Information current as of May 24, 2021.
Given the recently updated masking and social distancing guidelines the Centers for Disease Control and Prevention (CDC) on May 13 for those who are fully vaccinated, Atrium Health Levine Children’s is reminding the community that while this update is encouraging in the fight against the pandemic, many children are still not eligible for the COVID-19 vaccine and are unable to protect themselves from the virus. It’s important keep these children, and those who are at higher risk of severe COVID-19 disease in mind when deciding whether to wear a mask in order to protect the larger community. To help clarify when you should wear a mask and take other safety precautions moving forward, Lyn Nuse, MD, specialty medical director of pediatric primary care at Atrium Health Levine Children’s offers her recommendations.
What are the current recommendations from the CDC for when people should wear a mask?
For vaccinated people: According to the CDC, vaccinated people do not have to wear masks unless otherwise required by law (such as in healthcare facilities, planes, airports, mass transportation, etc.). Additionally, the CDC has recommended that schools should continue to require face masks “at all times, by all people in school facilities” for the rest of the 2020-2021academic year.
For unvaccinated people: The CDC recommend unvaccinated people continue to wear masks except in very limited circumstances — exercising outdoors, or a small outdoor gathering with vaccinated people. Gathering outdoors with a small group of both vaccinated and unvaccinated people is considered low risk, but masking is still recommended for those who are unvaccinated.
What should parents do if they have young children who are not yet eligible for the COVID-19 vaccine?
Technically, if parents are vaccinated, they do not have to wear masks, but we recommend that they continue to do so to set a great example for their children who aren’t yet vaccinated. Children mimic what they see trusted adults doing. If we consider masks to be “no big deal” and wear them without protest, children will follow in our footsteps and consider wearing a mask to be ok. Unvaccinated people of any age should continue wearing masks.
Can fully vaccinated people be around unvaccinated children without a mask?
Yes, they can, but we would still recommend they consider wearing a mask in order to set a good example and most importantly, to prevent transmission. Data isn’t completely clear as to how much the vaccine prevents us from passing on the infection to others. And no vaccine is 100% effective. While being vaccinated significantly lowers our risk of being infected or being contagious, it doesn’t make that risk zero.
What precautions should unvaccinated people take around children who are not vaccinated?
If everyone is unvaccinated, our recommendations are unchanged — wear a mask, social distance, wash your hands, and limit travel/unnecessary gatherings.
How do these recommendations vary indoors vs. outdoors?
We know that transmission risk is very low when outdoors. Contact tracing has shown that very few cases of COVID-19 occurred from outdoor activities. However, the risk will increase as more people become involved. So, venues like crowded outdoor concerts aren’t as safe as a small family picnic. Likewise, for indoor gatherings, risk increases if there are more people in a space not practicing social distancing or if it is poorly ventilated.
If a child who has been fully vaccinated for COVID-19 is immunocompromised, should they continue to wear a mask?
Yes. We are learning more about how well immunocompromised patients respond to the COVID-19 vaccines. Currently, it does appear that their response is less (protection is lower). We would encourage any immunocompromised child to continue masking, even after getting vaccinated, especially for activities where there are a lot of others around (school, travel, camp, etc.). And they should limit contact with any others who are not vaccinated.
Why is it important that people take these precautions to protect unvaccinated children?
COVID-19 infection in children is not always harmless or mild. Over 500 children in the US have died from COVID-19. Almost 3,800 children have developed Multisystem Inflammatory Syndrome (MIS-C), a condition that can affect the heart, brain, kidneys, liver, and other body systems potentially leading to long term damage or even death. It is rare, but it is one of the most serious complications of COVID-19 that can occur. Even with milder cases of infection, anywhere from 30-40% of children have at least one symptom that is lingering three months or more after they are initially sick with COVID-19. The more we protect the children in our communities by continuing to use the habits we have adopted over the past year to protect ourselves, the better. Our children deserve our best efforts on their behalf.
What other advice do you have for how to keep unvaccinated children protected from COVID-19?
This is bigger than each of us as individuals. We need to protect each other in a responsible and yet sensible way. There are things that are safe for vaccinated people to do, but even then, we still have to consider those around us who cannot get vaccinated, or who might not be fully protected from the vaccine. We still have variants developing and spreading rapidly. Many of the countries who had their infection rates under control have experienced new outbreaks. As a state and as a country, our vaccination rates are not yet high enough to really “squash” COVID-19 and give protection through herd immunity. So, if you are eligible but haven’t been vaccinated, please consider rolling up your sleeve and getting vaccinated as soon as possible. If you have concerns or questions, we are here to answer those and guide you in making an informed decision. We are here to partner with you for your health and well-being!
