Parents wonder what to do with their unvaccinated children as CDC changes mask guidance

The government’s recommendation that vaccinated people don’t have to wear masks indoors or outdoors in most cases has left the parents of children younger than 12 - a group that cannot yet be vaccinated - scrambling for answers.

Parents are contending with a flood of questions: Should vaccinated adults go unmasked while their unvaccinated kids cover their faces? Should the whole family go to indoor public places like restaurants, movies or grocery stores while the youngest are not protected? Right now pediatricians urged parents to remain cautious and vigilant, as so much remains unclear about how the new policy will affect transmission in communities and nationwide.

“Until younger children are eligible to be vaccinated for the coronavirus vaccine, they should continue to wear face masks when they are in public and around other people,” said Yvonne Maldonado, chair of the American Academy of Pediatrics committee on infectious diseases. “We’ve already seen how the masks have helped prevent the spread of respiratory infections within schools, camps and other community settings, particularly when everyone wears them, washes hands and follows other infection control guidance.”

Even adults and older children who are vaccinated may want to think about wearing masks if there are younger children in the family - either in solidarity or to keep the risk to unvaccinated children as low as possible.

“It depends on your comfort with risk. The risk of the vaccinated parents getting infected while they’re out and transmitting it to the child is low. And if the child gets infected the risk of severe illness is low. But that risk does exist. Do you as a parent want to take that risk?” said John Williams, chief of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh. “Parents should think about it like they think about car crashes. Statistically, the risk of serious injury in car accident is very very low, but you better believe I make sure my kids put on seat belt every time they get in the car.”

He noted only about half of the country’s adults have been vaccinated. Adolescents ages 12 to 15 only were approved for the vaccine this week, so few in that group are fully protected yet.

“The risk of severe disease is low in children, but it’s not zero,” Williams said. He pointed out that more than 300 children have died from covid-19. And roughly 15,000 children have been hospitalized - far more than in a typical flu season.

“We should not be shaming anyone for mask-wearing. It’s like shaming people for wearing seat belts or for not smoking cigarettes. They are responding to a very real risk,” he said.

Himani Shah, 43, mother of a 13-year-old and a 10-year-old in Berwyn, Pa., said she worries for her youngest child. While everyone else in the family is vaccinated - including 13-year-old Avani, who got her first shot this week - for now, her whole family intends to keep wearing masks when going out, she said. It’s a question of safety, risk versus benefit and solidarity for 10-year-old Leila.

“Rather than saying sorry, you’re alone on the island, I want to be in the fight with her,” said Shah. “So our whole family, we’re going to be eating outdoors at restaurants, masking up if we go to grocery store or any public place where we don’t feel safe.”

“I know if Leila gets infected it will probably be mild symptoms because she’s so young, but no one knows what the long haul effect could be,” Shah said. “The added burden of wearing a mask is so little compared to the peace of mind.”

“The other thing I think there’s definitely overlap between the people who are unwilling to get vaccinated and those who don’t wear a mask. You have no idea who’s not wearing mask because they’re vaccinated and who just doesn’t care,” Shah said.

John Williams, chief of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh, said because so many Americans are still not vaccinated, it is best for families to think carefully about going into crowded public spaces. Thirty-six percent of Americans are fully vaccinated, according to a Washington Post analysis of CDC data, and 46.8 percent have received at least one shot.

“I’m not saying don’t go, but be thoughtful about whether you need to go,” Williams said.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said that for her family, which includes 4- and 8-year-old children, she continues to use what she calls an “exposure budget,” assessing the risks and benefits of each situation. She will continue to wear a mask at a grocery store, she said, under the assumption that is store policy, and would avoid taking her children to a crowded indoor play space, which she said is “risky and not worth it.” But she would take them in a plane - wearing masks and using hand-sanitizer - and to visit freely with vaccinated family members.

Nuzzo said her kids have adapted to wearing masks. As an epidemiologist, she is not terribly worried about them getting the coronavirus, since severe outcomes are rare for children, and other measures, such as vaccinating older family members, social-distancing and masking afford them protections.

Williams said the decision on who in the family should wear a mask depends on tolerance for risk and the circumstances, and is more subjective for vaccinated family members.

“Are there people in the family who are immunocompromised or at higher risk? In those cases, even the vaccinated people might want to mask in high-transmission risk setting,” Williams said.

Some of the decisions will be driven by parenting, not science, he said.

“If I have both a 9-year-old and a 12-year-old, am I really going to make only the 9-year-old wear a mask?” Williams said. “You can’t tell (a) 9-year-old while the 12-year-old doesn’t have to eat veggies at all. Any parent knows that’s not going to fly.”