A version of this article first appeared in Emily Oster’s newsletter, ParentData.
On Monday, the Centers for Disease Control and Prevention issued guidance about post-vaccine behavior. This was long-awaited and, basically, well-received. The CDC is walking a fine line here. On the one hand, until more people are vaccinated, it does not want to give the impression it’s cool to have giant parties. On the other, it seems to be recognizing that if you tell people nothing changes with the vaccine, then they will wonder what the point is.
The three big takeaways from this round of advice are:
1. Vaccinated people can get together unmasked with other vaccinated people in groups, but the gatherings should be small.
2. Vaccinated people can hang out indoors with one other household of unvaccinated people, provided the latter group is low risk.
3. Vaccinated people should still wear masks and distance in public.
No. 2 above is clearly targeted at a favorite topic: grandparent-parent-kid interactions. And what it says is that if grandparents are vaccinated, it’s cool to hang out inside without masks as long as parents and kids are low risk. Yay!
A sidebar on risk: The logic behind the CDC’s guidelines is that an interaction between vaccinated and unvaccinated people has a low risk of transmitting COVID-19, but it could. So for a seriously immune-compromised adult or child, it is a good idea to be much more cautious. This would be true with any illness exposure. Maybe you can visit vaccinated grandparents outside, or enforce a stricter pre-visit quarantine even for vaccinated visitors.
But if what you mean by high-risk is that you fall into one of the millions of high-risk categories that one or another state has put on their list, we are in little more of a gray area. To the person who wrote to me to ask whether her postpartum BMI of 30.1 makes visits a no-no, or the person with well-controlled asthma who asked a similar question, the elevation in risk is extremely small. Given the low risk of transmission from vaccinated adults, I think that for those two people, refusing to hang out with vaccinated family would be an overly cautious interpretation of the CDC guidelines.
(And healthy infants past the first couple of months are also not high risk.)
Some people have suggested that the CDC should have gone farther toward the idea that vaccination means you can behave “normally”—more travel, for example. Travel is an especially loaded question if this much-anticipated, now-OK’d visit with vaccinated grandparents requires an airplane. What it really comes down to is: Is flying a risky activity? The answer is, basically, no. I pulled the quote below from the Economist, and this lines up with much of what we see in other reports. The number of infections on planes is really, really small. This may relate to their filtration systems, or the fact that people are wearing masks or just being really careful.
In October data collected by IATA found that only 44 out of 1.2bn passengers since the start of 2020 were known or thought to have contracted covid-19 on a plane. iata’s medical adviser notes that, even if 90% of cases went unreported, that implies just one infection for 2.7m passengers.
Triangulating the CDC guidance to this particular question is a little complicated. On the one hand, the CDC says even vaccinated people still shouldn’t do “nonessential travel.” But: They also say that vaccinated people do not need to quarantine after an exposure to COVID unless they are symptomatic. This is a disconnect. If you travel, the concern is that you’ll be exposed to someone with COVID-19. But if vaccinated people do not have to quarantine even after a known exposure to an infected person, why would they need to quarantine after travel, when exposure is basically the worst-case scenario?
My sense is that this is place where the CDC has still gone for an excess of caution, in the hopes that it can hold off the free-for-all travel for another month or so. But in practice, if this is what it takes to see grandparents, I can’t see a strong argument not to do it.
If you do travel, I think the CDC advice is still good: Test a day or two before leaving (even if vaccinated), wear a good-quality mask in the airport and on the plane, wash your hands frequently, and so on. And then enjoy your grandkids.
But visits with grandparents is not the only thing parents want for their kids. And kids will not be vaccinated for a long time. Parents are fucking tired. Based on the emails I receive, a lot of parents feel like this summer all the vaccinated people will be frolicking on the beach while they are stuck in their homes with unvaccinated kids and not traveling anywhere. I’m getting questions like: “Can I travel before kids are vaccinated?” “What about playdates?” “When can my kid’s friends come over?” “Can we vacation with my brother and his family once all the adults are vaccinated?”
In my view, this is the big hole in the CDC guidance. But we can still make sense of the path forward by thinking about the risk to unvaccinated children in context of all the other childhood risks we face even in non-pandemic years.
I want you to cast your mind back to January 2018. During one week in late January of that year, near the peak of flu season, the CDC reported flu hospitalization rates of 7.3 per 100,000 for children aged 0-4 and 1.4 per 100,000 for kids 5-17. This means that of 100,000 children aged 0 to 4, 7.3 of them were hospitalized with flu complications that week.
