Vaccination against COVID-19 has been a welcome relief for many adults around the world who have been lucky enough to easily access the shot. But if you’re a vaccinated parent and have unvaccinated kids who aren’t yet protected, you’re probably wondering what activities are safe for your family. Can you go back to work without unknowingly bringing home the virus? Can your kids come to an outdoor restaurant with you, or take a plane for vacation? And what should you do about that epic family reunion your unvaccinated aunt is planning with your 20 cousins and centenarian grandmother?
To make things more confusing, the World Health Organization recently urged even vaccinated people to continue masking due to the rise of more contagious variants, like the delta variant. Meanwhile, the Centers for Disease Control and Prevention maintains that fully vaccinated people can fully resume their normal activities without masks unless otherwise required by state or local authorities.
While it’s easy to get caught up in the what-ifs and minutiae of specific scenarios, experts say there are two big-picture variables that can help you make these kinds of safety-related decisions. One is how crowded and well-ventilated a space is. If you’re planning to go to a densely packed restaurant or concert hall where you don’t know the vaccination status of other people, your risks are much higher than if you’re in a less crowded and open place (or anywhere where everyone is required to be vaccinated). In the first case, it’s probably a good idea to wear a mask even if you are vaccinated (and your unvaccinated kids should skip the activity).
The other essential variable is the current COVID-19 situation in your own area. For now, the U.S. has reasonable vaccine coverage and relatively low case rates in many parts of the country. However, with the delta variant rapidly spreading in the U.S., new cases per 100,000 people have started rising in various hot spots. So check your local case rates, and consider taking more strict COVID-19 precautions accordingly.
For more specific guidance, SELF spoke with three experts in epidemiology and infectious disease to find out how parents can enjoy their vaccination status while still minimizing their unvaccinated children’s risk: Tara Smith, Ph.D., a professor of epidemiology at Kent State University College of Public Health; Saad B. Omer, Ph.D., MPH, the inaugural director of the Yale Institute for Global Health and a professor of infectious diseases at Yale School of Medicine; and Tony Moody, M.D., an associate professor in the department of pediatrics and division of infectious diseases and an associate professor in the department of immunology at Duke University.
SELF: How dangerous is COVID for kids? Are kids—especially those under 10 years old—at a relatively low risk of complications and symptoms? Has this risk changed recently with the delta variant? And are there any theoretical long-term risks of infection that we just don’t can’t confirm yet?
Tara Smith: Kids’ risk of serious illness and death is significantly lower than that of adults, but it is not zero. Even with many children out of in-person schools, there have been at least 300 COVID deaths in children in the U.S. That’s much more than we see in a bad flu year. We also know kids can develop long COVID, and we’re unsure if those issues will be permanent or eventually resolve. The delta variant just amps everything up. We know it’s more transmissible, and kids are one of the largest unvaccinated groups.
Saad Omer: There is some uncertainty around this pandemic. We do know that children get infected and play a clear role in transmission of the virus. We also know that their risk of severe outcomes is lower compared to other age groups. Regarding transmission, we have been in an artificial scenario where a lot of schools are shut down. Data around the relative risk of children was collected in a certain context. How it will evolve as things open up slowly remains to be seen.
Tony Moody: Children appear more likely to be asymptomatic, and when they do have symptoms, they are less likely to have complications like adults. That said, there are always low-level risks, including more severe respiratory illness needing oxygen and/or ventilator support. Then there is the post-infection multisystem inflammatory syndrome in children (MIS-C), which can be quite severe. As of right now, I am cautiously optimistic about the delta variant and don’t see anything to suggest that children will be hit harder. If it is a more transmissible variant and one that isn’t as well covered by our vaccines, then the potential for higher numbers of cases would increase the risk for children, simply because more cases mean more children with COVID-19.
With nearly half of American adults now fully vaccinated against COVID-19, are kids an important driver for new infections? Do my unvaccinated kids pose a real risk to other unvaccinated kids or adults?
Dr. Smith: Kids can transmit the virus, although potentially less efficiently than adults. The studies are mixed. We’ve seen outbreaks in kids as they went back to in-person schools at the end of the 2021 school year, but those were largely driven by extracurricular activities where kids were less likely to be masked. I’m concerned for next school year, with many schools removing mask requirements and no vaccines yet for kids under 12.
