post-vaccination back to normal, but with kids
April 9, 2021 8:15 AM   Subscribe

So maybe things are finally looking up again. People seem to be getting vaccinated, and that's letting people look ahead to a post-vaccination world that might be close to normal: dining out, traveling, etc. But so far the vaccines are only for adults. What does this mean for people with kids?

The virus obviously isn't going away just because a lot of people get vaccines. New strains, anti-vaxxers, whatever. "Back to normal" isn't the same as "zero risk", clearly. I've tried to read about herd immunity, but a lot of things seem contradictory. So what does "back to normal" look like for kids who can't get vaccinated? Like, my wife has been vaccinated, and I will be soon, and if we wanted to go out for a date night in May, or for a weekend trip over Memorial Day, the risk would be minimal. My question is really, when can we start taking our kids with us? If most adults get vaccinated, is that good enough to achieve herd immunity? Do we have to wait for a kids' vaccine?
posted by kevinbelt to Health & Fitness (28 answers total) 9 users marked this as a favorite
Emily Oster recently addressed this question with her what can I do calculator. It provides a rough framework for calculating risks of gatherings composed of combinations of vaccinated and unvaccinated people.

In this video she discusses a gathering of two families where some people are vaccinated and some aren't.
posted by Winnie the Proust at 8:20 AM on April 9, 2021 [2 favorites]

What I've heard is that unvaccinated kids are like vaccinated elderly, in terms of natural (and poorly-understood) protection from the virus. They can get it, and it can be bad, but it's less likely, just like for vaccinated people. So my family is considering it that we can socialize with other families and all their kids as soon as we're two weeks out from full vaccination and every other adult in that family's bubble is two weeks out from full vaccination. Functionally, it's like everyone's vaccinated.
posted by Pacrand at 8:43 AM on April 9, 2021 [3 favorites]

I don't believe Emily Oster to be a reliable source. She was excoriated by epidemiologists and healthcare professionals when she asserted that "kids are the same as your vaccinated grandma". In fact, the Atlantic (same publisher) just published an article refuting that point. I asked how the myth that unvaccinated children are like vaccinated adults could be combatted. She said: “Talk to any pediatrician.”

Tara Haelle, a science journalist, did create a risk calculator with the NYT, and also provided an additional explainer.
posted by toastyk at 8:46 AM on April 9, 2021 [37 favorites]

I like Emily Oster but i think she should have sat this one out.

My husband and I are just now booked for our first vaccine here in balmy Ontario but I can tell you what our approach is going to be even after our second shots (which will be prolonged.)

Over the summer, we are going to return to how things were for our family last summer, which means outdoor fairly-distanced play dates, picnics at the beach, last year we did go in and get shoes, that kind of thing. Depending on our community we might eat at a patio outside. If things go really well we might go through a distanced/timed art gallery.

We do have one camping trip booked (as we did last summer), and one vacation booked where we will have our own space (like a cottage) and our activities will be outdoors, although we may change that both for Covid and other reasons.

But other than that, we're planning to keep our Covid measures up until the fall and when the kids' vaccine comes. The new variants are landing younger and younger people in hospital, and long covid can affect kids - and we don't really know yet about all the cardiovascular impacts. For me, it's not worth it yet if we can fill our hearts/souls with outdoor things.
posted by warriorqueen at 9:02 AM on April 9, 2021 [15 favorites]

Just fwiw, Emily Oster is an economist.
posted by trig at 9:02 AM on April 9, 2021 [11 favorites]

It depends whether you're worried about the risk to your kids (since we don't really know if there might be long-term effects of covid in mildly symptomatic people, including kids) or the impact of them spreading it.

Until kids get vaccinated in large numbers, the virus will keep circulating in schools, making it a very different scenario from the vaccinated elderly. So kids will keep catching it, and will keep spreading it to other people. The only difference after widescale adult vaccinations is that it's less likely (though not impossible, the vaccines aren't 100% effective) that the kids will spread it to vaccinated adults. So things may go back to normal or mostly-normal as far as going out in the general public, gatherings with vaccinated people, etc, but it'll still be something to be aware of when visiting people who are more vulnerable or unvaccinated, besides the potential impact on the kids themselves.

