What Do You Do When The Kids Are Still Unvaccinated?

David Leonhardt NYT Many families will soon face a complicated choice about how quickly to resume their pre-pandemic activities. More than 50% of American ...

David LeonhardtNYTMany families will soon face a complicated choice about how quickly to resume their pre-pandemic activities.More than 50% of American adults have already received at least one COVID-19 vaccine shot. At the current pace, virtually all adults who want to get vaccinated will have been able to get a shot by July. Yet relatively few children, especially younger children, will have been vaccinated by then. While the Pfizer-BioNTech vaccine may be authorized for children ages 12 to 15 as early as next month, younger children appear to remain months away from being eligible for any vaccine.What should those families do this summer and next fall, as they consider sending children to day care, seeing relatives, socializing with friends, eating in restaurants or traveling on airplanes?The answers will not be easy. Families will make different decisions based on their preferences. There will be more than one reasonable approach.Some parents will choose to keep their children largely away from indoor social situations until vaccines are available for them. These parents will point out that some children have died from COVID-19, while a few thousand others have contracted a rare inflammatory condition. These parents will also rightly say that many things about COVID remain mysterious.Future variants could cause more severe effects in children, and the long-term effects of COVID-19 are unclear. A cautious approach may be especially sensible for families in which the children have underlying health conditions or some adults have chosen not to be vaccinated.But other parents will be more willing to resume many parts of normal life before all of their children have been vaccinated. And those parents will be making a decision that is as scientifically grounded as the more cautious approach.“It’s really important to look at a child’s overall health rather than a COVID-only perspective,” Dr Amesh Adalja, a pandemic expert at Johns Hopkins University, told me. Keeping children isolated is particularly fraught for lower-income parents, because it forecloses child-care options and can keep them from working a normal schedule.Any decision about family life over the next several months will have to involve weighing one set of dangers against another. My goal here is to walk you through the risks that COVID poses to children.As a comparison, let’s start with its effect on adults. For them, COVID-19 has exacted a brutal toll, one large enough to warrant the shutdown of much of daily life. The disease has killed about 16 times more Americans than the flu would have in a typical year.Nationwide, COVID-19 was the third-leading cause of death in 2020, after heart disease and cancer. Even for adults who are only in their 30s, COVID-19 has meaningfully increased the dangers of everyday life: It appears to have been the fifth most common cause of death over the past year, after accidents, suicide, cancer and heart disease — and ahead of murder, liver disease, diabetes and every other cause.But COVID’s effect on children has been fundamentally different from its effect on adults. For children, COVID looks much more like the kind of risk that society has long tolerated, without upending daily life.“For the average kid, COVID is a negligible risk,” Dr. Aaron Richterman, an infectious disease specialist at the University of Pennsylvania, told me. Richterman added that he would not upend his family’s life to avoid every possible exposure to children.It’s also helpful to put COVID-19 in the context of other risks that children face. About twice as many children drown in a typical year as have died from COVID-19 over the past year. About five times as many die in vehicle accidents. If protecting children from small but real risks of serious harm were society’s top goal, keeping children away from pools and cars would probably have a bigger effect than isolating them in coming months.There is also evidence that Americans are exaggerating COVID’s risks to children. When a large survey by Gallup and Franklin Templeton asked people to estimate the share of COVID deaths that have occurred among people under age 25, the average answer was 8% (and Democratic voters tended to give higher estimates than Republican voters did). The actual answer was 0.1%. By contrast, Americans badly underestimated the share of deaths among people over age 65.Jennifer Nuzzo, a public health researcher at Johns Hopkins, told me that she viewed decisions about children’s activities as a matter of personal choice that different parents would make differently. In her family, she said, she was worried about how a year of pandemic life had hurt her children by making them less comfortable in social situations. Once all the adults are vaccinated, she plans to restart more activities.“I can accept the risks of my kids getting COVID, in part because I compare it to the risk of them getting other infectious diseases and the risk seems very, very small,” Nuzzo said. “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.”Of course, many parents aren’t worried only about death or hospitalization with COVID-19. They are also anxious about chronic long-term effects, like potential neurological or cardiac damage. This is a murkier area — and arguably the best case for treating COVID exposure as different from flu exposure. There is a reason scientists use the term “novel coronavirus” to describe this virus: It’s new. We don’t yet know what its eventual effects will be.For children, the evidence so far does not offer much reason for alarm about COVID-19’s long-term effects. They are much less likely than adults to contract virtually every worrisome version or symptom of the disease.So what should your family do once the adults in it are vaccinated? Until all adults have had a chance to receive a shot, experts recommend caution, because children can spread the virus. Even after that, some basic safety measures will make sense, Nuzzo points out. They include wearing masks when in close contact with people who may not be vaccinated and avoiding situations that offer little benefit but a meaningful risk of infection. Taking children to a crowded, poorly ventilated restaurant, for example, seems questionable.But it’s important to keep in mind that acting in the best interests of children is not the same thing as minimizing COVID risk. “Everything has risk,” as Adalja of Johns Hopkins said. For more than a year, many Americans have reordered their lives because of the extreme danger of COVID-19. And COVID continues to dominate our thinking. Whether it should dominate our children’s lives is a different question.