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Vaccinated adults, unvaccinated kids — navigating the “new normal”

Vaccine supply is increasing, appointments are getting easier to find, and vaccine eligibility will soon expand to include roughly 90 percent of all American adults. Best of all, according to new CDC guidance, fully vaccinated individuals can begin taking their first steps back to a pre-pandemic normal: gathering in small groups — even indoors — without masks, distancing, or other precautions.

With the U.S. on track to vaccinate 200 million people by the end of April, many of us are looking forward to a summer of fun and relative freedom. As we make plans to celebrate the Fourth of July with vaccinated family members or spend a week on the Cape with friends, it can be easy to forget about the roughly 20 percent of the US population who have no chance of getting vaccinated anytime soon.

Unless you’re the parent of one of these individuals.

Illustration of three adults cooking food on a grill in the yard between two houses with a frowning child visible through a window of each house

We’re talking, of course, about children younger than 16, for whom no COVID-19 vaccine has yet been approved. For families with fully vaccinated parents and unvaccinated kids, the summer of 2021 may feel even more complicated than the summer of 2020. The questions we’re getting reflect that confusion:

Can our family, including the kids, get together with other fully vaccinated adults and their unvaccinated kids?

Can our kids have playdates?

Can we spend a week in Maine with my sister and her children? How about both sisters and all their kids? We haven’t seen any of them in almost two years!

Can I exclude relatives with unvaccinated kids from my summer cookouts?

That last question, we should note, came in an email signed with the (possibly hopeful) pseudonym “No Shots, No Tots?”

At this point in the pandemic, answering any one of these questions will involve something of a balancing act, acknowledges Associate Medical Director Shawn Ferullo. “Nothing is absolutely ‘safe’ or free of risk,” he stresses. “At the same time, we know that vaccinated adults are very well protected and that healthy kids are at relatively low risk of severe illness from COVID-19. There’s also evidence that kids younger than 11 or 12 are much less likely than adolescents or adults to transmit the virus if infected.”

Ferullo notes that the CDC guidance allows small gatherings of fully vaccinated people to include unvaccinated individuals from one other household, as long as none of these unvaccinated people or any unvaccinated member of their household is at increased risk for severe illness from COVID-19. “These guidelines allow for unvaccinated children from a single household to be included in a small gathering of fully vaccinated adults from multiple households,” he says.

But what about unvaccinated kids from different households?

“This is a good question that the CDC does not address and one on which thoughtful, well-informed individuals might differ,” he notes. “But as long as community spread is relatively low, and as long as none of the children are involved in outside activities that would increase their risk of contracting or spreading the virus, I would say that kids from two families can be included in small gatherings, and that the families can decide about mask use and other precautions individually, based on their comfort levels.”

MIT Medical Pediatrician Ed Levy concurs. “Recent cases in Massachusetts cases have been concentrated among individuals younger than 19, so there are still some public health considerations,” he says. “But I see more negative mental health effects in kids, as a result of isolation, than I see serious COVID disease. And the vaccination of elders has greatly reduced the risk of making a family member critically ill or worse.”

And there are ways to decrease the risk further, agree Ferullo, Levy, and Pediatrician Rosemarie Roqué Gordon. “I would recommend having the kids continue to wear masks,” Gordon says. “And, as the weather gets better, it’ll be easier to keep interactions mostly outdoors, where the risk of transmission is much lower.”

Levy and experts who have studied the virus agree about the relative safety of outdoor interactions. In one study of more than 7,300 cases in China early in the pandemic, just one was connected to outdoor transmission. A more recent analysis estimated the risk of transmission to be almost 19 times greater indoors than outside. “We know that this virus disperses relatively quickly in the air and is sensitive to UV light,” Levy adds. “I think that if you are in a lower-risk community, meet outside with one other family, distance, and don’t sing or shout, it is reasonable to get together without masks.”

“Sharing a vacation home with another family or two presents a higher level of risk, but that risk can be mitigated if you think of it as a temporary ‘bubble’ or ‘pod,’” says Gordon. To do this, the unvaccinated members of each family should quarantine for 10–14 days before the start of the vacation. Each family should drive to the destination in a private vehicle. And while it increasingly appears that vaccination is likely to protect against infection and transmission of the virus, it’s safest if the vaccinated adults also make an extra effort to reduce their risk of pre-vacation exposure.

“We’re all dealing with some level of ‘COVID fatigue’ right now,” Ferullo concedes. “But it’s helpful to reflect on how far we’ve come from last summer and to remember that current recommendations reflect only current conditions. As the proportion of vaccinated people continues to grow, the CDC is likely to loosen restrictions further. In the meantime, vaccinated adults can allow the kids in their lives to begin to do some things they couldn’t do last year, and we can find ways to allow them to do these things relatively safely.”

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