What activities can unvaccinated children do? Advice from 828 experts

As vaccinated Americans return to many parts of their pre-pandemic lives this summer, one group will be left out: children younger than 12, who cannot yet be vaccinated. So what should families with young children do when everyone else starts socializing again?

We asked experts as part of an informal New York Times survey. The group of 828 who responded included epidemiologists, who study public health, and pediatric infectious disease physicians, who research and treat children sick with diseases like COVID-19.

They noted that this phase was temporary. Pfizer has said vaccines for children ages 2 and older could come as soon as September. Of the survey respondents with young children, 92% said they would vaccinate their own children as soon as a shot was approved. (Only five said no; some were undecided.) In the meantime, families with young children may need to retain more precautions, like masking and distancing, than their childless friends do. But they said some minimally risky activities could help counteract the mental health effects of pandemic living.

“Kids need to be able to be kids,” said Mac McCullough, an associate professor at Arizona State University. “Outdoor activity isn’t perfectly safe, but its benefits are likely to outweigh its risks across an entire population.”

We asked the experts about a few situations that families could encounter and how they suggested parents and unvaccinated children should behave. There was no consensus, but they mostly advised weighing the relatively small health risks against the benefits of widening children’s worlds. As always, epidemiologists — who tend to be a very cautious group — emphasized that it would depend on the exact circumstances and on local case rates.

“I think a lot of families are frustrated and feel left out and anxious as to how to navigate life now,” said Dr. Sahera Dirajlal-Fargo, an infectious disease pediatrician at Case Western Reserve University. “Children have asked me, ‘Everyone else gets to move on; what about us?’ I am focusing on what we know families can do safely, and we know so much more than we did last year.”

Here is what they said.

Indoor and Crowded Outdoor Public Places

New guidance from the Centers for Disease Control and Prevention says that vaccinated people can go almost everywhere without a mask. But what should families with unvaccinated children do, since it is impossible to know whether maskless people in public places are vaccinated? A slight majority said that despite that uncertainty, children could still go inside public places or be in outdoor crowds, as long as they wore masks.

Indoor Social Gatherings With Other Unvaccinated Children

Vaccinated people can socialize indoors with one other household of unvaccinated people, the CDC says. But what about two families getting together, when the adults are vaccinated but the children are not? More than half of experts said unvaccinated children from different families should not gather indoors. But just over one-third said families could gather indoors if they limited the number of families they saw this way, like in a pod.

Outdoor Activities Where Masks Are Not an Option

Unvaccinated children are encouraged to continue wearing masks around other people, but there are some activities when that’s not possible. If they’re outdoors, and at low risk, it’s probably fine, 8 in 10 said.

Indoor Activities Where Masks Are Not an Option

But when it comes to indoor activities where masks cannot be worn at all times, children probably cannot safely do them this summer, three-quarters of the experts said.

Trips by Plane

It is most likely safe for children to fly this summer, as long as they are fully masked and everyone else on the plane is, too, 86% of the experts said. But they said this should be done with caution; consider double-masking and limiting the number and length of flights.

Outdoor Playgrounds and Sports

Almost two-thirds of the experts said unvaccinated children should still wear masks while at playgrounds or playing sports outdoors, even though the virus is much less likely to spread outside.

Advice for Vaccine-Hesitant Parents

This phase of the pandemic — with children becoming more of the focus — will become easier when children younger than 12 can be vaccinated. But some parents are hesitant about vaccinating their children, especially considering that the risk to them from COVID-19 is still so small.

Some epidemiologists and physicians were discussing this in their own families. Of the 8% who were unsure about vaccinating their young children, several said it was because they had not yet convinced their spouse that it was the best course of action.

As a group, the experts surveyed were not conflicted about vaccinating children. Many cited the risk of long-term physical and neurological effects of COVID-19, which are still unknown in children. And they worried about new variants of the virus that could become more dangerous for children.

“We’re still learning about the long-term effects of COVID-19 in asymptomatic and mildly symptomatic previously healthy individuals,” said Rosa Ergas, syndromic surveillance coordinator of the Massachusetts Department of Public Health. “I’m not panicked about my kids getting COVID, but I’d rather they didn’t.”

Others were more concerned. “I suspect that a proportion of children who have a COVID-19 infection will go on to have problems that are due to inflammation,” said Dr. Jessica Ericson, an infectious disease pediatrician at Penn State College of Medicine. “The long-term consequences of COVID-19 are unknown at this point but unlikely to be zero. This is in contrast to vaccination, which has no plausible long-term consequences.”

Beyond children’s health, they said, pediatric vaccines were necessary for the greater good. The pandemic is unlikely to end in the United States until children are vaccinated, they said. Even though children are less likely than adults to spread the coronavirus, as long as the virus can replicate, it will mutate, whether carriers are symptomatic adults or asymptomatic children. Also, even if Americans achieve widespread immunity, the virus will continue to spread and mutate in parts of the world without the same access to vaccines.

“It’s a big, altruistic ask for below-12s to be vaccinated in large numbers,” said Andrew Noymer, an epidemiologist at the University of California, Irvine. “The overwhelming majority of cases are not going to be sick. It’s not for their benefit; it’s to prevent them from spreading it to others.”

Dr. Andrew Handel, an infectious disease pediatrician at Stony Brook Medicine, said, “Once approved, I will enthusiastically have my children vaccinated. These vaccines are the best solution we have to the tremendous damage posed by this disease.”

The Costs of Isolation

Even as the experts urged continued caution until a pediatric vaccine arrives, they also emphasized that parents needed to weigh the risks of continued social isolation. Overall, the experts were somewhat more concerned about the mental health consequences of the pandemic for children than about its effects on their physical health.

“Isolation of children is detrimental to their mental and physical health,” said Kevin Andresen, leader of the COVID response team for the Colorado Department of Public Health. “Finding safe ways to have children socialize and play needs our full attention while we continue to evaluate vaccine efficacy in this group.”

Marissa Brash, chair of the department of public health at Azusa Pacific University, said, “We have done as many Zoom playdates as we can for my 9-year-old. She’s navigated Facebook friends. She’s streamed Netflix movies together over FaceTime. But nothing substitutes cartwheels and climbing trees and building sandcastles.”

They have started meeting a friend at a park. “The impact this has had on my daughter’s mental health is staggering,” Brash said.

The experts urged patience for a little longer. And many expressed optimism that children could bounce back from this difficult period.

“Most children don’t mind the masks, they have hand-washing down and are much more tolerant and accepting of all these changes,” said Dirajlal-Fargo of Case Western. “Most of them have been fantastic and, if anything, have taught us how to behave during this pandemic.”

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Our survey was distributed by email to members of five groups: the Society for Epidemiologic Research; the Council of State and Territorial Epidemiologists; the Pediatric Infectious Diseases Society; the Decision Sciences for Child Health Collaborative; and the American Academy of Pediatrics subspecialty group on epidemiology, public health and evidence. Responses were collected between April 28 and May 10. After the announcement of the CDC’s new policy on mask use for vaccinated people on May 13, we sent a series of follow-up questions to survey respondents and collected responses between Monday and Thursday. For various reasons, the number of responses differed by question.