NOW THAT Aubrey Samost and her husband are vaccinated against COVID-19, Samost said the Cambridge couple would not hesitate to go out for dinner – except they have a 15-month-old daughter, who is too young to be vaccinated.
“It has been difficult to figure out what we can and cannot do with it,” Samost said. “We feel like there is a lot we can do and she can’t.”
The couple are sending their daughter to daycare and have started socializing with other families where adults are vaccinated, but they won’t be taking her inside stores. Samost is an anesthesiologist and her husband is a scientist, but she recognizes that their parental decisions related to COVID are made as much on instinct as on data.
“We know her risks if she contracts COVID are low,” Samost said. “But we would also feel really guilty if anything happened to him, so we always tend to err on the side of caution.”
For many in Massachusetts, life is slowly returning to normal. The government has dropped almost all COVID-related restrictions, allowing businesses to fully resume operations. More than half of the state’s population is fully vaccinated and two-thirds have received a dose of the vaccine. But children under 12 remain ineligible for vaccines, putting parents in a dilemma as they face tough personal decisions about how much risk they’re willing to take.
“This is certainly a difficult question and the conversation is very confusing,” said Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics. While the United States Centers for Disease Control and other organizations make recommendations for vaccinated and unvaccinated adults, Fisher said, “No one gives children clear advice.”
It is clear that children are at less risk than adults of COVID-19, a virus that has been most dangerous for the elderly.
Vandana Madhavan, a pediatric infectious disease specialist at Massachusetts General Hospital, said children are less likely to contract COVID-19 and less likely to transmit it. The virus usually only causes mild symptoms in children, and many children admitted to hospital with COVID-19 were actually admitted for other reasons but also had the virus.
However, there have been cases of children with multisystem inflammatory syndrome after contracting COVID-19, a serious condition in which parts of the body can become inflamed, such as the heart, kidneys, or other organs. Madhavan said the risk is rare, but not zero.
Rick Malley, an infectious disease physician at Boston Children’s Hospital, said the best way to think about the issue was in terms of relative risk. “If someone were to ask the question, could COVID make a child sick, the answer of course is yes,” Malley said. “But when you talk about it in relation to the risk that this virus poses to older patients or to those who are immunocompromised, in the case of children, the risk of serious illness from COVID-19 is significantly reduced compared to that of adults.”
An important question then becomes the likelihood of children contracting the virus – which largely depends on the prevalence of COVID-19 in the child’s community.
Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, said it’s a misconception that not being vaccinated equates to dangerous. “Our children weren’t vaccinated in 2018 and they were safe,” Doron said. “Just because you haven’t been vaccinated against something doesn’t mean you are at high risk. It must be a combination of your susceptibility and vulnerability and the possibility of encountering infection in the community. “
Doron said there is no magic vaccination number that a community can be considered “safe,” but generally low case rates make everyone safer. She said the rates of cases in Massachusetts, which have fallen, are already at a point where the risk for any child of contracting COVID-19 and having a bad outcome is likely similar to the chance of having a bad one. flu result during a regular flu season. “We are probably already at a point where the risk of being in a car accident on the way to school is greater than the risk of acquiring COVID in school and having a bad result, ”said Doron.
Doron said families and communities need to think about the risks and benefits of placing restrictions on children. Several experts have accused COVID-related precautions – like school closings and peer isolation – of leading to a pediatric mental health crisis.
Doron questioned the perception that forcing children to wear masks is okay. She said it is beneficial to encourage children to exercise outside, even in hot weather, which is more difficult with a mask. Children who are hard of hearing or have social development challenges may need to see facial expressions in order to communicate. Requiring universal masking also makes it harder to distinguish between high-risk and low-risk situations, so it may make more sense to save masking for times and places where it is most needed – indoors or when the number of cases is high.
Doron said she frequently hears parents who “still have a ton of fear” around COVID. But, she said, “We don’t want fear-based decision making. We want science-based decision making.
Fisher advises families to think about their individual circumstances. If adults in a family are vaccinated, unmasking a child outside poses a very low risk to anyone. Reuniting indoors with another family when all adults are vaccinated is also low risk. But if a family member is immunocompromised, has a chronic illness, or is not vaccinated, it increases the risk of various activities.
“It’s not a clear answer,” Fisher said. “We know the risk is low, but the risk is still not zero.”
Fisher said he was encouraging families to take advantage of the summer to get outside, where the risk of transmitting the virus is lowest, and to let children go to camp and play in parks. “Even though on the whole, the children were not the ones who contracted a serious illness, they suffer from the lack of in-person schooling, the lack of the ability to socialize,” said Fisher.
Madhavan said she advises families to think about where the activities are taking place and with whom. Playing in a park is safer than eating out. Walking along a street is safer than attending a crowded concert. Visiting a family where adults are vaccinated is safer than going to an indoor public space, where the vaccination status of others is unknown. The risk for immunocompromised children is greater than the risk for healthy children.
“It’s not great, get back to normal, but really think about activities that would both benefit your mental health and make you feel like you’re getting closer to normal while being aware of the ever-present risk,” Madhavan said.
One question is whether the newly emerging COVID variants are more likely to harm children than the original virus. So far, Malley said, the variants have been shown to be more easily transmitted to adults and children. But there is no strain that causes more virulent illness in children.
Data showing that a higher proportion of cases occur in children does not necessarily reflect an increase in childhood illnesses, but a decrease in cases in adults as more adults are vaccinated. And Doron said studies have shown that all three COVID vaccines approved in the United States are effective against existing variants.
At the societal level, the more people vaccinated, the less likely COVID-19 is to spread. But Malley noted that some countries have had extraordinary success in crushing the virus even without immunizing children. Israel is the most frequently cited example of a country with high adult vaccination rates and an extraordinarily low number of cases, even though schools are open and children under 12 are not vaccinated. The UK also has a low spread of COVID, likely due to its strategy of spacing out the first and second vaccine doses by 12 weeks, allowing more people to get their first doses sooner.
“You can imagine a scenario where by the time the vaccine becomes available for very young children, there are so few diseases circulating that the value for money is really very low,” said Malley.
Rebecca, a Cambridge scientist who declined to give her last name, said she was waiting for the number of cases to drop dramatically or for her two and six-year-olds to be vaccinated to stop restricting their behavior. At this time, she does not let her children travel on planes or do indoor activities, even though she and her husband are vaccinated. Rebecca, when interviewed at a playground, said her priority was keeping her children healthy and being able to attend daycare and school.
“We’ve gotten used to it over the last 15 months so it’s pretty easy to keep going, especially now that the weather is nice,” she said.