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Everything you want to know about COVID-19 and kids (but were afraid to ask)

Dr. Rick Malley, pediatric infectious disease physician at Boston Children’s Hospital, gives us a dose of insight

Dr. Rich Malley said, "Whenever there’s a choice of indoor versus outdoor, it goes without saying, the outdoor choice is always better."Anatoliy -

At this point, many Massachusetts parents have gotten at least one vaccine shot. Last week, I went to an outdoor party with friends I’d barely seen in a year and it felt downright normal (until I freaked out about the one person I almost hugged. Is that allowed yet?).

But amid all this wading into normalcy, a “Simpsons” meme keeps popping up in my mind: Think of the children! What about them? We’re beginning to reassume our everyday lives, kids are playing sports and many are back in school, yet they’re not vaccinated. What’s the risk?

So I talked to one person who really knows: Rick Malley, M.D., senior physician in pediatrics, division of infectious diseases, at Boston Children’s Hospital. Here are questions that might be on your mind — I know they’re on mine — and his candid answers.


How normal will spring and summer be for our kids?

It’s a good question. What we’re looking forward to in spring, and especially the summer, is a lot of activities that can be done outdoors will replace the activities that people would have otherwise done indoors.

We can’t say with any degree of certainty what’s going to happen this summer. But as more Americans and people living in our communities are getting vaccinated — if, in fact, the total amount of virus in the community really drops, as it has, for example, in other communities that have had high vaccination rates, such as Israel — you could imagine that we’d be returning to a much nicer version of normal. There would be less virus circulating, especially when you add onto that outdoor activities where kids are at a certain distance from one another and the parents are vaccinated.

We’re not quite there yet, but it gets a lot more palatable, particularly if we can encourage, educate, and reassure people about vaccines. By April 19 in Massachusetts, everyone over the age of 16 can get vaccinated, so we can really suppress transmission.


Once you have less transmission, if you think of the events that have to happen for one kid playing with another kid outside to become infected one way or the other, the probability starts to drop significantly, because there is less virus around.

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Can grandparents visit, even if parents are just halfway vaccinated?

It would be considered very low risk. Young people still can get sick with COVID-19; kids can get sick and rarely have an unusual MIS-C syndrome, but those events are quite rare.

Even one dose of these vaccines confers significant protection against disease and probably also against asymptomatic shedding. Even with one dose, even though we want you to get your second one, you are already much better off than without any vaccine.

Why isn’t COVID-19 as risky for kids in this scenario?

There are three puzzling aspects of COVID-19 and children, and we don’t know the real explanation for all of them. It is believed that the following factors in children apply: First of all, and we knew this from the early days of the outbreak, children are much less likely to become severely ill once they’re infected with COVID-19.

The second thing we know is that children who are in the same environment as other people, adults for example, may seem to be less prone to be diagnosed as being infected with COVID-19. Even mild disease, or asymptomatic infection, might be less common. The reason we know this, or think it might be true, is by looking at the antibodies within children and adults in the same environment after an exposure. The kids have lower antibodies than you would’ve expected if infected at the same rate as adults. They are less likely to get sick and get the virus in the nose in the first place, which is interesting.


In general, when kids have been infected with COVID-19, it’s generally from an adult, not from another kid. The problem with that statement is, of course, as soon as we shut down schools and day cares, who else are they going to interact with? That’s why the data is suggestive, not proven.

What about kids in schools? How safe is that?

I think the virus has evolved, it’s more transmissible, and the line that everyone should be using is, “Schools are relatively safe, but nothing is 100 percent safe.” Unfortunately, it gets translated into, “There is no transmission in school,” which is absurd. That’s part of the messaging we’re all guilty of — we try to simplify the message that schools are safe and bars are not. In fact, it’s safer to say schools are “much safer” than bars. In bars, people are drinking and eating with masks off; in schools, most of the time, the masks are on. When they come down for eating and playing, you could envision that the relative safety of the schools might break down a little bit, particularly if the virus is more transmissible.


How can families protect their kids this summer?

Whenever there’s a choice of indoor versus outdoor, it goes without saying, the outdoor choice is always better.