Emily Oster is an economist and has no business making public health recommendations.
posted by randomnity at 9:03 AM on April 9, 2021 [12 favorites]

Until kids are vaccinated in large numbers, we're nowhere close to herd immunity. And given the ridiculous number of antivaxxers, and how some countries haven't even started vaccinating yet... herd immunity is still a pipe dream, not something we've almost reached.
posted by stormyteal at 9:07 AM on April 9, 2021 [9 favorites]

Eeek thanks for the information, people.
posted by Pacrand at 9:22 AM on April 9, 2021

My wife are both fully vaccinated, and both recently hit the two-week mark after our final doses. We have one daughter, 3.5 years old, who presumably will not be able to be vaccinated until late this year or early next year.

To protect ourselves, the people we come in contact with, and the people they come in contact with, we have followed the guidelines set out by public health officials since the beginning of the pandemic. Though we recognize that the guidelines have frequently been confusing or murky or subject to change, we've erred on the side of caution, and we haven't gotten sick.

  • We have not gathered with anyone without masks—save for one of my siblings, with whom we agreed to form a holiday bubble, including a two week quarantine.
  • Most shopping trips are curbside pickups.
  • We do meet up with people, including our friends and their children, but do so outdoors and with masks.
  • We haven't traveled to visit family on the other side of the continent.
  • We haven't been in anyone else's house.
  • Nobody has been in our house.
Now that my wife and I have been vaccinated, we are planning to visit grandparents and relatives that are within driving distance of our home, provided that everyone in their household must be vaccinated.

We are still not going to gather indoors or without masks with unvaccinated individuals—including children. Any get-togethers with other kids will be masked, outdoor affairs. Nobody that's unvaccinated comes into our home, and we don't go into anyone else's home who isn't fully vaccinated.

And we won't be traveling on a public method of transport with my daughter until she is vaccinated. Since my MIL lives across the country, and does not like to travel solo, so we are considering that my wife will likely fly out to bring her here for a visit, once my MIL is fully vaccinated.

Also, if my wife wants to wander by herself around Target with a mask for an hour or two, she's free to do so now. I shop online. 😉

I will caveat this by saying that if public health officials have enough evidence to conclude that children are low enough risk to travel, and/or gather with other children from households that are otherwise fully-vaccinated, we'll re-evaluate.

Once my daughter gets her vaccine, we plan to go back to as normal a life as we can manage, while still wearing masks in public as long as they are required or necessary.
posted by vitout at 9:37 AM on April 9, 2021 [9 favorites]

Emily Oster is an economist, not an epidemiologist. People will die and some kids will have lifelong health problems because so many people "heard" (often followed by "somewhere") what they wanted to hear. (Also what is up with all these expendable grandparents?)

In public, kids are vectors. There are still lots of people out in the world who aren't yet vaccinated due to eligibility, wildly inequitable access, health conditions/medication that contraindicate the current vaccines, and other legitimate concerns. There are also people who are effectively hostages to abusers who are preventing access for whatever reason. A kid who's "mildly" sick (and might be fine or might have lifelong cardiovascular, pulmonary, and/or neurological damage) can kill any of them.

And I don't yet personally feel willing to trust my vaccination to prevent me from every variant; I don't feel safe going around my friends' kids (note: I haven't seen any kind of friend for over a year, kids or no) even when I am extremely confident they have been taking appropriate precautions. I for sure don't trust kids I don't know, especially if they're out and about and thus already suggesting their parents aren't being particularly vigilant. I am assuming all children I can see in public are already going to in-person school and so are effectively petri dishes, because I'm familiar with the realities of schools' inability to actually follow the suspiciously-flexible rules available at any given time.

I think it's also worth considering what your children are going to think, in retrospect, when they are old enough to consider the context of All This. We have a whole generation of kids who one day may wonder if they've killed anyone. When whatever social AI serves them up memories of them at Disneyland or a big birthday party (or, like, a doctor's appointment or one short-lived return to in-person school) back in 2020 or 2021, are you going to have to confront a frowning teen who's just done the math and wants to know what you were thinking? I know a lot of people are getting around some of the repercussions by not taking/posting photos, basically vacationing on the down-low, but your children are capable of forming memories even without photos or social media posts, and I think we're going to be looking at some reckonings eventually.

