With coronavirus cases rising across the country and the highly contagious delta variant spreading in every state, many parents have been left wondering how best to keep their children safe, particularly when it comes to kids under 12 who are not yet eligible for vaccination.
Most schools are set to welcome students back in person in the coming weeks, but many aren't requiring them to wear masks. And as people look to plan last-minute vacations, set up play dates for their kids or attend other events, weighing the potential risks is challenging because many families are juggling different vaccination statuses within their own ranks.
"There are no easy answers, only tough trade-offs in so many situations," said Lindsey Leininger, a public health scientist and clinical professor at Dartmouth College's Tuck School of Business.
She said the best way to protect kids who are currently too young to get vaccinated is for everyone else in the household who is eligible to get the shots. After that, decisions should be guided by what's happening in individual communities and each family's comfort level, she added.
"The first thing that's always top of mind is the level of circulating disease in my community, because if the community is on fire, that really drives everything that I do," said Leininger, who has two children under 12. "If you're sitting in Vermont with low circulating disease and 80 percent of adults are vaccinated, it's not the same calculus as if you’re sitting in New Orleans and hospitals are overflowing."
Which activities are relatively safe, and which ones should be skipped? Here's how Leininger and other experts weigh the risks.
Is it safe for kids to go back to school?
Many experts agree that the overall benefits of in-person learning outweigh the risks, but for families with kids under 12 who are unvaccinated, decisions about what to do for the upcoming school year may be more complicated.
The Centers for Disease Control and Prevention has recommended that all school children wear masks in the fall, but not all schools have imposed mask mandates and many say they can't — or won't — enforce such rules.
Emergency authorization for Covid vaccines in children under 12 could come in early to midwinter, but until then, some families may feel that virtual learning is a more suitable option, said Dr. Danny Benjamin, a professor of pediatrics at the Duke University School of Medicine. That largely depends on the needs of the individual child, as well as the resources available to parents, he added. Working parents, for instance, may not be able to support online learning, and some children may fare better in classroom settings.
"At our house, we will probably grit our teeth and send our younger children to school, but a very reasonable family could look at this and say they want to keep their child out until Christmastime, until the vaccines get here," he said.
Nearly 4.2 million children have been diagnosed with Covid-19, according to the American Academy of Pediatrics, representing more than 14 percent of all cases. At least 340 children, ages 17 and younger, have died from Covid, according to the latest CDC data, but serious complications in young people are considered extremely rare.
"We can't say that about other age groups, but we can say that about kids when we look at the data," Leininger said. "So there is some reassurance that for the vast majority of kids, we're dealing with a much smaller risk."
But while young children are generally less vulnerable to Covid than older age groups and those with underlying conditions, kids can get sick. And as the delta variant continues to spread, cases among young children, including severe ones, are expected to increase, said Dr. Rachael Lee, an assistant professor of medicine at the University of Alabama at Birmingham.
It's not yet well understood if the delta variant is more dangerous for young children, or if kids are more susceptible to this strain compared to others who are unvaccinated, but doctors have reported a steady increase of Covid cases in children and medical experts have warned about the ongoing dangers of the virus.
Lee added that concerned parents can try to advocate for better mitigation measures in their school districts, including pushing for mask requirements, emphasizing more time outdoors and inquiring about ventilation improvements in classrooms.
Should you let kids go on play dates?
Children need time to socialize and need to spend time with their friends, said Lee, who has two young sons.
But to ensure playtimes are safe, she said it's important to understand each family's comfort level with risk. If, for instance, other parents are fully vaccinated and are diligent about mask use in public (particularly indoors), that could reduce the risk of exposure to their children.
"If you do end up getting together, maybe the kids can play outside," Lee said. "You can still do fun things and enjoy life while trying to be safe and protecting your child."
Leininger, who is one of the founders of Dear Pandemic, an online project that aims to help people navigate the onslaught of information about Covid, said she approaches things as a "mom scientist" but recognizes that people's interpretation of risk is neither static nor uniform.
"We all draw the line in different places for our families and our kids," she said. "That can vary for people with an immunocompromised family member, or someone at an elevated risk of Covid or not being able to mount a good vaccine response."
