A nationwide increase in Covid-19 cases and hospitalizations fueled by the highly contagious delta variant, which now accounts for the vast majority of infections, worries many about the most vulnerable as restrictions are being lifted.
Among them, parents of young children who aren't yet eligible for the coronavirus vaccines wonder what the delta variant means for their families.
The delta variant now accounts for more than 83 percent of Covid-19 cases, the Centers for Disease Control and Prevention said Tuesday. Just a month ago, the variant accounted for just over 30 percent of new cases.
And on Monday, the American Academy of Pediatrics, or AAP, recommended that all children over age 2 wear masks when they return to school this year, regardless of vaccination status. That contradicted the CDC's earlier guidance, which was that fully vaccinated students didn't need masks. Covid-19 vaccines have been authorized only for people ages 12 and up in the U.S.
As parents have been preparing for camp, vacations and the school year ahead, families are concerned about how safe their summer or fall plans may be for their kids.
Here's what top pediatricians said about what families should know about the delta variant and children.
What steps can I take to protect my family?
Emergency use authorization of vaccines for children may not come until midwinter, a Food and Drug Administration official said recently.
Dr. Jim Versalovic, the pathologist-in-chief and interim pediatrician-in-chief at Texas Children's Hospital, said: "This variant is spreading like wildfire. That means that we have to be extra careful among those who are unvaccinated and partially vaccinated. We're very concerned about children under 12 who have no access to the vaccine right now."
Versalovic said doctors had seen a "very dramatic shift" in the last two to three weeks to where delta is now "by far the most dominant" variant among children.
Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health, said the delta variant, while it is "certainly more contagious," doesn't appear to be more dangerous to children than other variants. As of Thursday, more than 4 million children had been diagnosed with Covid-19, about 14.2 percent of all cases, according to the AAP. Versalovic also said, "We have no firm evidence that the disease severity in children and adolescents is any different with the delta variant."
Dr. Michael Green, a pediatric infectious disease specialist and medical director of infection prevention at UPMC Children's Hospital of Pittsburgh, said getting vaccinated is "the most important thing that parents can do to protect their children" from getting the coronavirus in general, including the delta variant. Parents should consider encouraging other members of their families to get vaccinated, as well, he said.
Versalovic said getting vaccinated was "the No. 1 tool in preventing and mitigating the spread and transmission of Covid, including the delta variant."
"This is a race between the vaccines and the variants," he said.
What do experts say about in-person school?
The AAP, which said it's important for children to return to in-person learning this year, recommended that school staff members also wear masks.
The CDC and the AAP recommend in-person learning even as they differ over mask guidance. Some states have prohibited districts from requiring masks in schools. Local governments and school districts have the authority to make their own decisions about mask-wearing, even for unvaccinated students.
Versalovic said that while wearing masks was a politically charged debate, "it's certainly important to consider the importance of masking in schools, in addition to sanitizing."
Parents with children ages 12 and older should also consider the amount of time between two doses of the vaccines, he said.
"Now is the time to consider vaccinating a child before the next school year," he said.
Green said parents with children with underlying medical conditions or in states with low vaccination rates that restrict masks in schools might have much more difficult decisions.
"It is really, I think, a hard decision that parents have to make," said Green, who is involved in the care of children who have had organ transplants.
"When school districts choose to do it their own way and not to enforce masking at all, I suspect that we may learn that that's not a good thing to do," he said, adding, "The fear is that there will be more spread within schools than that we've seen previously."
Should my child go to camp this summer?
Medical experts said it was important for parents to be informed about whether summer camps were following public health guidelines and what safety measures they were taking to protect children.
Lighter said parents should try to find out the Covid-19 protocols of a camp, such as what symptom screening or testing it is doing, what its mask policies are for indoor and outdoor activities and the vaccination policies for its staff. Camps where staff members are vaccinated and those that have policies like encouraging masks indoors will reduce the risk for unvaccinated children, she said.
The AAP has also said campers should wear masks during indoor activities.
Versalovic said parents should work closely with their camps and ask key questions about what protocols are in place and the vaccination statuses of counselors and other personnel who will be with their children.
"I'm not here to discourage camp activity. We know it can be very important developmentally to children," he said. "I think we just need to work with the camps to make sure parents are fully aware of the practices that these camps are putting in place to keep their children safe, and that obviously includes masking, distancing and sanitizing in their facilities."
Should we take that flight to go visit Grandma?
Families planning vacations or long-awaited trips to visit relatives may be wondering what delta means for longer-distance travel plans.
Dr. Richard Malley, a pediatrician specializing in infectious diseases at Boston Children's Hospital, said that so far air travel itself hasn't been a major source of transmission of the coronavirus. Wearing masks is required on planes and other major forms of public transportation, while traveling within or out of the U.S. and while indoors at transportation hubs, such as airports and stations, according to the CDC.
Malley said wearing masks while flying reduces the risk of transmission, so while the form of travel itself might not be the major risk, the destination might be.
"So if you're going to a place that has a ton of virus, that may not be the best place for you to take your child," he said.
He said weighing the risk of traveling depends on the situation. If the trip involves other fully vaccinated adults with minimal exposure, the risk is reduced, he said. But if the trip involves children's being exposed to other unvaccinated adults, especially those in vulnerable populations, or crowded indoor settings where people may not have masks, "the equation is not in favor of that trip," he said.
What about play dates?
With the lifting of pandemic restrictions, families have been navigating how to return to their social lives safely. That includes how to set up play dates for their unvaccinated children, even though parents may not know the vaccination statuses of others around them.
Malley said asking parents ahead of time about the vaccination statuses of people in the household, as well as whether anyone in the home has any symptoms, is reasonable.
"I think parents and individuals have to get more comfortable asking these types of questions," he said.
Versalovic said other important factors are to make sure play dates are outdoors when possible and to hold them in uncrowded settings and in smaller play groups where parents can also keep their distance.
The risk would go up "dramatically," he said, if play dates were held in crowded indoor settings among other unvaccinated people, especially around potentially vulnerable unvaccinated adults or those with underlying medical conditions.
Malley said that because of the threat of the pandemic, parents have to be "more in tune with what they're doing with their kids" and "what are the best activities, what are the safest activities that are also fun and educational or physically rewarding."
He said there was a good chance that "we're going to be dealing with this for a pretty long time," even if not at the same intensity as when the pandemic began last year.
"This is here to stay, and if we figure out how to live in a way that is safe and yet at the same time not too restrictive with our kids, we will limit the collateral damage that kids have been experiencing," he said.