Freedom! Or not? Many parents are now double-dosed —but what do we do with the kids?
Photo: iStock/skynesher
I hadn’t even made it home after receiving my second COVID-19 vaccine before the rush of relief turned into apprehension. What about my kids? My own immunity doesn’t just flip the switch on a more normal life if my kids are still susceptible to COVID. Or does it?
As more and more Canadians over the age of 12 become fully vaccinated, case counts come down and COVID-19 restrictions start to lift, parents with children too young to get a vaccine are left wondering where this leaves them. Last week, the Public Health Agency of Canada released guidelines for fully or partially-vaccinated Canadians, but didn’t address families with kids under 12 who aren’t eligible for vaccines yet.
The good news is that, according to Sumon Chakrabarti, an infectious disease specialist at Trillium Health Partners in Mississauga, Ont., vaccinations have fundamentally changed the public health outlook in this country. This means that instead of blanket health guidelines that apply to everyone, we can expect to see an emphasis on personal risk assessment. What’s safe enough for the family across the street might not be safe enough for you.
We spoke with Chakrabarti and Michael Zakhary, a medical officer of health in Edmonton, Alta., to get a handle on what otherwise vaccinated families with children under 12 need to keep in mind this summer.
Both experts agree that families need to gauge their own comfort level when making their COVID-19 risk assessments. There’s nothing wrong with taking it slow or going above and beyond what the public health guidelines call for. “I want to empower people to make their own decisions. Just because something is safe, people might not be comfortable with it yet—and that’s okay,” said Chakrabarti.
At this point, what should we be worried about with kids when it comes to COVID—them getting sick, or them spreading it to others who are at higher risk?
Earlier in the pandemic, our main concern about kids catching COVID was that they could spread the virus to other high-risk community members, Chakrabarti reminds us. Children themselves have never been at a high risk for severe illness from COVID-19. Now that vaccination rates are way up across the country, the risk to kids is even smaller. “When you have a situation where community spread is very low, and you have people around the kids that are vaccinated, the chances of them getting it and spreading to others is very slim,” says Chakrabarti.
There is still some risk of children spreading COVID to people who are not fully vaccinated which is why Zackary stresses that families should consider whether people they interact with are vaccinated or if they have any high-risk health conditions. Zakhary urges everyone who can get immunized do so, “to protect themselves and to protect those around them, especially those who are at higher risk. This is also the best way to protect children who are not eligible for immunization.”
What are the factors families need to weigh when assessing their own risk?
Zakhary says that all the things we learned about risk mitigation throughout the pandemic still hold true: outdoors is safer than indoors and masks, distancing and good hygiene all make us safer. How careful you have to be largely depends on factors like the vaccination status of the people you’re in contact with, the vaccine rate in your community at large, the COVID case rate in your community and whether you have an immunocompromised or other high-risk individual in your life.
But Chakrabarti wants families to understand that they don’t have to worry much about the kids themselves. He said, “We are hearing kids being called ‘unvaccinated’ and that’s interesting, because kids weren’t high risk to begin with. The reason we vaccinated was to stop severe outcomes, and kids have almost no severe outcomes with COVID. Kids have been hospitalized with multisystem inflammatory syndrome (MIS-C), but that’s very, very rare, and it’s treatable.” Still, if the theoretical possibility of COVID exposure simply freaks you out, then that’s reason enough to be more careful.
Can kids hug their fully vaccinated grandparents?
If it’s cool with grandma, then it should be cool with you. “Even if a child happens to spread COVID to a grandparent, the grandparent is now protected against severe outcomes like hospitalization and death. So that’s why I feel absolutely OK with my own parents hugging my kids, because they’re protected,” Chakrabarti said.
But maybe grandma isn’t so sure. Some immunocompromised or otherwise extremely vulnerable and high-risk individuals might want to be extra cautious, as they would be during a regular flu season. In that case, Zakhary says that hugging doesn’t necessarily have to be off the table. “There are ways to reduce the risk, such as wearing masks to prevent the spread of respiratory droplets, perhaps facing away from the other person and decreasing the duration of contact.”
Can children attend indoor and outdoor gatherings?
These experts agree that the risk of COVID transmission outdoors is very low and there is no major safety concern with bringing children to outdoor events. But Chakrabarti says that even indoor events become less risky once people are fully vaccinated. “Once you’re vaccinated, even if you are high risk, your chance of a severe outcome is very, very low. So if someone is comfortable being at a larger indoor gathering like a party or a wedding (once it’s acceptable by the public health rules) then it’s absolutely safe for them also to have contact with children.” And the kids themselves, Chakrabarti reminds us, don’t get very sick from COVID either, even if they were to somehow contract the virus.
