Fully vaccinated grandparents and older adults around the US are now reuniting with their grandkids and other close kin, with the aid of new guidance from the Centers for Disease Control and Prevention released last week.
The updated guidelines say that it’s now relatively safe for a small group of fully vaccinated people to get together indoors without masks or distancing. What’s gotten less attention is that they can now also spend time unmasked with a (low-risk) household of unvaccinated people.
With this announcement, many have felt a weight lifting as they see glimmers of a future with far fewer necessary pandemic restrictions.
These new guidelines are helping to build the case that there will be more socializing this spring and summer of 2021. Which is particularly welcome to many families with kids who have been kept from normal school, activities, and socializing for the past 12 months.
“There’s more flexibility now,” says Michael Chang, a pediatric infectious disease specialist at the McGovern Medical School at UTHealth. And “this summer we’ll definitely see more flexibility.”
Part of the reason for this is that in the US, most adults — who are at higher risk of getting very sick with Covid-19 — will likely have the opportunity to be vaccinated by late spring. This leap in collective immunity is expected to help push down the amount of the virus spreading in the community, making the odds that kids will come into contact with the illness much lower.
“Having more adults vaccinated almost inherently makes [many] settings safer,” says Ibukun Akinboyo, a specialist in pediatric infectious disease and medical director of pediatric infection prevention at Duke University School of Medicine. But, she notes, “There are so many nuances built into what this future might look like, particularly this summer.”
Kids will still need to take precautions, especially because they’re unlikely to get the vaccine until late 2021 or into 2022. This will be key not just for keeping them safe (more than 3 million kids have had confirmed Covid-19 cases so far, about 1 percent of whom had to be hospitalized), but also for controlling spread of the virus. Older children tend to be nearly as able to spread Covid-19 as adults are. And younger ones can still spread it too.
So although the new changes in guidance might feel like the end of some of the most difficult pandemic restrictions, “it’s not like a blank check to do whatever you want,” Chang says.
Here’s what families with kids should know about the new CDC guidance, and what to expect for spring and summer 2021.
Visits with older, vaccinated adults are pretty much all that’s changing for kids right now
Kids younger than 16 won’t likely get vaccinated against Covid-19 for at least another several months, and possibly, for some, a year. (Even those 16 and older, for whom the Pfizer shot is authorized, have to wait for their turn alongside adults.)
So this leaves us, mostly, with the visits with grandparents and other vaccinated adults. (And, as states roll out vaccines for a growing list of others, more adults will be able to safely visit most unvaccinated households, too.)
Experts note some crucial caveats in the guidance:
- Wait two weeks after your last dose
Before people can jump into any of these new interactions, a vaccinated visitor has to have gotten all of their required shots (two for Pfizer and Moderna, one for Johnson & Johnson) — and also have waited at least two weeks after the final dose for their immunity to fully spin up.
- Keep to one household at a time
Fully vaccinated people should only share a close visit with unvaccinated people from one household at any one time. So that still means no big family reunions.
- Watch for risk factors
Immunized people should not fraternize with anyone who lives with someone who’s at higher risk of severe Covid-19 and is unvaccinated. So no hugging the grandkids if their unvaccinated dad has heart disease or if their unvaccinated mom is pregnant.
- Don’t visit if someone feels ill
Don’t get together with people face to face, regardless of vaccination status, if anyone is sick. (And those with symptoms should still isolate and get tested for Covid-19, even if they’ve been vaccinated.)
- No long-distance travel
The CDC hasn’t made any exceptions to its pandemic travel guidance, even for vaccinated people.
There are still no zero-risk interactions
For some families, this new green light might feel abrupt, and maybe even uncomfortable. And that’s okay. “Everyone’s assessment of how much risk they’re willing to take is different,” Chang says.
“Unfortunately, when it comes to any contagious infection, even apart from Covid, there’s no zero-risk way of doing this,” Chang says of having face-to-face interactions.
The CDC has made these new recommendations based on a calculation of risks and benefits. Public health officials have spent the past year trying, in particular, to protect from infection those with the highest risk of dying from Covid-19 — especially those 65 and older, who have made up more than 80 percent of deaths. This has involved keeping those folks away from others as much as possible, as well as reducing overall community spread.
