The pandemic is most frustrating when it pivots. After a variant spawns or a COVID protocol changes, it can breed fresh questions about how to behave in public.
This summer is no exception. The speedy rollout of COVID-19 vaccines helped squash the pandemic over the winter and spring, driving cases and hospitalizations to their lowest levels yet. School is out, and families are already hitting the road for vacation or dropping their kids off at camp.
According to the latest Siena College poll, most New York adults think the pandemic has turned the corner and are ready to resume gatherings. But because COVID-19 vaccines remain unavailable for anyone under 12, many parents are in the awkward position of feeling protected against the virus while their kids are not.
“Probably for the first time since COVID started, the risk profile has changed if you're an adult who's vaccinated versus a kid who's unvaccinated," said Dr. Philip Zachariah, a pediatrician at Columbia University and a hospital epidemiologist at New York-Presbyterian. “It's the first time that the adult is less likely to get infected versus the child.”
To be clear, the delta variant has not canceled summer. The overwhelming majority of children will be fine—even if they catch the coronavirus. But that still leaves room for a few thousand tri-state kids to be hospitalized because of the germ this year. New York City alone has recorded more than 1,700 pediatric hospitalizations since the pandemic began.
“I don't think it means that kids should be on lockdown,” said Dr. Denis Nash, professor of epidemiology at the CUNY Graduate School of Public Health. “But there really are a lot of valid considerations right now for families with kids that want to try to protect them from getting COVID until a vaccine is available to them, to protect them as much as possible.”
Both Zachariah and Nash say the COVID-19 vaccines offer a chance to safely revitalize the social lives and well-being of children who’ve been cooped up for a year. They described the scenario with the delta variant as a balancing act—one that requires weighing the individual risks associated with social activities or vacation trips.
So, here’s an evidence-laden parenting guide for navigating the summer of delta.
What has been very clear since COVID-19 emerged is that the risk of severe outcomes is much lower in children compared to adults. Minors make up about one in 10 U.S. cases—but only one of every 1,000 deaths. That storyline appears to be the same so far with the delta variant, based on data from the U.K. The problem is that delta spreads about twice as fast as the original virus.
During Britain’s second wave last winter, the case rate for 10- to 19-year-olds peaked at 300 infections per 100,000 kids. That was the worst it got. With the delta outbreak, the case rate for these adolescents is already double that last peak—at 600 infections per 100,000. British kids ages 5 to 9 have surpassed their second-wave summit, too. These trends could be because schools are open in the U.K., given that educational settings are now where most British outbreaks are happening.
But merely increasing the number of infections elevates the chances for severe outcomes for all unvaccinated people, including children. For example, last week, Public Health England reported 1.22 COVID hospitalizations per 100,000 infants. That’s still much smaller than the rate for senior citizens, but it’s actually a sixfold increase relative to where these kids were during the country’s low point three months ago. Children ages 5 to 14 experienced a similar fivefold jump. And keep in mind that hospitalizations tend to lag behind cases by several weeks.
Back stateside, about two of every 100 infected kids were hospitalized prior to delta’s recently established dominance. The danger profile was worse for older minors. A recent study from the Centers for Disease Control and Prevention shows that COVID hospitalization rates among adolescents this winter were about three times higher than that of seasonal influenza.
As of last week, New York City hadn’t recorded a major uptick in pediatric cases, according to New York City Health Commissioner Dr. Dave Chokshi.
“The rate of children being hospitalized is significantly lower than for adults, and it remains older adults who are at greatest risk of hospitalization,” Chokshi said during a press briefing on July 8th. “But what I will say is that for some children, we do now have the ability to confer even more protection because, of course, hospitalization is not the only outcome that we are most concerned about. We're also concerned about the longer-term effects from COVID-19.”
Chokshi urged parents to seriously consider getting their adolescents vaccinated, but would that be enough?
Zachariah from Columbia University said these days, most vaccinated parents are asking him about whether it is safe to travel and whether it is ok to bring kids to social activities where other adults might be unvaccinated.
The nation’s biggest hotspots right now—mainly in the Midwest and South—correlate with the lowest vaccination rates. On Tuesday, the Associated Press reported that summer camps in some of those locations are witnessing COVID-19 outbreaks.
