Playing sports. Hugging family and friends. Going to school or the doctor's office. What’s the risk of COVID-19 exposure for each of these activities among children who aren’t yet eligible for the COVID-19 vaccine?
“The risk calculation of how to keep my kids safe in a COVID world where masking is very inconsistent is very exhausting,” said Dr. Eve Bloomgarden, an endocrinologist and chief operating officer of the Illinois Medical Professionals Action Collaborative Team (IMPACT) who has two children of her own under age 6. “There hasn’t been a more trying time than right now with our kids who are currently not eligible for the vaccine because they’re too young.”
To help people better understand risks for kids under age 12, IMPACT and the Illinois State Medical Society asked 126 physicians across various specialties, including pediatricians and infectious disease doctors, to rate the COVID-19 exposure risk associated with a range of activities based on whether guidelines for face masks and social distancing are followed or not.
At the top of their list, in terms of risk: sleepovers with multiple households, attending an indoor event with more than 50 people and singing in a choir, even when masks are worn.
“When you put people from different households indoors in situations where they’re swapping air for long periods of time, the longer the time and the more people that gather, the more the chance of transmission,” said Bloomgarden. “And that certainly magnifies when you’re singing loudly or shouting in a choir.”
While smaller indoor gatherings are less risky than larger ones, both pose a risk, especially if masks aren’t worn, according to Bloomgarden. In comparison, attending an outdoor event with more than 50 people poses less of a risk than a smaller indoor gathering, according to the survey.
But not all outdoor activities pose the same risk of exposure.
High-contact outdoor sports like basketball, cheerleading and soccer pose a higher risk of exposure than low-contact sports like dance, tennis, swimming and baseball. That’s because in high-contact sports, participants are breathing heavily in close proximity, says Bloomgarden. “And whenever air is swapped, we see a significant jump in risk.”
High-contact sports were also found to have a higher risk of COVID-19 exposure than going to an outdoor public pool, beach or playground, according to the survey.
Risk of in-person school, carpooling
The coming school year brings with it questions about in-person learning. According to the survey, when masks and social distancing guidelines are followed, in-person learning poses a low risk for exposure to COVID-19. That risk increases, however, when masks aren’t worn and social distancing isn’t practiced.
“Masks make a big difference in perception of risk for kids, particularly when you’re looking at attending in-person school,” said Bloomgarden. “Swapping air indoors without masks is the highest risk and the more people you bring into a setting, the more risk involved, and a lot of that risk can be mitigated with masking.”
Last week, the Centers for Disease Control and Prevention recommended universal masking for teachers, staff, students and visitors at schools nationwide, regardless of vaccination status. The Illinois Department of Public Health and Illinois State Board of Education have also adopted similar recommendations.
But Bloomgarden says that’s not enough. She says a federal or statewide mask mandate is needed.
“We need strong guidance from at least the state, but ideally the federal government,” she said, adding that IMPACT is behind a Change.org petition calling for universal masking requirements in schools. “It’s such an easy thing to do. Wearing a mask works best when everyone is wearing one.”
Even getting kids to school can pose a risk. Carpooling with the windows closed poses a medium risk even when masks are worn, and that risk increases without masks.
“It seems innocent to pick up the kids, but you have to wear masks or put the windows down because you put kids in a very risky situation where they’re swapping air inside,” said Bloomgarden.
Going to the doctor or dentist was associated with a low or moderate risk, depending — again — whether or not masks are worn, according to the survey.
“What this shows is that masking makes an enormous difference in that scenario because people often present to their doctors feeling sick,” said Bloomgarden. “It’s safe to go to the doctor, but you need to wear mask. … Doctors and dentists wear (personal protective equipment) and are more likely to be vaccinated than if you were going to the supermarket. … It’s as safe as an environment as possible and you definitely shouldn’t skip your visits for fear of getting COVID.”
Dining outdoors at a restaurant, attending a backyard barbecue, and hugging a fully vaccinated person are among the activities associated with the lowest risk of exposure to COVID-19 among children under age 12, according to the survey.
Bloomgarden said she hopes the survey helps people make informed decisions and understand the importance of masks. “Ultimately, we can do our part to keep our kids safe and ourselves safe until the vaccine is available to everyone,” she said.
With the surge in coronavirus cases fueled by the delta variant, Bloomgarden is encouraging everyone who is eligible for the vaccine to get it.
“There’s no other exit strategy. Anyone who hasn’t gotten vaccinated, it’s time,” she said, adding that the vaccines are safe and effective. “We put a man on the moon, we can convince people to get vaccinated. We need to be better, we need to support each other and stop attacking each other and keep the end goal in sight.”
When vaccines become available for younger children, she hopes people will follow the lead of medical professionals, who overwhelmingly say they’ll vaccinate their kids.
Of 114 doctors surveyed, 77% said they would vaccinate their kids once a vaccine is approved by the Food and Drug Administration and granted emergency use authorization. Only 4% said they wouldn’t vaccinate their children.
“Every day we’re waiting for it,” said Bloomgarden, who intends to vaccinate her two children as soon as possible. “When the FDA gives the nod, I’ll be first as well many of my doctor colleagues.”
Those who aren’t considering vaccinating their children will remain at risk for getting infected with COVID-19, the long-term effects of which are unknown, according to Bloomgarden.