As a practicing primary-care doctor, I fully empathize with parents who worry about their unvaccinated kids’ potential exposure to the coronavirus. Raising my own children is a daily exercise in vulnerability. One rainy night this summer, my teenage son, a new driver who was running late for a babysitting job, asked for my keys. “Can’t you walk there instead?” I pleaded. He rolled his eyes. I let him use the car, but not before peppering him with reminders to be careful and to use the headlights and wipers. Shielding my kids from danger is a fundamental instinct; tolerating risk for them is hard emotional work.
So I understand why many parents were alarmed when, on July 27, the CDC’s director, Rochelle Walensky, said that vaccinated people infected with the Delta variant could transmit the virus “with the same capacity as an unvaccinated” person. For people who thought that the pandemic was ending, her televised statement was like the scene late in A Nightmare on Elm Street when Freddy Krueger’s claw reaches up from within Glen’s bed and pulls him in.
The phones at my office started ringing immediately. “Are my kids no longer safe around me?” “Should we cancel our trip to visit the grandparents?” “Do the vaccines not work like they used to?” Since then, reports that pediatric hospitals are filling up with COVID-19 patients in states with low vaccination rates has heightened the perception that children are uniformly in danger.
For most of the pandemic, children were assumed to be at low risk of serious illness from the coronavirus. But recent developments are naturally triggering many adults’ protective instincts. Although the evidence calls for prudence, not panic—even as the Delta variant spreads—many parents will struggle to keep fear from racing ahead of the data.
Hopes were high during the spring and early summer, as vaccination rates rose and hospitalization rates fell. Kids enjoyed indirect protection from COVID-19 as more adults became immunized. A relatively normal return to school in the fall started to seem possible. Even now, some reassuring facts remain: So far the Delta variant isn’t thought to be more lethal than prior variants. Although clearly more contagious, Delta doesn’t seem to specifically target kids. No one should be surprised that nonimmune children account for a bigger share of the total number of infections as more adults get vaccinated. Although cases are certainly increasing among children as well as adults, a recent report by the American Academy of Pediatrics shows that 0.9 percent of COVID-19 cases in children have resulted in hospitalization—a slight increase since the spring but well below the corresponding percentage for most of last year—and 0.01 percent have resulted in death.
A recent peer-reviewed study in Britain of nearly 260,000 children (1,700 of whom showed symptoms) reminds us that for most kids, a coronavirus infection will manifest as the common cold—if anything. Also reassuring is that only 4.4 percent of children diagnosed with COVID-19 in this study had symptoms after 28 days (and 1.8 percent after 56 days). Probably not surprising to any parent, about 1 percent of kids in this study who had upper-respiratory symptoms and tested negative for COVID-19 also had lingering symptoms at 56 days—a reminder that COVID-19 is only one potential cause for a child’s malaise.
Abundant evidence indicates that coronavirus transmissions rates in schools are roughly equal to or less than those of the surrounding community. In other words, educational settings are not inherently dangerous for younger children. This should reassure parents and policy makers who are nervous about sending them back to the classroom.
I do not dismiss the continuing danger that COVID-19 presents to kids. As of August 11, the CDC’s National Center for Health Statistics reports, more than 350 children (out of 74 million) across the United States have died from COVID-19 since the beginning of the pandemic. (For perspective, we’ve lost more than 600,000 American adults to COVID-19, and adults older than 85 are more than 600 times more likely to die from the disease than kids are.) Pediatric hospitalizations are rising in regions of the country where vaccine uptake is low. Long COVID—though rare in children, at least before Delta—can cause lasting symptoms for some otherwise healthy youngsters.
But fragmentary data and muddled messaging from the CDC and elsewhere have stoked the public’s collective fear—especially among parents. The “younger, sicker, quicker” narrative—which asserts that Delta infects people more intensely and at an earlier age—has taken hold on TV news and social media. The Delta surge has also created new opportunities for grifters, anti-vaccine propagandists, and others to spread misinformation that preys on parental anxiety.
Not all fear is irrational; some is actually required for survival. When parents are faced with a perceived or real threat to their children’s safety, stress hormones pour into the bloodstream, allowing us to sprint from danger, maintain alertness, and react quickly to sudden changes in our environment. During the coronavirus pandemic, individual vigilance has been essential to interpreting and responding to the steady stream of new information.
Being constantly wired like this nevertheless carries a cost: Rational thought is hijacked. Our risk tolerance goes down. Our instinct to protect shifts into overdrive. We default to primitive thought patterns including black-and-white thinking (School isn’t safe until all kids are vaccinated) and catastrophizing (My child’s runny nose will probably land him in the hospital). We also engage in filtering, a cognitive distortion whereby we sort through masses of information and latch onto specific ideas that reinforce a personal fear (After reading that ICU doctor’s Facebook post about a hospitalized infant, I’m certain my child will get sick with COVID-19).
Marinating in a toxic brine of fear and uncertainty can make us sick—whether from fatigue and insomnia or irritability and burnout. And when our children hear us processing endless loops of what if thinking, they can become worried and depressed too. Fixating on a single threat to children’s health can keep us from recognizing their broad human needs. I too can be a victim of my own mental gymnastics. (Just ask my kids.)
Reclaiming rational thought amid ongoing uncertainty can be vexingly difficult, yet it is crucial for our health. Parents must first absorb the scientific evidence on Delta. We must cross-check our internal narratives about our own kids against the facts of our local public-health landscape by checking in with trusted health-care professionals.
Next, we must accept the unpleasant reality that risk is everywhere. Children face many serious threats to their well-being, including other diseases, mental illness, and accidents. Vehicular crashes kill more than 1,000 Americans younger than 15 each year. Yet we’ve accepted this risk; we also don’t revisit it with every news story about a car crash.
When my patients ask me whether a given activity is safe, I usually tell them the answer isn’t a firm yes or no. Absolutism itself can do harm. Rather, I ask about individual patients’ circumstances, explain medical evidence, and try to help frame their decision by offering advice about relative risks and benefits. As with fear, risk cannot be eliminated; it can only be mitigated. Health stems from allowing fear to protect us from dying but not allowing it to prevent us from living.
Similarly, victory over COVID-19 will require accepting our perilous reality, releasing ourselves from the impossible task of eradicating danger, and relishing the sometimes-immeasurable reward that comes from tolerating risk. Had I prohibited my son from driving that rainy night, for example, he might have lost his job—or, worse, his faith in how much I trust him.