( Kin Cheung / AP Photo )
Daniel Griffin, MD, PhD, an infectious disease clinician and researcher at Columbia, ProHEALTH chief of the division of Infectious Disease and president of Parasites Without Borders, talks about how best to plan and enjoy summer activities with children too young for COVID vaccines, including family vacations and summer camp.
→Here are the CDC Guidelines for summer camps.
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Brian Lehrer: Brian Lehrer on WNYC. Now let's talk about summer and how parents can navigate the reopening of travel options, summer camps, backyard barbecues, and like we were just discussing Ballparks. All available for those of us who are vaccinated, but even if the FDA approves the Pfizer vaccine for 12 and up as it's expected to next week, that still means parents and caretakers of younger children will be navigating some bumpy terrain and trying to decide what the acceptable level of risk is for the kids in their care and for themselves because it's not settled.
For example, the CDC has set guidelines for summer camps that many think err on the side of too much caution and New York Magazine found an epidemiologist and a pediatric immunologist who called the guidance cruel and draconian. Even Dr. Fauci acknowledged that they were a bit strict his term on The Today's Show.
We've invited Dr. Daniel Griffin to join us again, to talk through some of this. He's been on the front lines of the pandemic with his patients and advising doctors as an infectious disease clinician and a researcher at Columbia and chief of the division of Infectious Disease at the ProHEALTH medical group. Hi, Dr. Griffin. Welcome back. Thanks for coming on again.
Dr. Daniel Griffin: Oh, good morning. My pleasure, Brian.
Brian Lehrer: Listeners, we can take some of your questions for Dr. Griffin. Do you have questions about summer camps, how to travel in mixed groups, vaccinated adults, unvaccinated children. How are you planning your family summer vacations? 646-435-7280, 646-435-7280, or tweet @BrianLehrer.
Doctor, part of what makes this complicated is that the risk assessment for kids is different than for adults given that kids are at a lower risk of serious symptoms, even if they're infected with COVID-19. If the adults around them are vaccinated, then what constitutes risk?
Dr. Daniel Griffin: I think that's a great question, Brian, and I love the way you phrase it because it is clear that children are at lower risk, that is clear, but they're not at no risk. We're trying to balance the fact that kids can get COVID, kids can die of COVID, kids can end up in the hospital and have long-term issues but at the same time, it's really hard for these kids. Every summer you miss is a summer you're never going to get back. We're trying to balance that.
I think the CDC is getting beaten up a little bit over their guidance here. I think Anthony Fauci was the kindest by saying it was a bit strict, but hopefully, we can go through this with the listeners because this is challenging. How do we balance the risks with really the need and the desire of all these kids and their families to have an enjoyable summer 2021?
Brian Lehrer: Does your advice differ from what the CDC has recommended? You've advised camps and sports teams.
Dr. Daniel Griffin: I have advised them and I continue to and started in this space last summer. Actually, I think the largest camp that I advised was a camp with about a thousand kids and it was very successful, smaller camps that had more water exposure than others, some were just purely land-based.
What I think I should point out is that this is a very complicated document as far as the guidance goes. Some of it is really clear and I'm on board with, the others there are subtleties to it. They strongly encourage vaccination, that's critical. They're also finally jumping in and really endorsing and saying there should be testing so that we're not bringing folks with COVID in there.
Then I'm going to say there are subtleties of interpretation relative to masks, physical distancing, how we're going to do that and to remember this is guidance, the actual rules are going to come from the governors of the states about what is specifically required, what's the size of a cohort, when can we get those masks off?
The CDC is already starting to talk about certain circumstances, such as if the kids are vaccinated, if they're going to be in the water, things like that. The kids will not, even if you follow the strict interpretation of the CDC guidance wearing masks 24 hours a day at these camps.
Brian Lehrer: I think that might be different than what people have heard, because one of the guidelines that seems to be drawing the most public criticism is that the CDC is recommending masking outdoors for children at summer camp, outdoors except when swimming, you're saying, it's not that strict?
Dr. Daniel Griffin: Those are the two areas where I think the CDC is getting a lot of criticism and it's masks and it's physical distancing. They are saying, and this is a little stricter than I think a lot of people were hoping that all people in camp facilities should wear masks at all times with exceptions and then they start laying out some of the exceptions.
I've seen a lot of news articles where they say, "Oh my gosh, no special needs kids will be able to go to summer camp," but they've clearly said, anyone with trouble breathing, anyone who would not be able to get a mask off as needed, those people will not be required to wear a mask at all times. They're already starting to say, "Let's use a little judgment here. This is not meant to be draconian. This is meant to allow us to say the camps can open. The camps can open safely, we're just going to have to make decisions about masks and distancing."
I think as you bring up, Brian, I think as we've all learned, outdoors is incredibly safe. If you move from indoors to outdoors, you've dropped your risk by 95%, mask is an 80% reduction. You got to start looking at these different layers, vaccination, that's the nuclear option. That's really going to change the summer experience for so many kids.
Brian Lehrer: Steven in Brooklyn, you're on WNYC with Dr. Griffin. Hi, Steven.
