The delta variant and kids: Parents’ questions answered

For a brief moment, it felt like we parents had made it. School was wrapping up. People, including our kids 12 and older, were getting vaccinated. Mask mandates were easing.

But now we’re facing the delta variant — a highly contagious strain of the coronavirus. States with large outbreaks are seeing rising case numbers among children as well as adults. As it reaches into our communities, how does this strain affect children, and how can we help them safely navigate their days?

We spoke with infectious-disease specialists about how to handle this widespread variant. Here are their answers to our questions.

An internal CDC document obtained by The Washington Post July 29 said it is “likely” that the delta variant causes more severe illness than previous variants. That has not been conclusively established, however, and some infectious disease experts have said they do not see persuasive evidence of a difference.

One thing is clear: “It is certainly more transmissible,” said Sean O’Leary, vice chair of the Committee on Infectious Diseases for the American Academy of Pediatrics. For comparison, the alpha variant, which was the most predominant in the United States before this one, was estimated to be 50 percent more transmissible than the original coronavirus.

The delta variant is 50 to 60 percent more transmissible than the alpha variant. “We’re in this situation where things are opening up while this is more predominant,” O’Leary said. “There are a lot of reasons for concern for all of us in general. Cases have jumped for kids specifically.”

The virus’s ability to spread quickly is especially worrisome because only 30 percent of the children who are eligible are vaccinated, according to the CDC. “That’s pitiful,” said Jennifer Lighter, pediatric infectious-disease specialist at New York University Langone Health. Covid-19 and the flu in children have “the same kind of morbidity,” she said, but added, “If it’s preventable, I don’t want any child getting it.”

“The most important thing that we can do is everyone who is eligible to be vaccinated, be vaccinated,” O’Leary said. “That is the best way we can protect society and children, including younger children.”

In addition, we must use the same measures we have all along to protect vaccinated and unvaccinated children, he said: “Be thoughtful about what you’re doing, where you’re going, and outdoors is safer than in. In larger crowds, wear a mask. And that applies to kids down to 2.”

The vaccine is effective in preventing severe disease among recipients, which is a vaccine’s job, said Allison Bartlett, a pediatric infectious-disease specialist with University of Chicago Medicine. “But it doesn’t protect them from getting infected at all,” she said. The best way to avoid the delta variant is just what we’ve been told so far. “Kids playing outdoors together at a playground is reasonable without masks now, even if they’re not vaccinated,” she said. “But when crowds get bigger or move indoors, masking by everyone is important to keep kids safe.”

Families need to try to “maintain some sense of sanity and recognize the importance of human contact while trying to be safe,” O’Leary said. For fully vaccinated grandparents, the risk of infection is “very, very low,” he said, adding, “Personally, my kids are both vaccinated, but if they weren’t, I wouldn’t hesitate to have them around their fully vaccinated grandparents.”

Lighter, whose parents are very much involved in her children’s lives, said she just follows the safety rules she normally would, pre-coronavirus: “Kid has a sniffle? We’re not seeing my parents.”

That said, “the most important thing a parent can do to protect their children is convince their parents to get vaccinated,” Lighter said.

During this phase of the pandemic, O’Leary said, approach the idea of taking unvaccinated children to indoor public places the same way you do during flu season. “In general, for a kid under 12, the risk for them is not the same as influenza, but it’s in the ballpark,” he said. “So the same decisions you’d make during flu season, this is similar.”

Making decisions about visiting indoor public spaces can be done on a case-by-case basis, Bartlett said. “If kids don’t need to be out and about, then we can spare them the exposure,” she said. “But if you and your child are masked and in a store that isn’t super crowded, it’s a reasonably safe thing to do, if a place is encouraging masking among others.”

What you do also depends on where you live and how viral the spread is in that community. If there is a lot of spread, take more precautions.

Finally, if you or your children are in contact with someone who is immunocompromised, you need to take extra precautions.

Vaccinated parents who are infected will have some amount of virus that they can spread, Bartlett said, but “it’s less than if not vaccinated.” Also, a “breakthrough infection” among vaccinated people is still very rare, Lighter added.

“This speaks to the importance of protecting the vulnerable,” Bartlett says. “Nothing we do is risk free. But having our daycares continue to do what they’re doing — teachers masking, have children 2 and up masking, and not mixing teachers and classrooms — are all things we still need to be doing to keep everyone safe.”

She encourages families, friends and childcare providers to do as much outdoors as possible with the little ones. The risk with delta, she says, is that even a vaccinated person who is feeling okay “could potentially spread and infect someone not vaccinated, and that absolutely includes 6-month-olds in a childcare setting. So I think that vaccinating and masking in schools and childcare settings is the way to go right now.”

Bartlett hopes that parents in areas where masks aren’t mandated will make it clear to children that it’s important to mask up when indoors. The kids are protecting themselves, but even more, they are protecting others if, in fact, a kid has the virus and doesn’t know it.

She also hopes that adults interacting with children wear masks as well. “We want those around them to wear their masks to protect our child,” she said.

“It makes sense to have layered mitigation measures but to have kids in school,” O’Leary said. “We absolutely want kids in school.”

The benefits of in-person school, she and other experts say, outweighs the risks of getting the virus. But schools must keep safety measures in place. “Kids are just missing too much school, and that needs to shift now,” Lighter said. “Not being in school caused a lot of unnecessary harm.”

For the vast majority of kids, Bartlett said, “there was less engagement in learning, less social emotional development, no physical therapy, occupational therapy … meals. And having friends and support systems. All those nonacademic components are essential and outweigh the risk of a covid infection if we’re doing everything to minimize the risk.”

The CDC and the American Academy of Pediatrics have advised that everyone in schools wear masks, particularly because “you can’t verify who is vaccinated and who isn’t,” Lighter pointed out. If everyone is wearing masks, the chance for spreading the virus is much lower.

Although many jurisdictions based their policies on CDC guidance, the CDC is not a regulatory agency and does not have authority to impose policies or enforce its guidance.

“I’m very concerned about schools that are not mandating mask use,” Bartlett said. “I don’t have great solutions at the moment other than [pointing out that] clearly the AAP is very strong in our opinion about wearing masks all the time in schools where not everyone is vaccinated.”

The specialists we spoke to were frustrated about the messaging around masks — from some adults. If a school doesn’t mandate masks, families should make sure their children are wearing them indoors, they said.

“Kids do fine with masks. … They understand the rationale behind it,” Bartlett said. “They’re vulnerable and want to get back to hanging out with friends. Masking will allow them to do that.”