Questions and answers regarding your children and COVID-19

December 24, 2020 (Hi reader. Once again, an issue of KidsTravelDoc is devoted to COVID-19’s effect on children, rather than our usual subject, keeping kids healthy and safe for travel and related outdoor activities. Family travel has been pummeled by concerns over the pandemic. Hopefully, soon we will return to discussing, “Is air travel safe for infants?” “Is outdoor cold ever too cold for young children?” and “How to protect your kids from the sun – and from certain sunscreens?”)

1. Does vaccinating parents against COVID-19 protect their children? Most children who do acquire COVID-19 do so from adults. And children are generally not the individuals who bring the virus into households; adults do. Moreover, to date, few outbreaks have been reported in schools, suggesting that spread within school settings to adults from children may be limited.

2. Should reports of reactions to COVID-19 vaccinations cause adults to hesitate being immunized? To date, the vast majority of recipients reported either no reactions or mild ones such as fatigue, headaches and muscle pain. Reactions occur after most vaccinations, likely indicating that the immune system is being activated. There has been a scattering of allergic reactions after the vaccine. In most cases, such reactions occurred in individuals with known allergic histories. The recipients were carrying appropriate medications for such events, used their medications and did well. In a handful of more serious reactions, recipients were kept under medical surveillance for a few hours, or in several cases, overnight, and recovered completely. Probably, by now more than a million doses of the vaccine has been administered.

3. Is the large increase in the number of children infected with COVID-19 worrisome? This number – now well over a million children in the US – merely reflects that the virus continues to spread and that the number of children being tested is increasing. There has been no increase in the percentage of infected children requiring hospitalization or dying. Children overwhelmingly have mild cases. The rate of hospitalization among children is 8 per 100,000 population, as compared with that in adults: 164 per 100,000 population. Deaths or serious complications are extremely rare, occurring almost exclusively in children with preexisting, serious health issues.

4. Should you allow your children to be tested for the virus? Testing helps answer questions such as should children have playdates (see below) and how common are asymptomatic cases. However, testing is not beneficial in all situations. Testing children in school settings failed to identify nearly half (45%) of all children infected with the virus.

5. Are playdates safe for children? The fewer individuals children come in contact with and the shorter those interactions are, the lower their risk of contracting COVID-19. However, completely isolating toddlers and kindergartners for long periods may also cause issues and is not generally recommended. While eliminating all risk is not achievable, risks can be greatly reduced by the following: well-ventilated indoor areas, windows open, air conditioning and fans going, children with no visible signs of illness, the same children for each playdate, responsible parents, mask wearing, no hugging, and no immunosuppressed people in children’s households. Daycare and nursery school attendance is more problematic. For more information, see https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html#General

6. When will there be a vaccine for children? Hopefully, vaccinating large numbers of children will occur by late summer/fall 2021. However, delays are possible. Large-scale trials of vaccines in children are still in the early stages and will take many months, and possibly longer. Several additional COVID-19 vaccines still being studied, but being counted on to fulfill expected needs, are experiencing delays in development. And children, because of their relatively mild COVID-19 illnesses, have low priority to be vaccinated.

7. Is it necessary for children to be vaccinated in order to eliminate COVID-19? A large percentage of the population, perhaps 75%, must be vaccinated to interrupt a pandemic. Many families are expected to refuse vaccination, especially at first. Moreover, even in the midst of the COVID-19 pandemic, only half of adults say they will “probably” or “definitely’’ get the vaccine. Less than half of adults have gotten previous recommended vaccines. The number of adult cases of vaccine-preventable diseases drops significantly only when the vaccine is included in pediatric vaccination programs. Children are a “captive audience.” Vaccination is generally required for school attendance.

8. Should children wear masks even though they are not considered important spreaders? Children two years of age and older should wear masks as do adults – and wear them correctly, covering both mouth and nose. However, the use of masks may be challenging for some children, especially children with cognitive, intellectual, developmental, sensory and behavioral disorders. Most organizations that deal with such disorders have suggestions for mask wearing on their websites. These suggestions may also be helpful for children without these issues.

9. Is it true that the virus rarely spreads by touching virus-contaminated objects? Articles to that effect are appearing in the media. Likely they are true, but research is lacking. Distances that COVID-19 travels through the air depends on the force with which an infected individual coughs (young children cough less forcefully than adults), air currents, humidity and temperature, and other factors. Survival of the virus depends on the surface on which the virus lands (metal or cloth, for example). Children should continue to wash their hands often and thoroughly. They constantly touch objects and then place their fingers in their mouth, nose, and eyes.

10. Why is it especially important this year to vaccinate children against the flu? The incidence of flu is surprisingly low, likely because protective measures against COVID-19 also protect against the flu. However, surveillance for flu shows that the flu virus is present in most communities. Many children remain unvaccinated and are vulnerable. (Some parents avoid pediatric offices fearing their children will become infected with the COVID-19). In fact, for children, the flu may be the more serious of the two diseases and children are better “spreaders” of the flu virus than they are of COVID-19.

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