October 12, 2023/Infectious Disease

What We Learn From ‘Getting Cooties’ as Kids

Cooties aren’t real, but the lessons they teach us about infectious disease are

children on playground running and playing tag.

It’s finally happened. Despite your speed, agility, cunning and many feats of strength, you’ve come down with a dreaded case of cooties. You probably have lots of questions. Do I have to go to the hospital to get my cootie shot? Does insurance cover circle circle, dot dots? What if my doctor has cooties, too?!

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Before you get too worried, it’s important we let you know: Cooties aren’t real. At least, not as we understand them today.

So, why are we bothering to talk about cooties if they aren’t real? Simply put, it doesn’t matter that cooties are a figment of our collective imagination because they have a symbolic meaning in many cultures. This fictional disease is powerful because it can offer a chance to teach children how to behave in the face of real disease.

We asked pediatric infectious disease specialist Frank Esper, MD, to help us dissect this imaginary communicable disease. Read on to learn why it exists and what it tells us about the ways societies respond to public health crises.

The history of cooties

That’s right: Cooties are fake, but they have a real — and important — history. It starts in the Pacific. Many different Austronesian languages use words that sound vaguely like “cootie” to describe parasitic insects. The word took on a life of its own when cultures came together.

Origins of the word ‘cooties’

Unfortunately, there are few things that bring different cultures into contact like war. That’s exactly what happened with cooties. As you may have learned in history class, World War I soldiers did most of their fighting from trenches. Those muddy pits were hot beds for all sorts of creepy crawlies, many of which carried infectious diseases like typhus, malaria and yellow fever. In fact, more people died from disease and famine during World War I than died in battle.

Soldiers used the word “cooties” to describe both the parasitic bugs that lived in the trenches with them and the illnesses the bugs gave them. In fact, they had another name for cooties: arithmetic bugs. Why? Because when the so-called cooties got on the soldiers, “They added to our troubles, subtracted from our pleasures, divided our attention, and multiplied like hell.”

While we know people were speaking about cooties in the early 20th century, the term was popularized later, by American soldiers returning home from the South Pacific theaters of World War II. Their children heard it and starting using the term as a form of social rejection. In particular, you’d use cooties as a way to mock members of the opposite sex as “icky” or “dirty.” If little boys and girls get too close to each other, one is sure to give the other their cooties.

Cooties spread throughout U.S. culture in part because — as serious as epidemic disease and social rejection may be — cooties also became the subject of many games, specifically, board games.

The board game

You might be surprised to know that there’s actually a board game version of the cooties game. In fact, there have been several.

In every single version of the board game, there’s no ambivalence: Cooties are parasitic bugs. It’s that simple. But only some children encounter cooties on a tabletop. Most of us are first exposed to the concept of cooties in backyards and on playgrounds, where there’s a lot more room for interpretation … and invention.

The playground version

While its popularity waxes and wanes in response to current events, children in many different communities around the world have been playing free-form cooties games for generations now. In most versions of the game, one or more “infected” children chase the cootie-free children, spreading the fictional disease through some form of physical contact.

Some children play the game zombie-style: The cootie-havers’ ranks grow and grow, making it increasingly difficult for the uninfected to win.

Other children treat it more like a game of tag: Once the cootie-haver transfers the infection to another child, they’re cured.

Real-world cooties

Cooties may not be real, but are there any infections that you could call “cootie-esque”? Dr. Esper thinks so.

“I’ve always felt scabies is most akin to cooties,” he says. Scabies, also known as sarcoptic mange, is a common parasitic condition caused by mites burrowing under the skin and laying eggs there.

Lice are similarly strong candidates. In fact, some scholars believe the word “cootie” originates from the Malay and Māori word for louse: “kutu.”

There’s nothing “sexy” about parasites and parasitic bugs — and they don’t get nearly the same attention that viral and bacterial infections do — but they should.

“There are many, many different parasites,” Dr. Esper says. “They fall under the umbrella of ‘infectious disease’ because an infectious disease is basically any organism that tries to take advantage of you, harming you in the process.

“Parasites are fairly uncommon in the United States,” he continues, “but they are extremely common globally. In fact, parasitic infections are some of the most common infections worldwide.” He notes that you’ll find more parasites anywhere that doesn’t have substantial water sanitation or insect control.

