How Parents Should Think About Omicron

The Omicron variant is spreading widely and risk for infections is higher than before. This creates uncertainty for parents, especially those with children too young to be vaccinated. We asked two experts about how to think about risk for children. Their answers have been edited for length and clarity.

The experts

• Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health who focuses on infectious diseases. Dr. Nuzzo is also a parent to two children, ages 5 and 8, who attend public school and are fully vaccinated.

• Dr. Peter Hotez, a pediatrician and scientist at the Baylor College of Medicine who studies vaccines. This includes a Covid-19 vaccine called Corbevax, intended for low- and middle-income countries.

My children are too young to be vaccinated. How should I think about Omicron’s risk generally?

Jennifer Nuzzo: I know many parents in this situation who are very worried. I really feel for them. Being a parent to young children is terrifying enough when it’s not a pandemic!

I generally try to encourage people to think of risk in two ways: the risk of getting infected and risk of becoming seriously ill. A high level of infection in the community does increase the risk of infection in all ages. With the likelihood that Omicron will drive an increase in Covid cases in communities, the risk of infection is, unfortunately, increasing.

But vaccinating children isn’t the only way to protect them. Generally, we’ve seen that we can increase the protection of unvaccinated children by ensuring that the adults in their lives are vaccinated. This remains an important way to protect children who are too young to be vaccinated.

You can also reduce the risk that your child will be exposed to the virus by avoiding crowded, indoor spaces and other gatherings, using rapid tests before social events and having adults wear masks around your young children.

Regarding the risk of disease in young children, fortunately, all the data we have suggest that the risk of their developing severe illness if they become infected is much lower than for adults and teens. New data also show that the risk of “long Covid” among children is low, too. I would take more precautions if I had an infant under 12 months of age, as they may have a larger risk of severe illness than toddlers. But, fortunately, it’s easier to limit infants’ exposure as many are not fully mobile at that age. Children with underlying health conditions may have a greater risk and parents should consult with their child’s medical provider for specific guidance.

While it’s still early, we’ve not yet seen any data from the Omicron variant to make us worry that the risk of severe illness among children has changed. These relatively low risks and our ability to lower them further may help ease some anxieties over the next few months.

Peter Hotez: I agree. I would also add that in South Africa, we have seen young children require hospitalization with the Omicron variant. However, some of these children may have been hospitalized with Covid, but not for Covid. It’s unlikely that Omicron is selectively targeting children, but because the variant is so transmissible it can create a firestorm effect, and children get swept up in the firestorm along with adults. Something similar happened with children and the Delta variant here in Texas over the summer.

My child’s school has closed one grade because of new coronavirus cases. Are the other grades really safe?

Nuzzo: Public health experts prefer to talk about safety in relative terms — “safer” over “safe.” In general, schools that employ mitigation strategies can be safer environments for children than other community settings.

Serious disease risks in kids have been low throughout the pandemic. And school-age students now can get vaccinated to further reduce their risk of serious disease. The details are important. For example, what did the school’s contact tracing efforts conclude about the likely source of common exposure? Often, when there are infections in a classroom, they may not have resulted from an exposure at school, but rather a social or extracurricular activity that classmates attend.

Generally, cases among exposed contacts in school settings are quite rare. This risk can be reduced if schools implement “test to stay” strategies: Instead of requiring contacts of cases to quarantine, rapid tests are used during what would have been the quarantine period to determine if contacts of cases are safe to attend school. The Centers for Disease Control and Prevention recently endorsed this policy.

Hotez: There are not many silver linings in this Omicron wave of infection, but at least it’s now accelerating during a time when children are being sent home for the winter break or holidays. Therefore, K-12 schools and most colleges and universities won’t be in session at a time when infections are at their worst. In January there may be some delayed openings, especially if we are already at the downslope of this new wave and there is added benefit by waiting an extra week or two. But like any new variant, we really won’t know, until we know.

Does Omicron present a larger outdoor risk than Delta? Should children be masked on playgrounds?

