Kids are People, too
Pro tip: If you’re too pooped to read this whole thing, skip to the bottom for the upshot. (Giddyup if you’re ready to talk turkey about kids!)
The CDC finally issued new guidelines this week allowing vaccinated people to ditch their masks outside. Yahoo. This is a bit like saying The Sky is Blue, but we’ll take it. It’s a BABY step in the right direction — but only for adults.
What about our actual babies — from toddlers to teens — whose lives have been upended but for whom a vaccine is not yet an option?
Do kids still need to mask outside — for sports and on playgrounds? How can families plan for the summer with unvaccinated, vulnerable youngsters? What will camp look like this summer?
These are the questions that I’m regularly fielding — and that I’m trying to answer for myself. I have three teenage kids. My sons (ages 19 and 17) have both been recently vaccinated. I’ve also got a patiently peeved 15-year-old daughter who’s chomping at the bit for a vaccine.
How do I console her while she languishes on the sofa in an unvaccinated funk? I remind her of three things:
If all goes as expected, the Pfizer-BioNTech vaccine is likely to receive Emergency Use Authorization by the FDA for ages 12-15 in May.
She is incrementally safer with each passing day as more and more people in her midst are vaccinated (cue the annoying vaccinated brother sauntering through the kitchen with a wink and a smile)
I feel her pain! I, too, felt naked and (kind of but not really) afraid until I got my shots of mRNA.
What should you tell your kids — and how should you consider your kids’ risks in these muddy waters of fear, hope, and mixed messages?
There’s no one-size-fits-all prescription for human behavior. Every child, guardian, and family have unique medical issues, risks, and risk tolerances. (This is exactly why you need a doctor!) But by grounding these questions with facts we might understand our kiddos’ risks a wee bit better.
Let’s go!
Children and young adults remain at low risk for COVID-19.
It’s been well-established that COVID has affected kids in fundamentally different ways than it has adults. To put it in perspective, according to the CDC, COVID has killed 277 kids under the age of 18 which is about 0.46 per 100,000 and far fewer deaths in that age group than in a typical flu season. For example, in 2017-2018, the flu virus took the lives of approximately 643 kids under age 18.
Can kids die from COVID or the flu? YES. Of course, any death of a child is tragic. But the risk of death from COVID-19 in kids under 18 is very small. It’s on par with the risk that we undertake every flu season when we send our kids to school, daycare, activities, and social gatherings. We don’t close down our lives for the flu. We also don’t mask up our kids — inside or out! — during flu season.
I said a loud “AMEN!” when Dr. Jennifer Nunzo, an epidemiologist at Johns Hopkins recently said, “I can accept the risks of my kids getting COVID, in part because I compare it to the risk of getting other infectious diseases and the risk seems very, very small. I feel that if my kids were to get COVID, they would be OK. I also see the direct harms of their not having a normal life.”
Kids under age 20 with COVID-19 are over one-third less likely to spread the virus to others.
Back in 2020 we thought kids were major vectors of infection, teeming with viral particles and responsible for sickening adults. We were wrong. Kids not only don’t get COVID as much as adults and generally don’t get that sick if they do get COVID, they also don’t transmit the virus to others like grown-ups do. Can kids transmit the virus? Absolutely! Have they sickened other people? For sure! It’s just that it’s less likely in kids, particularly if they don’t get COVID in the first place.
FYI the UK is crushing the pandemic without masking kids under 12.
The risk of outdoor transmission of coronavirus is tiny.
To read about the hot debate of outdoor masking, check out this gem from BMJ. The long story short? Outdoor masking, in my humble opinion and in the opinion of many experts, isn’t evidence-based and is performative, erodes trust in our public health leaders, diverts attention from higher-risk situations, and shouldn’t be mandated — even for unvaccinated folks — when the risk of outdoor transmission is so small.
FYI the WHO has never recommended outdoor masking.
Of course many people, particularly unvaccinated adults, may want to stay masked, but that can be their choice.
The emotional toll of the pandemic on kids is high and well-documented.
