Though many North Carolinians welcomed the loosening of COVID-19 restrictions, particularly the mask mandate in most settings, some parents with children who are not yet eligible for vaccination are confused and concerned.
“I’m very excited for myself, but this makes things harder for parents of unvaccinated children,” said Emily Brewer, who lives in Carrboro with her 11-year-old son, Dylan. “Now I feel like I’ll have to weigh every single outing and decide if I feel safe to bring my son.”
On Friday, Gov. Roy Cooper issued an executive order that lifted all social distancing and capacity restrictions in North Carolina, as well as indoor mask mandates in most situations. This came one day after the national Centers for Disease Control and Prevention released new guidance saying fully vaccinated individuals no longer needed to wear masks in most situations.
“If only vaccinated people didn’t wear masks and unvaccinated people did wear them — if people really complied — then I’d feel safe,” said Kelly Alexander, mother to David, 11, and Clara, who is 7.
“But that’s not going to happen. It only takes one person who is unvaccinated, gets sick and doesn’t wear a mask to possibly make my kid sick. I’m not OK with that.”
Children between the ages of 12 and 15 are now able to be vaccinated since the Pfizer/BioNTech vaccine was granted emergency use authorization last week. Alexander and Brewer said that as soon as their children turn 12, they plan to get them vaccinated.
Clinical trials are already underway for younger children to determine what the ideal dosage and timing for them will be while also studying safety and efficacy.
While there is no definite end date for the trials, optimistic estimates have young children being vaccinated around September and babies may be able to be vaccinated by December or in early 2022, while more conservative estimates place 6- to 12-year-old children being vaccinated by the end of 2021.
Even before CDC’s announcement, parents across the state struggled to calculate risks and make decisions about how to approach a summer when a majority of adults are now vaccinated, but their children are not.
Dr. Whitney Robinson, an associate professor of epidemiology at the UNC Gillings School of Global Public Health, said she was particularly concerned that the new CDC guidelines offered no specific guidance for parents or settings that involved children such as schools or day care facilities.
“I think the parents of children, especially those who are immunocompromised or disabled, I think they feel ignored right now,” Robinson said. “We can’t just treat kids just like we would treat any unvaccinated people. Their lives are different. They are not just adults with the ability to just make any decision that they want.”
The risk for kids
With a year of evidence, many scientists agree that though COVID-19 has been deadly for older adults, it appears to pose about the same risk as, or a smaller risk than, the flu for hospitalization in children.
Children continue to show lower risk of infection and, if they are infected, appear to have fewer serious cases and are less likely to spread the disease to others.
Children ages 17 and younger account for approximately 12% of all COVID-19 cases, despite making up over 22% of the population, according to CDC data. It is possible that this is an undercount since many children present only minor or no symptoms, but multiple studies have shown that children, particularly those younger than 12, appear less likely to catch COVID-19 and are less likely to spread it than adults, though unvaccinated children should still wear masks in public to limit that possibility even more.
In recent weeks, however, children account for a higher percentage of new COVID-19 cases.
According to the American Academy of Pediatrics, children accounted for 24% of COVID-19 infections for the week ending May 6.
Children’s increased representation in new cases comes primarily due to the drastic reduction in cases among adults as they become more and more vaccinated.
“This is one of the key changes in recent months,” said Dr. Ibukun Kalu, a pediatric infectious disease specialist at Duke Hospital in Durham.
“As we’ve vaccinated a bunch of adults, the largest population of unvaccinated people is becoming children. Even as cases decrease, children are becoming the population most likely to be infected, by nature of being unvaccinated … so the concern now becomes, how can we take in all of the new recommendations for fully vaccinated people, but continue to account for children?”
While most children remain at low risk for serious outcomes, Robinson said she understood why easing mask mandates so suddenly could cause frustration for parents.
“The cognitive load is a huge thing. I think people are so tired of making all these calculations, making decisions, adapting schedules,” Robinson said. “Now this change just adds this other level of unpredictability that I think is very hard on families who are really worn out from doing it the past year.”
