More than a year into the pandemic, many families who have been stuck at home are itching to go on a vacation. But don’t pack your bags quite yet, experts say.
While more adults are getting vaccinated against the coronavirus every day, children, particularly younger ones, are not expected to get the vaccine for months.
In the meantime, once all the adults in your family have been vaccinated, does that mean it’s now safe to take that long-delayed trip?
The Centers for Disease Control and Prevention is still recommending against nonessential travel, even for those who have been fully vaccinated. But as Covid-19 rates go down, that guidance could change.
NBC News spoke with seven pediatric health experts about the risks of going on a family vacation before children have been vaccinated. The consensus among them was that by summer or fall, safe family getaways could be possible, provided Covid-19 cases are low.
“One of the biggest determinants of how safe things are is how much virus is circulating,” said Dr. Andrew Pavia, chief of the pediatric infectious diseases division at the University of Utah Health. “Once the level of transmission goes down dramatically in your community and in the place you’re traveling to, everything becomes safer.”
The overall risk of the coronavirus to healthy children has been mercifully low. Children are generally more likely to have mild casesof Covid-19 than adults. Young children also appear to be less likely to spread the virus than adults.
But they are still capable of transmitting Covid-19 to other people, and though rare, there have been severe and fatal cases in children.
“Children aren’t risk-free,” said Dr. Kelly Fradin, a pediatrician in New York City who is the author of “Parenting in a Pandemic: How to Help Your Family Through Covid-19.” “We want to balance, realistically, that they are low-risk but not absolutely no risk.”
That doesn’t mean all travel has to be forbidden, said Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics’ Committee on Infectious Diseases and a professor of pediatrics at the University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado.
“It’s really a personal decision, and depends on lots of different factors. Does the child have underlying health issues that may put them at higher risk?” he said, referring to conditions such as diabetes, obesity, cystic fibrosis and asthma.
It’s important to consider other people’s health as well, he added. “Does the parent have a high-risk condition? Will they be coming home to a household where there’s a frail, elderly person?”
Your form of transportation and how much exposure that could bring is something to consider, said Dr. Ibukun Akinboyo, an assistant professor in the division of pediatric infectious diseases at Duke University Hospital. Driving your own car is the best option, she said, and she advised travelers to research whether there will be ways to avoid crowds once they get to their destination.
She said she advises her patients’ families to ask themselves: “Can you maintain a bubble as you go through that trip?”
The safest kind of vacation is one that is mostly outdoors and where it is reasonable to expect that everyone will be practicing social distancing and wearing masks, said Dr. Buddy Creech, director of the Vanderbilt Vaccine Research Program.
“If I had a patient say, ‘We’re going to the beach,’ I wouldn’t be frustrated by that, provided they take the necessary precautions when they’re outside of their family unit,” he said, adding that masks should still be worn in public by everyone in the family who is 2 and older, even if the state you are traveling to no longer mandates masks.
Creech said he would be a little more hesitant if families wanted to travel to other outdoor attractions, such as water parks. Water itself does not seem to pose an inherent risk of transmitting the virus, but standing in long lines for the rides might.
Cruises, on the other hand, are a definite no.
“Any activity outdoors and spaced out is lower-risk than indoor, clustered, shared equipment-type of activities, and I think that would directly apply to something like a cruise,” Akinboyo said.
Experts urge everyone, vaccinated or not, to still wear masks in public. While the vaccines have been shown to drastically reduce the risk of hospitalization and death after catching Covid-19, vaccinated individuals can still get less severe cases.
And while there is encouraging evidence that the vaccines may protect against infection and transmission, data is still being collected on whether the vaccinated are capable of spreading the virus to the unvaccinated.
“Just because you’re protected doesn’t necessarily mean you can’t become a carrier,” said Dr. Frank Esper, a pediatric infectious diseases specialist at Cleveland Clinic Children's whose research focuses on viral respiratory infections and newly recognized infectious diseases.
Despite the unanswered questions, early indicators of the vaccines’ effectiveness are so promising that in guidance this month, the CDC specifically allowed for indoor, mask-free reunions between fully vaccinated grandparents, unvaccinated grandchildren and their unvaccinated parents, provided no one who is unvaccinated is at risk for complications of Covid-19.
How to achieve such visits as safely as possible may depend on how far away grandparents live. If they are a plane ride away, it gets more complex.
“Depending on the length of the flight, depending on whether your kids are seated next to other people, whether masks are enforced, how you get to and from the airport, kids might be at higher risk” of catching the coronavirus, as would anyone else who has yet to be vaccinated, Pavia said.
While planes have air filtration systemsto protect passengers during flights, crowded airports could pose a risk, the experts said.
As for the flight itself, direct is best when possible; shorter flights are ideal; and when traveling with children, try to minimize the number of times they will need to take off their mask during the flight, which might mean not traveling during meal or snack times, O’Leary said. He also suggested double-masking or wearing face shields on top of masks on flights.
As long as hotels are successfully reducing congestion in common areas, such as lobbies, the experts did not feel strongly about staying in a hotel versus staying in a vacation rental home.
There is still a lot that is not yet known.
“We have yet to determine how long the protection will be offered by these vaccines, especially in the setting of variants,” Fradin said, adding that it is believed that the vaccines will offer protection for at least 8 to 9 months, but immunity could then wear off.
Widespread travel could unnecessarily spread a variant from one part of the country to another, complicating efforts to climb out from under the pandemic, she said.
The bottom line, the experts say, is to hold off as long as possible with making plans for an elaborate trip. While vaccines were quickly approved for adults, the process takes longer for children because studies need to be conducted to determine the exact dose to give.
In the meantime, traveling should be limited.
“Think about if that risk is really worth it to your family,” said Dr. Grace Lee, a pediatric infectious disease expert at Stanford Children’s Hospital. “If you can just hang tight for weeks to a couple of months, we’re going to be in a better situation. That risk will go down just by having the majority of the population vaccinated.”