For these reasons, Zachariah said that parents should remember two things when planning social activities this summer. The first is the likelihood of your child being around an unvaccinated adult.
“Do they expect all the adults in the camp counselors and staff to be vaccinated?” Zachariah said, citing school-based studies showing that coronavirus outbreaks tend to originate with adults. COVID-19 vaccines are already breaking this adult-to-child transmission. The nation is tantalizingly close to pushing pediatric cases to zero—even without vaccines being available for kids under 12.
When asked what level of COVID-19 vaccine coverage he’d want to see among camp staff or summer school employees to feel secure, Zachariah said greater than 80 to 90%. WNYC/Gothamist reached out to the New York City Department of Education for the latest rates among staff, but 50% of the workforce had been vaccinated with at least one dose as of May 10th.
For his second tip, Zachariah recommended that parents get a sense of whether people are likely to follow mask guidance wherever they’re heading. Federal rules require mask-wearing on planes, trains, buses, so the bigger concern revolves around the final destination. That’s especially true for places where vaccine rates are low or community transmission is high.
“I would say that if it's a very communal setting and there's a lot of mixing—particularly with teenagers—then having universal masking is probably good,” Zachariah said. “Because you're not going to be able to police who's unvaccinated.”
Cases are also creeping upward in regions where COVID-19 shots have been more popular, such as New York City and the tri-state. Even Manhattan—the borough with the greatest proportion of dose takers—has recorded a recent uptick in the growth of outbreaks.
So far, the COVID-19 vaccines remain strong protectors against delta, especially when it comes to warding off severe disease and hospitalization for most people. Yet compared to its predecessors, this variant is causing more breakthrough infections among vaccinated people that generate symptoms, including milder ones.
The reason is a mystery. The delta variant does appear to weaken our antibody defenses slightly, but recent data for the Pfizer, Moderna and Johnson & Johnson vaccines show this reduction is less intense compared to other versions of the coronavirus. If more symptomatic breakthroughs are happening with variants such as delta, then it implies that antibodies significantly contribute toward protection from disease, said Dr. Paul Bieniasz, a virologist and a professor at The Rockefeller University in New York City.
“Variants that evade antibodies are therefore likely to cause a greater number of serious infections in vaccine recipients than variants that don’t evade antibodies,” Bieniasz said via email. “That doesn’t mean that serious disease caused by variants will be frequent in vaccine recipients, but it does mean that serious disease may not be absent from vaccine recipients.”
Some researchers posit that T cells—the wardens of our immune systems—could be compensating for the shortcomings of antibodies, but more study is needed to make a verdict.
“While it’s true that the variants don't yet evade T-cell responses, it is something of a leap from that fact to the conclusion that T cells are entirely responsible for residual vaccine protection against variants,” Bieniasz said.
The other reason could be the reopening. “We're now in a situation where people are mixing a lot more,” said Nash from CUNY, which means more opportunities for breakthrough infections. As one astute virologist said on Twitter this week, vaccines work like raincoats. They can keep you dry most of the time, but if you keep “going in and out of rainstorms all the time, you could end up getting wet.”
Regardless, those extra coughs, sneezes, and COVID-filled breaths could mean that vaccinated folks are spreading the virus more often than previously thought. This situation doesn’t really change the calculus on health advice. Anyone who experiences COVID symptoms is still recommended to seek testing and isolate if positive, whether or not they’re vaccinated.
“There are other infections that are circulating right now,” said Nash from CUNY, citing the recent uptick in cold cases. “People are having cold-like symptoms, and it's not necessarily COVID. But if you have symptoms like shortness of breath and or loss of taste or smell, then I think these are reasons to seek a COVID test cause that might be what it is.”
These breakthrough infections don’t mean that vaccinated parents need to abandon their return to normalcy. Health experts simply recommend that concerned parents avoid crowded, indoor settings in areas with a lot of unvaccinated people.
“If you're vaccinated, the odds that you're going to get sick or be in the hospital, even if you go to an area with unvaccinated people, are still very low,” Zachariah said. “But if you're thinking about the variant, you have unvaccinated people at home, and you are worried about that rare chance of breakthrough infection, then minimize the highest risk activities in areas where vaccination rates are low.”