Kalu also understood parents’ worries but said that as long as parents stick to the tried-and-true methods for avoiding infection they have been using for the past year, the likelihood of infection is low.
“Parents have done a great job figuring how to manage exposures this past year,” Kalu said. “It does feel like a bit of whiplash and people trying to wrap their heads around it, but I don’t expect major changes in places like schools, summer camps, or places where children are the primary focus.”
The newly relaxed mask mandate’s biggest impact for parents will likely be at indoor businesses.
Though unvaccinated people are supposed to continue masking when indoors and in public, Gov. Cooper said at a press conference on Friday that “yes, you are likely to see a number of people who are unvaccinated stop wearing masks.”
Kalu said parents who must visit businesses with children should try to avoid peak hours, make sure that children wear masks that fits securely over their mouth, nose and chin, get in and out of the store quickly, and wash or sanitize their hands afterward.
The caution is not without additional labor. Robinson said her family had already booked a hotel for a trip later this summer, and she plans to call the hotel chain to learn if they will continue requiring masks for all guests.
Parents can also use their county’s vaccination rate as a way to approximate what the level of vaccination is in their community. Those living in locations with high vaccine enthusiasm might feel safer in public than those living where vaccine uptake has been slower.
“I’m honestly not sure what effect these changes will have on my behavior. It’s all so new, so I’ll kind of be seeing how people react in the coming days,” Robinson said.
“I live in a highly vaccinated area … but if I see a bunch of other people in an indoor setting without masks, I’ll still probably try to avoid that establishment and go somewhere else for now.”
Calculating risks for summer activities
While the change in restrictions complicated an already challenging situation for many parents, most were already making decisions about summer plans.
Many summer camps that were canceled last year will open back up this year, and the CDC is still advising children to wear masks in most situations.
“If you are thinking about a sleep-away camp, ask the camp about their plans for COVID mitigation,” Kalu said. “If they’re sharing logical plans with you, I think that may be a safe option for children to participate in.”
Ann Smith, the mother of twin 11-year-old boys, said she will be sending them to a sleep-away summer camp where the majority of staff will be vaccinated, all campers must submit a negative COVID test within 72 of the camp beginning, and when they are indoors, they will be kept in pods to limit any potential spread.
Smith said she was a little nervous about the possibility of her sons being infected, but knowing all of the adults in their immediate and extended family were already vaccinated made her less anxious.
Brewer, of Carrboro, said that she was only enrolling her son in outdoor camps this year out of an abundance of caution.
“I’m just not willing to take too much risk this year,” Brewer said. “We don’t want to loosen up on the indoor stuff until he gets his vaccine.”
While parents may want to avoid indoor activities in public, Kalu said people might begin to feel more comfortable indoors as long as it is with people who they know are vaccinated.
For example, a small indoor event where all the adults are vaccinated and the children are unvaccinated likely posed a similar risk to an outdoor event with a poorly vaccinated crowd, she said.
“Of course, it all depends on how you calculate it and if you know for sure everyone is vaccinated,” Kalu said. “People should get used to being upfront about their vaccination status so that communities can build trust and safely have small indoor gatherings or outdoor events this summer.”
Alexander, of Chapel Hill, allowed her children to play maskless outdoors and visit individual friends indoors without masks as long as she knew that the adults were vaccinated.
“We haven’t yet done indoor dining or ditched the masks in public, but as long as we know who they are with, we felt safe enough to open that option for them so they didn’t feel excluded from their friends” Alexander said.
Kalu said she saw summer camps and small indoor maskless interactions like these as relatively low risk, especially because of the social and developmental benefits they provide for children.
“We have to prioritize our kids this summer and going forward,” Kalu said. “I think they’ve sort of fallen by the wayside with all of the other issues around COVID, but as we’re all returning slowly, we need to prioritize the return of our kids.”