With COVID-19 vaccinations available for ages 12 and older, Atlanta Parent checked back in with Dr. Andi Shane, a mother and a pediatric infectious diseases expert at Children’s Healthcare of Atlanta and Emory University, to discuss the importance of vaccinations, as well as how to plan safe summer fun.

Andi Shane

What would you tell parents who are hesitant to get the vaccine themselves?

The first step in any discussion about vaccine hesitancy is understanding why a person is hesitant. I would ask the parent why they are hesitant to help frame the discussion and make sure that I address their concerns. The COVID-19 vaccines have been thoroughly studied in clinical trials and subsequently as millions of doses have been given. The vaccines are safe and effective and are our key to protecting every individual and the community in which they reside.

What should parents know about getting their teens vaccinated?

Most teens have fewer side effects from vaccination than those experienced by adults, and we are also seeing encouraging results suggesting that rates of protection may be better than in adults. COVID-19 vaccination is the key to being able to return to and live a pre-pandemic life.

What can parents do to continue to protect their younger children who are unable to vaccinate?

They can vaccinate themselves and advocate for everyone around them who is able to be vaccinated to do so to optimize “herd protection.”

How should parents assess the risk to their families when planning their summer?

I would suggest that families consider who will be traveling, their vaccination and overall health status, and their ability to comply with mitigation efforts (masking, hand hygiene and physical distancing). I would consider the destination, activities at the destination, and how the family would travel to reach the destination. Traveling with members of your household and/or fully vaccinated people is safer than mixing with those who are not. Car travel with immediate family and planned stops in less crowded locations are safer from an infectious perspective than airplane travel. Outdoor activities are safer from an infectious perspective than indoor activities. When in doubt, mask.

What should parents keep in mind for summer vacations and traveling?

Anyone who is unvaccinated older than the age of 2 years should remain masked during travel. Try to avoid popular travel times to decrease exposure potential.

What should parents keep in mind about indoor vs. outdoor attractions?

In general, outdoor activities pose less of an infectious risk than indoor activities, but one must also consider the density and vaccination status of the people in each of these settings and whether unvaccinated people will be masked or unmasked. As this is usually unknown, participating in outdoor activities with few people and maintaining distance, along with hand hygiene, is optimal.

What family activities are safe to do with younger children?

Outdoor activities, such as visiting a zoo or gardens, hiking or swimming/water play are activities that are less likely to pose an infectious risk.

What about dining out as a family?

As with everything, there is a gradation of risks starting with low risk with drive-through/takeout, followed by medium risk with on-site outdoor dining with tables spaced at least six feet apart. On-site dining indoors with tables spaced six feet apart or outdoor dining without six feet separation probably represents the highest risk.

What’s your advice to parents who are trying to determine how they’ll school their children for the 2021-22 year?

In-school instruction is a personal choice, and every family needs to make a decision based on what works best for their child and their family. We have increasing evidence that secondary transmission (infections resulting from infections in children and staff at school) is rare. In addition, as more people 12 and older are being vaccinated, the risk of transmission in the school setting is reduced even further. We also know that the social, emotional and developmental opportunities afforded by in-person instruction far outweigh the risks of infection transmission. However, as a pediatrician specializing in infectious disease and epidemiology, we still need to be safe. This means ensuring that students and staff are completely asymptomatic before going into the school environment, emphasizing hand hygiene and masking, and reminding students about reporting symptoms immediately.

What guidelines do you have for masks?

Until we have universal vaccine availability to all ages, I would recommend that unvaccinated people older than the age of 2 years wear a mask.

Should masks still be worn in situations where it’s unlikely you’ll be able to socially distance?

Yes. I would also like to emphasize that hand hygiene before removing or placing a mask on one’s face or on a child’s face should occur. In addition, minimizing mask manipulation is important as contaminated fingers and hands are one way that SARS-CoV-2 and other viruses may be transmitted from person to person.

What’s your advice for handling gatherings with extended family, friends or neighbors?

My advice would be the same as for travel. I would strongly urge everyone who is eligible to be vaccinated and for organizers of gatherings to consider vaccination status as they compile invitation lists. A recent invitation to a social gathering that I received requested that unvaccinated or incompletely vaccinated people older than the age of 2 years to continue to mask while in attendance at the gathering. It also stated that masking is encouraged for comfort as well. It was simple and straightforward.

What should parents keep in mind about the future of COVID-19?
Whether or not we reach the vaccination threshold for immunity, it is likely that we will need to coexist with SARS-CoV-2. We are likely to see increases and decreases in rates of infection and circulation of SARS-CoV-2, the emergence of variants and the possibility for a need for a booster vaccine. All that is to say that adherence to the basic preventative measures and making informed choices are the way to coexist with this virus and others.

Do you have any other advice for Atlanta families?

During the past year, many people understandably felt despondent, fearful and without a sense of control. As a parent, this can be very challenging, especially as we try to shield our children from an environment in which this sense of control is lost. I do think that it is important to remember that everyone can do their part to protect themselves, their families and their community. It is important to stay informed and up to date and to receive information from trustworthy sources. It is important to ask questions and to learn as we all have been doing daily; even for those who consider themselves to be experts.