Kids get the flu from a lot of sources—school, child care, their parents, travel, indoor trampoline parks. And flu can be very serious; there were almost 200 pediatric flu deaths during that 2017–2018 flu season. But I would venture that in that time frame, most parents were not making choices about activities based on flu risk.
The peak week of the COVID-19 pandemic for hospitalization for children 0 to 4 was mid-December (data here). During this week, the hospitalization rate for this group was 2.3 per 100,000. For children 5 to 17, the peak was the first week of January, with hospitalization rate of 1.3 per 100,000. In the most recent week of reported data, the week ending February 27th, these rates were 0.3 per 100,000 for children aged 0 to 4 and 0.6 per 100,000 for children 5 to 17.
Here’s all these numbers in a graph:
Bottom line here: Hospitalization rates even at the peak COVID-19 week were below that week in January 2018.
Let me add onto this another set of facts, as seen in the graph below (original paper here). This graph shows non-COVID death rates for children in two age groups (based on 2018 data), and COVID-19 death rates over the period from March through October 2020.
Deaths in these age groups from any cause are really, really rare, so I’m not trying to freak you out. But I am trying to convey that death rates from COVID-19 in these age groups over this period are less than a typical year of suicide, homicide, or cancer. They are an order of magnitude less than car accidents. Infants are not in this chart, but the same logic applies. COVID-19 death rates are higher in absolute numbers, but lower in ratios. The SIDS death rate for infants under one in this comparison period is 80 times higher than the death rate for COVID-19.
The you from 2018 was not thinking about most of these non-COVID risks. Yes, in the back of your mind you probably worried about your kids getting the flu and had some sense of the idea that cars are dangerous. But you were planning travel and playdates and everything else in spite of these risks because they are small. And for kids, the COVID-19 risks are even smaller. This isn’t true for adults. But it is true for kids.
This doesn’t mean kids do not get COVID-19. They do get it (although probably at lower rates than adults). Just like they can get flus, and colds, and other viral illnesses. But they are simply very, very unlikely to get extremely sick.
Look forward, now, to the summer. You’re vaccinated, your parents are, your brother is. Barring some surprise, COVID-19 rates are expected to be even lower than they are now. Not zero, but lower. This makes COVID-19 even less of a threat to kids. They are extremely unlikely to be infected. And if they were, they would be extremely unlikely to get very sick, and they wouldn’t spread it to older people because those people will have been vaccinated.
What’s going to happen if your family and your brother’s family and your parents rent a beach house together with all the cousins for a weekend? Let me tell you based on personal experience. Monday after you return home one of the children in one of the families will be vomiting, and the other family will recall one of their children complaining about a stomach issue that they didn’t think to mention.
What if you fly with your kids to a vacation? They might get sick on the airplane and ruin your first two days complaining about their sore throat.
My point is: Kids get viruses. You cannot avoid the possibility they might get sick on vacation, or from being out in the world. But the presence of COVID-19 in a world of vaccinated adults does not change the risk of this very much at all.
The challenge of this summer, I think, is going to be figuring out how we can consciously move towards normalcy despite lack of full vaccination for kids and despite the fact that COVID-19 will always be with us. It is going to require putting our minds to it. Booking that summer trip might be the first step.
With that partial return to normalcy on the horizon, you may find yourself wondering about other precautions we’ve adopted in the last year. Earlier this week my 5-year-old, Finn, asked when he could stop wearing a mask. I told him I would address that this week. Here you go, Finn!
You know how I feel about camp and school in general. We should have it. Schools (in some places) have been operating safely all year. Camps operated safely last summer. The situation this summer, barring some bad change, will be much better. Camps should be on. I am shipping my older one to sleepaway camp.
But: When we talk about a lot of unvaccinated kids interacting together, we do need to talk about precautions. A lot of the precautions we are taking with schools will continue—hand washing, maybe some cohorts. And, probably, masks.
On the one hand, I think that based on what I’ve said above, there is probably an argument for lightening up on the kid masks once all adults are vaccinated. On the other, masks are a much less arduous precaution than many others we’ve adopted, so we shouldn’t rush to stop wearing them. And given how well most kids have adapted to masks, the pressure may not be there.
Eventually, we are going to need to remove the masks. Will it be this summer? I’m betting no. Sorry, Finn.