A second thing you can do is [monitor] the size of the group. So, with a family with close family friends who also have kids the same age as yours — you’re taking a risk, of course, but that risk is less than if you took your child and mixed them with 10 kids from 10 different families, even if those families are known to you. You’re still multiplying the small risk that one of those kids might be asymptomatically infected. If you’re very risk-averse, it makes sense that you’d rather your kid hang out with a family that has similar ideas of how to keep their kids free of the virus.

The third thing that often comes up is travel. We have not seen a lot of super-spreading events on airplanes, but we want to make sure we don’t become complacent and start having planes packed the way they used to be.

It’s important to remember that, even if you yourself are not at significant risk of COVID-19 because you’re vaccinated and kids are healthy, if any medical complication did take place in a country that is battling COVID, their medical systems could be overwhelmed. Even if you’re vaccinated and your kids are at low risk, do you think now is the right time to go to a country where, if something that in the US would be treated very simply and quickly and effectively, suddenly becomes a life-threatening situation?


When will kids get vaccinated?

The horizon looks promising for Pfizer and Moderna; Pfizer submitted an emergency-use extension of their vaccine. If everything looks good, you could imagine that by the middle to end of the summer, we might start vaccinating teenagers 12 to 16.

For younger kids, the trials have begun, both Moderna and Pfizer, and those are going to take a little bit longer. They have to figure out what dose to use. There will be initial studies that are ongoing for what we call dose-finding; you start low and see how the child responds to slightly increasing doses, and once that’s done, they do a much larger study where they look at the dose and the age group. We could possibly expect an authorization in younger age groups by early 2022.

What will school look like in September?

If, as we hope, there’s a major impact on transmission from adults getting vaccinated and more teenagers getting vaccinated, I can imagine two possibilities. One is that schools, no matter what, will be open. The question is: Will there be enough virus circulating to justify maintaining physical distance and masks and all those things? That’s a tougher question. It will depend on how much virus is still circulating, and by then we’ll know whether these [new] variants are escaping the effects of vaccines or controlled.

We’ll also know a little more about the duration of protection. Right now, we think the vaccines are good for at least six months, but we hope it will be longer. I’m optimistic because of what we’re seeing in the UK and Israel, in countries that have implemented aggressive vaccination. We’re seeing the number of cases really being pushed down. In the United States, the numbers aren’t as reassuring. We need to continue this push to get as many people vaccinated as quickly and safely as possible.

When will we actually go back to life as we knew it before, if ever?

I think the summer will feel very different from last summer in a good way. The fall is going to feel different because more kids will be back in school, sports and activities will be taking place, but there are some very important moral, ethical, and practical questions that our society will have to tackle.

Social interactions are very important for the psychological well-being of our children and of adults. The social distancing we’ve been doing, I hope, will not persist beyond the summer, because it’s imposing a huge burden on the health of our children and young adults.

And maybe there will be greater willingness of people to say, “I have the sniffles; I’ll work from home today,” without being afraid of people thinking they’re relaxing at home.

Let’s talk about some popular activities and their safety: sleepaway camp?

I’m not crazy about that. If there’s little virus circulating, it’s probably OK. I think to me it’s probably something that would require smaller groups of kids and a pretty good understanding of the risk you’re taking. For me, it’s probably something that will take a bit longer to come back. I’m not saying it’s unsafe, but it’s less safe.

Outdoor spring sports?

I think those are going to come back very quickly. But you can envision for teenagers whether there would ever be a mandate: If you want to participate in team sports, you have to be vaccinated. It’s a difficult question. As a public health and infectious disease doctor, I think the idea of giving safe vaccines to prevent spread and infection is laudable, but I think it’s a charged question. You could imagine certain private groups, such as a private soccer club, might say, “In order to play in this league, unless you have a contraindication, you have to be vaccinated.”

Outdoor dining with family at restaurants?

That’s fine. I think that’s a good idea. I’d do it as a family or with another family with kids the same age who are known to you. You don’t want your kid to get it if you don’t have to and then spread it to someone, unbeknownst to you, who’s immunocompromised.

Outdoor drinks with families in your yard?

I think it’s OK, as long as they’re not on top of one another. Some of us last summer had friends over in yards and 6 feet apart, and I think we learned one important thing: worrying about utensils, glassware, and contact with surfaces is not a risk for transmission. We have pretty good evidence that it isn’t. The best form of ventilation is being outdoors.

Outdoor pools?

Sounds good to me.

Interview was edited and condensed.

Kara Baskin can be reached at Follow her @kcbaskin.