What are you looking forward to doing with your family this summer?

We will be exploring Georgia with local hikes and outdoor activities. We have started finding local trails and waterfalls and enjoying family time together as we explore.

What are you looking forward to as the world returns to the normalcy of pre-pandemic times and more people are vaccinated?

We have all learned a lot about ourselves and the community in which we live during the pandemic. I look forward to seeing people’s facial expressions, especially the children for whom I provide care and their parents. While continued masking is important in certain situations, it is wonderful to be able to share a smile with a friend, colleague or neighbor.

From February 2021:

There’s a lot of misinformation about vaccines. What should people understand about vaccines?

In general, vaccines are the best tools we have against preventing infection. Along with hand hygiene, vaccines have been an important contributor to public health. Vaccines are an excellent way to create population immunity (or resistance to having disease) without having the actual disease. Vaccines provide a non-infectious way to make the body think that it has had an infection, so the next time it sees a bacteria or virus, it automatically mounts an immune response. Vaccines are a safe way to get our own immune system to be a fighter for us.

COVID-19 vaccines have been shown to be safe and to result in very high levels of immunity, with few side effects. The short time period in which COVID-19 vaccines were developed and studied is the result of a huge investment of time and money in partnerships between scientists, industry and government. The COVID-19 vaccines that are currently available build on technology that has been known for about 30 years. Up to now, there has not been an opportunity to use this technology; however, the virus that causes COVID-19 is one that this technology is very effective in combatting.

What would you tell people who are nervous about the COVID-19 vaccine?

I am more nervous about the COVID-19 disease. Although most infections in children are mild, there are rare complications that can occur 3-4 weeks after mild COVID-19 in some children. Widespread vaccination offers us the best chance to protect ourselves from infection. With time, as more people become vaccinated, we will likely see lower rates of transmission in the community. Without vaccination, we will continue to see high rates of illness and death. Since COVID-19 vaccines are currently available only to certain groups of people, we need to have as many people as possible who can get vaccinated do so.

Right now, we have two vaccines. One vaccine was tested in people ages 16 and older and one in people ages 18 and older. There will be clinical trials opening soon for older children and young adolescents to understand how the vaccine protects in these age groups. Like the trials in adults, there will be extensive efforts to make sure that COVID-19 vaccines are safe and work well in children.

Quarantine may be tough on some kids who haven’t gotten to hang out with their friends in a long time. What are your thoughts on meeting up for outdoor play, such as a hike or at the playground?

The surge in cases is due to the fact that people gathered over the holiday season. We know that shared time with people who you do not live with results in transmission. Increased risk is associated with activities in which people are less than six feet apart and unmasked. Indoor activities are more likely to result in transmission than outdoor activities. There are gradations of what is safe. The least risk of transmission is to stay apart and interact only with your own household, do everything virtually, and wear masks when you leave your home. Next, would be to get together in small pods or classroom settings in schools, adhering to masking, distancing and hand hygiene. Also, if you choose to get together in small groups, keep the number to less than 10 (adults and children), remain masked, use hand hygiene before and after interacting, avoid eating and drinking, and try to remain outside. Although children may have symptoms of illness for reasons other than COVID-19, we must assume that every symptom could be related to COVID. Therefore, children with symptoms should not join playgroups or attend gatherings.

What is your advice for helping kids or adolescents who are having a hard time behaviorally or developmentally?

The lack of interaction and socialization is challenging at every age, but especially challenging for adolescents. Younger children may “act out” or regress, as they know that they are not in daycare or school, they know they’re not seeing their grandparents, they know this is not normal. Children’s Healthcare of Atlanta has put resources together to address some of those challenges. The American Academy of Pediatrics also has resources for parents and adolescents. Children and adolescents who are feeling depressed, anxious or sad may benefit from a visit to their pediatrician. Many counselors and therapists are conducting video consultations and appointments, and your child or teen’s pediatrician can help connect you to these resources.

What advice would you give to parents that are wondering about spring birthday parties or holding birthday get-togethers outdoors?

It’s hard to predict the future. Right now, the healthcare system is challenged. As more people become vaccinated, we are hopeful that fewer people will be ill. Everything is a balance. Smaller outdoor gatherings with less than 10 people who are completely asymptomatic, wearing masks and who may be together in school may be a way to balance socialization and remaining safe. Be creative about activities that don’t involve close physical contact or air exchange. If food is served, choose individual servings, such as cupcakes rather than a cake, no candles or bubbles, and seat children more than six feet apart.

Looking to the future, what would you tell families who are trying to determine their summer vacation or summer camp plans?

As above, it is hard to predict the future. I would recommend that families make plans that can be altered if needed. Prior to the holidays, Georgia’s rates of COVID were decreasing; however, after many people traveled both into and out of Georgia, rates of COVID have soared in our community. There are many opportunities for transmission of the virus when you interact with people you are not around every day. Testing before traveling tells you if you have evidence of the virus that causes COVID-19 at the time that you are tested, but it does not tell you if you will have the virus in your nose at the time that you socialize with family members. Many people have received a false sense of security by testing “negative” before traveling and have developed COVID-19 after traveling and interacting with others outside their homes.

