told MNT that this is a myth — nipple piercings do not increase breast cancer risk.

“However,” he elaborated, “they can lead to complications, such as infection, abscess, difficulty breastfeeding due to blocked ducts from scar tissue, nerve damage, keloids, cysts, and more rare but serious illness from HIV and hepatitis B and C.”

“For these reasons,” he said, “I always recommend against nipple piercing. If the deed is done, I recommend removing it.”

12. Sugar causes breast cancer

Dr. Zeidman maintains a firm stance on sugar: “Sugar should be avoided in general. It is addictive.”

“It can cause mood swings,” he continued, “It leads to spikes in insulin, which puts the body in a pro-inflammatory state. This, in turn, can lead to heart disease, diabetes, and other chronic inflammatory diseases.”

“Too much sugar can result in obesity, which is a risk factor for breast cancer.”

However, he explained that studies investigating links between sugar and breast cancer have been “mixed and inconsistent.”

While discussing sugar, it is worth busting a related myth: that sugar helps tumors grow. This myth arose because cancer cells divide rapidly and, therefore, need a lot of energy.

“While there is no concrete evidence to support this,” stated Dr. Zeidman, “I still recommend abstaining from added sugar as much as possible for overall well-being.”

13. Men do not get breast cancer

“Men have breasts… so yes, they too get breast cancer,” said Dr. Zeidman. “In fact, 1%

of all breast cancer diagnoses in the U.S. are in men.”

According to the Centers for Disease Control and Prevention (CDC), there were 2,300 new cases of male breast cancer in 2017 and 500 deaths.

“While breast cancer is more common in women than men, there are still men who get breast cancer,” explained Dr. Fancher, “It’s important for men also to be aware of any changes in their breast since there are no recommended screening guidelines for men.”

“Any lump, pain, or changes should be brought to your doctor’s attention, even if you don’t have a strong family history.”
– Dr. Fancher

Dr. Reitherman added, “Men are diagnosed with breast cancer rarely the most common risk factor is a family history of breast cancer. The BRCA2

genetic mutation markedly increased the risk of breast cancer in males who carry this gene.”

14. Mammograms cause breast cancer to spread

“This is a common misconception that I hear from my patients,” Dr. Zeidman told us.

“The thinking is that squeezing the cancer with compression during mammography, or performing a needle biopsy on the cancer, will cause the cancer to seed other parts of the breast.” However, he confirms:

“There is absolutely no evidence to support this.”

Dr. Reitherman agrees: “There is absolutely no evidence that mammograms cause breast cancer. The performance of a mammogram uses a very low dose of radiation and compression and has no documented or theoretical relationship to causing breast cancer.”

15. If there is no lump, there is no cancer

“If this were true, then we would not need mammograms,” said Dr. Zeidman. “Mammograms have been proven to save lives because they allow us to catch the cancer before it becomes palpable,”

In this context, “palpable” means that a person can feel the lump with their fingers.

“If we diagnose and treat a breast cancer while it is stage 1, survival approaches 100%. Survival drops as the stage advances. In fact, the cancer may never be palpable and still spread to other parts of the body,” Dr. Zeidman added.

According to Dr. Fancher, “Many breast cancers are found on screening mammograms and may not be felt. This is especially true for noninvasive breast cancer or ductal carcinoma in situ, which may only show up as calcifications on a screening mammogram.”

The take-home

Breast cancer is common, and while a healthy lifestyle might reduce the risk to a certain extent, vigilance is key. The earlier a doctor catches breast cancer, the higher the chances of surviving it.

Sexually transmitted infections (STIs) have been on the rise in the United States. In April 2021, the Centers for Disease Control and Prevention (CDC) announced that, in 2019, STIs had reached an all-time high for the sixth consecutive year.

In 2019, the CDC received reports of over 2.5 million cases of chlamydia, gonorrhea, and syphilis.

The World Health Organization (WHO) estimates that 1 million STIs are acquired worldwide each day.

Despite rising rates, there is still significant stigma attached to STIs. For some, this might mean individuals are less willing to speak about sexual health concerns or raise questions with a doctor.

This unwillingness to speak openly about sexual health can breed misinformation.

Of course, the internet is a convenient first port of call when someone has a question they would like to ask anonymously. Sadly, not all information that appears on the web can be trusted.

Here, Medical News Today approached some common myths associated with sexual health and asked for input from an expert:

Dr. Sue Mann, a consultant in sexual and reproductive health and a medical expert in reproductive health at Public Health England.