“Malaria is one of the most common parasitic infections worldwide that is transmitted by mosquitoes,” says Dr. Esper. “We eliminated malaria in the U.S. through a large-scale public health campaign in the 1950s,” he adds, “But after seven decades, we’re beginning to see local transmission again.”

The lessons cooties teach us

If you’ve ever watched a nature documentary before, you’ve probably heard that play is incredibly important. It’s almost like rehearsing for real life. A tiger cub, for example, learns how to hunt by stalking and “attacking” its siblings. Games are just as important for human children (and let’s be honest, for adults, too). Playing helps us confront things that would otherwise scare us in a safe environment.

Is there a lesson that the cooties game helps children learn? What are we rehearsing? What insecurities are children playing their way through when they give each other cooties? Here are some of our best guesses.

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How to avoid getting sick

However you play the cooties game, the goal is the same: avoiding infection. That’s a really good life lesson to learn!

In some versions of the game, you can actually get rid of cooties by giving them to somebody else. It adds a little extra hide-and-seek, cloak-and-dagger flavor to what would otherwise be a simple game of tag.

And it’s good training, too, because germs are sneaky!

“Infections will take any advantage whatsoever,” Dr. Esper says. “They will transmit through skin contact, through the air, through coughing — they even take advantage of the environment.”

He adds that some conditions, like ringworm (a fungus), can live on a surface for long periods of time, lying in wait to infect the next person who touches that surface. In some cases, the “surface” in question can even be a beloved pet.

On the playground, kids don’t get cooties by touching surfaces — they get them by touching each other. But the basic idea is the same: Germs pass through touch. And while you may not need to break into a sprint to avoid them, being cautious about the surfaces we touch and how close we are to other people can help us prevent illness.

“Infections have evolved with us,” Dr. Esper explains, “and they have looked for any way that they can move from one person to the next. Touch is one of the most common ways to transmit infections because we touch each other all the time, from shaking hands to playing sports and so on. Humans are social creatures, and we enjoy physical contact.”

The importance of vaccination

So, you’ve let your guard down, and now you have cooties, What next? If you’re lucky, somebody will come to your rescue with a rhyme. “Circle circle, dot dot, now you have your cooties shot!”

That’s right: In some iterations of the cooties game, you can become immune to cooties through the power of vaccination. Especially in light of the COVID-19 pandemic, it’s more important than ever that kids understand what vaccines are, how they work and why they’re important.

Dr. Esper defines vaccines as “a way to prepare your immune system to fight off an infection before it happens.” He stresses that vaccinations are only effective if you get them before getting sick, which isn’t how it usually works in the cooties game. In the real world, you have to know what conditions are common in your area to properly protect yourself.

“If you travel around the world, you may be exposed to different germs,” Dr. Esper says. “We can prepare people to travel by vaccinating them before they go abroad.”

Sometimes, you get vaccinated against a disease once and you’re done. In other cases (as is arguably the case with a make-believe disease like cooties), we get vaccinated regularly. The flu, for example, looks a bit different every year, which is why it’s important to get an annual flu shot.

What we shouldn’t learn from cooties

There are many useful lessons we can learn from catching — or narrowly dodging — cooties throughout our childhood. The game serves as a fun primer on public health and concepts like transmission, immunity and vaccination. But it can also promote beliefs and behaviors that are best forgotten when the imaginary play is done.

As the adults in the room, it’s our job to counteract those lessons. In that spirit, we’ve compiled a few quick and easy reminders to share with children after a rousing game of cooties.

Be kind, and avoid the blame game

When you hear children talk about cooties, it’s not unusual to detect mockery in their tiny voices. People with cooties, you’ll hear, are gross. They’re bad.

While it’s important to keep your distance from a person if they have a real contagious illness, making fun of somebody for being sick is a huge no-no. At least, it should be.

Unfortunately, some people engage in that kind of bullying well into adulthood.

“When you have an infection, however minor the problem is, there’s a stigma,” Dr. Esper explains. “‘Why did you get that infection? There must be something wrong with you.’ That’s what people say. But there’s nothing wrong with somebody who gets an infection. It’s a part of life.”

He continues that it’s important to be mindful about how we discuss contagion. “When a child comes home and they have strep throat, you’ll hear people say, ‘Who gave you that strep throat?’ as if someone purposefully gave them the infection.

“Don’t blame a person. Blame the germ. It’s not the person’s fault they got sick — they are a victim, too. The germ is the culprit.”

Bullying is wrong

The cooties game can promote other forms of stigmatization as well.

