Don’t let children under 12 slip through the cracks in the fight against Covid

“Vaxxed and waxed” may be the TikTok sensation of the moment, a rallying cry for plenty of Americans who — thinking the pandemic is at an end — are emerging from their homes and aiming to enjoy a carefree summer. But many families with children younger than 12 — ours included — continue to worry about wearing masks and social distancing, especially as the Delta variant continues to surge, increasing Covid-19 cases across the country.

Pandemic-related guidelines and protections have to evolve. It isn’t flip-flopping, as some charge. It’s what must happen as the pandemic changes and knowledge about it grows. One example has been wearing masks: As the evidence base has evolved, so too have guidelines from the Centers for Disease Control and Prevention. Initial guidance refrained from recommending mask use by the public to preserve supplies for health workers. Subsequent iterations recommended, and then dropped, the indoor mask mandate.

With these changes, the public messaging about caution seemed to get lost, with evidence from beach resorts of adult partygoers tossing aside caution and returning to their newest normal. Now that it is clear that the virus is airborne, and that masks protect the wearers and those around them from the highly transmissible Delta variant, the CDC has returned to recommending indoor mask wearing for all — even vaccinated individuals — in areas of substantial or high virus transmission.

In the latest evolution, new guidance from the CDC recommends that all children attending K-12 schools wear masks — even those who are vaccinated. This shift was aimed at protecting children under 12, who cannot yet be vaccinated.

As public health professionals and parents of children under 12 ourselves, we welcome this change, which recognizes that guidelines need to take into account the situation of people who are not protected by vaccination. Policies must continue to ensure the safety of vulnerable people in our communities. It is not just a moral imperative: If we fail to protect all individuals in our communities, efforts to control the pandemic will always fall short.

According to the U.S. Census Bureau, approximately 19% of households in the United States include at least one child aged under 12 years old — almost 1 out of every 5 households. These children represent a group that is not yet eligible for vaccination and thus face an elevated risk of contracting Covid-19, especially given the highly contagious Delta variant.

While it remains true that most children have avoided the worst consequences of Covid-19 disease, a significant and unpredictable minority have experienced serious complications. Further, the risk of long-term effects of Covid-19 among children remains unknown. Children can spread the virus to each other and to the adults in their lives, regardless of whether they have symptoms, and they can also contribute to the ongoing mutation of the virus. This is increasingly apparent with the rise of the Delta variant, and 20% of all new Covid-19 cases reported in the week ending July 29 were among children.

Unfortunately, many of the recent public health messages and strategies to address the Covid-19 pandemic seem to overlook children under 12, who do not yet have a choice to be vaccinated and who rely on the vaccinated adults around them to shield them from exposure to SARS-CoV-2. Instructions for isolation following a positive test for Covid-19 are exclusively addressed to adults and have been entirely impossible and unrealistic to implement for young children or infants, who often require care and supervision and can’t prepare their own food, leading to potential exposure in the household and additional quarantine strictures for the rest of the household. Guidelines for the use of communal spaces like recreational facilities and places of worship routinely fail to address the particular circumstances of families with young children.

We believe that a return to pre-pandemic behaviors has come too early and disregarded the many families seeking to protect their children from Covid-19. In the United States, many state and local governments look at the balance between health and economics and prioritize broad reopenings, sometimes even with schools prohibited from implementing mask mandates.

In our dual roles as public health professionals and parents of young children, we have felt these tensions — and if we have trouble navigating the current environment, it must be even harder for those without direct public health experience. We have found it challenging to determine what the guidelines and policies mean for our families: Should we go to a local barbecue? A movie? Summer camp? We struggle to maintain our children’s safety amid a wider population largely unaware of and unsympathetic to these concerns because they think the pandemic is over.

In many parts of the country, parents are grappling with the prospect of in-person schooling in the fall, where mitigation strategies like universal masking and improved ventilation are minimal or nonexistent. The new guidelines will be helpful, but vaccinated parents continue to face questions and even hostility when we wear masks alongside our children out of solidarity and integrity — and to protect them, given the predominance of the Delta variant in the U.S.

We teach our children the values of kindness and caring for vulnerable people by wearing masks for their protection. We provide reassurance that we are doing our best to keep them safe, even as they watch people all around them doing things they are forbidden to do. We’re making furious calculations about playdates and playgrounds and pools and camps and babysitters and birthdays and even school modalities this fall, entirely in the absence of societal support, community norms, or clear guidelines.

It has never been clearer to us that families with young children are an overlooked group in the U.S. As if the continuing absence of maternity leave and early childhood care and the underfunded education sector were not evidence enough, the ongoing evolution of the coronavirus pandemic and the strategies to stop it — including a lack of commitment to reopen schools safely — adds to our chagrin.

As the country moves forward, it is crucial that schools and communities learn from the past year about how to open schools safely for in-person learning by focusing on achieving high rates of vaccinations and low rates of SARS-CoV-2 transmission in the community, improving ventilation, mandating mask-wearing, and regular rapid testing. At the same time, messaging and policies more broadly need to take into consideration the needs of children and their families while many are still not eligible for vaccination, especially with the start of the new school year right around the corner.

The new CDC guidelines are a good first step. It is in all of our best interests to protect those in the community who remain vulnerable.

Katie D. Schenk is an epidemiologist in the U.S. Medical Reserve Corps, teaches global health at American University in Washington D.C., and served as a senior epidemiologist in the CDC Foundation’s Covid-19 Corps at DC Health. Elizabeth A. Stuart is professor of mental health, biostatistics, and health policy and management at Johns Hopkins Bloomberg School of Public Health.