Increasing understanding of sexual health helps people make informed, safe decisions. Although one article cannot brush away deeply ingrained falsehoods, the more trustworthy information that is available, the better.

1. When someone is taking ‘the pill,’ they cannot contract an STI

This is a myth. Oral contraception cannot protect against contracting an STI.

As Dr. Mann explained to MNT, “oral contraception […] only works to prevent pregnancy. The only way to protect yourself from getting an STI when using oral contraception is by wearing a condom.”

Mirroring this, the CDC states: “Birth control methods like the pill, patch, ring, and intrauterine device (IUD) are very effective at preventing pregnancy, but they do not protect against [STIs] and HIV.”

2. The ‘withdrawal method’ prevents pregnancy

The so-called withdrawal method, also called coitus interruptus or the pull-out method, is when the penis is pulled out of the vagina before ejaculation. Although it may reduce the chance of pregnancy, “the withdrawal method is not a reliable way to prevent pregnancy,” said Dr. Mann.

When used accurately, it can reduce the risk of pregnancy, but accuracy can be difficult in the heat of the moment.

Additionally, the penis releases pre-ejaculate, or pre-cum, before ejaculation. In some cases, sperm can be present in this fluid.

In one study, for instance, scientists examined samples of pre-ejaculate from 27 participants. The scientists identified viable sperm in 10 of the participant’s pre-ejaculate.

Each volunteer provided a maximum of five samples. Interestingly, the researchers found sperm in either all or none of their samples. In other words, some people tend to have sperm in their pre-ejaculate, while others do not. The authors concluded:

“[C]ondoms should continue to be used from the first moment of genital contact, although it may be that some men, less likely to leak spermatozoa in their pre-ejaculatory fluid, are able to practice coitus interruptus more successfully than others.”

4. Using two condoms doubles the protection

It is understandable why people might assume two condoms would provide twice the protection, but this is a myth.

“It is actually more risky to use two or more condoms when having sex,” said Dr. Mann. “The likelihood of the condom breaking is higher due to the amount of friction the condom is enduring. A single condom is the best option.”

5. You can contract STIs from a toilet seat

This is perhaps one of the most persistent myths associated with STIs. Yet, despite being repeatedly debunked, it remains a myth. Dr. Mann told MNT:

“STIs are spread through unprotected vaginal, anal, or oral sex, and by genital contact and sharing sex toys.”

She also explained that the viruses that cause “STIs cannot survive for long outside the human body, so they generally die quickly on surfaces like toilet seats.”

Similarly, the bacteria responsible for STIs, such as chlamydia, gonorrhea, and syphilis, cannot survive outside the body’s mucous membranes for a significant amount of time. For that reason, they would not survive on a toilet seat.

6. There are no treatments for STIs

This is not true. However, although they can be treated, not all can be cured. The WHO explains that eight pathogens make up the vast majority of STIs.

Four of the eight are curable: the bacterial infections syphilis, gonorrhea, and chlamydia, and the parasitic infection trichomoniasis.

The remaining four are viral: hepatitis B, herpes simplex virus (HSV), HIV, and human papillomavirus (HPV). These cannot yet be cured. However, it is worth noting that HPV infections are often cleared by the body naturally.

7. You can’t contract an STI unless you have penetrative sex

“Penetrative sex isn’t the only way someone can contract an STI. Oral sex, genital contact, and sharing sex toys are other ways that STIs can be spread,” Dr. Mann told MNT.

Beyond sexual contact, it is also possible to contract an STI from exposure to blood that contains the infectious pathogen, including through sharing needles.

8. Only gay males contract HIV

This is another longstanding and entirely incorrect assumption. According to Dr. Mann:

“Anyone, regardless of sexual orientation, race, ethnicity, age, or gender, can contract HIV. If you have HIV and don’t know it, you’re more likely to pass it on. But if you know your status, you can make sure you and your partner(s) are taking steps to stay healthy.”

Dr. Mann underscores the importance of testing, explaining that in many countries, “testing is free, easy, and confidential. You can even do a test in the comfort of your own home.”

9. You can only transmit an STI if you have symptoms

“A lot of people pass on STIs to others without even knowing,” said Dr. Mann. “STIs can be spread with symptoms or without.”

Indeed, the WHO explains that “[t]he majority of STIs have no symptoms or only mild symptoms that may not be recognized as an STI.”