Dr. Moody: Children are an important reservoir of infectious diseases generally. From what data we have, it appears that COVID-19 is similar. So yes, I think children are an important part of the transmission problem. Unvaccinated kids and adults are the most likely to transmit.
How much of a problem is it if my toddler refuses to wear a mask? Do you have any tips to get young kids to wear one?
Dr. Smith: Young children are unlikely to get serious disease, but they could spread the virus and infect other children or adults.
Dr. Moody: I totally understand the challenges in getting a toddler to mask. While I don’t have any magic answers, there are some things to keep in mind. First is behavior modeling—that is, it may be wise for vaccinated parents to wear masks as an example. Second is providing an incentive for masking, such as pointing out that your child gets to do something they may want to do. While I don’t condone bribing a child, I admit that I don’t know a parent who has never done so. Third is some amount of time masked is better than none at all. If people cannot mask for whatever reason, physical distancing is the next important thing. Try to be reasonable. If the child is visiting a sick grandparent, the stakes are higher. But I recommend parents not fall into the trap of “I can’t get total compliance, so I won’t bother.”
Dr. Omer: When you’re looking at community immunity, you are looking at group behavior. That means masking is useful. But it depends on the toddler, and kids are kids. I would look at who else is wearing a mask and is vaccinated around a child to determine the cumulative risk. I think we should strive for health behavior that comes with a bit of empathy, especially when it comes to children.
As more kids participate in activities, daycare, and school, they might come down with random bugs that might be hard to differentiate from COVID-19. Are there any clear signs or symptoms parents need to worry about, or that signify their kids need to get tested?
Dr. Moody: Unfortunately, no, there are no specific symptoms that are 100% sensitive or specific for COVID-19. Certainly, loss of the sense of smell is highly associated with COVID-19, but most of the other symptoms fall into the typical flu-like illness or common cold illness. It will be very hard to tell a common summer or winter cold apart from COVID-19. I think we are probably stuck with testing for a while. I am hopeful that testing will also include non-COVID-19 viruses as well, so folks can better know what’s going on.
Dr. Omer: There is a typical syndrome with COVID-19, where in addition to respiratory symptoms there is a loss of smell and taste. But it seems that may not always be the case when it comes to the newer variants. As things open up, there will be other infections like the seasonal flu. I think the smartest thing to do is just get your kids tested—don’t try to diagnose them yourself.
Can vaccinated parents spend time indoors at work or at a restaurant, for example, without having to worry too much about transmitting the coronavirus to their kids?
Dr. Smith: I think the risk is low for vaccinated parents. It will depend on local transmission levels, including the spread of more transmissible variants that could potentially render vaccines less effective. We have still been avoiding indoor areas but have done some outside dining.
Dr. Moody: In general, yes, I think vaccinated parents have some degree of protection from getting the virus. And if they don’t get it, they aren’t going to transmit it to their children. So, parents having a date night out or spending time with vaccinated friends is totally reasonable. There will be breakthrough cases and exceptions, but for vaccinated parents, these will be much less frequent than for unvaccinated parents.
Dr. Omer: I think there was more nuance needed in the CDC’s guidance. Based on rates in the U.S., I think it’s reasonable to remove your mask if you’re vaccinated and inside where there’s a low to medium density of people. If there is a situation where it’s really crowded and you really don’t know who’s vaccinated, it’s reasonable to wear a mask, especially with new variants around the corner.
After more than a year apart, this summer a lot of families are planning big, multi-generational family BBQs and other outdoor gatherings. Is it safe for kids to attend these events with relatives who may not be vaccinated, even if part of the event is indoors? What precautions should parents take?
Dr. Smith: I would not risk having my unvaccinated child indoors and unmasked with unvaccinated individuals. I would suggest trying to keep people moving around outside and require masks for times indoors.
Dr. Omer: If you have a family gathering where you know most people ages 16 or over are vaccinated, vaccinated parents can remove their masks. Unvaccinated kids should wear a mask.