With those individuals now eligible for vaccines — and many of them fully vaccinated — the landscape is different. But that doesn’t mean there’s no risk. The vaccines are remarkably effective. But vaccinated people can and do occasionally catch Covid-19.
We also don’t have an entirely clear picture of how well the vaccines stop people from spreading the virus to others. Early data show that people who are vaccinated are less likely to be carrying the virus (which was part of the CDC’s recent decision-making process), but those numbers aren’t zero. So it is still possible for a vaccinated grandparent or other adult to bring the virus into a household and sicken an unvaccinated person, adult, or child. “It’s a delicate balance,” Chang says.
The bottom line is that “the risks are now low enough that each person can have this flexibility to make these decisions now,” Chang says.
If most adults get vaccinated in the spring, what will kids be able to do this summer?
Likely a good deal more. Even though most kids probably won’t be able to get their shots by the end of this summer, that doesn’t mean the summer of 2021 will necessarily be a repeat of 2020’s summer.
With smart mitigation measures and consistently lower local transmission rates, many in-person activities are likely to be safer.
“The lower the case rates in the community, the lower the risk of transmission,” says Tina Tan, a professor of pediatrics and infectious diseases at the Feinberg School of Medicine at Northwestern University. “But that doesn’t mean that it can’t occur,” she notes.
This projection is, of course, barring major interference from new variants, or case spikes from other causes (like too-soon relaxation of restrictions). The CDC will continue to update guidance on their recommendations for various activities, and people should still also be following their local case rates and advisories.
So what can families with kids likely expect to be able to do in the coming months?
Outdoor activities, such as pools, parks, and playgrounds are likely to be a fair amount safer this summer, especially if capacities are limited and attendees continue to mask and distance as much as possible. And the standbys from last summer — biking, hiking, and the like — will continue to be quite safe when limited to single households, now with the addition of another fully vaccinated person, too.
Chang also sees less risk with outdoor kids’ sporting activities, with especially lower chances adult coaches and spectators will catch or spread the disease as they get vaccinated. Although Tan cautions that without CDC-recommended mitigation protocols in place, some close-contact kids’ sports could still be risky.
Summer camps might be an area where parents check to see if staff are old enough to get vaccinated, to lower the risk of a coronavirus outbreak.
Even some indoor activities in which children can maintain their distance and stay masked, such as a well-managed dance class, will likely be okay, Chang notes.
Many of these theoretically welcome changes might require parents to do some recalibrating. “It’s going to take a little adjustment period,” Chang says. Activities that felt unthinkable even just a couple of months ago could soon be much safer, especially with involved adults vaccinated. “More things are going to be okay, and sooner than later hopefully,” he says.
There are also some activities, however, that will remain riskier for kids.
Tan advises against kids’ indoor activities in which physical distancing is difficult to maintain, such as trampoline parks. Chang, too, flags some close-contact indoor sports, such as wrestling, as likely to stay riskier. And it will remain a good idea to avoid crowds.
Other once-normal things like indoor playdates and sleepovers will still technically carry more risk than those that are outdoors or highly regulated. But the risk to vaccinated adults in the household will be substantially lower, and if community transmission rates are also low, to the children as well. Still, “it’s important to be very upfront about your risks and risk behaviors,” Akinboyo says. As well as your risk tolerance. “Making risk a part of your natural conversation will allow you to break free from the household a little more. And that is needed.”
Toddlers and teenagers might have different summers
Although all kids need to keep up pandemic safety measures, families might be able to calibrate their expectations based on kids’ ages. Children 10 and older seem about as likely to spread the coronavirus as adults are. So these kids should be especially vigilant about continuing to mask and distance. And high school- and college-age people need to be especially diligent in following every precaution adults do.
For kids ages 5-10, Chang notes, their risk of catching Covid-19 appears markedly lower than that of older kids and adults, but it’s still possible. So, he says, masking and distancing among these kids are still key. But he says, for example, that outdoor group activities, like on-field sports, are less risky for them than they are for older kids.
