Daniel Horowitz’s grip tightened around his children’s hands as he looked upon the sea of people in horror. Nobody was wearing a mask.
The amusement park's website said any unvaccinated visitors were required to wear face coverings, but it didn’t take long for the 42-year-old father to realize these rules weren’t being enforced.
This was not the safe, socially distanced summer Horowitz had in mind.
Although the dad from Wilmington, Delaware, is fully vaccinated, his 8-year-old daughter, Emily, and 4-year-old son, Adam, are still unprotected. Horowitz was excited to give them the summer they had lost last year, but he says the lack of regard for unvaccinated children puts them at risk.
“They don’t seem to be taking the kids into account too much when making these regulations,” he said. “We want our kids to do fun things, but we wish it was safer for them.”
As the country picks up where it left off, fully vaccinated parents feel left behind, with their children unvaccinated and unprotected against the coronavirus.
Studies have shown children are less likely to get infected and develop severe illness from COVID-19, but these studies were conducted during mask and social distancing mandates, and while the country had robust testing. Some parents feel the Centers for Disease Control and Protection should offer more specific guidance for navigating the new normal with their unvaccinated kids.
“It’s hard to take action when the information is so nebulous,” said Tawny Ochoa, a 41-year-old mother from Whittier, California. “You’re just floating around hanging in limbo.”
Children infected with the virus are more likely to be asymptomatic than infected adults, making it difficult to collect information on transmission. But from the little data that exists, health experts say the best way to protect a child from COVID-19 is for parents to get vaccinated.
More than 4 million children have tested positive for COVID-19 in the U.S., according to the American Academy of Pediatrics. Children represent 2.2% of total COVID-19 hospitalizations and .07% of total deaths.
Since the start of the pandemic, more than 4,000 children have been hospitalized with multisystem inflammatory syndrome – a rare but dangerous condition associated with COVID-19 that causes different parts of the body to become inflamed.
Although children are less likely to die from COVID-19 compared to adults, it’s deadlier than other pediatric diseases, according to data presented at a recent Johns Hopkins symposium.
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More children are hospitalized for influenza during a normal flu season than COVID-19, with 32 to 92 hospitalizations per 100,000 flu cases, compared with 22 hospitalizations per 100,00 COVID cases. However, deaths from the flu are fewer. A normal flu season has about 110 to 192 influenza deaths in children, whereas more than 300 children have died from COVID-19.
“Young, healthy children are not supposed to die,” CDC Director Dr. Rochelle Walensky said during the June 30 symposium.
Data from reopened schools in the 2020-21 year suggested kids weren’t super-spreaders of the original coronavirus. More infections tracked in schools were passed between adults. But when schools followed strict mitigation practices, such as consistent mask-wearing and social distancing, transmission was negligible, several studies showed.
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“Based on the data available, in-person learning in schools has not been associated with substantial community transmission,” noted a widely cited CDC study from March 19. “Significant secondary transmission of COVID-19 can and does occur in school settings when prevention strategies are not implemented and followed,” the study warned.
Infections in kids more commonly came from close contact with other people with COVID-19, including attending gatherings and having visitors in the home, according to the CDC.
The CDC released guidance Friday that lifted indoor masking guidelines for fully vaccinated teachers and students in school. The agency urged schools to fully reopen in the fall “regardless of whether all prevention strategies can be implemented,” calling a return to in-person learning “a priority.” Masks should still be worn indoors by everyone over 2 years old who is not fully vaccinated, the CDC said.
With all this in mind, families still have to weigh what level of risk they’re willing to tolerate, said Amanda Simanek, an epidemiology professor at University of Wisconsin-Milwaukee.
“We are in a pand-exit period – it’s limbo,” said Simanek, a mother of two children, including one who is 12 and fully vaccinated and two younger children who are not yet eligible for the vaccine.
Humans weigh risks unrelated to COVID-19 every day, even if they're not always conscious of it – when a parent sends their child to school, lets them climb a tree, leaves them in the care of a babysitter or drives them anywhere in a car.
"There are risks associated with being in a car, but most of us don't worry about that on a daily basis, because we've accepted those risks as part of the price of getting where we want to go," said Lynn Bufka, senior director of practice transformation and quality at the American Psychological Association.
Research shows cognitive, emotional and hormonal factors can influence how an individual makes decisions involving risk. Risk is approached and tolerated differently based on biological factors and life experiences. In the case of COVID-19, it's also influenced by the health of the family and how the adults weigh the tension between physical safety and mental health.
An immunocompromised family may be less risk-tolerant than one that is not. A family that lost someone to COVID-19 may be more cautious than one that hasn't been personally touched by the virus. Conversely, a family more concerned with the effects of a young child's isolation than contracting COVID-19 may choose to engage in activities with some risk of virus exposure.
The problem is people want simple answers in black and white, said psychology and neural science professor Jay Van Bavel, of New York University. They struggle to weigh probabilities. Unfortunately, COVID-19 presents too many variables, he said.
While it's prudent to balance risks related to COVID-19, there is no way to completely eliminate them, Bufka said.
"There's no perfect decision," she said. "We all live in a world where there will always be decisions that involve risk."
The decision to take on that risk also may be impacted by the highly transmissible Delta variant, which has been reported in children and is spreading rapidly throughout the U.S.
The CDC says the Delta variant, first identified in India, is now the dominant strain in the U.S, making up more than half of all new infections. In some pockets of the country, such as the Midwest and the upper Mountain States, that number is closer to 80%, Walensky said at a news conference last week.
While studies show vaccinated people are safe against the Delta variant, health experts say the strain is highly transmissible among partially vaccinated and unvaccinated people – leaving younger children vulnerable to infection.
On June 30, Texas Children’s Hospital reported several of the country’s first pediatric infections – all occurring in children under 12. Although it’s too early to tell if the Delta variant causes more severe disease in children, experts say it’s clear it’s causing more symptomatic infections.
“Because it’s the most highly contagious variant to date based on all the data we’ve accumulated so far, we expect to see more rapid transmission of this virus from adults and adolescents to children,” said. Dr. James Versalovic, pathologist-in-chief and interim pediatrician-in-chief at Texas Children’s Hospital.
That why’s health experts are urging adults and adolescents to get vaccinated, not only to protect themselves from the variant, but also to protect younger children in the household. Studies have shown children are more likely to get the coronavirus from adults and teens than they are from other children.
“While it’s pretty clear younger children were considerably less likely to be infected by the virus we were dealing with a year ago, the variants that have emerged since then are certainly capable of causing outbreaks in schools,” said William Hanage, an epidemiology professor at the Harvard T.H. Chan School of Public Health.
After getting fully vaccinated, Versalovic said parents can protect their children by having them wear a mask and practice social distancing whenever the vaccination status of nearby adults or teens is unknown.
He emphasizes the importance of social distancing and hand hygiene for parents of children too young to wear masks.
“It’s a tough message for parents, but we’re going to need to be especially careful this summer,” Versalovic said.
In the meantime, scientists are redoubling their efforts to finish clinical trials so the Food and Drug Administration can authorize a COVID-19 vaccine for younger children as soon as possible.
Texas Children’s Hospital partnered with vaccine developers Pfizer and Moderna to combine Phase 2 and 3 trials, expediting the process during the summer months to submit data by early fall.
“Early in the next school year, we hope to have emergency use authorization for these COVID vaccines for children under 12 by early to mid-fall,” Versalovic said. “That remains a top priority and has now added urgency with the rapid spread of the Delta variant.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
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