How to Protect Kids From COVID

Kids cluster on a playground slide. Dr. Sarah Schaffer of Children's National Hospital says that parents should not only consider what they should do, they need to consider what their family —and their child— are actually going to do. E.O’Gorek/CCN

Tim Rutherford would not have bothered to test himself if his elementary school-aged daughter hadn’t tested positive first.

Even her test was precautionary; Rutherford (an alias) told the Hill Rag that his daughter was robust and healthy. Rutherford and his wife were fully vaccinated, but were still exercising caution: all were wearing masks in public where they could not socially-distance; their daughter didn’t even go into grocery stores. When dining out, it was always outdoors.

They were on the way to visit Rutherford’s mother in Boston when they got his daughter’s results. They cancelled the trip and headed back to DC where Rutherford and his wife were tested. His wife tested negative. Rutherford, who had the second shot of his Pfizer vaccine in mid-April, was not so lucky.

“I was fully vaccinated, so I wouldn’t have known I had COVID if my daughter hadn’t tested positive—at least not until I had symptoms,” Rutherford said. By then, he could already have been to visit his mother, her health compromised by ongoing chemotherapy. “There’s really no guarantee you’re not carrying it and spreading it to someone more vulnerable,” he said.

While most of the District’s residents have been vaccinated, children under 12 cannot receive the vaccine, leaving them open to infection that can often pass undetected and be transmitted to those at greater risk.

The District is open, and schools will reopen shortly. How do we continue protect those too young to be vaccinated as the city unmasks around them?

Kids Do Get COVID
Children do get COVID. To date over 4 million kids have tested positive for the disease, resulting in over 18,000 hospitalizations and just over 300 deaths.

While children tend to have more mild cases with either very few or no symptoms, they are able to transmit the disease to other kids as well as adults, said Dr. Tina Tan, professor of pediatrics at the Northwestern University Feinberg School of Medicine and a member of the board of directors of the Infectious Diseases Society of America.

Dr. Tina Tan, professor of pediatrics at the Northwestern University Feinberg School of Medicine and a member of the board of directors of the Infectious Diseases Society of America. Courtesy: Dr. T. Tan

Health officials are warning that the Delta variant of the COVID-19 virus is more than 60 percent more contagious than previous variants like Alpha, let alone the original version of the virus. Delta is the dominant strain in the DMV.

“Basically it [Delta] has the same symptoms and the same findings as the regular variant or the other variants that we’re seeing,” said Dr. Tan. “However, there is some indication that it may lead to a higher rate of hospitalizations and complications–in anyone–and we know that the Delta variant now is being seen here in the United States in the pediatric population.”

While information is still evolving, the presence of the Delta variant amps up the danger for children, said Dr. Sarah Schaffer DeRoo, a pediatrician at Children’s National Hospital. “The fact that children are unvaccinated makes them more vulnerable, of course, because as society opens up and mask mandates are lifted, it puts children at higher risk,” she said.

Dr. Schaffer counsels caution, encouraging families to use discretion with children while out in public, and notes that little is known about the long-term consequences of the virus in children.

Dr. Sarah Schaffer DeRoo is a pediatrician at Children’s National Hospital. Courtesy: Children’s National

“We [only] have about a year and a half of evidence to go on,” Dr. Schaffer said. “I worry about the risk of hospitalization and death that is small, but real. And when your family has that one child that’s affected, your risk becomes 100 percent.”

Weigh the Risk
But does that mean you should leave your kids at home for non-essential trips? Not necessarily, say the medical professionals. But you do have to weigh the risk, both in your own household and in any given situation.

“Unfortunately, it feels like a lot of the [CDC] guidelines leave families out of the decision-making,” Schaffer said. “Cities are reopening, but the American Academy of Pediatrics (AAP) essentially recommends the same rules from before mask mandates were lifted, unchanged. That has left many parents scrambling.”

Dr. Tan said that establishing general guidelines is difficult because best practices can depend on the situation—what a family needs and where they plan to be.

However, general advice for a given situation boils down to consideration of the space and the number of people in it. Will you be indoors or outdoors? Can you maintain social distance? Will others be masked? Do you know (no, really know) the vaccination status of others that are present?

A problem, Tan said, is that in most jurisdictions, mask mandates have only been lifted for the fully vaccinated. “But people take advantage of that all the time,” Dr. Tan added. “You don’t know who in the community is vaccinated and who’s not.”

So families need to weigh the risk for themselves.

“I would say that anytime you know you’re going to a place where there is a potential for large crowds to be, that it would be much safer for an unvaccinated person to wear a mask,” Dr. Tan said.

Parents will have to ask themselves similar questions when a child is brought indoors where the vaccination status of others is unknown, such as a restaurant or busy store. “We know that transmission definitely is much more likely indoors, especially in more enclosed areas. So in those areas, people should be wearing a mask,” Tan said.

Dr. Schaffer agrees, and adds that parents should not only consider what they should do; they also need to be realistic about what their child is capable of (and willing to do) in a given situation.

“I think that parents really need to use their best judgment. Is the personal distancing something that is possible?” asked Schaffer, herself the parent of a four-year-old. “Is it something that they can maintain knowing their own children and their behaviors? Is masking something that they’re able to do if they’re in public spaces?”

Back to School
While pediatricians say using one’s judgement is key, most District families will not be able to make the final decision about whether their children will go to school this year. On April 9, Mayor Muriel Bowser (D) announced that there would be a return to full-time in-person learning for DC public schools in the fall, with only a few exceptions made where it is required for a child’s health.

All experts agree that there is a risk in sending kids to school this fall. But they say the risk of coronavirus on children needs to be weighed against the downsides of not going school and the lifelong consequences of being behind from an educational achievement standpoint.

Realistically, kids in school will have a higher COVID risk than those not in school, said Dr. Matthew Ferrari, Director Penn State University’s Center for Infectious Disease Dynamics. That’s because there will almost certainly be a large group of unvaccinated potential transmitters together in enclosed spaces.

But he said that the school discussion has to be taken in terms of the overall cost and benefits of putting kids in school.

“This is not like, “Should I go to a restaurant?” but rather “What are kids’ educational and development outcomes when they’re in the school session, when they’re learning?”

Overall, Dr. Ferrari said, the total absolute risk for kids will be dramatically lower in September 2021 than it was a year ago. Data indicates that preventative measures taken by schools —hand washing, social distancing and masking, protocols for quarantine when someone tests positive —have been working, Dr. Tan points out. Until kids can be vaccinated, those measures should be continued. “Optimally, all the teachers and staff in that school should be vaccinated,” she said. “But we know there are going to be hold-outs.” At this time, DCPS is not requiring teachers or school staff to be vaccinated.

Preventing More Outbreaks
As they gear up for school, Dr. Tan reminds parents to get their children up to date on all their routine preventative vaccines. “You don’t want to have vaccine-preventable disease outbreaks in addition to COVID,” she said. “Now is the time to prevent that.”

“I think the most important thing to realize is that COVID’s not gone,” Tan added. “It’s still there in the community, and all these people that are refusing to get vaccinated only allows this virus to spread more rapidly, and the more that it spreads the more that it can mutate.”

Experts say that children understand the need for caution better than adults often think they do and agree that the situation can be explained to children as young as 4 or 5 years of age using simple, developmentally appropriate language. Be honest, clear and consistent about the situations and public places in which children must be masked and socially distanced.

“The children that we have seen are incredibly adaptable,” assures Dr. Schaffer. “They wear masks and forget about them –for the most part they are better than many adults I see at wearing their masks.”