“That is why,” Dr. Mann explained, “it is important to be tested regularly and to use a condom to prevent STIs as much as possible.”

Children are being hospitalized with COVID-19 in record numbers across the United States. As most children are not old enough to get vaccinated, hospitalizations could further increase as schools reopen. Doctors and epidemiologists are thus calling for the use of safety precautions, such as masks and ventilation, during class.

The rise in cases of COVID-19 among children in the U.S. is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.

Although the Centers for Disease Control and Prevention (CDC) recommend universal indoor masking and physical distancing in schools, mask-wearing is optional in North Dakota and Ohio.

Rapidly increasing infection rates among children and teachers have forced many schools in the U.S. to halt in-person learning and turn to hybrid models of education. This comes despite 175 pediatric disease experts agreeing earlier this year that elementary schools could open full-time for in-person instruction.

Although children generally have milder COVID-19 symptoms than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?

To answer these questions and more, we spoke with seven doctors and researchers who specialize in pediatrics and infectious diseases and have worked directly with children with COVID-19.

Why are COVID-19 hospitalizations among children increasing?

The Delta variant of COVID-19 is more than two times as contagious as previous variants. Alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.

The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic.

Now, you have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, you will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases.

Another reason for rising COVID-19 hospitalizations among children may be that those under the age of 12 years cannot get the vaccination yet.

Vaccines remain effective at preventing severe illness, hospitalization, and death from [SARS-CoV-2] infection, even Delta strain infection,” Kristin Moffitt, M.D., an infectious disease expert at Boston Children’s Hospital, MA. “This is consistent with reports that the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated individuals.

“Since children under 12 aren’t yet able to be vaccinated, and many adolescents and young adults remain unvaccinated relative to older individuals, this age group is making up a bigger proportion of those at risk for severe illness based on their unvaccinated status,” she added.

Dr. Karen Ravin, M.D., chief of infectious diseases at Nemours Children’s Hospital in Delaware, agreed. “Children under 12 years of age make up a substantial proportion of the unvaccinated population in the U.S., so they are the population at highest risk,” she said. “Early in the pandemic, schools were closed, and children had a lower risk of exposure in the community. Contrast this to now, schools are open for in-person instruction so children are at greater risk for being exposed, becoming infected, and, unfortunately, being hospitalized.”

“Overall, children are at lower risk for severe illness, hospitalization, and death due to COVID-19, but they are not at no risk.”

– Dr. Karen Ravin

“Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population,” noted Dr. Adriana Cadilla, an infectious diseases pediatric specialist at Nemours Children’s Hospital in Orlando, FL. “[In Florida,] there has been over a four-fold increase in child [SARS-CoV-2] infections in the past month,” Dr. Cadilla added.

Is the Delta variant more severe than earlier strains? 

Although the number of COVID-19 cases among children is increasing more quickly now than at any other time in the pandemic, it is unclear whether the Delta variant of SARS-CoV-2 is more severe for children than previous variants.

“We don’t know if the Delta variant causes more severe disease for kids than previous variants, but it’s definitely more contagious,” said Dr. Chang.

Due to low testing and hospital admissions among children from previous variants, the data to compare the outcome of COVID-19 strains are sparse. As schools reopen, however, and safety precautions such as mask-wearing wane, more children are becoming infected with SARS-CoV-2 at the same time, leading to higher numbers of children developing severe COVID-19.

There are some indications to suggest that COVID-19 from the Delta variant is more severe in children than with earlier strains,” Dr. Allison Ross Eckard, M.D., professor of pediatrics and medicine at the Medical University of South Carolina.

“We are seeing a greater number of children, particularly unvaccinated adolescents, with more severe COVID-19 resulting in respiratory failure that is requiring intubation and sometimes ECMO (heart-lung bypass machine), ARDS (a very serious lung condition that develops as a result of the inflammation associated with COVID-19), and other COVID-related problems — all complications we more commonly see in adults,” she continued.

“It may be that the increased number of hospitalizations among children is a result of both of these factors — more cases combined with a higher chance of severe disease. More data is needed to determine the exact reason(s) behind what we are seeing,” she added.

Which children are at higher risk of adverse outcomes from COVID-19?

The CDC says that children with underlying medical conditions, such as congenital heart disease or genetic, neurologic, or metabolic conditions, could have an increased risk of severe outcomes from COVID-19.

The CDC states that this higher risk also applies to children with obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression.