Steven: Hi, guys. Thank you for having me.
Brian Lehrer: Go ahead.
Steven: Hello.
Brian Lehrer: Yes, [crosstalk].
Steven: I think kids are pretty much safe and the guidance from CDC have been giving us that even in school, they want us to be three feet apart instead of six feet apart. The kids don't have that much of a mortaliture, even infection rate as an adult. We really need to open the schools already a long time ago but, in my perspective, I want my kids to be out.
I want them to be playing with other kids. I want them to be in camps. If the camps probably wants to have, probably they need to have precautious of some sort, but I don't mind my kids to be around them. I'm sending them to the sleep-away camps. I'm sending them to Florida, to New Hampshire, to whatever. They have to be out there in the summer. They have to get back to the schools. They have to be back for the kids around them, get social. I'm not really concerned about that COVID thing.
Brian Lehrer: Steven, thank you very much. Dr. Griffin, I don't know, maybe there's somewhere between Steven and the CDC [laughs] where you would come down?
Dr. Daniel Griffin: Yes.
Brian Lehrer: Another thing is that-- Well, go ahead. Do you want to comment on that call? Go ahead.
Dr. Daniel Griffin: Oh, certainly, Brian. I think one of the things we say in public health is that when you succeed with your public health interventions, everyone says, "Oh, why did you worry so much?" Success seems to invalidate things we do.
Here in the US even as a lot of people felt, like Steven, "Oh, kids, you don't have to worry about kids," a lot of the moms, I'm going to give moms credit so that the angry involved dads can call in, but the parents said, "You know what? I am going to keep my kids safe." Doing everything we did, we shut down schools, we had the kids wear masks, we did these virtual learning programs, we still had hundreds of kids in the US die. We still had thousands of kids end up in the hospital.
You look at Brazil where they didn't take this seriously in kids and there wasn't a lot of mitigation, thousands of kids died, over a thousand babies are dead. I think that people have this perception, "Oh, you don't have to worry about the kids. We haven't seen a lot of kids die." We've seen 200 kids die in the US alone. In my mind, that's a lot of kids, that's way too many.
The reason the number is 200 and not a thousand is because we've done all these things and we don't want summer camp to be a place where we see kids dying. I think that we can do this safely but we can certainly also do it unsafely. We do not want Steven to say, "Oh my gosh, I was wrong," because now we're seeing pictures of dead children at summer camps.
Brian Lehrer: Dana in Mendham, you're on WNYC. Hi, Dana.
Dana: Hi. How are you?
Brian Lehrer: Good.
Dana: I was just wondering, I don't have a child who's old enough for summer camps yet, but I have a 10-month-old that I'm still nursing and I'm fully vaccinated and we're still trying to navigate, how do we be around other children and the family who can't get vaccines and other family members who might not be vaccinated yet knowing that the baby might have passive protection, but knowing that there's not a guarantee for that either.
Brian Lehrer: Doctor, can you advise Dana?
Dr. Daniel Griffin: Oh, certainly. Dana, great that you're vaccinated and actually great that you're probably passively vaccinating your 10-month-old. What the CDC came out and said, I think yesterday, was public saying, "We give all these guidance, but you know what, for vaccinated people, it's a very different world. People who are vaccinated, particularly young mother like yourself, incredibly low risk of getting infected, also incredibly low risk of spreading it to others.
To carry this into the masking world and to the camps but also for you, if you're vaccinated, if you're breastfeeding your baby, you're really low risk for these other individuals. The CDC has said, "Hey, small groups, vaccinated people, even indoors, the masks can be off. You could start hugging people. You could start spending time again."
If you've got a high-risk individual, let's say you've got that uncle in his 70s who has cancer. Who's on certain medications. Maybe there you want to make different decisions. For a lot of us, it's going to be really much of a return to normal come July, particularly with vaccinations. We're hoping come Tuesday 6:00 AM, we're going to hear the expansion of the e-way for the Pfizer vaccine down to kids 12.
If we hear 12 and all the way up, these kids can get vaccinated, the chocolate-covered carrot of vaccination is going to mean these kids are out there having fun with masks off. Maybe that's going to get rates low enough for those kids below there. Maybe if the rates are low enough, we can start extending that freedom.
Brian Lehrer: The chocolate-covered carrot. What flavor is the stick?
Dr. Daniel Griffin: [laughs] It's all covered in salt, Brian.
Brian Lehrer: Salt and sugar and fat. The low risk of serious illness for kids, does it create a bit of an ethical dilemma when it comes to vaccinations? Are the children being vaccinated to protect their teachers and grandparents, for example, more than themselves?
Dr. Daniel Griffin: Brian, I don't think they are in all honesty. I brought up the experience of Brazil. That destroys me to hear over a thousand babies have died of COVID down there because they have not taken all these measures.
I was talking with the head of our pediatric group, Jay Berger, the other day about a child he had just admitted to the ICU, a young kid in his teens. Now, kids can get COVID too. Kids can die of COVID. Kids can end up in the ICU. Kids can end up with long-term consequences where they can't concentrate in school. They can't participate in sports. Kids need to be protected as well. We do not know the long-term complications 10, 20 years from now if we let all our kids go out and get COVID.