I don't think being cautious can possibly do more harm than acting like this is all over. Yes people are restless, and yes people want to pretend this is over because it'll feel good for a minute, but consider worst-case scenarios and long-games too, before making a decision.
posted by Lyn Never at 9:40 AM on April 9, 2021 [13 favorites]

I don’t know about recommendations, but I can tell you what I’m actually going to do.

Once my wife and I are fully vaccinated, we’re going to start doing stuff again. Indoors and outdoors. Bringing kiddo when appropriate based on activity. Wearing masks where required/encouraged. Traveling in July, to meet with family members where all the adults will be vaccinated.

Kiddo will get vaxxed when available, but we’re not all going to stay in the house for however long that takes.
posted by Huffy Puffy at 9:49 AM on April 9, 2021 [7 favorites]

I'll just add, I have lost a child to a 1:10,000 medical event, which makes me both suspect and also really experienced in these things. My family also lives under a kind of carpe diem mandate as a result - what I wanted for my daughter was of course a better outcome but also to live and enjoy life.

For us, there are so many things still to enjoy outdoors, seeing our friends and family on decks and in parks and for walks (with masks), and so much takeout and home cooking left to enjoy. Even in winter we've been out a lot. That won't be the case for everyone!

But in ours, I can't personally see what indoors is so urgent (in our climate) that is worth the risk mere months before kid vaccines will likely arrive, or what trip can't be postponed a little longer.
posted by warriorqueen at 10:00 AM on April 9, 2021 [9 favorites]

I'm a pretty COVID-cautious person (probably the most cautious person I know), but coming to AskMeFi always makes me feel like I'm a laissez faire, anti-vax, anti-masker.

My wife and I have both gotten our second shot and will be maximally protected in 1.5-2 weeks. We have been cautious -- very cautious -- for the past year. We took the calculated risk to send our kids (9 and 5) to school and have been OK with that decision. It's where we have chosen to spend our "risk budget" and realize that it was a pretty big "spend," so we have been very careful in other areas of our life. Despite concerns that others have about the viability and enforcement of masking with children, my experience is that your average kid in a school is significantly better than your average adult in masking. There has been, as far as I can tell, zero community spread in our area schools -- individual kids and teachers get sick, but don't appear to spread it to their classmates. This makes me feel very comfortable about masking and ventilation being an excellent way of limiting the (already smaller) level of spread among kids.

No activity is risk-free. Early on in the pandemic, the potential cost in lost lives and life-long illness was clearly worth it to justify strong and complete lockdowns. But there was some cost associated with this choice: neither of my kids have had a playdate with a friend in over a year. That is a real cost and, as the risk associated with COVID-19 goes down due to vaccination, I think it's only fair to evaluate whether paying that cost is worth it any more.

I have a really hard time ratcheting down my vigilance because it's been ratcheted up for so long. But there are legitimate, real costs to not allowing my kids to hang out with friends and family to play. If all adults are vaccinated, I am coming to conclusion that I am OK with hanging out with unvaccinated kids. We'll probably start masked and outside, but then not worry *so* much if a kid has to go in to use our bathroom or if their mask slips down below their nose while they're running. It is not zero risk, but nothing in life is. It's a risk I'm OK with taking because I think the pros now outweigh the cons.
posted by Betelgeuse at 10:13 AM on April 9, 2021 [20 favorites]

Response by poster: Complicating factor that I probably should have included in the original question: Both of my kids have stayed in daycare since the beginning (my wife is considered an essential worker), so they're around other kids every day. My daughter is extremely compliant about masking (she often doesn't want to take it off after leaving), but my son is young enough (19 months) that he's not required to mask up yet, and it probably wouldn't stay on long even if he did.

With that in mind, is the risk of going out in public, or traveling, or whatever, higher or lower than the risk of just going to daycare normally, since our baseline exposure is a little higher?

Probably not relevant but maybe: The daycare did have an outbreak already, around the holidays, when an asymptomatic kid of an infected parent spread it around, including to us.
posted by kevinbelt at 10:59 AM on April 9, 2021 [1 favorite]

The risk of going out in public is not going to be higher or lower because your kids are in daycare. Rather, the risk is going to be add on to the top of the risk that you are already taking. The more of those risks that you add in, the more likely that somewhere in all of those events your kid will have a serious exposure.

