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Based on information gathered from Emily Oster’s recent article in The Atlantic, can I consider it safe for children to travel and have unmasked/indoor playdates, especially looking ahead to summer?

Families Staying Safe Vaccines

A: No. Dr. Oster’s article did not suggest that it’s safe for children to have unmasked playdates and return to 100% normal life this summer.

As science journalist Tara Haelle put it, “it’s fine for your unvaccinated kids to go on a road trip and hug their vaccinated grandmas. It’s just not okay to pretend your unvaccinated kids *are* vaccinated grandmas.”

Dr. Oster’s piece in The Atlantic drew a comparison between the risk *of hospitalization* for an unvaccinated child and a vaccinated older adult. These rates are about the same.

Dr. Oster has also argued many times that we should consider “competing risks” as we navigate the pandemic—risks like missed education and socialization opportunities. And yes, these are important to consider! We need to strike a balance of the risks when it comes to kids. Keeping kids in the house until a kids’ vaccine becomes available is also fraught, and no one is suggesting that.

With nearly two million vaccinations administered daily, the US is on track to vaccinate every adult who wants to be vaccinated by the end of May. Hooray for this progress!! Alas, this will not be enough to get us to herd immunity by summer in the States; and most other countries are far behind the US in terms of vaccine rollout. So we do not expect that our kids will be protected by herd immunity by summer.

In order to reach herd immunity–when COVID-19 transmission is so rare that cases will decline even without behavioral changes (like wearing masks)–we need to get at least 70% of the whole population vaccinated. 22% of the US population is too young to be vaccinated, and right now around 22% of adults say they won’t get the vaccine. Even if some of those adults with reservations change their mind, herd immunity by summer is not gonna happen. Don’t get us wrong–things will start improving. But it is not going to feel like flipping a switch some day in May.

When we mix in unequal access to vaccines, racial and social disparities in health risks, travel to places with much lower vaccination levels, variation in state policies about wearing masks, some states abandoning all preventive measures with just 10 or 15% of the population vaccinated, and unknowns about new variants… it’s just too soon to tell what summer might look like.

Your best practice is to follow the advice of your local heath department and the places where you plan to travel. They are the agencies keeping track of infection in the specific respective areas.

Another important point is that the risk that a kid might *be infected* is not at all like that of someone who has been vaccinated; and a kid who is infected can transmit COVID-19 to other unvaccinated people. So even though Dr. Oster is right that your otherwise low-risk kid is very unlikely to have a serious case of COVID-19 and end up in the hospital, that does NOT mean the guidance for fully vaccinated people can be applied to kids. Kids do still need to wear masks and follow the rest of the SMART guidance. Dr. Oster did not suggest dropping all precautions for children in her article.

Children are less often severely affected by COVID-19, but are not naturally immune to infection. And even a small risk can turn into a big number when we apply it to millions and millions of people. There have been more than 3.3 million confirmed COVID-19 cases so far among the 74.2 million children in the United States, with around 33,000 of them requiring hospitalization. Much is still unknown about COVID in kids, including outcomes from mild or moderate illness, long COVID, and causes of the very rare MIS-C. A little over 200* children have died of COVID-19 in the United States since March of 2020. As a point of reference, during the 2017-18 flu season (one of the worst in recent memory), 188 children in the United States died from influenza. Just 211 children were hospitalized with influenza in the 2017-18 season.

Dr. Oster drew a comparison between risk of hospitalization for vaccinated older adults and unvaccinated kids. This is just one of the many risks to consider. And, it was an analogy. Oster did NOT mean that your child is basically already vaccinated. When pediatric vaccines become available, it will be really important for kids to get them. In the meantime, kids should #StaySMART

↔️ Space: Keep your distance from other people.
😷 Masks: Keep your nose + mouth covered.
💨 Air: Keep it fresh.
🔄 Restrict: Keep your circle small.
⏲️ Time: Keep your interactions brief.

The infectious disease epidemiology community on Twitter got apoplectic about Oster’s article for these reasons, and Oster clarified these points in an apology she offered on her blog.

Tara Haelle, science journalist, offered a very good summary of what #epitwitter had to say, as well as practical advice for planning that summer vacation. Which–yes! You can take!! With some cautions.

The TL;DR: “It’s fine for your unvaccinated kids to go on a road trip and hug their vaccinated grandmas. It’s just not okay to pretend your unvaccinated kids are vaccinated grandmas.”

Other references included below:

American Academy of Pediatrics

Kaiser Family Foundation

CNN

* note this figure was updated at 2:04 pm 2021-03-24 to the CDC official count rather than AAP’s estimated death rate.

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