Summer camps that are adhering to public health guidance may be an option for children. However, it is important to remain flexible and to balance and weigh options of your family’s individual situation and needs.

What can parents do to continue to protect their children?

Continue to enforce masking, hand hygiene and social distancing. Even though we have seen very, very low rates of influenza, make sure that everybody in your family receives a flu vaccine. Make sure that all of your child’s immunizations are up to date and that your child continues to receive care from your pediatrician. Most importantly, make sure that your child stays home when they have symptoms of an illness.

From our August 2020 issue:

What is your advice to parents who choose to send their kids back to a physical school vs. parents who choose online schooling or homeschooling?

The infectious disease community would recommend choosing one or the other. If your children are going back to school, we want to keep all the same children together as much as possible. That way, there’s less chance of transmission. When you mix groups, transmission is more likely to occur. Try to commit to a decision, which seems very challenging for a parent to do now, but it makes the most sense. Whatever is chosen, it should be something parents can adhere to most of the time.

Some schools are doing half-days or every other day, which could be more difficult. When children are not in school, they may be mixing with other peers outside of school, with the potential for transmission. When they’re engaged in school-related activities, there’s a structure for what children have to do every day and that is more likely to keep infections down. When there’s free or unsupervised time, that makes it more challenging. If they choose online, that choice should be respected, and they should maintain it throughout the school term, for all the reasons we have talked about. When the child goes outside of the home or interacts with other children, make sure they’re masking and social distancing, and try to keep the same group of children the child socializes with together.

How can parents distinguish between COVID-19 and common colds?

Be attuned to your children’s symptoms. It can be hard to know what is a regular cold and what might be more involved than that. Use symptoms to decide whether or not to keep the kids at home. If the child has a temperature or fever, keep them at home. Have them remain at home for 24 hours to see if symptoms progress. If a child has had contact with someone with known or suspected COVID-19, they should follow public health guidance and remain isolated at home. They might not have the COVID-19 infection; we’re coming up on the respiratory virus season, and they could have influenza, cold viruses, other viruses. A symptom-based approach is the optimal way to determine the child’s illness.

Any other health tips?

As we’re entering the respiratory virus season, it is very, very important for parents
to make sure that they and their children receive their flu vaccines as soon as it becomes available. It’s not perfect, but it does the best it can at preventing and decreasing severity, hospitalizations and death. It’s something parents can actively do to protect children and themselves. Make sure children are up to date on other vaccines, and get up to date before they go back to school. Whether or not they go back to school, they’re going to interact with other people, and vaccinations help prevent  other infections.

Many parents feel overwhelmed at their inability to control much during the COVID-19 pandemic, but hand hygiene, masks, social distancing and immunizations are things you can actively do to prevent diseases.

What would you tell parents who are trying to determine if it really is safe for them to go out and about, even with the new protocols in place?

Attractions have done a nice job adhering to guidance from the Centers for Disease
Control and Prevention and the Georgia Department of Public Health. At most places, you have to make an appointment or sign up, they’re limiting the number of people, and children older than age 2 wear a mask. Outdoor attractions are a little different – there’s less chance of transfer.

Are playgrounds, pools, splash pads and waterparks safe?

In those situations, there’s not normally a ticket or reservation. Parents have to use
their own judgement. The recommendation is to limit gatherings to less than 10 people, which is a good marker for families to use. Assess how crowded a playground is, and if it gets more crowded, remove the child. Use appropriate hand hygiene before and after. Children can adhere to guidelines differently. If they’re not able to mask or not able to follow directions, these attractions may not be a good idea at this time; consider other locations.

What advice do you have for a summer vacation?

In general, driving is less likely to bring people together with unknown people. It’s a safer way of getting from location to location. If you stop at a rest stop or a restaurant, hand hygiene, social distancing and masks are necessary.

Try to avoid large crowds, so parents can control who they and their children interact with. It’s really important to bring down the amount of activities a child will participate in. This guidance goes to parents, too. Parents socialize at night after the kids have gone to bed, and being in public places, bars or venues with large numbers of people who can’t social distance is more likely to cause transmission. Being with the same group of people in an uncrowded environment is the best way to think about a family vacation.

How should children properly wear a mask?

Use cloth face masks, and I encourage families to have multiple masks. Washing once a day is reasonable. If it gets soiled, wet or comes into contact with the secretions of someone else, you should replace the mask at that time, so it might be a good idea for parents to have several on them. It has to cover both the nose and the mouth at the same time. We’re seeing a lot of people who are only covering their mouth, but these are the two parts of the face you want to cover. Make sure it fits well, and you want kids to be comfortable in it. They may need to wear it inside the home to get used to what it feels like. Remind them not to touch the mask. Practice hand hygiene before and after taking the mask off or replacing it. If kids are at an appropriate age, make it into a game: wearing a mask can make you like a superhero, like Batman.

I have a 6 1/2-year-old. He went to camp with a Star Wars mask and came home with a Batman mask. I asked him what happened to his mask, and he said he and his friend traded at the end of the day. Remind them to wear their own mask and not to exchange them.

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