Did your kids get COVID from the confirmed school based case? If so, then that might have given some protective immunity but I really can't say how much you might want to rely on that in terms of reducing the chances of them getting re-infected. (Combination of we don't really know how well or how long immunity lasts - probably depends on the initial exposure - plus I certainly don't know how immunity might play out differently in very young children.)
posted by metahawk at 11:15 AM on April 9, 2021 [2 favorites]

The risk of going outdoors in public, masked and distanced, remains pretty low. If I had unvaccinated kids, I'd still hold off on indoor activities for now. With the spring upon us, you should be able to socialize and have fun outdoors and thus not deprive your kids unwarrantedly. It's not so much the amount of risk as whether the benefit is great enough to justify taking the risk (as with school). If their grandparent were dying, I'd probably take them to see them. But not to visit Chuck E. Cheese, you know?

We have a whole generation of kids who one day may wonder if they've killed anyone.

This is a somewhat odd way of framing it, considering that flu is clearly spread by kids and kills a nontrivial number of people each year. The fact is, almost any of us may have killed someone any year we got flu. This year, flu deaths are down hugely, despite the strain on the medical system--if we wanted to prevent flu from spreading, we could stick to 2020 precautions and mandate vaccination, but we never have and we're not going to. There's got to be a probability adjustment, not just a fixation on the worst outcome.
posted by praemunire at 11:24 AM on April 9, 2021 [16 favorites]

The idea that economists are not qualified to speak on matters of risk analysis is really silly. You can disagree with Oster's analysis if you'd like but it's incorrect to state that she is unqualified to talk about statistical risk simply because she's an economist. And really, Oster's What can I do calculator linked above is a great resource for this, because what you need to figure out is what risks you are or are not willing to take. You can change the parameters to reflect beliefs that different interventions have higher or lower mitigating factors in spread. There is no strong argument that this is a bad approach to thinking about risk. At some point modeling is modeling and you don't get better at it because you have a degree in epidemiology instead of economics (in fact, you're probably worse at it).

We can contrast it with Helle's risk calculator for the times, which among other things, put the value of everyone in a group being vaccinated as not enough risk reducing to balance out those vaccinated people also being people who haven't been "following health guidelines such as wearing masks and social distancing." What? This is just incredibly bizarre logic. A vaccine that prevents serious consequences from the virus for all but the rarest unlucky individuals and knocks down even infection by around 90% should eliminate our need to do things like "wear masks and social distance" over time, and yet here we are touting this as a reasonable risk analysis? This is just incongruous. What are the actual mathematical inputs we're getting to make the risk decision here? I would honestly like to know how "everyone vaccinated" doesn't basically take the risk down to near-zero, modulo the community risk you've got around. Again, you can actually look at the numbers in Oster's formula, but you can't do that in Helle's.

Anyway, personally I see pretty low risk of most traveling just in general. There are a lot of ways to travel that involve very little indoor time with unrelated people: stay in a rental house that you drive to, get takeout, do outdoor activities. I will wait to fly for vacations with my kids or indulge in indoor dining with them until the community spread is lower than it is now, but I anticipate that being likely sometime this summer. That's my analysis, having read extensively about the risks, consequences, and likely future paths for this pandemic here in the US.
posted by ch1x0r at 12:05 PM on April 9, 2021 [8 favorites]

An ONS study found that around 13 percent (depending on age) of kids who tested positive for COVID in a random testing environment (not a symptomatic-only testing environment) got long-COVID. I focus on that number more than on the low chance of an even worse outcome. Here's an article linking to a few studies, including that one.

I follow Dr. Zoe Hyde on Twitter for info. She is on the more cautionary side so I feel like I'm able to be aware of what risks do exist. I don't like to follow people who feel like denialists or who throw around BS. I get really frustrated when I see people like Emily Oster claim that young people have a lower risk for certain outcomes than older people -- linking/citing to research that doesn't even include kids as eligible study participants. How does she know it's not a U-shaped curve, with higher risks to the very old AND very young? I haven't seen any evidence that it is, but that's why it's nice to look at studies that actually study the population you're making claims about.
posted by slidell at 12:29 PM on April 9, 2021 [1 favorite]

How does she know it's not a U-shaped curve, with higher risks to the very old AND very young?
Easy. We would see the kind of significant excess deaths and hospitalizations of children that we see in the elderly if it were a U-shaped curve. We have not seen any of that at all. There is just no evidence that this is, comparably speaking, a serious disease for children (as opposed to the many other common illnesses out there for kids, like RSV). And there are serious consequences to overplaying the risks to kids, including: keeping them out of school far longer than is necessary, keeping them isolated far longer than is necessary. Risks have got to be balanced.

