Vaccinated Parents, Unvaccinated Kids

A month ago, COVID vaccines were this hot ticket item that you got with some combination of priority status, luck, connections and a lot of web page refreshing. Yesterday, New York State opened them up toeveryone over age 30, and on Saturday, they will be available to all New Yorkers over age 16 (the lower age limit of the FDA’s emergency use authorization for the Pfizer vaccine). Production has ramped up significantly, and with three vaccines approved for emergency use, even with the expanded priority groups it's getting easier to get an appointment. And in other good news, vaccine hesitancy is dropping, and the United States as a country is doing well in terms of vaccine distribution. This week, we have about 16% of our population fully vaccinated (which means 2 weeks after the last shot).

Furthermore, it looks like in addition to preventing you from dying of COVID-19 (which is good!), the vaccines have been shown to significantly slow the spread of the virus in the real world, which is a critical victory. Even asymptomatic cases of SARS-CoV-2 infection turn your body into a factory for producing mutant strains, also known as variants. The more variants that are created, the greater the chance that one of them will get an evolutionary advantage and become more lethal, more spreadable, or resistant to the vaccines. It’s an arms race that we can’t afford to lose.

So I’m writing today about the situation that a lot of families - mine included - are suddenly finding themselves in. How do we act when the adults are fully vaccinated and the kids aren’t?

If you don’t have unvaccinated kids in your lives, and if you and your adult friends are fully vaccinated, then in many ways you really can go back to the "before times". The CDC says that groups of vaccinated individuals can socialize indoors with no masks. Since the pediatric vaccination trials aren't complete, it may be some time until kids can do this. On the other hand, there are promising early signs on that front. I don't want to make too many predictions, especially based on data that has yet to be independently reviewed, but Pfizer's announcement today is fantastic - ZERO cases of infection of ANY type (even asymptomatic!) in a group of 12-15 year olds.

Well, what do we do until then? How do families interact? How do we do birthday parties, summer camps and play dates? Will the fact that any adult who wants a shot will soon have one change how we do these things? Unfortunately, most of the official guidance on that is a lot of “we still don’t have enough data” and “the answer depends on a lot of factors”. So forgive me - I can’t give you simple rules that apply to all situations. But here are some things to think about when making decisions in a few weeks, when most adults are vaccinated.

Just like in-person education is far superior to remote education for a variety of developmental reasons, socialization outside of school is important for kids’ emotional well being. And just like education, it has to be done safely. It’s great that vaccinated people can dispense with some mitigation efforts in certain circumstances, but it’s critical to remember that young children are still just as likely to transmit the virus among themselves, with the risk of variant production. Now is NOT the time to back off our efforts to control the spread. COVID rates are much higher right now than they were last summer, currently over 10% in some NYC zip codes, so that’s a lot of circulating virus. We need to juggle risks to schedule activities. A good way to think about these risks is to break them down into categories.

First, you have the risk to your kids. While there have been cases of severe and even fatal COVID-19 in children, this is still quite uncommon (although obviously children with underlying conditions need to be especially careful). Next, you have the risks to adults - with vaccinated individuals, it looks as if the chance of hospitalization and death has almost entirely been eliminated. This is especially wonderful for grandparents who haven’t been able to visit and hug their grandkids for a year.

Third, you have the risk to people outside your social circles. Remember, the more the virus circulates, the greater the chance of someone, somewhere, who ISN’T protected catching it and dying from it. Despite all of the advances that have been made in treating the sickest patients, 685 people died of COVID yesterday in this country. You may not see them or know them, but they were real people with families who grieve. Anything you do to stop the spread of the virus may save someone’s life. And finally, the more cases, the more variants. This is the risk to the community at large, including young, healthy, currently vaccinated people. You don’t want to promote the development of vaccine-resistant variants and undermine all the amazing work that has been done to fight this pandemic.

Fortunately, we have a pretty good model for how to get kids together safely - schools. As I last wrote, the reason that transmission at in-person schools has been low is because of things like improved ventilation, masking, hand hygiene, testing, cohorting and social distancing. School children all go home to different households with varying rates of potential COVID exposure. But the schools have been able to bring them together safely.

So think about that when setting up a kids birthday party. In previous years, you might have invited friends from different circles, beyond the classroom. This year, it would be better to limit the gathering to a group that your child is exposed to - safely - every school day. Children at parties should still observe school-style precautions, even if their parents are fully vaccinated. That means outdoor activities (hooray for Spring!), social distancing between members of different families, and masks for children playing together. My daughter won't attend indoor parties just now, no matter how many adults are vaccinated.

Mixing unvaccinated children in larger groups will happen over the summer at camp. Day camps can follow the practices developed by schools, but sleep away camps allow for the creation of “bubbles”. At overnight camps, there is no mixing of kids from separate families at home at the end of the day. That means that with effort, you can create a large group with a very low risk of transmission, similar to that of individual households. The camps can, for example, require several tests for campers and staff prior to opening day. They can also have more stringent protocols for the fist week or so - cohorting, with masking and distancing when in larger groups. It will likely also be possible to require vaccination of all staff above age 16 by then. By creating this bubble, it means that these children will eventually be able to be together indoors and mask free - something that should not be done in schools just yet. And a similar approach could be used when multiple families travel or vacation together in a shared space, like a rental house. Vaccines make this easy for groups of adults, but once unvaccinated children are involved, you need to be much more careful.

The warm weather is coming, and we have had a VERY difficult year. You feel it, I feel it, kids feel it. Although no one can point to a date on the calendar and call it the end of COVID, we do know that this is a critical time to fight this thing. Masks and other mitigation factors now - for all of us in public and for unvaccinated groups of children - really do make a difference.

We are so close, please join me in ending this thing. Let kids socialize, but do it safely.