With omicron exploding throughout the United States, many of the questions that have bedeviled caregivers for the length of the pandemic are taking on a new urgency. If we want our children to stay healthy, and not infect other friends, families and strangers, what should we be doing right now? What shouldn’t we be doing? Because omicron appears to cause less severe illness, does it even matter if a healthy kid catches covid?
Absolute answers are in short supply. With that in mind, we asked experts of different backgrounds to weigh in questions gathered from two dozen parents:
Sean O’Leary, pediatric infectious diseases specialist, professor of pediatrics at the University of Colorado and vice chair of the Committee on Infectious Diseases at the American Academy of Pediatrics.
Anisha Abraham, pediatrician, teen health specialist, and author of “Raising Global Teens: A Practical Handbook for Parenting in the 21st Century.” She is on faculty in the adolescent and young adult medicine division at Children’s National Hospital in Washington.
Meghan Leahy, parenting advice columnist at The Washington Post, author of “Parenting Outside the Lines,” and former school counselor.
Jessica Calarco, associate professor of sociology at Indiana University, focusing on systems of inequality.
Wilbur Lam, associate professor in the department of pediatrics at Emory University and in the department of biomedical engineering at Georgia Institute of Technology.
The experts answered what they felt most qualified to answer. In some instances, we have edited their responses for length and clarity.
There’s a sense of “Just let the kids catch omicron and get it over with” among some parents in my area. Is this crazy? Reasonable? Somewhere in between?
Sean O’Leary: I wouldn’t say it’s any of those things. We are still seeing kids get covid and get hospitalized. It’s not nothing. It’s the same for cold and flu season: You’re not going to try to expose your kids to influenza just because.
Meghan Leahy: Nothing is crazy any more. I have had these thoughts myself. I think it is a manifestation of fatigue and frustration. Our brains know that we don’t want to “just to catch it,” but our hearts are tired. I think we need to keep just assessing our risk and moving forward the best way we can. As a mother, I have to accept (and reaccept) every day that this is how we are going to be living from here on out.
Anisha Abraham: I am hearing parents discussing the merits of their kids catching omicron. I get it: “It’s mild, let’s get it over with, and it will boost the immune system even more in addition to my kids’ vaccines, right?” Well, it’s hard to predict. Omicron is a less severe variant, but it’s still an illness. Your child or teen could still get rather ill. Long covid can cause shortness of breath, persistent fatigue and more. Also, an infected kid can pass on omicron to others with compromised immune systems, i.e. those who really should not get it. So, probably best to avoid.
What type of activities can fully vaccinated kids safely do?
O’Leary: The concept of safety is not binary. Some parents let their kids ride ATVs without a helmet, and others wrap them in bubble wrap to walk down the street. If it’s a not very crowded indoor pool, that’s safer than a crowded indoor pool. But that’s not safer than outdoors. For birthday parties: Is it two or three children? Or 20 to 30? Is it older children who are vaccinated? Or younger children who aren’t? This depends a bit on parents’ own risk aversion and individual circumstances of what is and is not okay.
We recognize we’re in the second year of this thing and we can’t be locked down. There is balance. There is this whole concept of risk mitigation versus risk elimination and it still holds true. I don’t think we’re at a place where the horse is out of the barn and we just forget everything. But putting that in perspective of what is important for children in general, like socialization and being able to be around other people, is important. I don’t think you necessarily completely avoid all social interaction. We certainly have been sending our own children to school, and I would encourage parents to send even children under the age of 5 to child care.
Leahy: The first issue to consider is vaccination status plus proximity to compromised folks. I don’t think it is best to go buck-wild even if you are vaccinated (indoor unmasked concerts, etc.), but the entire point of masks and vaccinations is to live knowing that you may have a breakthrough case of covid, and you won’t die! If your family is healthy and vaccinated, I would follow your pediatrician’s advice and try to enjoy your activities.
Abraham: I’d suggest a two-stage strategy: be extra vigilant until the omicron spike is over, hopefully by mid-February or so. During that time, consider taking your events outdoors or having one or two friends indoors with masks on. After that, yes, let’s do indoor birthday parties or events again while adhering to safety protocols, including mask-wearing, reasonable distancing and of course vaccinating.
Lam: If you have a child who has a chronic illness, maybe not even that severe, you might weigh that differently than if you have a kid with behavioral issues, where not seeing their peers would stunt their development. We care not just about the health aspect of things. We care about the psychosocial. In adulthood, those things converge.
If my child has asthma, should my kid be in lockdown? Maybe not. If my kid has leukemia, should my kid be in lockdown? Even health-care providers are going to have different answers.
