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Opinion It’s time for children to finally get back to normal life

Children ages 12 to 15 wait to get their vital signs checked before getting their Pfizer covid-19 vaccine at Families Together of Orange County in Tustin, Calif., on May 13. (Jae C. Hong/AP)
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This column has been updated.

Tracy Beth Høeg is a physician, an epidemiologist and an associate researcher at the University of California at Davis. Lucy McBride is a practicing internist in D.C. Allison Krug is an epidemiologist in Virginia Beach. Monica Gandhi, an infectious-disease physician, is a professor of medicine at the University of California at San Francisco.

As covid-19 cases continue to fall and vaccines demonstrate vigor against even the most concerning variants, it’s time to evaluate which pandemic restrictions are worth keeping in place. Here’s one simple recommendation: Children should return to their normal lives this summer and in the upcoming school year, without masks and regardless of their vaccination status.

Overall, the risk to children is too low to justify the remaining restrictions they face. Somewhere between 0.1 and 1.9 percent of covid-19 infections in children result in hospitalizations — and that’s likely an overestimate given that recent studies suggest approximately 40 percent of pediatric covid-19 admissions were misclassified. The risk of a child developing MIS-C, a serious inflammatory condition with effective treatments, is less than 1 in 1,000. The virus has claimed the lives of nearly 400 children in 17 months, lower than the estimated deaths among children in recent influenza seasons.

“Long covid” in children is also rarer than previously thought, with less than 2 percent of children experiencing any symptoms two months after infection. And multiple reassuring studies have found little evidence of the disease affecting children’s hearts.

This low risk for children nearly vanishes as cases plummet. As we saw in Israel and Britain, vaccinating adults indirectly protects children. The same trend is evident here in the United States: Adult vaccination has lowered covid-19 incidence among children by 50 percent in the past four weeks. On average, fewer than 0.01 percent of Americans are currently infected, and the chance of an asymptomatic person transmitting to a close contact is about 0.7 percent. That yields a scant 0.00007 percent chance that any close contact will transmit infection to a child. If the contact is outdoors, the risk appears to be more than 1,000 times lower.

Full coverage of the coronavirus pandemic

Given these numbers, the impetus for returning children to their normal lives is enormous. Start with in-person education: Recent data from more than 1.5 million students and staff at K-12 schools — before adult vaccination — found that lower classroom density was associated with higher rates of infection. Mask mandates were also not associated with student or teacher infection rates when controlled for spread within the community.

For those reasons, schools should lift mask requirements for children, especially outdoors. They should also do away with plexiglass barriers, face shields and deep cleaning, which were never supported by science. Instead, schools should rely on staff vaccination to protect adults and children. Vaccinated teachers, per guidance from the Centers for Disease Control and Prevention, do not need to mask in school, which can create barriers to learning, especially for younger children (although teachers at high risk who remain unvaccinated can choose to use a cloth or N95 mask).

Youth masking during sports, indoors or outdoors, has also not been found to impact disease spread. This might be because covid-19 spread related to sports is so low — with or without masks — that adding this layer of mitigation has had no detectable effect.

Similarly, closing off playgrounds, restricting use of athletic equipment and masking at recess are not backed by science. Research has found minimal spread at schools where children do not wear masks outdoors, even in communities with high rates of transmission. Contagion via athletic equipment has also proved exceptionally low. Plus, restrictions at recess discourage children from participating in lower-risk, but essential, playtime and exercise.

We make these recommendations assuming that young children are still not eligible for vaccination. The decision by families to vaccinate their children should not be from fears of academic or social repercussions. There have been rare reports of myocarditis following mRNA vaccination, mainly in young males, and the CDC will make additional recommendations regarding this rare event in coming weeks.

Returning school and recess to normal would be a sizable step in restoring good mental health in children. Pandemic restrictions appear to have caused a surge in mental health-related emergency room visits last year, including a 24 percent increase for children ages 5 to 11 and a 31 percent increase among teens ages 12 to 17. In fact, Children’s Hospital Colorado on Tuesday declared a pediatric mental health emergency, saying children had “run out of resilience” from covid-19-related stressors.

Even small steps toward normality can have a large impact on a child. One study found adolescent athletes who played a sport during the pandemic had less anxiety and depression than athletes who did not. The simple gesture of allowing a child to take off their mask might give them more sense of control and allow them to see that reassuring smile from a friend.

As we emerge from a difficult 14 months, let’s act to improve the well-being of our children. Simple metrics on deciding when children can be unmasked in schools indoors, such as covid-19 hospitalization rates of 3-5/100,000 and adult vaccination rates, should be applied in the U.S. as they were in the U.K. But no matter what metrics they choose, our children deserve to have their needs put first.

Read more:

Leana S. Wen: The pandemic isn’t over — especially for our children

Drew Altman: We aren’t getting a national vaccine ‘passport.’ So let’s use the next best thing: CDC vaccination cards.

Salman Rushdie: What’s irretrievable after a pandemic year

Kathleen Parker: We get to see faces again. Here’s why that is so important.