Many parents across the country are undoubtedly breathing a sigh of relief as they watch a shot slide into their child’s arm. But immediately afterward comes a new question: What exactly is safe for these children to do?
In the U.S., nearly one million kids under 12 have already received their first dose of the Pfizer-BioNTech COVID-19 vaccine now that it has been authorized for five- to 11-year-olds by the Food and Drug Administration and recommended by the Centers for Disease Control and Prevention.
This authorization of the vaccine for kids is important in the fight against the disease. More than 5.7 million American children under 18 have been infected with COVID-19 since its beginning, and 900 have died. Crucially, research from Harvard University confirmed last month that infected children carry high levels of virus—whether they have symptoms or not—suggesting they can easily spread it to others.
Still, in mid-November most five- to 11-year-olds are not much safer than they were before, says physician Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. The vaccine dosage for younger kids may be lower than it is for adults, but the schedule is the same: two inoculations given three weeks apart.
“Optimal immune response doesn’t begin until two weeks after that second dose,” Wen says, noting that although antibody production does ramp up after the first shot, the level of protection that offers is unclear. One study in adults found that the first dose of an mRNA vaccine was only 30 percent effective against the Delta variant that now dominates in the U.S.
This means that as families gather for the Thanksgiving holiday, younger kids who got their shot after its authorization in early November will not have had time to be fully immunized. Families will need to take the same precautions as they have previously to protect their children, especially since socializing maskless, elbow-to-elbow—practically the definition of Thanksgiving—offers one of the highest risks for COVID-19 spread.
Wen recommends that families in this situation consider gathering outside, weather permitting. In parts of the country where that’s not possible, risk should be reduced in other ways, such as by spacing people around the table (or tables) and using a portable air purifier with a HEPA filter, says Thomas Murray, a pediatric infectious diseases doctor at Yale Medicine.
Wen also advises asking holiday guests to modify their optional activities in the five days before the gathering to lower everyone’s risk of exposure—no indoor restaurants or playdates, for example, as well as rigorously wearing masks at work and school—and then taking rapid antigen tests that morning.
Risk, and risk tolerance, play key roles
Once the full immune response has kicked in, many parents can feel comfortable loosening the reins they have held tightly on their children for nearly two years, says Aaron Glatt, an infectious disease doctor at Mount Sinai South Nassau in Oceanside, New York.
But it’s important to remember that we’re now at a point in the pandemic with no clear-cut answers that fit every situation, he says. “An all-vaccinated healthy young family is at much lower risk than one where a member is immunocompromised or a grandparent or other relative is not vaccinated,” Glatt says. In addition, people have differing levels of risk tolerance, he says. “Deciding what you’re comfortable doing is a personal choice.”
In a healthy family, it’s reasonable for children to resume the beloved activities they may have abandoned, such as having sleepovers with other vaccinated kids or even attending that post-game restaurant celebration with a child’s vaccinated team, Glatt says.
Nonetheless, experts caution parents to remember that a pandemic is still raging. The seven-day case average in the U.S. is 75,000, a high number and one that has ticked up in recent weeks. Since the rate varies depending on where you live, it’s important that families track their local transmission and vaccination rates and adjust their actions if they are high, says Kristin Moffitt, a pediatric infectious disease expert at Boston Children’s Hospital. Updated descriptions of local spread can be found on the CDC’s website.
If the virus is raging around you, consider ways you can allow your vaccinated child to have fun while not being reckless, Moffitt says. “Risk is a numbers game. Having four or five kids in a head-to-head sleepover is different than having 14,” she says. Similarly, allowing your vaccinated 10-year-old to resume an indoor dance class is safer in a center with fewer children, she notes.
The ventilation of the space also matters, “especially when families are going to be indoors and around people whose vaccine status is unknown,” Moffit says. If a child is invited to an indoor birthday party at a trampoline park filled with heavy breathers, for example, you’d want to inquire whether they have upgraded their ventilation system due to the pandemic, she says. At a crowded party, it can help to just open a window.
Plus, the risks add up. Ask yourself what activities are most important to your family, Wen advises. If it’s gathering with friends for the Christmas holidays, for instance, consider avoiding high-spread locations like restaurants and bars to limit the family’s overall exposure.
Who else is in your household?
Even when the children are vaccinated, families living with someone with underlying medical issues that increase their odds of developing severe COVID-19 should continue taking stringent precautions, Wen says. “What to someone else could be a mild breakthrough infection could land that person in the hospital,” she says.
The same is true in homes with children under five who are still too young to get a shot. As each older child in the home is vaccinated, the risk to those more vulnerable does go down, researchers have found, but it doesn’t drop to zero.
All children, including those who are vaccinated, should wear masks in schools, according to guidance from the American Academy of Pediatrics, which notes that it may revise the recommendation when a higher percentage of students are fully vaccinated.
When it comes to masks, quality matters. “At this point in the pandemic no one should be wearing cloth masks,” Wen says. She recommends an N95, KN95 or KF94, or at a minimum a surgical mask, for sufficient protection. These masks may be reused for as long as they are in good shape and fit well, but once they’re frayed, bent, or the elastic has lost its stretch they should be replaced, she says.
As more children and adults get shots in their arms, experts are hopeful the pandemic may begin to tame. But even then, parents shouldn’t get complacent. Case rates in the country surged last winter after the holiday season and again late this summer when the Delta wave struck. If numbers in your community start rising, you might want to pull back on your child’s activities for a while, Moffitt says.
As to whether young children will eventually need a booster, as is now recommended for some adults, no one can say yet. The U.S. is the first Western country to authorize the Pfizer vaccine for children under 12, so experts are watching closely to determine whether immunity might wane in children, as it does in adults. For now, though, once a kid is two weeks past that second dose, parents can feel good about allowing them to return to the important work of play.
