What should vaccinated parents with unvaccinated kids do?

More and more adults are getting vaccinated, but their children under 12 are not yet eligible. What does this mean for parents who are now returning to work and for children going back to summer camp, daycare and, eventually, school? The younger kids are, the more care they need. What’s safe when it comes to child care arrangements, and what if you’re living in a state that’s no longer requiring masks in most settings?

We asked CNN Medical Analyst Dr. Leana Wen to help us sort out the questions. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s author the forthcoming “Lifelines: A Doctor’s Journey in the Fight for Public Health” and significant in this case — also the mother of two young kids.

CNN: Are kids at risk from COVID-19?

Dr. Leana Wen: While children are much less likely to become severely ill from COVID-19, they can contract it and become sick from it. According to the American Academy of Pediatrics, nearly 4 million children in the United States have been diagnosed since the beginning of the pandemic, and more than 18,000 have been hospitalized. Tragically, more than 300 kids have died.

As more and more adults are vaccinated, the overall level of COVID-19 is lower in many communities, but kids are still at risk. In fact, pediatric infections are now nearly 1 in 4 of the total coronavirus infections in the US.

CNN: Can vaccinated parents transmit COVID-19 to their kids?

Wen: This is a really important question. We know that getting the coronavirus vaccine protects you very well from getting sick yourself, and it also reduces your likelihood of being an asymptomatic carrier who can transmit the virus to others.

Having parents get the vaccine definitely reduces the COVID-19 risk for the entire family. However, there is a still a small chance that vaccinated parents could transmit coronavirus to their children. It’s hard to quantify exactly what this risk is, because it also depends on the rate of coronavirus spread in the community. The higher the level of COVID-19 around you, the more likely you are to become infected and infectious yourself, despite being vaccinated.

For parents who want to remain as cautious as is reasonable, I’d encourage them to try to reduce their own risk. My husband and I, for example, will see friends who we know are vaccinated indoors, without masks or distancing, and we’ll certainly socialize and take part in all outdoor activities. But if we’re going to be in indoor settings with other potentially unvaccinated people, we’ll still wear masks. We’ll continue to stay out of the highest risk settings, such as crowded indoor bars, until the level of community spread in our area decreases further.

CNN: What about daycare and summer camp are they safe? What would you look for to make sure they are?

Wen: I’m sending my almost 4-year-old son to summer camp at a daycare center, and here’s what I looked for. First, I was glad to see that the kids spend most of their time outdoors, even when it’s raining. Outdoors is much safer than indoors when it comes to reducing coronavirus transmission. I’d be fine with a daycare that doesn’t require masks when outdoors. Mealtimes are all outdoors, which is important, since masks can’t exactly be worn when kids are eating.

Second, all of the daycare staff are fully vaccinated. This gave us additional peace of mind. Third, masks are still required when kids are indoors. In the area where we’re living, in Baltimore, there is still high community transmission of COVID-19, so it was important that indoor masking is required.

CNN: What if the daycare, camp or school doesn’t require masks when indoors?

Wen: This will depend on your comfort level and risk tolerance, as well as the community transmission level of COVID-19. If you live in an area where there’s pretty low transmission, it’s probably low risk even if kids aren’t masked indoors. On the other hand, in areas of high community transmission, there’s a higher likelihood of unvaccinated kids transmitting coronavirus to one another.

I’d advise that you ask the daycare or school how many children are wearing masks indoors. If most kids are wearing masks indoors, yours can too, and it will help to protect your child. However, if none of the kids are wearing masks, while your child can probably still choose to wear a mask, this might create discomfort for your child, and you might want to see if you can find another facility that more closely aligns with your risk tolerance.

CNN: Many parents are now being asked to go back to work in person. Should they still wear masks, even if they’re not required?

Wen: That depends. If you’re going into an office, and you’re pretty sure that everyone else is fully vaccinated, I think it’s fine to forgo masks at work. If you’re a retail worker, though, or in another job where you have to interact with many customers indoors, who may be unmasked and unvaccinated, you might want to consider keeping your mask on. The vaccines protect you very well, and your chance of carrying coronavirus back to your unvaccinated kids is low. But the mask is an additional layer of protection, especially if you’re around many other potentially unvaccinated people.

CNN: Are there situations at work that would make you feel uncomfortable from a coronavirus safety perspective?

Wen: Yes. I had a patient who felt very uncomfortable with being asked to go into tightly packed conference rooms, sitting shoulder-to-shoulder with co-workers she was pretty sure were unvaccinated. This patient lived with an elderly parent who was immunocompromised, and I advised her that she should let her supervisor know that she’d rather attend such meetings virtually. The supervisor agreed, and she and other people can call into the meeting while sitting in their own offices. If you have young kids and are in a similar situation, you could ask for such types of accommodations.

CNN: What if you’re in a cubicle, and the people around you are less than 6 feet away?

Wen: If the people in the cubicles around me are vaccinated, I’d feel fine with all of us not wearing masks. If someone isn’t vaccinated and masks aren’t required — and there aren’t other safeguards such as regular testing — you could consider asking your supervisor if you could be relocated to a location where people around you are known to be vaccinated.

CNN: Would you wear a mask to go to the restroom or the break room at work?

Wen: If people around me are not all vaccinated, yes, I’d wear a mask in crowded, communal places. And I probably wouldn’t eat in the break room.

CNN: Does it matter if my kids have already had COVID-19?

Wen: Yes. If your kids have already had coronavirus and recovered from it, they likely have some level of immune protection. We don’t know how long it lasts, and it’s possible they could be reinfected, but I think you could feel a bit less concerned about them immediately contracting coronavirus again.

CNN: What if I have to take public transportation to get into work?

Wen: Masks are currently required on buses, subways, trains and so forth. I’d wear a well-fitting mask, but otherwise, would not worry as much about the exposure during transportation if you’re vaccinated.

CNN: What if I have children over the age of 12 who haven’t yet been vaccinated?

Wen: I’d urge you to get them the inoculation as soon as possible. The Pfizer-BioN-Tech vaccine is authorized for children 12 years of age and older. It’s been found to be safe and very effective.

A study from the US Centers for Disease Control and Prevention found that there has been an increase in the level of infections and hospitalizations among adolescents in the 12 to 17 age range. Even as infections and hospitalizations have fallen for adults during the same time period, they’ve risen in this age group, perhaps due to the dominance of more contagious and more virulent variants.

This study also found that nearly 1 in 3 kids in this age group who were hospitalized were so severely ill that they required ICU care. While about 70% had underlying medical conditions, 30% were previously healthy.

We are so fortunate to have the vaccine available for kids 12 years and older. Getting them vaccinated will protect them, and give you as the parents and the entire family peace of mind.