How should vaccinated parents make decisions about visits, eating out, and vacations when their children are not vaccinated? Dr. Lina Wen, CNN medical analyst, emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health.
Dr. Leena Wen: Pfizer-BioNTech’s vaccine is currently approved for people 16 and older; all other vaccines are for people 18 and older. Studies are conducted for younger age groups. Dr. Anthony Fauci (long-time director of the National Institute of Allergy and Infectious Diseases) predicts that results for people 12 and older could be available by the end of the summer, and teens could be vaccinated before the school year begins. Young children probably won’t be able to get the vaccine until 2022.
CNN: It’s a long way. Can the kids go back to school in the fall for full-time education?
Wen: Yes, and now they should be able to go back to school full time as well. Numerous studies have shown that protective measures, such as the general use of masks, can reduce the risk, resulting in lower infection rates in schools than in the community. This means that schools can be among the safest places for children.
It is important that all teachers, school staff and parents get vaccinated in the fall. This further reduces transmission in the community and protects those who have not yet been vaccinated, especially children.
CNN: Meanwhile, many parents are getting vaccinated. What would you advise them to do? Are they allowed to visit the grandparents if the children are not vaccinated?
Wen: Vaccination by the parents is very important. This reduces their own risk of contracting the disease and also reduces the likelihood that they will transmit the coronavirus to those around them, including their children. It also makes it safer for other family members who come to visit. The U.S. Centers for Disease Control and Prevention has said that fully vaccinated people can visit another family where not everyone has been vaccinated, as long as the people who have not yet been vaccinated are not at high risk of serious illness from Covid-19 itself. This means that it is good for grandparents to visit their children and grandchildren and stay with them, eat with them in the house, hug them and not wear masks.
CNN: What about visiting another family whose parents are vaccinated and the children are not?
Wen: This is where we get into tricky territory. Vaccinated grandparents visiting a family with unvaccinated members is one thing, but it is quite another when two families, each with unvaccinated members, visit each other.
We know that adults are more likely to transmit coronavirus than young children. It should also be noted that adolescents seem to transmit coronavirus as frequently as adults. If unvaccinated people get together, they are at risk of contracting and transmitting Covid-19.
To date, despite the high baseline level of coronavirus circulation in the United States, it is best to see families with unvaccinated individuals only outdoors, where members of different families are within 2 meters of each other. If children are playing together and cannot always keep a six-metre distance, they should wear masks.
Always try to be outside. If people need to stay indoors, they should wear masks in their environment. And make sure your child has a serious illness. Again, wearing the mask is very important to them and to everyone around them.
CNN: Are there conditions in which families with children can safely get together? What happens when three families want to rent a house together?
Wen: If three families with all unvaccinated children want to get together for an extended period of time and stay in the same room, I suggest that they all be quarantined and tested. In particular, I recommend that uncertified members of each family reduce their risk for seven days and then get tested, or reduce their risk for 14 days before getting tested if testing is not readily available.
This means that no other meetings will be held during this period, especially in closed rooms. My recommendation here is that vaccinated people probably do not need to be tested because the likelihood of them contracting and transmitting coronavirus is greatly reduced. However, out of abundant caution, I would advise even those who are vaccinated to limit their risk indoors before such an encounter, even during this period.
CNN: How about eating out? Should parents go alone, or can they bring their children?
Wen: I think it’s important to point out that there is almost nothing that is 100% certain. It is about understanding the relative risk and then trying to assess and manage the risk for each family.
Takeaways remain the safest, followed by eating out. An indoor restaurant always carries a certain amount of risk. The risk for vaccinated parents is much lower than for the full vaccination. People may weigh their risks and decide that they want to continue some of their pre-pandemic activities after vaccination. Parents who want to go to a restaurant once in a while should do so and try to stay out of it. If they want to dine inside, choose venues with strict safety protocols, including a spacious table and good ventilation.
It is up to each family to decide whether or not they want to put unvaccinated children in this situation. The risk is not zero, but probably quite low, in outdoor restaurants. Indoors, this risk will be greater. I would be especially careful if it is a child with immunosuppression or additional risk factors for severe covidia.
CNN: What about attending birthday parties? Does it matter that all parents in these areas are vaccinated?
Wen: I would certainly feel better at a birthday party where I know that all the parents of the children attending have been vaccinated, because the chances of one of the attendees being an asymptomatic carrier of Covid-19 are much lower. But given the number of unvaccinated children, I wouldn’t want them congregating in the house. I would still make sure the meeting is outside and that there is at least 2 feet between families. Everyone should wear masks. The same goes for playdates, family reunions and other gatherings.
CNN: Many parents want to travel with their children in the summer. Is it safe?
Wen: This is another situation where we need to talk about relative risk. Traveling by car is not a big risk. Even if you are traveling by air, it is unlikely that everyone is wearing a mask. My biggest concern with travel is not so much the risk in transit, but what people do at the destination. If all meals must be taken in a restaurant, the risk increases significantly. But if you want to cook or have something to eat, the risk is much lower. The same goes for the activities you do when you travel. Visiting amusement parks and cinemas, where it is very crowded, is much riskier than hiking and camping. A large family reunion or wedding would be riskier than a small reunion with just the grandparents.
At this stage of the pandemic, we need to move to the concept of risk assessment and try to reduce the risk as much as possible. Parental vaccination is an important step in reducing the risk, even if children have not yet been vaccinated, but there are still steps that can be taken to protect children – and everyone around us – from Covid-19.