“Children who are at higher risk of adverse outcomes from COVID-19 are those under 1 year of age, those with underlying conditions, and those with immunocompromising conditions, including those on immunocompromising medications,” Dr. Tina Q. Tan, M.D., medical director at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“Other children may also develop more severe disease, resulting in the need for hospitalization, but at a lower rate than those with underlying or immunocompromising conditions,” she added.

“Anecdotally, most of our hospitalized patients with COVID-19 are unvaccinated teenagers. Many of these teens are quite ill, and their only risk factors are obesity and/or asthma,” Dr. Danielle Zerr, M.D., M.P.H., professor and division chief of pediatric infectious disease and adjunct professor of epidemiology, University of Washington.

Dr. Chang echoed these statements, saying that teenagers with a body mass index of 25 or above and infants under the age of 1 year have a higher risk of hospitalization.

“Many families think their children are healthy and, therefore, not at risk of severe COVID-19,” said Dr. Eckard. “While that is true statistically, we cannot always predict which children will develop severe disease, and children [without underlying conditions] sometimes do develop severe disease.”

“In addition, some children are healthy but perhaps require an inhaler a couple of times per year, or some children’s families don’t even realize they are overweight. So, there is sometimes a misconception about a child’s risk. Therefore, it is very important for every family to discuss their child’s health with their primary care physicians to ensure that all children are appropriately protected.”

– Dr. Allison Eckard

“We are still learning what causes some children to develop more severe COVID-19 than others, but it is important to know that perfectly healthy children can develop severe COVID-19,” Elizabeth Mack, M.D., M.S., medical director of pediatric critical care medicine at the Medical University of South Carolina, told MNT.

Dr. Mack also noted that the risk of death from severe COVID-19 remains a possibility even for children without underlying conditions.

Race, ethnicity, and socioeconomic conditions may also play a role in adverse outcomes from COVID-19 among children. Dr. Cadilla noted, “Hospitalization rates are higher among Hispanic [and] Latino children and non-Hispanic Black children, mirroring adult data.”

While more data are necessary to confirm why this is the case among children, among adults, research highlights deep-seated inequities that put these populations at higher risk.

For example, Hispanic, Latinx, and non-Hispanic Black populations are more likely to be uninsured, working in jobs that do not offer remote working, and living in conditions that make it difficult to practice physical distancing and self-isolation. These populations also have higher rates of underlying health conditions, such as diabetes and obesity.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.

Ulcerative colitis is a relatively common long-term condition that causes inflammation in the colon. It is a form of inflammatory bowel disease (IBD) that is similar to Crohn’s disease.

The colon removes nutrients from undigested food and eliminates waste products through the rectum and anus as feces.

In severe cases, ulcers form on the lining of the colon. These ulcers may bleed, which produces pus and mucus.

Various medication options are available, and doctors can tailor treatment to meet individual needs.

Symptoms

The first symptom of ulcerative colitis is usually diarrhea.

Stools become progressively looser, and some people may experience abdominal pain with cramps and a severe urge to go to the bathroom.

Diarrhea may begin slowly or suddenly. Symptoms depend on the extent and spread of inflammation.

The most common symptoms of ulcerative colitis include:

• abdominal pain
• bloody diarrhea with mucus

Some people may also experience:

• fatigue or tiredness
• weight loss
• loss of appetite
• anemia
• elevated temperature
• dehydration
• a constant urge to pass stools

Symptoms are often worse early in the morning.

Symptoms may be mild or absent for months or years at a time. However, they will usually return without treatment and vary depending on the affected part of the colon.

What causes red diarrhea?

Types

Symptoms may vary depending on the area of inflammation.

The sections below discuss the various types of ulcerative colitis, many of which affect different parts of the colon:

Ulcerative proctitis

This type affects only the end of the colon, or the rectum. Symptoms tend to include:

• rectal bleeding, which may be the only symptom
• rectal pain
• an inability to pass stools despite frequent urges

Ulcerative proctitis is usually the mildest type of ulcerative colitis.

Proctosigmoiditis

This involves the rectum and the sigmoid colon, which is the lower end of the colon.

Symptoms include:

• bloody diarrhea
• abdominal cramps
• abdominal pain
• a constant urge to pass stool

Left-sided colitis

This affects the rectum and the left side of the sigmoid and descending colon.

Symptoms usually include:

• bloody diarrhea
• abdominal cramping on the left side
• weight loss

Pancolitis

This affects the whole colon. Symptoms include:

• occasionally severe, bloody diarrhea
• abdominal pain and cramps
• fatigue
• considerable weight loss

Fulminant colitis

This is a rare, potentially life threatening form of colitis that affects the whole colon.