Dr. Moody: Hoo boy, this is a tough one. With my academic hat on, I would say that those kinds of gatherings are a bad idea generally and are where transmission risks are highest. Putting on my general pediatrician hat, I would say that family interactions are very important for child development, as is maintaining family ties in a year as stressful as the last one. Personally, I think that any decision needs to be balanced by a clear understanding of the unique risks. I would ask (1) where are folks coming from, (2) how many are vaccinated, (3) what medical conditions do they have that might put them at risk, (4) how many people are gathering, (5) how much time will we be indoors, (6) do I have the freedom to miss work if I get sick, and (7) how much will me missing the event create family conflict? It’s hard to give a single answer because, to paraphrase Tolstoy, families each have their own way.
What if an unvaccinated aunt tries to hug or kiss my kids at a family get-together? How risky is that contact, and should I try to block it?
Dr. Omer: I would discourage that behavior at this point. We’re in a pandemic that’s not over yet. Setting some boundaries in that situation would be helpful.
Dr. Smith: A brief interaction outside probably isn’t high-risk, but I would consider working to set some ground rules in advance that may address those types of issues so no one is surprised and put on the spot.
Dr. Moody: If the aunt hasn’t got COVID-19, then the risk is no different than any other year. If the aunt has cold or flu symptoms, then they should probably be practicing self-control. The one that is hard to assess is the risk of asymptomatic infection. One way to think about it would be to think back to similar gatherings in the past. How frequently did you or your children get sick after one of those events in pre-COVID-19 years? If it was frequently, then the risks are probably higher than if it was infrequently.
Can my kids and I eat at a restaurant with outdoor seating, even where the tables are not spaced at least six feet apart? Do my kids need to take any extra precautions, like wearing masks at the table?
Dr. Omer: As long as there’s decent ventilation out on the patio, I think it’s okay at this point. That also depends on our current infection rates.
Dr. Moody: Outdoor seating with good ventilation is good protection against transmission. Six feet is not a magic number. A reasonable distance of four or five feet is only slightly riskier. Think of it as a reasonable distance, where closer is higher risk and farther is lower risk. A tightly packed outdoor space is probably not great. As for masking, it’s not wrong to mask while not eating and drinking, but it is also a question of compliance. If anything, eating and leaving is probably a better strategy than eating and hanging out while trying to keep masking.
Dr. Smith: The CDC puts that in the “less safe” category. If you are in relatively close contact with others of unknown vaccination status, I’d keep masks on the kids when they are not eating to minimize exposure or look for a place that is more spread out. We have been doing a lot of takeout to eat in a park, for example.
How risky is it to eat at an indoor restaurant with my kids? Do they have to put their mask back on between each bite? Even then, is it safe?
Dr. Omer: Don’t go into super-crowded restaurants. But it’s not the end of the world if you’re in a situation these days where you are in an indoor restaurant and it’s low- to medium-density. Your unvaccinated kids can remove their masks while eating.
Dr. Moody: It’s a gradation of risks and assessing where the risks actually lie. I think trying to get anyone to mask between bites is a challenge. I would think a strategy of “get in, get out” is probably better. I do think that finding a place with outdoor seating is probably wiser, at least for now.
Dr. Smith: I would say this is unsafe. The CDC characterizes this type of activity as “least safe” for unvaccinated individuals. If you choose to do so, I would mask as much as possible and try to be seated as far from others as possible.
Can my kids go back to playing sports or doing other group activities outdoors? Should they take any particular precautions?
Dr. Omer: It depends on the activity. I think for most activities they can remove the mask right now. This might change if there’s a change in infection rates.
Dr. Smith: This will also depend on local levels of spread. This should be fairly safe in general, but any extended time in close contact with others, even outdoors, can increase risk.
Dr. Moody: Any child with cold or flu symptoms should not be participating, period. With that assumption, I would say that outdoor sports and activities don’t pose a huge risk, but that masking should be maintained if exertion levels permit. As with everything else, nothing is zero risk.
Is it safe for my kids to participate in indoor sports or activities, like basketball or indoor swimming? What can they do to stay safe?
Dr. Smith: I would look at local levels of spread and the size and ventilation of indoor locations. A very large location with good airflow, like a gymnasium with fans and open doors and a small number of people, would be less risky than a small workout room with minimal ventilation and lots of people. Masks are still recommended if indoors.
