Why parents should brace themselves for another uncertain summer and fall
Posted January 30, 2021 6:02 a.m. EST
CNN — I remember the talk among parents on my son's last day of in-person school since the pandemic began. Back in March, some of them didn't believe it might be three whole weeks until our kids could return to school here in Oakland, California.
Then there were those parents, sadists I was certain, whispering about how it might last until the end of the school year.
Nobody knew back then when schools would reopen, and here's a truth I don't want to admit -- nobody knows now.
Like so many parents, I am desperate for some clarity. I want to hope. I also want to plan.
Should we budget for extra child care again next year if there is no in-person school? Or should we find ways to cut back at work? Should we sign up for summer camps? Then, the hardest part, what do we say to our children when they look us in the eye and ask when-oh-when can they have birthday parties and soccer games and sleepovers and the incalculable other rites of passage they are being denied? How much longer do we have to say no?
Parents, caregivers, kids: We just don't know.
High case rates, new variants, teacher union negotiations, and elaborate and costly protocols for safe school reopenings all complicate a return to our kids' pre-pandemic life.
Experts agree that a widely available pediatric vaccine would simplify the process, but we don't know when we can expect it and whether it's necessary for a safe return.
The state of the research on kids
Now that Covid-19 vaccines are proven to be safe and effective in adults, drug companies have begun studying those same vaccines in children. Researchers are currently focused on teens and tweens with the intention of, over time, working their way to younger children as safety in older kids is proven in clinical trials.
"From an ethics standpoint, you don't want to start studying a medication with vulnerable populations like children and pregnant women until you have proven safety and efficacy in the adult population," explained Dr. Larry Kociolek, a pediatric infectious disease specialist and medical director of infection prevention and control at the Ann & Robert H. Lurie Children's Hospital of Chicago.
Children older than 16 were included in adult trials, and the Pfizer/BioNTech vaccine is now approved for ages 16 and older. (The Moderna vaccine is approved for adults ages 18 and older.) Their vaccinations are a matter of vaccine availability -- which is yet another point of uncertainty.
Children ages 12 to 17 are currently being studied, though the time lines as to when those results might come out remain unclear. Children under 12 have yet to be studied, but things are progressing quickly.
"No US studies that have opened go down into those age ranges, and the exact time line for starting studies on younger children is not available," said Dr. Evan Anderson, professor of pediatrics at Emory University and a physician at Children's Healthcare in Atlanta.
Older teens might get vaccinated for fall
If you have a 16-year-old at home, there is a decent chance they will get vaccinated in time for the new school year this fall, experts say. But it's increasingly doubtful whether the vaccination -- and the second follow-up shot -- will happen in time for summer camp.
Those 12 and up are next in line, and have a good chance of seeing a vaccine in time for next school year, which would make it more likely for them to return to school.
Have kids 12 and under? Don't count on a vaccine in time for the fall.
"It's possible that that age group will be eligible as early as late summer or early fall, but that may be optimistic. But even if they are, it will take several months or longer to broadly distribute the vaccine," Kociolek said.
Preschoolers will take even longer to get vaccinated, likely not until 2022. Nonetheless, many preschools have managed to safely stay open during the pandemic.
Anderson believes it's still possible to get a vaccine to elementary school kids in time for next school year, "but that window is rapidly closing."
Herd immunity and school reopenings
Fine. No holding our breath for vaccines for those 12 and under in time for next school year. But what impact does this have on this age group possibly going back to school next year?
There is increasing evidence that schools can be opened safely for everyone, if they have the ability to follow the recommended protocols. As we've all learned, that's a big "if," one that leaves us with, yes, more uncertainty.
Widespread vaccination and herd immunity would remove much of the risk, even if schools can't follow these protocols. Is vaccinating adults enough to achieve immunity and minimize risks? Or is it unsafe until kids are vaccinated as well?
On this, the experts are split.
A widely distributed pediatric vaccine should be a priority, Anderson believes.
"In order for us to completely move out of pandemic mode, we need to ensure that our children are able to, and do, receive a vaccine," he explained. "Otherwise you have a continuous reservoir of children who are susceptible to Covid-19. We are likely to see sustained transmission among young children and the virus leaping from this group to other unvaccinated populations or individuals."
He worries that children could give it to immunocompromised adults who might not respond to the vaccine. He also worries about children falling ill themselves; while Covid-19 is far less dangerous for kids, it is not risk-free. The number of children who died from Covid-19 this past year was akin to a particularly fatal flu season. "We vaccinate them for the flu," he said.
The US Centers for Disease Control and Prevention held a meeting of its Advisory Committee on Immunization Practices on January 27. Dr. Emily Erbelding, director of the division of microbiology and infectious diseases at the National Institute of Allergy and Infectious Diseases, noted that the "pediatric burden of disease is significant," that there is a "disproportionate burden among children in minority communities," and there will be a "continued burden if we wait for natural 'herd' effects."
Will vaccinated adults reduce children's risk?
Other experts want to emphasize that the likelihood of children getting Covid-19 will go down considerably when adults are vaccinated.
"In regards to Covid-19 in children, the highest risk of exposure for children is coming from those who care for them in their homes," Kociolek explained. "We know if we vaccinate parents against pertussis (whooping cough), for example, it can prevent it in infants. We call it cocooning, and it's a way to protect children by creating a web of immunity."
If you take into account all the people who have already contracted the coronavirus and combine that factor with those who are likely to get the vaccine in the next six months, it seems likely that we will achieve herd immunity without a pediatric vaccine, said Dr. Paul Offit, director of the Vaccine Education Center and professor of pediatrics in the division of infectious diseases at Children's Hospital of Philadelphia.
"You probably don't need to vaccinate children to stop the spread," he said.
For now, educators aren't sure. Some are already calling for the vaccination of teachers and students before they will return to work. Many others are waiting to follow the lead of scientists and public health officials.
Becky Pringle, president of the National Education Association, said it's possible that a safe reopening for all could involve a vaccine for kids, "but we don't have the science on that yet. I'm a science teacher, and so I know we have to listen to the professionals on that. We're not making any statement yet."
Living with uncertainty
"What I am telling you (in late January) may not be accurate very soon considering how fast this is moving," Kociolek said. That's a sentiment echoed by many of his medical colleagues. There are so many unknowns, so many variables, and they're all subject to change. Which leads us back to more uncertainty.
There is a certain relief in accepting the uncertainty and putting an end to speculating. It reminds us to make only plans that can easily be broken, and to avoid counting on anything that will break our kids' hearts should it have to be canceled.
It also pushes us to envision what another potentially 12 months of having elementary school kids at home looks like, and what, if anything, you might be able to do to make it work better for your family. This might include realizing the limits of DIY-ing our way through the pandemic and fighting for more structural support; a Marshall Plan for Moms, perhaps?
I hesitate to suggest that this is an opportunity to teach kids about uncertainty, as I am not sure our kids need any more lessons from this furshlugginer (Yiddish for "piece of junk") pandemic, as my firstborn now refers to it. At this point, the kids are probably all lessoned out.
Kids do appreciate honesty, though. Tell older kids that you don't know if they are going back to school this spring. If they are younger, tell them you don't know if they are going to camp or back to school next fall.
Tell them a lot of good, hard-working people are doing what they can to make this happen as soon as possible. Will they succeed? Eventually, yes. We just don't know when.