And “under 4 and 5 years, the risk of transmission to and from [these kids] is actually quite low, and the risk of having serious illness is low, so you can be more flexible,” in terms of what they might be able to do, Chang says. (Infants are more likely than their slightly older counterparts to get severe Covid-19.)
Regardless of age, kids and their families are still going to need to remain vigilant. “Through the end of this year, I think there’s going to be some type of mitigation protocols in place, especially for kids,” Tan says.
The good news is, the more we all adhere to these very familiar steps, the more we’ll be able to do — and sooner. “People just have to be patient and stick to what they’re doing,” Tan says. Otherwise, if we rush back into risky situations too quickly, “that is just setting us up for another surge of disease,” which will only further delay getting back to more normal activities.
When will kids get the Covid-19 vaccines?
Kids are among the last to have Covid-19 vaccines tested and authorized for them. And approvals are likely to trickle out based on children’s age.
Covid-19 vaccine trials are currently underway in kids 12–16, and Moderna announced Tuesday it plans to enroll children ages six months through 11 years in a phase 2/3 study. But it could take a while to get results. Researchers are using kids’ immune response — rather than waiting for natural infections like they did in the trials for adults — to see if the vaccines are likely to be effective, which will speed up that half of the process.
However, they will spend more time than they did for adults following the safety profile, in large part because children have a lower risk of getting severely ill from the disease. And “the safety data just takes time,” Chang says. He expects the FDA will want six months or so of safety data before greenlighting any of these vaccines even for adolescents.
Tan suggests that if the trials go smoothly, we might have vaccines okayed for kids 12–16 by the fall, but kids under 12 will likely be waiting until “some time in 2022.” (She notes that it will be important, as more kids return to school and other activities in the meantime, to ensure they’re up to date on all of their routine vaccinations.)
Not only will vaccines be essential for protecting kids against catching Covid-19, but also in helping to keep all of us safe. The hope is that we can all start to drop major pandemic restrictions, such as public masking and distancing, as we cross the threshold into herd immunity. But for that to happen, we need at least 70 percent of people (and possibly more) to be immune to the virus through a combination of vaccines and acquired immunity. And we’re unlikely to reach that without vaccinating minors, who make up about 25 percent of the US population.
So, what about spring break?
We still likely have more than two months before the majority of adults in the US are fully vaccinated (that is, had their final dose at least two weeks ago). So, although we expect kids to be facing much lower risks in the months to come, we’re not there yet.
“Obviously people are tired of Covid,” Tan says. “But we’ve not controlled Covid in this country. People still need to be careful.”
With spring break upon us, Tan is concerned about families traveling (an undertaking that the CDC says we should still avoid). In particular, she worries about popular destinations, such as Florida, where some spots, including the Miami area, still have moderately high case rates.
Chang seconds that. “I probably still wouldn’t go to Daytona Beach and hang out,” he says. “This particular spring break is not yet the one where you go and do whatever you want.”
Local camping with your household — and now including someone else who is fully vaccinated — is still a great option for travel, Chang notes. But most other travel is still not recommended by the CDC, regardless of your vaccination status. And Akinboyo points to the importance of heeding specific travel advisories. (Many states, for example, are still requiring out-of-state visitors to quarantine upon arrival.)
We also don’t yet know what the coming weeks will bring. Some states are starting to lift more mask and distancing restrictions, which could send case rates — and risks of coming into contact with the virus — climbing again. It tends to take weeks after major changes or events, like holidays, to see impacts on case numbers. “We may see another surge of Covid-19. It would not be surprising,” Tan says, due to these rule changes and the new variants spreading.
Others agree. “We’re still going to have more disappointment as we march through Covid-19 eradication, but in the end, vaccines give us hope,” Akinboyo says.
Until vaccines are universally available to people of all ages in the US, however, kids should continue basic pandemic protocols — masks, distancing, hand hygiene, opting for outdoors. Even vaccinated adults should, too. And not just to prevent the spread of infection.
“We’re shifting to a new time, where we’re putting people into categories depending on their vaccination status,” Akinboyo says. “We know kids across ages model behavior that they see.” So it will be a big help if even the vaccinated can mostly keep up these behaviors in public. “It’s a little bit easier when everyone’s doing it,” she says.