Symptoms tend to include severe pain and diarrhea, which can lead to dehydration and shock.

Fulminant colitis can present a risk of colon rupture and toxic megacolon, which causes the colon to become severely distended.

Diet

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), some dietary measures may help relieve symptoms, including:

• eating smaller, more regular meals, such as five or six small meals per day
• drinking plenty of fluids, especially water, to prevent dehydration
• avoiding caffeine and alcohol, which can both increase diarrhea
• avoiding sodas, which can increase gas
• keeping a food diary to identify which foods make symptoms worse

A doctor may suggest temporarily following a specific diet depending on symptoms, such as:

• a low fiber diet
• a lactose-free diet
• a low fat diet
• a low salt diet

It may help to take supplements or eliminate particular foods from the diet. However, a person should discuss any complementary or alternative measures with a doctor before trying them.

Here, find out more about what to eat and avoid with ulcerative colitis.

Causes

The exact causes of ulcerative colitis are unclear. However, they may involve the following:

Genetic factors

ResearchTrusted Source suggests that people with ulcerative colitis are more likely to have certain genetic features. The specific genetic feature that a person has may affect the age at which the disease appears.

Environment

The following environmental factors might affect the onset of ulcerative colitis:

• diet
• air pollution
• cigarette smoke

Immune system

The body might respond to a viral or bacterial infection in a way that causes the inflammation associated with ulcerative colitis.

Once the infection resolves, the immune system continues to respond, which leads to ongoing inflammation.

Another theory suggests that ulcerative colitis may be an autoimmune condition. A fault in the immune system may cause it to fight nonexistent infections, leading to inflammation in the colon.

Risk factors

Some known risk factors for ulcerative colitis include:

• Age: Ulcerative colitis can affect people at any age but is more common at 15–30 years of age.
• Ethnicity: White people and those of Ashkenazi Jewish descent have a higher risk of developing the condition.
• Genetics: Although recent studies have identified specific genes that may play a role in ulcerative colitis, the link is unclear due to the role of environmental factors.

Diagnosis

A doctor will ask about a person’s symptoms and medical history. They will also ask whether any close relatives have had ulcerative colitis, IBD, or Crohn’s disease.

They will also check for signs of anemia, or low iron levels in the blood, and tenderness around the abdomen.

Several tests can help rule out other possible conditions and diseases, including Crohn’s disease, infection, and irritable bowel syndrome.

These include:

• blood tests
• stool tests
• X-ray
• barium enema, during which a healthcare professional passes a fluid called barium through the colon to show any changes or anomalies in a scan
• sigmoidoscopy, in which a healthcare professional inserts a flexible tube with a camera at the end, called an endoscope, into the rectum
• colonoscopy, wherein a doctor examines the whole colon using an endoscope
• a CT scan of the abdomen or pelvis

A person with ulcerative colitis will need to see a doctor who specializes in treating conditions of the digestive system, or a gastroenterologist.

They will assess the type and severity of the condition and create a treatment plan.

Treatment

Ulcerative colitis symptoms can range from mild to severe, but it needs treatment. Without treatment, the symptoms may go away, but there is a higher chance of them coming back.

Most people will receive outpatient treatment. However, around 15% of people with the disease have a severe form. Of these, 1 in 5 may need to spend time in the hospital.

Treatment will focus on:

• maintaining remission to prevent further symptoms
• managing a flare until symptoms go into remission

Various medications are available, and a doctor will make a treatment plan that takes individual needs and wishes into account. Natural approaches can support medical treatment, but they cannot replace it. 

Long-term treatment to maintain remission

The first aim of treatment is to reduce the risk of a flare and its severity if a flare does occur. Long-term therapy can help achieve this.

There are several types of medication, and a doctor will make a treatment plan to suit the individual.

Ulcerative colitis results from a problem with the immune system. Three types of drugs that can help are biologics, immunomodulators, and small molecules. These target the way the immune system works.

They include: 

• TNF-α antagonists, such as infliximab (Remicade) or adalimumab (Humira)
• anti-integrin agents, such as vedolizumab (Entyvio)
• Janus kinase inhibitors, such as tofacitinib (Xeljanz)
• interleukin 12/23 antagonists, such as ustekinumab (Stelara)
• immunomodulators, for instance, thiopurines (azathioprines) and methotrexate

These drugs can help people with moderate to severe symptoms, but they may have adverse effects. People should talk to their doctor about the options available and the benefits and risks of each drug.