When children play the cooties game, it’s not uncommon to see them gang up on people they perceive as different or “less than” for some reason. For example, you’ll often hear children talk about this fake infectious disease as a thing girls give to boys or vice versa.

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In some cases, the cooties game becomes a socially acceptable way to bully and ostracize a particular child that’s perceived to be different.

The same thing happens beyond the playground. Throughout history, people have been singled out and bullied as dirty or dangerous. Take for example, Gaetan Dugas, the French-Canadian flight attendant who was incorrectly labeled the “Patient Zero” of the HIV epidemic. It’s been decades since his death — and we know beyond a shadow of a doubt that Dugas was not responsible for the AIDS epidemic — but his reputation never recovered.

It’s common to use fear of disease to discriminate against others. Look at syphilis, for example. This common sexually transmitted infection has many names. The English and Germans used to call it “The French Disease,” while the French called it “The Spanish Pox.” Meanwhile, in Russia, it was “The Polish Disease.”

In 2015, the World Health Organization (WHO) issued new guidance for naming diseases that included avoiding geographic and cultural descriptors. As Assistant Director-General for Health Security, Dr. Keiji Fukuda put it, “This may seem like a trivial issue to some, but disease names really do matter to the people who are directly affected.” Nevertheless, some on social media still incorrectly refer to COVID-19 as “The China Virus” or “The Wuhan Virus.”

We could give you many, many more examples, but you get the idea: Humans have a pretty bad track record when it comes to using diseases as an excuse to discriminate against each other. And the cooties game isn’t always helping. That’s why it’s important to address bullying behavior in children when we see it.

Keep your germs to yourself

In a world of the cooties game, spreading cooties is all part of the fun. In the real world, it’s crucial to avoid spreading infectious diseases.

“If the game was real, and I had cooties,” Dr. Esper notes, “I’d leave the game and wouldn’t tag anybody. I’d go home until my infection is gone. That’s a boring game, but that’s the one we all should play.”

He acknowledges that hasn’t always been the way, though.

Before the COVID-19 pandemic, we sometimes glorified working while sick. “Young people who were early in their career and trying to climb up the career ladder, they’d show up to work sick and tell everybody how they are suffering with this infection,” he says.

But during COVID-19, presenteeism became a serious concern — in all sectors. What is presenteeism? Dr. Esper describes it as showing up to work when you shouldn’t. Basically, it’s the opposite of absenteeism.

But the COVID-19 crisis has changed the way some employers think about illness. “During the pandemic many companies figured it out,” Dr. Esper continues. “Before they were giving out gold stars for coming to work sick. Now, they tell their employees, ‘You stay home or I’ll be upset with you because you’re taking out my workforce.’”

So, while actively trying to give people cooties makes for a good game, it’s important to remember that — when the game’s over — we have a responsibility to take care of ourselves and each other.

Faux infections and the real future

It may be a product of our imaginations, but the cultural legacy of cooties is complicated. The word “cooties” still means something to many children — and you’ll still see a wide range of cootie-based games played out on playgrounds around the world. It’s a game about a pretend infection, based in a very real history.

What the cooties game looks like and how popular it is in a given generation depends on what’s happening around the world. Games like this can teach children how society functions (for better and worse) and can offer a fun space to cope with their insecurities.

We can’t know what children will be learning or worrying about in the future, but we do know this: They’ll be living with the threat of infectious disease.

COVID-19 will not be the last epidemic disease,” Dr. Esper reminds us.

Recent history shows that he’s right. There was SARS in 2003, bird flu from 2005 to 2007 and the swine flu from 2009 to 2010. Before COVID-19, there was a MERS coronavirus outbreak in 2011. Add Zika, Ebola and Mpox (formerly called monkeypox) into the mix, too. And that’s just the big epidemics of the last two decades.

“This is a recurring cycle,” he says. “We should expect that global infectious disease outbreaks and even pandemics will happen regularly as we become more connected. That’s the new reality.”

The challenge we face is clear. But imaginary infections like cooties offer us an opportunity to teach our children how to protect themselves and others. And if we’re inventive enough about how we teach our kids to avoid cooties and reject bullying, we might be able to teach them to be kinder and more responsible citizens.

“If we learn from our past mistakes, maybe we will be ready for the cootie pandemic of 2027,” Dr. Esper jokes. “We’ll see.”

Learn more about our editorial process.

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