While masking kids, keeping them out of school, and limiting their movements no doubt was appropriate in 2020 and continues to reduce their risk for COVID-19, we have to acknowledge the COSTS of these interventions to kids.
Clearly closing schools was the right thing to do in the hair-on-fire days of spring 2020. But with a clear understanding of how to mitigate risk, plummeting case rates due to widespread vaccination, and abundant evidence of the low risk of COVID to kids, the case for school closures is on extremely thin ice.
In short, the harms of kids not engaging in their normal life are clear; the risk of COVID-19 in the average kid is small. The risks to unvaccinated people get smaller every day. We make complex decisions in our everyday lives. We’ve got to step back and realize the consequences to our kids of aggressive risk mitigation for the sake of a mild respiratory illness.
Here are the counterpoints I anticipate from you savvy readers:
But what about the risk of MIS-C, the feared vascular complication from COVID-19?
The risk of MIS-C is extremely rare. A recent article in JAMA estimates that over the last year, MIS-C has affected 2.1 in 100,000 children. By comparison, we see around 10,500 cases of childhood cancer diagnosed every year.
And what about the risk of my child getting long COVID?
Many of you well understand that the risk of a child dying from COVID is tiny but worry more about the ongoing unknowns of COVID-19 — and in particular the risk for long COVID. The risk of long COVID in kids is a lot lower than previously thought. Some early reports suggested that long COVID is present in 13% of infected kids, but this turns out to be an overestimate. In fact, experts have determined that developing any fatigue, cough, headache, loss of taste or smell, myalgia, sore throat, fever, shortness of breath, nausea/vomiting, diarrhea or abdominal pain within five weeks of infection is normal and not to be confused with long-COVID.
What about the variants? Aren’t they more dangerous for unvaccinated people?
The variants are indeed more contagious, but they haven’t been shown to be any more lethal than the “regular” coronavirus. The vaccines protect against all of the variants, and as we edge closer to herd immunity (e.g. as more people are vaccinated and therefore unlikely to sicken others), the less risk posed to unvaccinated folks goes down. In brief, you shouldn’t think about the variants any differently than you would the regular coronavirus EXCEPT if you’re indoors, unvaccinated, and/or in an area where case rates are high.
What are the upshots?
Get vaccinated if and when you’re eligible. Vaccination prevents COVID-19 and sickening others. The vaccines essentially take death and severe disease off the table and turn COVID-19 into a milder respiratory illness (if anything). Recall that the risk of getting COVID after vaccination is 0.005% based on real-world data from the CDC.
Treat your 12-15 year old to the vaccine once it’s out. Just like watering a withered hydrangea in the hot July sun, my sons came back to LIFE after getting the shot!
Please consider letting your kids (and yourself) unmask outside — even if you’re unvaccinated. The risks are tiny and the upsides unmeasurably high. Is this a good plan for every child? Not at all. Some kids are high risk. Some live with high-risk or unvaccinated family members. Some kids aren’t ready to unmask. But for the average kid, outdoor masking just isn’t necessary.
Plan for outdoor fun now and this summer. Outside is safe. Kids need camp! Even when unvaccinated, the benefits of socializing, getting out in nature, and allowing parents to work are HUGE in comparison to small risks of COVID in the average kid. I was interviewed for the New York Times on this very subject this week!
Know that as the public health landscape shifts, so does our risk. In the US, our risk for getting COVID is changing under our noses. As vaccinations go into arms and case rates fall, our risk calculations should appropriately shift. In other words, we’re in a much better position than we were even a month ago. By July we should be nearly “done” (with the understanding that COVID will be with us for quite a long time).
Health is more than the absence of disease. Not getting a cold is nice, but what about living? For kids, socializing with friends, engaging with the outdoor world, and allowing some safe rewards for their 14 months of diligence seems healthy to me.
We’ve never been promised a risk-free existence. Risk is everywhere. We can’t make it zero, so let’s consider the risk/benefit ratio of doing and NOT doing. It all matters to our everyday lives and, ultimately, to our health and well-being.
I will see you next week. Until then, be well.