Calarco: In the United States, we treat health as a personal responsibility. We tell people “make the choice that’s right for you.” But that model has two problems. First, it creates a huge mental burden for people, especially for parents and caregivers, because they have to figure out what’s best for them as individuals but also what’s best for the children they care for. This leads to a lot of decision fatigue. .
Say a child gets invited to a birthday party. Parents have to do the research: Who’s going to be at the party? Will it be inside or outside? Will people be eating? How likely is it that everyone will be wearing masks and fully vaccinated? What are the current case rates? What are the chances their child will get infected? That they’ll experience serious symptoms? That they’ll infect someone else?
Many parents try to reduce their cognitive burden by simplifying their risk calculations. That means focusing on whether a decision, like sending their child to a birthday party, is safe for their own child, and not on how that decision might ripple out to affect the safety of others, as well.
But think about all the people that you and your kids will interact with over the two weeks after your child goes to that birthday party. Now think about all the people with whom each of those people will interact in the two weeks after that. How much do you know about those people and what covid could mean for them? And not just their risk of death or hospitalization, but losing a job or losing income because they can’t go to work or because their kids can’t go to school or child care?
How worried should we actually be for our kids about omicron? Is MIS-C still a concern? What do we know about long covid in kids? Or that covid may be triggering diabetes type 1 in children?
O’Leary: We’re definitely still seeing MIS-C [multisystem inflammatory syndrome], probably as a result of the delta variant. But in terms of the vaccinated versus the unvaccinated, there was a study published by the CDC [recently] looking to see how effective the vaccine is in preventing MIS-C. You’re much more likely to get MIS-C if you’re not vaccinated. All the critically ill MIS-C patients are unvaccinated.
As for long covid in kids, there’s nothing much new. What we’ve gathered so far is it does seem to happen, but it’s less common than in adults.
As for diabetes, the issue there is that any time you see an association in a study of secondary data like that, it’s just an association. There are some concerns raised in adults, so there may be some truth there. It might trigger diabetes. It’s possible that association is real, but it’s still a relatively rare disease in children. There are a lot of other reasons we still worry about covid, and that’s just one more thing. I don’t think it changes things markedly in terms of how we approach covid; it’s a pretty low risk.
Lam: We have 85 covid hospitalizations right now — about 11 percent of our population in our hospital has covid. Out of the kids who are hospitalized, 82 percent have some underlying issue: diabetes, immunosuppression, neurological condition, congenital heart disease. But 18 percent were previously healthy. So it’s not zero risk.
We don’t know much about long covid. What’s interesting about this is there are very similar diseases that are associated with other viruses. So the concept of long covid is actually not too surprising, but it’s also not surprising we know so little about it. And with kids, we know even less. We don’t even know the prevalence.
How should parents balance accumulating risks? Should we be modifying our activities to limit exposure outside of school?
O’Leary: School is absolutely a priority. But just because they are getting potentially exposed at school, there are still reasons to be careful outside of school.
Calarco: My answer is a paraphrased version of what my son’s teacher said in an email to parents, after her own son had to spend four days at home waiting for a (thankfully negative) PCR test. Having schools open is good for kids and good for parents, and there’s a much higher chance that schools will be able to stay open if families are taking fewer chances with things like restaurants, playdates, birthday parties, and other activities on the weekends and after school.
If my family has had covid and recovers, how cautious should we be going forward?
Lam: There is always the risk of reinfection. But that is true of any illness, or any cold virus even. Sometimes you can get the same one again, it’s just mutated a little bit. In general, it tends to be milder than the one before, and it’s usually at least a few months after the first round.
Practically speaking, I would say it creates a temporary breath of relief for that family. The likelihood of them getting covid again, at least with the current variant, is pretty low. But there are caveats. Could you actually get a subvariant and get sick again, even pretty early on, less than several months? It’s possible, if kind of unlikely.
If a parent tests positive, how much interaction with an unvaccinated child is okay? Should a parent bother isolating from a positive kid? Is omicron so contagious that once it’s in your household it’s sort of moot anyway?
O’Leary: It’s next to impossible to [isolate] with a really young child. So you do what you can. One of the things we learned throughout this pandemic: Just because you can’t do everything doesn’t mean you do nothing. If you have someone infected in the house and you want to do what you can to try to keep it from spreading, you can wear masks. You can sit across a larger room as opposed to next to each other. You can lower the risk. It is still worth it trying not to get infected.
