We’ve been hearing many concerns from parents about the delta variant in children, especially in light of school starting back up. Is it safe for children to be around other children? Go to school?
Generally speaking, if eligible members of your family are vaccinated and you follow public health guidelines, then yes it is safe. While we have been seeing an increase in positive test results in children since delta has been going around, most kids are still negative and it’s extremely rare for healthy children with vaccinated parents to fall seriously ill from the virus (I’ll get to kids with pre-existing conditions in a minute). Most importantly, nearly all of the children admitted to the hospital here in Portland (delta or not) live with an unvaccinated parent.
The unvaccinated parent is key. That suggests that for kids to get seriously ill from the virus, they need a fairly high initial viral loading. This doesn’t easily occur in most kid-to-kid settings, but can occur if there is an unvaccinated adult whom they live with. It’s a confined space for prolonged periods day and night without masks, sharing food & drink, surfaces, bathrooms, etc. There’s also a good chance the unvaccinated adult has not been social distancing or wearing masks, so they’re likely to bring home a higher viral load. This means the child gets a “dose” of the virus so overwhelming their immune system has no time to respond, and this is the recipe required to get children sick enough to be hospitalized from this virus.
When you follow general public health guidelines, and the eligible adults in your circle are vaccinated, the risk is much lower. Exposures outside the family tend to be less intimate, less duration, and from other children or vaccinated adults. Sure, one of these exposures could be technically contagious, but neither tend to spew as large a viral load. So the chance of passing on extremely large quantities of virus is slim, and that’s what matters. Ultimately, most kids in these settings either never catch it (most of our tests even after exposure are NEGATIVE), or catch such a small viral load that they either have no symptoms or recover at home quickly from mild symptoms (like a cold or flu illness).
So it may help to rephrase the question from “is there a chance my child could catch COVID/delta” (sure) to “is there a chance my child could come to harm from COVID/delta” (extremely unlikely if your family follows public health guidelines).
Take home point: a child’s safety at home appears to be more telling of their risk than their exposures from peers and school. If you’re following public health guidelines yourselves, and your community is too (eg teachers and playdate parents are vaccinated), great job! Your kids can go to school, see other children, and you have very little to be concerned about or do beyond following public health recommendations. But if you aren’t being safe or haven’t gotten the vaccine yourself, then it’s home you need to worry about, not school.
What risk is acceptable? Throughout history there have always been risks of kids interacting together - flu, pneumonia, etc. We have always put kids together anyway because children going to school and spending time with other children is a truly critical developmental need. So critical that it should only be halted if there is an imminent threat to their health concerning enough to override this critical need. At this point, we are not seeing a level of illness in children outside the range of what other illnesses have caused in previous years when everyone felt comfortable with kids playing together.
Other common questions:
What about long term effects of catching it or MIS-C? This should absolutely be taken into account when we make decisions about level of community exposure we’re comfortable with. Without being able to see the future, we have to look back at what we know historically from other diseases as well as what we’re seeing presently from COVID and make our best deduction about what this risk might be. We do know that MIS-C does occur, most commonly in school-aged children, but it’s rare. There have also been reports of “long COVID”. But we also know that other viruses can cause inflammatory reactions and trigger autoimmune states, too. And with less of those around right now, the risk of having such a consequence on the whole this year (including COVID) does not appear to be much different from the risk of long term illness-related complications would be from various infections on any other year. Pediatricians have been treating such types of complications from various infections for years, it just hasn’t been in the spotlight until a new virus comes on the scene and makes headlines.
Should my eligible teen (12+ years) get the vaccine? Yes.
Should I lie about my 11 year old’s age to get the vaccine early before it’s approved? No. We need to make sure the benefits outweigh the risks and also confirm what dose is best tolerated and most effective in this new age group.
When will the vaccine be available for children less than 12? We’re hoping soon this fall, and we will announce once it is ready. Note that it needs to go through both FDA approval AND be recommended by the ACIP for administration for all teens. Approval (it can legally be used) isn’t the same as recommendation (it should be used).
What about children with pre-existing medical problems? Children with pre-existing medical problems may be at risk for complications of infectious illnesses, including COVID. But this risk would not be specific to COVID, it would be just as much from other things such as the flu. So yes COVID should be avoided for these children, though that shouldn’t actually change that much for you given that major caution would already be warranted for any respiratory infection. In other words, there probably aren’t new precautions purely due to COVID that they shouldn’t already be following for every other dangerous respiratory virus out there. With that said, this may act as a reminder to families that there are actually serious things out there, and if you haven’t been taking things that seriously, maybe this is a good reminder to do so.
Should my child wear masks when playing with other children? This depends on the context. Of course wearing a mask is always safer than not. However, it is also hard to get some kids to comply, difficult with sports, and can make it harder for them to connect more intimately with their peers such as reading social expressions. In general, for preschool-aged children the risk is so low that if your child and the other children’s parents are vaccinated it’s probably fine to let them play together without masks. Their risk of catching it or getting sick doesn’t appear to be any greater than a vaccinated adult, who we do allow to be together without masks. School-aged children do have a bit greater chance of catching it and of getting sick, so it would be ideal for them to wear masks when interacting with unvaccinated people outside your family until your child is able to get the vaccine.