Weigh the risks and benefits of activities to keep your unvaccinated children safe

Editor’s note: As the Delta variant pushes Canada into a fourth wave, Healthy Debate Editor-in-Chief Seema Marwaha discusses how to keep our children safe for the rest of the summer. This Q&A is adapted from a CBC interview broadcast on multiple CBC radio stations.

How do you stay safe with unvaccinated children under 12 this summer, especially with the Delta variant on the rise?

It’s easy to get caught up in the small details regarding safe activities with children. And the rules can be confusing, especially because it differs province to province.

The most impactful thing we can do to protect unvaccinated children is get everyone who is eligible vaccinated. But being vaccinated does not guarantee you won’t get infected and transmit, so we must continue to follow key public health measures of masking and distancing.

There are two big picture variables to consider when deciding if an activity is safe. The first is how crowded and ventilated a space is. The second is the current COVID-19 variant situation in your province and city.

Pick distanced, outdoor activities preferably. For indoor activities, try to gather as much information as possible about the vaccine status of others, number of people in attendance and ventilation/size of the space. If you’re planning to go to a densely packed restaurant or arena where you don’t know the vaccination status of others, your risks are much higher than if you’re in a less crowded and open place.

Mask when indoors and be extra cautious if your local case rates are high.

It’s also important to think about the risks and benefits of summer activities. Activities are important for mental health, development and bonding. But they also need to be safely done as children and unvaccinated adults are an important part of the transmission of COVID variants.

What do we know about whether Delta has affected young children?

What we know is that it is more transmissible. It’s unclear if it causes more severe infection in adults or children. But since there is a vaccine available – like with the flu – any childhood morbidity or mortality is preventable.

Throughout the pandemic, children’s risk of serious illness and death has been significantly lower than that of adults, but it is not zero and more than we see in a bad flu year. We also know children can develop long COVID, and we’re unsure if those issues will be permanent or eventually be resolved. There is also the rare but severe post-infection, multisystem inflammatory syndrome in children (MIS-C) that can be quite severe.

The Delta variant just amps everything up because we know it’s more transmissible, and children are one of the largest unvaccinated groups.

Are there activities vaccinated parents should avoid if they have young children – like going to work?

For vaccinated parents, we advise them to follow the public health guidance of masking indoors at workplaces and public places – especially when you don’t know the vaccine status of those around you.

Vaccinated parents can still get infected. They will have some amount of virus that they can spread even if it’s less than if not vaccinated. Also, a “breakthrough infection” among vaccinated people is still very rare but can happen. Be hypervigilant if you live in an area with increasing case counts.

Are children safe in group activities – like camp, sports games or amusement parks?

First and foremost, any child with flu-like symptoms should not be participating. Period. This is important to get across.

Outdoor sports and activities don’t pose huge risks. If possible, masking should be maintained, especially if it’s crowded or close contact.

For indoor activities, I would look at the local case rates and the ventilation of the indoor space. If case rates are low and the activity is in a large, well-ventilated gym, that is lower risk. Crowded indoor spaces should be avoided for all unvaccinated people, including children. And we are recommending masking indoors for most activities at this time.

Day camp activities are usually outdoors and safe. Masking when indoors is recommended and I would ask what the mitigation plan is for rainy days or overnights. I have to mention that the child development benefits of camps can be huge and I’m in favour of these as long as masking and distancing can be maintained, and good measures are in place.

This may change if case rates sharply increase in your area because extended time with others increases the risk of transmission, even outside.

Any restriction on indoor family activities, like multigenerational reunions, family dinners or weddings?

My take on this is that each activity is an important risk-benefit calculation

For example, if vaccinated grandparents or aunts/uncles want to visit with children indoors, the risk of infection is pretty low and the human contact and family time is so important for all parties. But if someone is unvaccinated or immunocompromised, this might change what you do.

For larger events, like weddings or family reunions, try to gather more information, like: where are attendees coming from; how many people are attending; how many are vaccinated; what medical conditions do people have that might put them at risk; and, how much of the event is indoors.

Public health guidance suggests that large indoor gatherings are where transmission might be the highest. But family interactions are very important for child development, as is maintaining family ties in a year as stressful as the last one

We are getting to the point where parents must make a risk-benefit calculation and decide. Carefully consider the risk-benefit of each of these activities on a case-by-case basis and opt for outdoor gatherings when at all possible. The pandemic is not over, and variants are on the rise.