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We parents of unvaccinated children need more guidance

As mask mandates and other protections fall away — and the vaccines are delayed — we’re wondering what we should be doing to protect our children

Ilana Diener plays with her son, Hudson, 3, at home in Commack, N.Y., on Nov. 30 before an appointment for a Moderna coronavirus vaccine trial. (Emma H. Tobin/AP)
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We parents of young children who can’t be vaccinated feel abandoned at this late stage of the pandemic. Federal officials, it seems, have decided to leave it up to us to figure out how to navigate coronavirus risks for our children. This lack of information has bred distrust in parents while putting public health agencies in an unenviable Catch-22 as they prepare to — finally, hopefully — vaccinate children under 5.

Either the risks to this age group are minimal, which potentially weakens the imminent message to vaccinate children younger than 5 years old, or they are more substantial, and public officials have failed to adequately advise parents about how to protect children in the absence of a vaccine. It’s not too late for public health agencies to correct course and issue guidance for what we should be doing (and not doing) to protect our young unvaccinated children from covid’s short-term and long-term harms.

Moderna recently requested emergency-use authorization of its coronavirus vaccine for babies and the youngest children, but the Food and Drug Administration has delayed a decision until June, apparently to review it alongside a candidate vaccine from Pfizer-BioNTech.

This follows an earlier about-face on authorization of the Pfizer vaccine for children under 5. (The FDA planned to evaluate a two-dose regimen in February, then, after disappointing data, pushed off the review to see how three shots fared.) Meanwhile, parents have received maddeningly little information about the reasons for the delay and about what they should do in the interim.

The mixed messaging is frustrating. Public health agencies emphasize the importance of vaccinating older children and adults who interact with unvaccinated children — like my 2-year-old daughter. And they stress keeping these children distanced from others in public indoor spaces; or, when that is not possible, and ventilation is poor, making sure everyone is masked. But the Centers for Disease Control and Prevention has relaxed its public masking guidance, leading cities and counties to abandon mandates, making it nearly impossible for parents to act on that advice.

I’m a bioethicist who, stuck in parental limbo, has become a fervent amateur epidemiology researcher, devouring information to decipher the risks to our youngest child. But like other parents, I’m exhausted from the effort and confused by the data, and I believe that public health agencies, not me, should be doing the work of summarizing the most salient findings and explaining how to act on them.

I’ve been comforted that the short-term odds of death and other severe outcomes for the youngest have remained quite low, relative to older populations, even though their hospitalization and death rates rose during the omicron variant wave. If the risk of taking my child out in public was limited to a short bout with the disease, I would not be overly concerned; at the youngest ages, comparisons with the flu are not unfounded. (The flu, after all, can be deadly, too.) But I would like federal health officials to affirm that my judgment is correct.

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It’s the known and unknown risks of long covid that worry me more and that exacerbate my frustration at the lack of public health guidance. One concern, for instance, is multisystem inflammatory syndrome in children, a rare condition that has been linked to covid.

Granted, some of the data on long covid in children is ambiguous: One study, from Britain, suggested that tens of thousands of children there (11 to 17) could be suffering from long-term symptoms. Another large study, examining children in Denmark (17 and under), found only a very small difference in the prevalence of long-covid symptoms experienced by those diagnosed with covid-19 and those who had never been infected. But it shouldn’t be up to parents to reconcile conflicting medical studies; that’s the job of public health officials.

As research accumulates on the long-term impact of covid on adults, we parents are wondering whether the dangers for children are similar. Do children also suffer an increased risk of stroke, heart failure and other cardiovascular problems? What should we make of the data that says even mild cases in older adults increase brain matter loss? (Evidence of cognitive decline in that study was slight.) Given that children’s brains are developing rapidly, should we be taking even greater precautions to make sure our youngest aren’t infected — or are there reasons not to worry? Either way, parents want to know.

What is my family doing, day to day? We lost a child to an infection with respiratory syncytial virus (RSV), so we are more conservative than many, but I don’t think we are being unreasonably cautious. We balance maintaining the mental health and well-being of our 7-year-old — who needs to interact with other children and teachers, we’ve decided — with the risk to our 2-year old, and we reevaluate frequently.

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Everyone else in our household is vaccinated, and we are spending time indoors only with vaccinated friends and family. We also ask everyone to take a rapid antigen test before spending time unmasked with us. We do let our 7-year-old have indoor playdates with other vaccinated children, although we encourage them to play outdoors whenever possible. She also attends school in person (where the indoor masking requirement was recently lifted).

When the case counts came crashing down, we took our children out to breakfast a couple of times inside a restaurant with widely spaced tables, but as cases climbed, we went back to avoiding indoor dining with strangers. We postponed a plane trip to visit in-laws when the mask mandate was dropped. I have delayed weaning my 2-year-old to give her antibodies to SARS-CoV-2 through breast milk, one of the only ways I can actively protect her.

Everyone has their own risk calculus, but we shouldn’t be forced to wing it like this. My family’s approach seems reasonable, but there’s just no way to know for sure. All of us need timely information to make choices to best protect our children, and parents of young children especially need this information, given that we continue to wait for vaccines. Unfortunately, federal health officials are letting us down — still.

correction

This article originally referred incorrectly to a study of pediatric long covid "based on an American population." The study was conducted in Denmark. The article has been corrected.

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