Of course, the relative risk of these events still hinges on the vaccination status of those attending. While we are seeing encouraging uptake of vaccines in general, there may still be pockets of vaccine hesitancy. If you want to be cautious and you don’t know the vaccination and health status of some of the people attending, then Zakhary would advise limiting the size and duration of the gathering and using masks and/or distancing to further decrease the risk.
What should we expect from camps?
Camps will have varying COVID safety measures in place according to their own preferences and different provincial guidelines. Most will probably operate with protocols similar to what kids have seen in school this past year. “If you’re less comfortable with the kid being indoors, then you may want to send them to an outdoor camp. Some camps will enforce masking everywhere, and if that’s what makes you comfortable, you do that camp,” Chakrabarti says. So go ahead and add “fits my COVID-risk comfort level” to your list of criteria when selecting camps this summer.
And do remember to keep monitoring your kid for symptoms this summer, Zakhary stresses. Keeping your kids home if they’re sick and getting them tested is still important. Chakrabarti adds: “Is there a chance that there’s going to be kids that have COVID? Yes, but it’s much less now because community transmission is quite low.”
Can we go to a restaurant?
In terms of risk, Chakrabarti says restaurants are fine. “Even if, for example, the 50-year-old parent has diabetes, if they are vaccinated, their risk is effectively eliminated. Would you have gone to a Boston Pizza with your family in the winter of 2018 when influenza was high? The answer is probably yes. And now vaccinations allow us to do that with COVID because it has essentially reduced COVID to a mild respiratory illness.” And Zakhary noted that as the provinces continue to reopen in the coming weeks we can expect further guidance about what kind of measures need to be in place at restaurants and whether they will affect unvaccinated children.
Should families be flying?
Flying itself is not as high risk as we thought it was, Chakrabarti notes. Studies that have shown that the quality of ventilation and air flow helped to prevent the spread of COVID on planes. What’s more, as Zakhary pointed out, governments and airlines continue to enforce stringent rules about masking. (Masks are mandatory on Canadian flights for anyone six and up and strongly recommended for kids between two and five.) This helps keep everyone safer during the flight—even if your three-year-old throws a fit and won’t wear her mask. It’s also a good idea to “check the COVID-19 situations in the area you’re traveling to and assess the risk to your family accordingly,” Zakhary said. You might want to reconsider the trip if there’s a local outbreak or at least plan to take more precautions to avoid close contact with strangers.
What about extended stays—can we see our long-distance grandparents now?
Good news, Chakrabarti said that it is safe as long as the guests are fully vaccinated. If there are other unvaccinated people in the home, perhaps another family with kids under 12, then the scales tip slightly toward more risk. “As there are more unvaccinated, or not fully vaccinated, people among the houseguests (assuming there’s significant indoor contact), the risk incrementally increases,” Chakrabarti said. But he’s also quick to point out that even if not everyone is vaccinated, the risk remains small during the summer when there’s not a lot of COVID in the community.
Are playdates and sleepovers back on the table? Chakrabarti said that if the rest of the household is fully vaccinated, then the risk of anyone developing severe illness is extremely low. The higher the number of children attending a playdate or a sleepover, the greater the risk of someone contracting COVID. But with community spread of the virus low right now, the risk of getting COVID at all remains small. Zakhary reminds parents to consider their own individual circumstances and risk tolerance and says that outdoor playdates remain safer than indoor ones. Masks and distancing will decrease the risk of any transmission. So when exactly do kids need to wear masks? Should they continue to wear them even when their vaccinated family members no longer need to?
As long as mask mandates are in place, children, like anyone, have to wear a mask in most indoor public spaces. But as the COVID-19 situation continues to improve in Canada, both Chakrabarti and Zakhary see the relaxation of mask mandates on the horizon. Schools will likely be the last place kids are obligated to wear masks, according to Chakrabarti. As to whether kids under 12 should continue to wear masks in settings where they’re not mandated, both experts say that it depends on the individual circumstances and risk tolerance of the family. From a medical standpoint, Chakrabarti said, “Children under 12 have an almost non-existent risk of severe COVID, so it would be safe to go without a mask in all the places adults do. Once people start to get comfortable with the fact that kids are not at risk for severe outcomes, that we have low community transmission, and that the people around them are vaccinated, they’ll understand that protects them better than any mask ever could.”
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