Also, Zoe Hyde is a total fearmonger who will always play to conclusions that children are superspreaders, high risk, etc. I'd encourage you to find a sampling of additional experts, perhaps pediatricians and others who actually treat children, in order to have a clearer picture of the evidence.
posted by ch1x0r at 12:43 PM on April 9, 2021 [8 favorites]

We would see the kind of significant excess deaths and hospitalizations of children that we see in the elderly if it were a U-shaped curve. We have not seen any of that at all.

And I think many of us were expecting it! It's not some phenomenon hidden because no one thought to crunch the numbers.
posted by praemunire at 12:51 PM on April 9, 2021 [5 favorites]

Ugh, I knew nothing about Emily Oster a year ago and now every time I see her name my blood boils. She’s made too many public errors for my taste without publicly acknowledging them. (The first of these was claiming in an op-ed that if 5/200 people in your school have covid, your risk of exposure to covid is 5/200. That is grievously wrong in a way that favored her position, and it’s really probability 101 stuff — not the kind of mistake I’d expect faculty in a mathematical science to make innocently.)

When Oster says things that are near the center of gravity of what other experts across the relevant disciplines are saying, I think it’s probably fine to listen. I thought the report she coauthored on returning to school was not unreasonable. But on this issue of how to think about risk to kids, she got a torrent of pushback, and I think it was deserved.

I’d also like to note that the kids and covid thing itself seems to be a really fluid situation right now. The last two weeks have seen a lot of press reports about increased incidence of covid in children with some of the variants that are going around, alongside reports of outbreaks in settings like school and youth sports. Moreover, there’s huge geographic heterogeneity in variant dominance. Things are exploding badly in Michigan, for instance, complete with calls for shutting down high schools and sports again, but next door in Wisconsin we’re only just starting to see another uptick and a shift in variant share (and we did just have a large childcare outbreak tied to b117). I don’t think it’s time to pull out the three klaxon tweets or anything, but in your shoes I would follow this issue closely in your local papers, be aware that it’s possible that your childcare situation may change, and not plan on taking the kids too far from home over the medium term.
posted by eirias at 1:08 PM on April 9, 2021 [10 favorites]

Ugh, I knew nothing about Emily Oster a year ago and now every time I see her name my blood boils. She’s made too many public errors for my taste without publicly acknowledging them. (The first of these was claiming in an op-ed that if 5/200 people in your school have covid, your risk of exposure to covid is 5/200. That is grievously wrong in a way that favored her position, and it’s really probability 101 stuff — not the kind of mistake I’d expect faculty in a mathematical science to make innocently.)

Uh, what? From said op-ed:
One way to think about it: If there are five cases in a school of 15, then if your child interacts with other children randomly, there is a 35 percent chance that they interact with someone who has Covid-19. If there are 5 cases in a school of 1,500, there is a 0.33 percent chance. That’s the denominator. (link).

This does not say "their risk of exposure is 5/200." And this is a very reasonable aspect of modeling that should happen to understand school spread risk. Number of kids and number of infected kids. It's certainly not all of it, because of course one kid can theoretically infect a classroom. This is a simplification to explain an important concept: the size of the student population relative to the size of infections matters, a lot. Accusing her of failing stats 101 is exactly the kind of mean-spirited gatekeeping that you regularly see from scientists who themselves have doubled-down for periods on all kinds of ultimately incorrect science in the course of this pandemic. Literally no scientist out there is making perfect predictions. Plenty of them fought the idea that covid spread through respiratory particles (or "airborne" or whatever the appropriate term is) for a bit longer than the evidence took to turn. And so many scientists are unwilling to honestly communicate risk to people because they seem to have this idea that if they present optimistic outcomes and things go bad, no one will ever listen to them. It's patronizing to all of us and just as poor quality information as simplified explanations of complex concepts that actually are likely to come true (I for one would bet money that Oster's prediction that it will be safe to travel with kids this summer in the US will be correct).