Dr. Moody: For indoor sports and activities, I would recommend masking as much as possible, recognizing that some activities like swimming are impractical. Where masking isn’t feasible, distancing is helpful. For sports like basketball which cannot be done without close contact, the team culture will probably dictate the risk, but things like masking while on the bench can help.
Like school, summer camps are filled with mostly unvaccinated kids, but many activities are outdoors. Is there any way my kids can safely go to summer camp?
Dr. Omer: Yes, as long as they wear a mask indoors. It’s always a good idea to encourage outside activities anyway in these situations.
Dr. Smith: An outdoor day camp would be less risky than an extended overnight camp, with large groups of kids from different areas crowded into bunks together. Ask the camps what mitigation measures they have in place, if meals would be outdoors or inside in a crowded cafeteria, and what happens during rainy days.
Dr. Moody: In general, I think summer camps appear to be pretty safe based both on data from last summer and what we are seeing this summer. This is a situation where the child development benefits are huge, and so I’m really in favor of kids going to camps so long as some degree of masking and distancing can be maintained. Having the activities in well-ventilated and outdoor spaces certainly helps.
Can kids safely go into crowded indoor areas like movie theaters or children’s gyms, as long as they wear a mask?
Dr. Omer: If you’re unvaccinated it’s not a great idea to do these super-crowded activities. For the vaccinated, it’s perfectly fine, but I would still recommend wearing a mask if you don’t know everyone’s vaccination status.
Dr. Smith: The CDC puts crowded indoor activities as their highest-risk category (“least safe”), which includes movie theaters. Risk can be reduced if everyone is masked, but space and ventilation are also key. I know some movie theaters are renting out spaces for private movies; perhaps something like this could be done instead.
Dr. Moody: It’s all about balancing risks. For indoor venues, it’s all about density. Low-density indoor activities where people are masked are higher risk than not going, but lower risk than if the venue is packed.
What about having an indoor playdate with just a couple of other unvaccinated kids whose parents are vaccinated? Do my kids still need to wear a mask?
Dr. Smith: I am keeping my child masked when he is indoors with friends and trying to maximize time outdoors instead. But again, this is something that can vary depending on local transmission levels, and the exposures to other children and their parents.
Dr. Moody: I’m in favor of playdates for the same reasons as the other activities. I think so long as there are no symptomatic children, then unmasked activities are not unreasonable. I think it’s impractical to keep kids in a playdate masked the whole time anyway, and so long as the numbers are controlled it is not unreasonable. As with everything, outdoor activities might be a good way to reduce risk, but it’s about balance.
I’ve read that planes have pretty good circulation that drastically reduces the risk of coronavirus transmission. Is it possible to safely take a plane with my kids, as long as we wear masks the whole time?
Dr. Omer: The evidence was there fairly early. With the requirements airlines have, it’s good air circulation overall. I think it’s perfectly reasonable if people are masking.
Dr. Moody: Planes do have good ventilation and circulation, and so the risks are not as high as they could be. Masking is important. The larger the number of people who are on the flight, the more likely it is that someone could have COVID-19. The length of the flight is the other part: The longer you are exposed, the more likely you are to get the virus. I would consider my plans accordingly.
If we stay at an Airbnb or a hotel, is there a risk that our kids could catch COVID-19 if the previous occupants were sick? Should the space be unused for a certain amount of time, or should the place have a HEPA filter or some other sort of protocol? And what else can we do to make sure our stay is safe for our kids?
Dr. Moody: I think most of the data now suggests that surfaces are really not a big transmission risk for COVID-19. Assuming that the place has been given a typical cleaning, the risk of transmission from a previous occupant would be low. As long as air was allowed to circulate, there is little risk of the virus remaining airborne at high enough density to be a problem. Honestly, I would be more concerned about all the other things kids can get into in a new environment where I didn’t have control—such as exposed outlets for toddlers, chemicals, and fall hazards.
Dr. Smith: Transmission from inanimate objects seems to be rare. If you’re unsure about cleaning, you can always wipe surfaces when you arrive. In hotels, the bigger issue is likely exposure to others in shared areas, such as the lobby or elevators, where I would recommend staying masked.