As pediatricians, we know just how confused, overwhelmed, and alone parents feel as our society begins to reopen. Parents have heard every piece of conflicting advice: An economist comparing unvaccinated children to vaccinated grandparents; politicians advocating complete return to normal as if the pandemic never occurred; other worried parents who fear reopening society at all to not-yet-vaccinated children, especially as basic precautions like indoor mask-wearing rapidly and dramatically loosen on an almost daily basis. Parents stand alone, stranded in an ocean of extreme recommendations that fail to truly consider the best interests of children.
We are here to give hope without sacrificing science and reason. As the weather warms, vaccination uptake increases, and age ranges for vaccination expand, we are positioned to enter this summer season in excellent shape for a return towards normal. Parents are right to feel a sense of protection as vaccination rates increase, even before most children themselves are able to receive it. With rapidly emerging data showing how well vaccines stop transmission, we can count on vaccinated adults to help contain the spread of Covid and keep our children safer. And mortality rates for children who do contract COVID-19 remain extremely low, a much needed comfort in a sea of ongoing pandemic uncertainty.
But as pediatricians, we are also all too familiar with the innumerable effects of Covid on children. We have seen the rare but serious cases of acute COVID-19 infection, the strange and serious post-covid inflammatory disease called MIS-C, and the seemingly endless downstream harm that this pandemic has created for children everywhere. It is possible to understand that Covid is a threat to children– especially as new variants emerge, become more virulent, and rely increasingly on unvaccinated children for transmission– without succumbing to fear or sacrificing optimism.
While many focus only on mortality statistics to advocate for an immediate return to pre-pandemic summer activities, the reality is that COVID-19 remains a threat to children. The 0.03% mortality rate is just one small component of pediatric risk assessment. It fails to acknowledge the morbidity from COVID-19, from the rare but serious MIS-C, to the “long-hauler” adolescent patients we treat, to those who must isolate, miss school, and stand to lose out on the summer activities we hope for them to gain. Looking only at mortality rate forgets that this is just a percentage, and that increasing transmission means increasing the total number of children who will suffer and die if spread is unchecked. It ignores the reality that every number is a child, often a medically vulnerable child, whose life is worth saving. And looking at mortality ignores the fact that there is so much we have yet to learn about the long term effects of this unpredictable virus. Each week brings reports of the potential for harm, of ways in which children’s bodies may be changed by this virus.
After a year of emotional pain and social sacrifice, we know that a return to activities is crucial for our children. We are not here to advocate for prolonged isolation by any means. Rather, we know that making smart and strategic choices about how to reintroduce unvaccinated kids to a pre-pandemic lifestyle is what will end the pandemic fastest, prevent further cycles of lockdown and restrictions, and ultimately provide them with the definitive and permanent return to the precaution-free lifestyles they deserve.
The latest change in CDC recommendations lifting indoor masking recommendations for vaccinated individuals stand to leave many behind. As businesses lift mask mandates and hope for honesty in vaccination status and masking practices, we see a gaping hole in community protection that threatens all unvaccinated individuals. In a tragic continuation of our pandemic priorities, we see how society has chosen the convenience of adult existence over the health and wellbeing of vulnerable populations, including children. After a year of restaurants reopening before schools, sports events broadcast live before parents could stay with their hospitalized toddlers, it is a cruel irony that children again are asked to bear the burden of our own impatience and selfishness.
It is impossible to redirect an entire nation in its pandemic perspective and its commitment to protecting children. But for pediatricians and parents, this is our daily work. Even when guidelines fail to fully consider the best interests of children, we will be here to put their needs front and center. How can we make sure that this summer is as safe and joyful as possible for overlooked, vulnerable children who have already suffered so much? The solution is surprisingly simple. While pundits debate in black-and-white, while experts tell parents that summer plans can only exist as an all-or-none between full precautions or none, we respond with a new framework, and a new call to action.
It’s time to get back to basics. The very concept of a normal summer must be called into question. Lavish vacations with plane and train travel make little sense with unvaccinated children, and threaten the progress we’ve made in containing COVID-19. With uncertain indoor masking practices and constantly evolving recommendations, most large indoor gatherings stand to carry more risk than benefit. With our guards lowered and reasonable caution to the wind, we push a full return to normal only farther into the future. We allow further viral mutations that stall vaccine efficacy, and place children at risk of acute and long-term COVID-19 complications with unclear benefit.
Instead, parents can embrace and enjoy the steady incremental progress we can, and should, make. In a world that demands increasing activities, consumer materials, and expectations of our parenting, it becomes all too easy to feel that an immediate return to largess is the only way to return to normal. But there are so many simple activities that will restore our children. Summer camp, outdoor celebrations, a return to indoor play dates once adults are vaccinated, finally reuniting with loved ones– these are the milestones that cannot be diminished. And crucially, families can count on catching up on missed time with now-vaccinated grandparents, both near and far (this time, though, it’s grandma and grandpa who will do the traveling when able).
Focusing on safe activities not “only” gives us time as a society to build towards herd immunity and definitively end the pandemic, it is also more than enough for our children. The pandemic silver linings are few and far between, but among them is the opportunity to refocus our parenting. International adventures, bucket-list trips, and lavish vacations and parties can stay on hold.
It’s time to step up and give children the summer that they — not we — need. With an intentional reset, we can give children the key ingredients to health and happiness — play, joy, presence, touch, friends, and family — without the noise of excess and extravagance. This summer, it’s time to reconnect to each other and strengthen the quality of our time together. In the end, it’s exactly what the pediatrician ordered.
Rebekah Diamond, MD is a hospital pediatrician in New York City and an Assistant Professor of Pediatrics at Columbia University. She also gives safe, realistic parenting guidance on Instagram @parentlikeapediatrician and is the author of the upcoming book Parent Like A Pediatrician.
Risa Hoshino, MD is a Board Certified Pediatrician in New York City. She also provides vaccine and health education content on Instagram @dr.risahoshino