As a pediatric infectious disease specialist, Dr. Amy Edwards has fielded a lot of questions from worried parents during the pandemic. As case numbers drop -- among children, Covid-19 cases have fallen to levels not seen since October -- the question she's getting is: Do younger children really need to be vaccinated against Covid-19 when a shot becomes available?
Her answer is yes.
Experts say vaccinating young people is an integral part of protecting the broader community from Covid-19, and although serious disease among children is rare, they need protection, too.
"The truth of the matter is, kids wouldn't have to get vaccinated if all the adults would," said Edwards, who is the associate medical director of Pediatric Infection Control at UH Rainbow Babies and Children's Hospital in Cleveland.
"I think then you'd have so little community spread that it wouldn't be a problem. However, we know that a huge chunk of adults aren't going to get vaccinated, and that leaves some kids vulnerable, and that's why they need the vaccine."
Currently there are only 12 states where at least 70% of adults have at least one dose of Covid-19 vaccine. It's not clear if or when the United States will reach community immunity, but doctors say children -- not only adults -- will need to play a role, too.
"We really need to add another group of children to be vaccinated to come across that threshold to reach herd immunity," said Dr. Claire Boogaard, a pediatrician and medical director of the Covid-19 vaccine program at Children's National.
Everyone has the right to ask questions and "be thoughtful about this, especially when it comes to kids," Boogaard said.
"I'm a mom of a three- and six-year-old, and frankly just knowing how devastating the illness can be medically, and also just how disruptive it can be socially for the kids, I can't wait for my kids to get the vaccine, as long as it's proven to be safe in their age group. I think it just gives them the freedom that they've all been patiently waiting for."
They may not be waiting much longer.
The US Food and Drug Administration has already authorized the Pfizer vaccine for people who are 12 and older. Moderna and Pfizer have started testing vaccines in people ages 6 months to 11 years and Johnson & Johnson is currently testing its single-dose vaccine in people ages 12 to 17.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN's New Day on Thursday that he's cautiously optimistic some people younger than 12 will be able to be vaccinated by Thanksgiving, and children of all ages may be eligible by the end of the year.
More vaccinations mean more lives saved
Early research has shown that vaccination among adults might indirectly protect people in a household. A May preprint study in Finland found that the protection Covid-19 vaccines provided to unvaccinated members in a household wasn't as effective as getting a vaccine, but it was "substantial." A preprint study from Israel showed similar results.
Studies show most younger children don't seem to be the source of infection with this novel coronavirus. Rather, when kids get sick with Covid-19, they typically get it after being exposed to an adult with the virus.
While the question about the importance of vaccines for little kids is still theoretical, it's still an important one to answer, said Dr. Sean O'Leary, a pediatric infectious disease specialist at Children's Hospital Colorado.
He gets asked about it at least twice a day, and said he tells parents he wants everyone vaccinated, regardless of falling case numbers.
Vaccination is good for the children who are eligible, good for the community, and he said -- the numbers are falling because vaccines work.
"The more people we can vaccinate, the more lives we're going to save," O'Leary said. "That includes children."
Child deaths from any cause are rare, but Covid-19 is now among the top causes, O'Leary said: "If you can prevent one of those causes of death with something as simple as a vaccine, obviously you would want to do that."
And there are practical reasons to vaccinate kids. The current US Centers for Disease Control and Prevention guidelines say that people who are exposed to Covid-19 who aren't vaccinated should stay home from school or camp for two weeks.
If vaccinated, kids don't have to quarantine.
Covid-19 in children can be severe
Covid-19 is more likely to be severe in adults, but children can become severely ill, too, and some have died.
During a White House Covid-19 briefing on Thursday, CDC Director Dr. Rochelle Walensky noted that in the month before the Pfizer vaccine was authorized for people as young as 12, the agency observed "troubling data" about adolescents hospitalized with severe Covid-19.
"More concerning were the number of adolescents admitted to the hospital who required treatment in the intensive care unit with mechanical ventilation," Walensky said, noting the findings are expected to be published Friday. "It is these findings within this publication -- one that demonstrates the level of severe disease, even among youth, that are preventable -- that force us to redouble our motivation to get our adolescents and young adults vaccinated."
And while cases across the country overall have declined, the pandemic isn't over yet.
"I have seen children in the ICU on breathing machines for a month or more. Any idea how damaging that is to their lungs? It's so incredibly damaging," Edwards said. She has also seen kids in her hospital's Covid-19 long haul clinics. "I've got kids who didn't get to finish their school year, not because they couldn't do distance learning, but because they couldn't get out of bed with this. It's serious."
Boogaard said that when she thinks about kids and the vaccine, she thinks about all the sacrifices they have made over the last year.
"Essentially, kids have disrupted their whole lives to protect the older people in their lives and in their communities and it hasn't been easy on them. A lot of kids have struggled," Boogaard said. "It kind of stinks that they're the last ones to get the opportunity to take their mask off and eat inside and things like that.
"So if getting the vaccine can help them feel safer and return to the things they enjoy, I would say, consider that as part of the decision making, and get them the vaccine."