Calarco: A key thing to keep in mind here is that many parents don’t have the luxury of isolating from unvaccinated children. I interviewed one single mom recently whose fiance died last summer. She is now working three part-time jobs to make ends meet for herself, her 1-year-old, and her 4-year-old. They can’t afford a large apartment. They also don’t have any family nearby who could help. If this mom gets sick with covid, which is a real possibility, since she’s working in retail and manufacturing, there’s no way she’ll be able to isolate from her kids.
When we tell parents they should try to isolate from their unvaccinated children if they get sick, we effectively tell mothers like the single mother I interviewed: “Well, too bad for you.”
How can I identify anxiety or depression in my child thanks to all of this, and what should I do about it?
O’Leary: There are a lot of resources to help. Specifically, there are very nice resources on our healthychildren.org site about mental health. It’s also never a bad idea to reach out to your pediatrician. My colleagues in primary care have never seen the volume of mental health issues they’ve seen in the last year or year and a half, but there are resources out there.
Abraham: At Children’s National Hospital in DC, we are seeing a significant increase in the number of kids presenting for anxiety, depression and self-injury. Be aware of changes in younger kids such as excessive clinginess, irritability, or new onset of bed wetting. For older kids, be attuned to withdrawal from normal activities, changes in eating or sleeping. Ask preteens and teens specifically if they are feeling stressed, anxious or depressed, or if they think life is not worth living. Many parents and caregivers are afraid to directly ask about suicide, fearing it may make an adolescent suicidal — but in fact doing so is more likely to get a teen the care they need. Also consider getting a health-care provider involved, such as your pediatrician or a mental health counselor. Many are providing appointments virtually.
Leahy: One of the most important things to remember is that many parents have a “spidey-sense” about all of this (not always, some children are quite adept at masking symptoms), so always listen to that little voice inside you. If you suspect that something is afoot, start making a LIFT list (length, intensity, frequency, trigger) of the symptoms. A pattern may emerge (or not), but this is valuable info for your pediatrician, therapist, or psychiatrist. Try not to panic, just get your data, and take it one step at a time.
What’s the current best guess on when a vaccine might be approved for kids under 5?
Lam: The bottom line is that the clinical trial for kids under 5 basically failed. It didn’t work. The reason it didn’t work is, at least with the Pfizer drug, they under-dosed. What the trial designers said was “We’re going to go low and hope it works.” And they undershot it. I think what they have to do is go back to the drawing board. They could add another dose. But I don’t think we are going to see any emergency authorization for these young kids any time soon. Especially for the babies.
O’Leary: The two end points in the trial are safety and immunogenicity [how well the vaccine works]. Is it safe? Yes [for both age groups]. And with the 6 month to 2-year-olds, they met the immunogenicity goal. But in the 2 to 4-year-olds, they did not. So they …will add a third dose. What we’ve seen in older individuals is this may be a three dose vaccine. The immune response is much more robust. Those kids are already enrolled [in the trial] and should be getting a third dose soon. Then it’s a matter of a few months to get the data and submit the application for emergency use authorization to the FDA. It’s not dead in the water. A best guess for [the vaccine approval for this age group] is probably in the next two to four months.
All of the at-home tests that I’ve found have said they’re for ages 2 and up, but we have used them for our baby. Are we making a mistake? Why are they labeled this way?
Lam: Can you use it? Yes, you can. All the studies assessing whether these tests work were in people over 2. That’s all. It’s not dangerous to use the tests on kids under 2.
You just have to use it with a caveat. The test was not designed and was not optimized for a kid that age. But that’s true of many aspects of pediatric medicine. Because kids are by and large very healthy, the medical device industry is not very incentivized to make things for kids. It’s what’s called off-label use. In many ways, that’s a rule of thumb in pediatric medicine. I tell my brother who has a young baby to use those tests as well.
On another note, we have been collaborating with the FDA to ask the question: Can kids swab themselves? There was a very scientifically rigorous study where we had kids swab themselves. We found kids as young as age 4 could swab themselves and get a decent sample.
This will allow tests to be used at schools. It means kids can swab themselves, and the teacher won’t have to take up 15 minutes of class time. That allows a lot of public health measures to be easier, that allows school health measures to be easier.
Summer camp registration season is coming. Is there any way to predict what might be going on in June?
O’Leary: It’s become kind of cliche at this point, but we’re going to get through this. We’re in this together. I do think things in terms of hospitalizations will get worse before they get better, but most people think this is perhaps beginning to peak already and we may be in a much better place in a few months than we are right now. I’m optimistic we’ll have a fairly normal summer, and maybe even school year next year.
The more people who can get vaccinated, the better off we will be. The best thing [caregivers] can do is get their children vaccinated. That’s much better than any of the other measures.
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