How should vaccinated parents navigate summer? A doctor’s advice

The camp bill is due.

One of my kid’s favorite camps delayed charging us this summer because they weren’t sure if they’d be partially or 100% online. As I sit in front of this bill, after more than a year of trying to avoid the coronavirus, I want my family to re-enter the world. We are lucky her school had strict protocols, and my work can be from home full-time.

I still worry, and my kid would tell you it’s another full-time job for me these days. While the vaccine has been shown to prevent hospitalization and death — which is excellent news — some people can still get sick from the virus. And while my teen will qualify for a vaccine once it’s approved for emergency use by the US Food and Drug Administration, people with children under age 12 don’t have an answer yet.

And that vaccine doesn’t change the past.

One friend lost her beloved father; another her mother. A third friend lost two of her uncles. They had to say goodbye over the phone. Over the phone. No in-person funerals or memorials for any of them. When I say to my family that we can wait a little while longer to get together, I am thinking of these friends.

I’m also thinking of my dear mother, who is 84 and still amazingly saying, “Do not visit yet.” Really? She is firm in her conviction that we will not get on a plane and rent an expensive car to see her in California — and take her out for Mexican food or burgers and the Monterey Bay Aquarium. “Not yet,” she repeats. “Maybe soon.” We have traditions to start up again. Pools to swim in, oceans to play in, games to play, people to hug.

I turned to CNN Medical Analyst Dr. Leana Wen to help struggling parents in the sandwich generation think through the tough choices summer holds. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s also the author of the forthcoming book “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Can we spend time with my teen’s friends?

Dr. Leana Wen: The short answer is yes. The longer answer is a bit more complicated. It depends on three things: the type of activity involved, the risk profile of your household and your risk tolerance.

As we’ve said throughout the pandemic, it’s safe to see one another outdoors, with people from different households spaced at least 6 feet apart. That’s certainly the safest way to hang out when you have “mixed” households — households with a combination of vaccinated and unvaccinated people.

Now, there’s increasing evidence that outdoors is just so much safer than indoors. One study out of China found only one documented case of outdoor transmission among more than 7,000 infections. The US Centers for Disease Control and Prevention now says that unvaccinated people can be outdoors, without masks, if going on walks with their own households. They should still wear masks if going on walks with friends from different households or getting together for backyard events, if they’re not keeping 6 feet apart.

I think the CDC guidance is too cautious here. I actually think most outdoor events are safe, even for unvaccinated people. I’m fine with my 3-year-old son playing outside with a few of his friends without masks. Any time he’s inside with others, though, he wears a mask, and so do the others.

Risk profile and risk tolerance really matter too. You’d add more caution if you have a child who is severely immunocompromised — such as a child with cancer on chemotherapy. And people also have different levels of risk tolerance. They will look at the same data and come up with different conclusions.

Take the data about children and coronavirus, for example: More than 3.7 million children have been diagnosed with Covid-19. Based on data from 43 states, New York City, Puerto Rico and Guam, 296 children have died from coronavirus. Some will look at this data and say they want to take all the necessary precautions while their children are not yet vaccinated. Others will interpret it to mean children are at far less risk than adults, and that it’s OK to resume many pre-pandemic normal activities once the parents are vaccinated.

CNN: Can my kid go to in-person camp?

Wen: That again depends on the camp and the precautions involved, as well as the risk profile and tolerance of the family. Let’s say that your child is generally healthy, and the family wants to be on the cautious side. I’d take a close look at the camp that you’re thinking about. Talk to the person in charge and make sure their Covid-19 protocols align with the CDC recommendations.

Ask about what mitigation measures are put into place. Ideally, kids are outdoors as much as possible, and when indoors, there is good ventilation. Beyond that, are masks required every time kids are indoors? Will children be separated into pods? Is there strict symptom-checking enforced? How will you find out if another child tests positive, and what kind of quarantining procedures are in place? Are the staff required to be vaccinated?

If the camp is a sleep-away camp, it’s possible that all the children and staff are considered to be in a pod with one another. A CDC study has found that this could be done safely, but with a lot of preparation — such as required pre-departure testing, quarantining for a period of time in pods, then another set of testing. If all that’s done, children can potentially play with one another without restriction, including no masks or distancing.

CNN: Can we drive four hours to see vaccinated grandparents?

Wen: Yes. The CDC says that a vaccinated household can see a household in which some people are not yet vaccinated, as long as the unvaccinated ones are not at high risk for severe outcomes from coronavirus. You can definitely take a drive to see the vaccinated grandparents.

CNN: Can we travel across the country to see vaccinated grandparents?

Wen: This depends on risk tolerance and the importance of the visit. The risk of flying itself is relatively low. Planes require masking, and there have been few documented cases of in-flight transmission when this very important protective measure is used.

That said, not everyone will keep their masks on during the flight, particularly if they eat and drink. Little children may find a cross-country flight difficult as it is, and even more so with a mask on for that length of time. Then there are the very small children, like my 1-year, who can’t really wear a mask yet. That’s why we are deciding not to visit South Africa, where my mother-in-law lives, just yet. An 18-hour flight with a rambunctious 3-year-old and a 1-year old who can’t yet use a mask isn’t something we want to do at the moment.

What you decide will depend on your specific situation, too. If the visit is very important — to see an ill grandparent, for example — and the children are a bit older or are better at traveling and masking, that would tip the scale in favor of going. If the kids are little, and it’s possible for the grandparent to travel, it might make more sense for the grandparents to visit the kids instead of the other way around. But the risk of the travel itself to the unvaccinated kids is pretty low.

CNN: Given the expected upcoming FDA approvals, do you see most 12- to 15-year-olds getting vaccinated this summer, before they head back to school?

Wen: I think there are many, many children — and their parents — who are very eager to see this group get vaccinated before returning to school in the fall. These kids are eager to get back to as close to “normal” life as possible. Vaccination is a layer of mitigation that could replace other layers and allow a lot of pre-pandemic activities to return safely. Youth sports have been a source of outbreaks, for example, but they can proceed with few concerns if everyone participating is vaccinated. Teens who want to have sleepovers and indoor meals together can do this again when they’re vaccinated. And a lot of families will have peace of mind when everyone is protected. As with adults, I expect we will have one group that’s very eager to be vaccinated that will go first; then others will see their friends get vaccinated and want to get the benefit of the vaccine, too.

CNN: What do you expect for fall? Will schools be back for full-time, in-person learning?

Wen: I expect so, yes. We now know that schools can be some of the safest places for children, as long as mitigation measures like masking are followed. I expect the fall will be even safer, as infection numbers decrease and more adults and older children are vaccinated. Some mitigation measures will still need to be in place, and increasing vaccinations will be key.

Remember that we have two reasons to get vaccinated: to protect ourselves from severe illness due to Covid-19 and to cast the protective effect of the vaccine over the community. There will be some, including younger children, who are not yet able to get vaccinated. We get vaccinated, in part, to also protect them. That’s our continued obligation to one another.