Worried about traveling with unvaccinated children? 6 questions answered on how to manage risk

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(CNN) – In the United States, Covid-19 cases are on the rise again, mostly in unvaccinated populations. Most of these cases are due to the highly infectious delta variant of SARS-Cov-2, the coronavirus that causes Covid-19. Many children are among those who are not vaccinated, simply because no vaccine has been authorized for children under 12 years of age. About a quarter of children aged 12 to 15 have been vaccinated. With the increase in cases and the inability to vaccinate young children, many parents are concerned about the safety of travel this summer.

The risk of Covid-19 associated with travel is largely determined by how you travel, where you go, who will be there, and what you do there. By evaluating these variables, parents can make informed decisions about their travel plans.

1. What is the risk that Covid-19 represents for children?

When thinking about Covid-19 and unvaccinated children, two types of risks must be taken into account: both the direct risk to the child and the risk of transmission to others. Children develop severe Covid-19 illness much less often than adults, and they die much less often. But children are dying from Covid-19. Covid-19 has caused nearly 500 deaths of children aged 17 and under in the United States. And some children also suffer from a long Covid-19 – the lingering effects of Covid-19 that are still not fully understood.

To put this in perspective, the number of flu deaths in a typical flu season is around 150 to 200 children in the United States. But only one child died from the flu during the 2020-2021 flu season. Over the past year, Covid-19 has been one of the most common causes of death from infectious diseases in children.

But even when children don’t get seriously ill with Covid-19 or show symptoms, they can still pass the virus on to other children and adults. The rate of child-to-adult transmission of SARS-CoV-2 is approximately half the rate of adult-to-child transmission. Thus, even when the risk to children is low, transmission to other unvaccinated children and adults remains a serious concern.

2. Is car travel safer than air travel?

People may meet others more often when traveling than in their daily lives, which automatically increases the possibility of being exposed to someone with Covid-19.

With air travel, families need to consider the number of people they are exposed to at airports, as well as on the plane. At airports, travelers are exposed indoors to many people, potentially from different parts of the country and the world. But the risk is reduced by the requirement to wear masks indoors at all times at US airports.

On an airplane, travelers may sit near multiple people outside of their own families for a few hours, and some of those people may not consistently comply with mask requirements. Although outbreaks have been associated with air travel, fortunately these reported outbreaks have been rare.

In general, traveling by car is likely to be safer, with exposures limited to infrequent rest stops and short meal breaks.

3. How does the destination affect the risk?

Whether in one’s own community or while traveling far away, a serious risk factor to consider is the rate of Covid-19 cases, including the incidence of the delta variant in that community. When Covid-19 rates rise in a community, that destination typically becomes less safe than a community with low and stable rates.

4. What types of gatherings are safe at this time?

When people travel, they come into contact with strangers, friends, and extended family that they would not meet at home. These interactions, which epidemiologists call “mixing,” increase the chances that people will be exposed to SARS-CoV-2.

The additional risk of this mixture depends on the vaccination status of the people encountered, the number of people encountered, the nature of this encounter and the duration of the encounter. If you are near many people for several hours, the risk is greater than if you are near a few people for a short time. If almost everyone you come into contact with is vaccinated, the risk will be very low. But as the number of unvaccinated people increases, so will the risk.

5. What types of activities are safe?

A family enjoys a picnic in London’s Greenwich Park in April 2020.

Peter Summers / Getty Images

An important rule of thumb is that being outdoors is safer than indoors. Indoors, the virus can stay in the air for some time, increasing potential exposure. Outdoors, the virus disperses quickly, greatly reducing the chance of exposure to the virus emitted by a person infected with the coronavirus.

The main concern outdoors is when people are close to each other for long periods of time. Sitting near other people for several hours outdoors, such as at a baseball game or music festival, can involve some risk, especially if people are not wearing masks and the rate vaccination in the community is low. For children who play together, an activity like wrestling in the grass will be less safe than playing soccer or throwing a Frisbee.

6. What measures can reduce the risk of infection?

No one decision will be good for everyone. Each parent will have to weigh the risks and make their own decisions. Traveling will inevitably result in exposure to unvaccinated children and adults. But the risk will be determined by the extent of this exposure.

It is important to remember that vaccination is only one tool that can be used to reduce risk. Consider using masks indoors whenever possible. Masks reduce transmission and have been shown to be an effective adjunct to vaccination. Wearing a mask indoors and in public spaces some of the time – even if not all of the time – further reduces risk.

Before traveling, families should discuss expectations and concerns, both within their own family and with others they will meet. These conversations can be difficult. People should talk openly, honestly and without judgment about who has been vaccinated and who has not, and agree to a set of rules from the start.

And then do your best to enjoy your vacation.

William C. Miller is Senior Associate Dean of Research and Professor of Epidemiology at Ohio State University. It receives funding from the United States National Institutes of Health, the United States Centers for Disease Control and Prevention, and the American Sexually Transmitted Diseases Association.