Nuzzo: I’ve not seen specific data that Omicron poses an increased risk of outdoor transmission. With any of our safety measures, we have to balance how much protection the measure will add versus the degree of disruption it will cause. The most important place to mask is indoors. Some kids are perfectly happy wearing masks on playgrounds, especially if it’s not too hot. But other children really benefit from having mask breaks.

My children’s school does not make them wear masks during outdoor recess and my children are very grateful to get a break from wearing masks in school all day. I support this. Our family generally doesn’t wear masks when we are outdoors, but we do wear them if we are in crowds.

Can we take children to indoor masked events like the theater? What about places like museums?

Nuzzo: The answer to this question depends on your children’s specific situation and your level of risk tolerance. My children are both vaccinated, so I feel comfortable taking them to museums. If they had underlying health conditions such that I worried about their level of protection from the vaccine or their risk of developing severe illness were they to become infected, I would likely try to avoid to a greater degree crowded, indoor spaces.

Before my children were able to get vaccinated, we were more selective about where we took them and prioritized going to those places that provided social or developmental benefits. I would consider taking them to the science museum, though I would prefer to visit in the summer when community transmission was lower.

How should we view play dates for vaccinated or unvaccinated children?

Nuzzo: The safest play dates are those with other vaccinated kids with whom your children already have regular exposure, such as classmates. Before my children were vaccinated, I preferred outdoor play dates. We have not yet done indoor play dates, but I would generally feel comfortable doing this now that our whole family is vaccinated and given the importance of playing for children’s growth and development.

Hotez: Here in the southern part of the country it’s usually nice enough weather for kids to play outdoors, or if they are indoors to leave a back door or window open to the outside to encourage ventilation. Otherwise, I agree with Jennifer.

My children are vaccinated, but we are hoping to have a small holiday celebration with older or immune-compromised family members. Should we rethink that?

Nuzzo: It is possible to gather relatively safely, given that everyone is vaccinated. Rapid tests and masks would add layers of protection. Ultimately, the decision should be up to the family members who are at risk. They should decide what level of additional risk they are willing to tolerate to get the family together.

Hotez: I think it depends on the level of underlying risk based on either age or the extent to which individuals are immune-compromised. It also depends on when the most susceptible people in your group got their booster, since recent studies show that protection against illness with symptoms can wane a few months after the booster.

What about large family gatherings?

Hotez: The more people in a gathering, usually the higher the risk. I would discourage this during the Omicron wave. But if you are going to gather, I recommend everyone be fully vaccinated and boosted and that people use rapid tests and masks and increase ventilation by opening windows.

My family includes kids too young to be vaccinated, and we are not planning to make major changes to the precautions we already take. We send our kids to school (masked) and attend church (masked). We do rapid tests when someone has symptoms. We plan to visit family over Christmas, including two over-70 grandparents. Are we being foolish?

Nuzzo: I know some people are fundamentally changing their behaviors in response to rising cases because they don’t want to contribute to increased transmission or stress on the health system. I greatly appreciate and support those efforts. But, as a parent, I find it really hard to do this after nearly two years of keeping our kids at home, out of school, away from relatives during holidays, etc.

So I think a more realistic answer to give is that what you should do depends on your risk tolerance, your ability to make activities safer, and your ability to handle an infection if you get one. What you’ve described is generally how our family lived before our children were vaccinated. We prioritized going places and doing things that were most important to us as a family. For us, that meant visiting with family and close friends and going to school.

Omicron doesn’t fundamentally change how we protect ourselves. But it will increase the probability that you and your family members will be exposed to the virus as the level of infection in communities increases. But the measures we take to protect ourselves from the virus remain the same.

I still think it’s possible to gather safely with family, especially if everyone who can be vaccinated is. Rapid tests right before gathering with people you haven’t seen in a while can help. Good ventilation and masks help make these gatherings safer. Even if risks are low, people should be prepared for the fact that they could become infected and will have to isolate if they do.

Hotez: It is essential that everyone is maxed out on their vaccines. People who are eligible for boosters should get them. Those who have been infected previously need to get vaccinated given the high rates of Omicron re-infections. All children age 5 and older should get vaccinated.

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