Medical Examiner

What Parents Need to Know About the New Mask Guidance

Mom face to face with her child, both wearing surgical masks
tatyana_tomsickova/iStock/Getty Images Plus

The Centers for Disease Control and Prevention announced last week that people vaccinated against COVID-19 no longer need to wear masks indoors. Plenty has been written about whether this decision was well communicated, whether it was too hasty, and whether it could possibly have the intended effect of swaying anyone toward vaccines. But if you’re a parent like me, already exhausted from a year of trying to take care of a small person during a global crisis, you likely have one overarching question: What am I supposed to do now?

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So many parents are now responsible for shepherding their unvaccinated kids through a semi-vaxxed-and-unmasked world. Vaccines protecting against COVID-19 aren’t yet available for kids under 12, and kids ages 12 to 15 just became eligible for the Pfizer vaccine on May 10. So unless your kid is in a vaccine clinical trial—and you’re confident they didn’t get a placebo—all parents of kids ages 12 and under are in the sticky situation of figuring out how to handle unvaccinated family members. The CDC gives basically no guidance on how parents can trust that the unmasked people around them are vaccinated, or how risky it is to take a little one to the store when mask mandates are down and case rates are up. “It seems like kids are just getting overlooked in this,” says Tara Smith, an infectious disease epidemiologist at Kent State University in Ohio and parent of a 7-year-old. To navigate this new morass of risk calculations, I spoke to Smith and Monica Gandhi, an infectious disease doctor at the University of California, San Francisco. They had somewhat different outlooks—illustrating just how much work is being thrust on parents right now to make constant judgment calls.

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The first thing to know—and what the experts did agree on—is that vaccinated people, even if they’re unmasked and indoors, are really not a risk to your kid unless your kid is immunocompromised. The biology at the heart of the CDC’s decision is sound. “Vaccines very effectively block transmission, even in times that are high circulating virus,” says Gandhi, and Smith agreed. So if you take your kid to, say, a gathering at a house with other adults, and you know that everyone there is vaccinated, you’re fine. The problem comes if you’re somewhere public where folks are maskless and unvaccinated. Both experts agreed that does put your kid at risk of getting COVID-19. “I would keep them [your kids] away from people or have a mask on them,” says Gandhi.

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So then the question is, should you trust unvaccinated strangers to mask? It really depends on whom you ask, and maybe where you live. Gandhi said yes. It’s worth noting that San Francisco, where she’s based, has a strong culture of masking: “Here, if you don’t wear a mask, everyone glares at you,” Gandhi told Slate in April. (And for now, the city still requires masks to go inside a business and even outdoors if you’re not at least 6 feet apart.) Smith had a much different outlook: “If there’s one thing I’ve learned over the pandemic, it’s that I really don’t trust people.” Smith lives in rural Ohio. “I’ve already seen many people declare their intention to go out unmasked and unvaccinated,” she says. “All over my Facebook page, friends of friends who are not vaccinated are proudly saying that they ‘identify as vaccinated’—that’s become apparently a popular tagline.” You may feel more trust—and be off the hook for some risk calculations—if your state or city keeps regulations around indoor masking, if individual businesses decide to keep enforcing masking, or if there are strong social norms around masking indoors in your area. “Here in rural Ohio, I know the sentiment has been very strongly against masks from the beginning, and we have a lot of people also against vaccines,” says Smith.

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To properly calibrate your worry about your kid catching a disease from a stranger essentially lying about their health status—because apparently that’s part of parents’ jobs now!—you also need to have a grasp on how bad it might be if your kid gets COVID-19. “Children are at low risk for severe COVID, period,” says Gandhi, noting that, generally, the younger kids are, the lower their risk of getting COVID and of severe effects of COVID. Smith is more cautious. “Kids are at lower risk of serious infection than adults,” she agrees. But “depending on what database you use, anywhere from 300 to 600 kids have been reported to have died.” This is much, much, much lower than mortality numbers for adults, but 1.5 to 3 times higher than the annual number of kids who die from the flu. You might reasonably be worried especially if your kid is immunocompromised or has a condition that places them at higher risk of complications if they get COVID-19. “I would be more careful about those kids for sure, in terms of masking or keeping them away from places where there are high incidences of people who aren’t masking,” says Gandhi. And of course, there are also nonmedical negative effects of COVID-19 exposure to consider. Parents can take an economic hit from taking extra time off to keep kids out of day care or school to get tested, and even more time off to quarantine if kids test positive. Parents in tenuous and hourly jobs can even be fired for it.

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This is already a lot to consider about your own personal comfort level, your child’s health status, and the norms in your area. But both Gandhi and Smith agreed that what makes the CDC guidelines so fundamentally confusing is that they are blanket national advice, when the virus’s activity—and the population’s vaccination status—varies pretty greatly by location. “How worried” you should reasonably be about your kids depends in large part on what’s happening with COVID in your area. Both experts recommended checking a few local numbers if you want to take your kids indoors and don’t trust people to mask; if cases are low and vaccinations are high, it’s going to be much, much lower-risk to, say, run errands at Target where folks are unmasked. Gandhi recommends checking for at least a 50 percent vaccination rate and no more than two to three new hospitalizations per 100,000 people. “The reason I like the hospitalizations is because that’s a hard metric and doesn’t depend on testing rates in your region, but if you do a lot of testing you could do it on cases,” says Gandhi. Smith has been using five new cases per 100,000 as her personal threshold for feeling more at ease with taking risks.

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If cases are high and you do need (or want) to go inside with your kid, both experts said the No. 1 thing that makes an indoor space safer is—as you’ve probably heard—good ventilation. Look for “two windows open that are opposite so there’s circulation, or a HEPA filter,” says Gandhi. Larger spaces and less crowded ones are also safer. You can also take some comfort that if your kid is masking, they will have some protection even if other people aren’t. (Wearing a mask yourself as an example might help.) Masking does protect the wearer, stressed Gandhi, who has published seven papers about masking. She says well-fitting cloth masks are fine for kids. (The exception here is that if your kids are younger than 2, they’re not required to wear masks and may not be capable of doing so. But this age group is “at extremely low risk for COVID,” says Gandhi.) Smith bought some KN95s for her 7-year-old, although she admits, “I don’t trust them completely because I don’t think they undergo quite as good evaluation as the adult ones.”

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This is all a lot. I tried to make a flow chart for myself as I reported this article, and it turned out complicated and messy to use. Even I am exhausted of thinking through the nuances of this virus—and I’m a science journalist who reads medical literature for fun. Some parents will understandably say that they are tired of these calculations, and the risk is low enough, and they’re not going to worry about it. Others might rightfully continue to be very cautious with kids, and even angry about the lack of support for parents in the CDC guidelines. My kid recently had a tantrum because we aren’t going inside his best friend’s house yet, and I almost congratulated him for his grasp of the situation. Never was a screaming 3-year-old more justified.

I asked Gandhi if she thought the CDC guidance made parents’ decisions harder. “You know, I don’t, actually,” she said, “because I know that anyone can know the case incidence rates in their area, and I think it will make other people get vaccinated, so I think that we’re all gonna be safer because of this.” Then Gandhi conceded, “It does make it, like, more calculations in your head, about things like community incidence, so I guess it does make it harder.”

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