Brian Lehrer: Sarah in the Bronx, you're on WNYC. Hi, Sarah.
Sarah: Hi, long-time listener, first-time caller. Thank you so much for talking about this. My entire family works at day camp and we've been camp counselors for many years. My real question is, on the lakefront, are lifeguards going to be required to wear masks? My question is, the kids are unvaccinated, the lifeguards will be vaccinated, but having to jump in at a moment's notice with a mask on could be a safety issue.
Dr. Daniel Griffin: Yes, that is a great question and the CDC specifically addresses that. That's one of the settings or activities as they say such as eating, drinking, or swimming. If you're there trying to make sure these kids are safe. If you're going to have to jump in at a moment's notice, you don't want to be taking this time to pull up that mask. You want to be ready to go.
CDC has clearly said the risk-benefit here is get that mask off, be ready to jump in. You don't want to be jumping in the water and realizing you've got a wet mask that's impeding your ability to breathe or the delay is preventing you from being able to keep these kids safe. Everything here is a risk-benefit balance.
Brian Lehrer: Ally in Manhattan, you're on WNYC with Dr. Daniel Griffin. Hi, there.
Ally: Hello.
Brian Lehrer: Hi, you're on the air. Yes, it's you. Don't listen to your radio, listen to the phone. You'll hear me in real-time. Ally, do I have your name right? Ally once.
Ally: Can you hear me?
Brian Lehrer: Yes. Can you hear me? You're on the air.
Ally: Yes, I can. Thank you for taking my call. I just wanted to know about the vaccines and I guess their availability to school-age children. How do we see this kind of being like the flu shot similar to where the children are going to need to take it on a regular basis?
I know you're talking about summer plans, but do you have a view, I think, just kind of the way things are going if we're expecting that this is going to be just like a mandate, the way other schools have said or some universities have said that to come back-- I know Brian, you had the president of Rutgers on. Eventually, do we think that's going to be the mandate for children as well? Is this going to be like the flu shot where they're going to have to take it on a regular basis?
Brian Lehrer: Thank you.
Dr. Daniel Griffin: Sure.
Brian Lehrer: Dr. Griffin.
Dr. Daniel Griffin: Happy to address that large picture thing. Yes, we're already hearing from a lot of schools that they anticipate that come the fall this will be a required, just like all the other vaccinations, for school attendance. At university level, we're seeing that that's probably going to extend down lower.
One of the nice things I will say is Pfizer is now looking for full licensure. That puts it into the normal paradigm we're used to. Not something e-way but something fully licensed. We expect the other vaccines to follow suit. This will be the normal paradigm, "Hey, before you go off to do college or school, there will be required vaccinations. There'll be the normal exceptions that we're used to overtime."
Now, will this be an every year? The interesting thing we saw, the really encouraging thing we saw is kids, teenagers, adolescents, really have a robust response. The Pfizer data was incredible. They were following these kids, testing them weekly, none of the vaccinated kids tested positive.
It maybe that younger kids have a more durable response than adults which would be fantastic. This may become one of our childhood vaccines. We'll see, the data is still going to follow. Hopefully, this isn't something you have to get every year but we'll see.
Brian Lehrer: Is it safe for extended families to go on vacation together this summer with the unvaccinated kids and the vaccinated grandparents?
Dr. Daniel Griffin: I think, again, this is going to be each person looking at a risk-benefit. As mentioned, kids, if you don't protect them as we saw in Brazil, things can go really poorly. We want to keep those kids safe. I think it's going to be a no-brainer for 12 and on up. If incidents rates get really low, it's going to depend where you want to go on vacation.
If you're going to a place where there's really low rates, then I think that that's reasonable. If you're going to these large crowded areas in places that maybe do not have the control, the success that most of our country will have by July, that's a different scenario. No, I think we can look forward for families really having a great summer.
Brian Lehrer: The CDC guidelines, tell me if this is right, vaccinated people can hang out with one unvaccinated household?
Dr. Daniel Griffin: That sounds about right. I think that one of the tough things, Brian, keeps moving forward and it is moving forward. The guidance keeps changing, but the guidance is changing as we learn more and as those rates drop. My anticipation is when we get to July when rates here we're seeing in New York percent positivity rates are below 2%. I think they'll be below 1% rather soon. We're falling off a cliff, thanks to the nuclear option of vaccines. Then things are going to be even more liberal.
Brian Lehrer: Real quick. We have 30 seconds left. Your reaction to what we were talking about earlier in the show. Governor Cuomo's reopening of Broadway, full capacity, no vaccination requirement for the audience September 14th. Are you good with that?
Dr. Daniel Griffin: I have to say people by then, if you want to have a vaccine, you're going to be able to get it. If you choose not to be vaccinated, then you're taking a risk.
Brian Lehrer: Dr. Daniel Griffin, researcher at Columbia and chief of the division of Infectious Disease at the ProHEALTH medical group. Thank you for all your work and all your information again.
Dr. Daniel Griffin: Thank you. Everyone, be safe.
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