It is true that the situation is fluid though, and perhaps the meta-advice should really be: don't book an optional trip/activity you can't afford to cancel.
posted by ch1x0r at 2:06 PM on April 9, 2021 [5 favorites]

I think it's too early to be making firm plans. The vaccines are incredibly effective, distribution is skyrocketing, and there is evidence that the vaccines become more effective over time, but cases remain plateaued in many places, so the facts on the ground are changing very quickly. My personal opinion is that it's fine to continue my typical pandemic caution for another small number of weeks while things shake out. I think that the answer to your question will be much more clear by Memorial Day and that firm opinions in this thread will be out of date.
posted by Kwine at 3:11 PM on April 9, 2021 [4 favorites]

If there are five cases in a school of 1500, this is the simplified math, assuming everyone has an equal chance of being infected:

P(someone your kid interacts with has covid) =
1 - P(no one they interact with has covid)=
1-(1-P(any individual student has covid))^(number of students your kid interacts with)

For simplicity let’s say they interact with 30 students (the size of a class). That works out to approximately a ten percent chance. It’s far from 100%, but it’s not negligible and it’s way the hell more than she claimed. Is that the same as the probability that your kid *gets* covid, no, but she didn’t claim that, she literally claimed there was less than a 1% chance that they would even interact with anyone who had it and that was wrong by a factor of 28. This is very literally intro to undergraduate probability stuff. I understand that people in LOTS of fields are needed to solve this massive interdisciplinary problem; I don’t say economists have nothing useful to say; when I was in the thick of trying to understand this issue for the purpose of trying to help someone who needed to make decisions — someone who himself had to call on lots of other experts who know many things I don’t know Jack shit about — I was reading really broadly and way outside my field myself, everyone from people modeling air flow (I could only follow the gloss) to epidemiology (that’s closer to home for me). But I am right to be pissed about this specific person and her specific statements to the media that are breezily, poisonously wrong. And when I make statements to this decision maker I am careful to couch things in terms of what I know and where I could be wrong. This person doesn’t and her wrongness is self serving in the ugliest way. You can be a school reopening advocate and not suck. You absolutely can. Most scientists were in this camp as far as I can tell. But Emily Oster is not that person.
posted by eirias at 4:38 PM on April 9, 2021 [1 favorite]

I personally will not feel completely safe till my kid is fully vaccinated, so will keep distancing. She is going to her tiny school where she wears a mask, distances and gets outside a lot, which is a huge privilege but still makes me nervous. Her dad and I will soon be fully vaccinated.

We won't be doing indoor large family stuff with her till she's vaccinated because we are pretty sure some of our extended family will not get vaccinated and may not be honest about it. Same for travel/hotels/planes: not till she's vaccinated.
posted by emjaybee at 7:31 PM on April 9, 2021 [2 favorites]

There’s a big difference between kids under 12 and kids over 12, and I would expect vaccine authorization in the latter group by fall at the latest, since studies look promising so far. That second group also appears to spread Covid much more efficiently than younger kids. So I think the precise age of your kids is a big factor in the risk calculus here.
posted by en forme de poire at 8:03 AM on April 10, 2021 [3 favorites]

Also a lot of the studies of long Covid in children do not have control groups and/or have other sources of bias (non-representative hospital samples that have much higher rates of complications than the population average, surveys that don’t control for differential drop-out, etc). They are still useful for showing that long Covid does exist in children, but less helpful when it comes to estimating its prevalence accurately. Apples-to-apples comparisons do show that they are at substantially decreased risk of lingering Covid symptoms compared to people in their 30s.

Lately I have seen what looks like motivated reasoning both by people who think we should be more cautious and by people who think that the evidence warrants fewer restrictions. Unfortunately this is now a highly politicized and emotionally-charged issue, with lots of experts who are not in consensus and also (justifiably) directly involved in political advocacy for their own perspective, and with some aspects that seem to come down to different priorities, baseline risk tolerance, or values more than different facts. This makes it really difficult to give a blanket recommendation. I think the best advice I can offer is probably to listen to a wide variety of actual epidemiology/virology/public-health experts and try to form your own gestalt about it — sorry that that’s not very helpful.
posted by en forme de poire at 9:03 AM on April 10, 2021 [6 favorites]

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