The safest bet, Benjamin said, is to keep playdates outdoors, particularly because many kids may not keep their masks on properly over their nose and mouth for the duration of an indoor playdate.
Should parents of young kids go back to offices?
Many front-line or essential workers did not have the luxury of working from home, but for others whose remote work may be winding down, experts said there are still ways to remain safe and protect others, including young kids, in the household.
“The delta variant has not broken the laws of viral physics,” Leininger said. “All of our mitigation measures still apply.”
She recommended wearing a mask indoors, practicing social distancing and asking employers about better indoor ventilation.
Dr. Janko Nikolich-Žugich, an immunologist and professor of medicine at the University of Arizona, said recent findings from the CDC that vaccinated people who are infected with the delta variant could spread the virus just as easily as unvaccinated individuals should prompt behavioral changes across the board.
“What we do not know at this point is whether the virus produced in vaccinated people is still at the same level of infectivity, or whether the presence of antibodies in these people may make the virus less infectious,” he said. “Until we learn about that, the delta variant behavior should mandate a change in strategies and approaches.”
In areas where the delta variant is spreading widely, that may mean being more vigilant about wearing a mask, practicing social distancing and working from home, when possible, regardless of vaccination status.
But Leininger said it’s also important to recognize how challenging the situation is, and to exercise patience and compassion for yourself and others.
“My husband and I are both vaccinated but I have two kids under the age of 12, so I’m living this reality along with every other parent right now,” she said. “Our brains are awash in uncertainty and anxiety and neither of those are good for decisionmaking. So the first thing I do is take a deep breath and get through my emotions, before I start making these calculations for my kids.”
Is it safe to go to the movies, sporting events, concerts or other activities?
The risks associated with going to movie theaters, sporting events and other activities will largely depend on local conditions and whether big outbreaks are happening in the community, according to experts.
In areas where the virus is spreading widely, it may be a good idea to refrain from things that involve being in close contact with other people for prolonged periods of time, Benjamin said.
"With the delta variant, going to an unmasked movie theater is not an awesome decision," he said. "I wouldn’t engage in that sort of behavior unless it's something crucially important."
Leininger said she's not personally comfortable going to movie theaters yet, but added that she tries not to judge how others manage their own risk.
"You don’t know if going to the movies is the one thing that is keeping somebody sane in the pandemic," she said. "I never judge how anyone else is using their risk budget, just like I don’t judge how they're using their financial budget."
Dr. Randall Olsen, medical director of the Medical Diagnostics Lab at Houston Methodist hospital, said it’s critical to adjust behaviors based on who else is around.
"If I’m with friends and family, people in my social circle who I know are vaccinated and safe, then I’m relaxed," he said. "If I’m in a situation where I’m around people I don’t know, and especially if I'm indoors, then I’m masking."
Lee said her family has adjusted its behavior based on the local conditions where they live in Birmingham, Alabama. In recent weeks as cases have increased, she said they've stopped going to dine at restaurants and halted most activities that require them to be in closed spaces. Outdoor events such as minor league baseball games are still within her comfort zone, however.
"You may have to adjust what you're currently doing depending on the rates in your community," she said. "As an example, if you have a child that does indoor sports and if your community rates are incredibly high, that may be a higher risk for your child."
Is it OK to continue summer travel?
Many experts said it's likely safe to travel because airports and airlines have strict mask requirements for passengers, but parents should take into consideration their personal comfort level.
Benjamin said families with unvaccinated young children may want to consider road trips in a family car, if possible, but added that air travel has not been associated with significant clusters of infection.
Beyond transportation options, it's also important to weigh the potential risks at the destination. Will the trip consist of mostly spending time with vaccinated family members or friends, or will it involve sightseeing or other activities around a lot of strangers? Will time be spent mostly indoors or outdoors?
"If you're at a national park and you're hiking with your family, that's probably a safe situation," Olsen said. "If you're in the hotel lobby, in a museum or some other indoor space, you really have to just be aware of who is around you and how close they are."
For some, the stress of traveling during a pandemic may simply be too much of a hassle.
"I have not been on a plane in almost two years," Olsen said. "To me, it's not worth the risk."