However, for mild to moderate symptoms, guidelines suggest 5-aminosalicylic acid, or aminosalicylates (5-ASA), as a first-line treatment.

Examples include:

• mesalamine
• balsalazide
• sulfasalazine

Other options

Aminosalicylates: In the past, 5-ASA played a key role in treating the symptoms of ulcerative colitis. These are still an option, but current guidelines recommend focusing on long-term treatment to prevent symptoms from occurring in the first place.

Steroids: These can help manage inflammation if aminosalicylates do not help. However, long-term use can have adverse effects, and experts recommend minimizing their use.

Managing severe active ulcerative colitis

A person with severe symptoms may need to spend time in the hospital. Hospital treatment can reduce the risk of malnutrition, dehydration, and life threatening complications, such as colon rupture. Treatment will include intravenous fluids and medications.

Surgery

If other treatments do not provide relief, surgery may be an option.

Some surgical options include:

• Colectomy: A surgeon removes part or all of the colon.
• Ileostomy: A surgeon makes an incision in the stomach, extracts the end of the small intestine, and connects it to an external pouch, called a Kock pouch. The pouch then collects waste material from the intestine.
• Ileoanal pouch: A surgeon constructs a pouch from the small intestine and connects it to the muscles surrounding the anus. The ileoanal pouch is not an external pouch. Sometimes it is called a J-pouch.

According to the American Gastroenterological Association, around 10–15% of people with ulcerative colitis will need a colectomy.

Lifestyle and natural remedies

Some home care strategies and remedies may help manage the symptoms of ulcerative colitis. 

Natural medicine

Here are some options that people may use:

• Probiotics: A 2019 review suggests that some probiotics may help manage IBD.
• Herbal remedies: Other researchTrusted Source from 2019 found that some herbal remedies may help reduce symptoms and manage the condition. Examples include aloe vera gel and wheatgrass juice. 
• Fruits and other plant-based foods: Some earlier research shows that ingredients naturally present in blueberries, black raspberries, cocoa, Indian quince, green tea, grapes, olive oil, and Indian gooseberries may have a beneficial effect.
• Spices: Garlic, ginger, fenugreek, saffron, turmeric, and Malabar tamarind may help with IBD symptoms.

Research has not yet confirmed the possible benefits of the options above, but moderate amounts appear safe to add to the diet. However, it is worth checking with a healthcare professional first.

Lifestyle options

Scientists have also found that the following may help:

Education: The more a person knows about a health condition, the more in control they tend to feel. Learning about ulcerative colitis can help ease anxiety and lead to effective coping and management techniques, research from 2017Trusted Source shows.

Exercise: Some research suggests that aerobic exercise may have an anti-inflammatory effect, which could benefit people with ulcerative colitis. One 2019 studyTrusted Source, for example, found that combining exercise with an anti-inflammatory diet could have a positive effect. Check with a healthcare professional before changing an exercise routine, however, as 20% of participants with ulcerative colitis in a 2016 study experienced a worsening of symptoms after doing intense exercise.

Mindfulness: In a 2020 study, 37 people with ulcerative colitis engaged in a mindfulness-based intervention that involved four online therapy and four face-to-face sessions. After 6 months, the participants had lower markers of inflammation than 20 participants who did not have the sessions. 

Complications

The possible complications of ulcerative colitis can range from a lack of nutrients to potentially fatal bleeding from the rectum. 

Possible complications include:

Colorectal cancer

Ulcerative colitis, especially if symptoms are severe or extensive, increases the risk of developing colon cancer.

According to the NIDDK, colon cancer risk is highest when ulcerative colitis affects the entire colon for longer than 8 years.

Toxic megacolon

This complication occurs in a few cases of severe ulcerative colitis.

In toxic megacolon, gas becomes trapped, causing the colon to swell. When this occurs, there is a risk of colon rupture, septicemia, and shock.

Other complications

Other possible complications of ulcerative colitis include:

• inflammation of the skin, joints, and eyes
• liver disease
• osteoporosis
• perforated colon
• severe bleeding
• severe dehydration

To prevent bone density loss, a doctor may prescribe vitamin D supplements, calcium, or other medications.

Attending regular medical appointments, closely following a doctor’s advice, and being aware of symptoms can help prevent these complications.