While the U.S. has passed many happy pandemic milestones in recent weeks, Hawaii this week passed a grim one: The first child under the age of 11 passed away from COVID-19 complications in the Aloha state while vacationing with his vaccinated parents.
The young boy, whose exact age was not released, began showing symptoms hours after arriving in Hawaii, according to health officials. Both of the boy’s parents had recently tested negative for COVID-19. The Hawaii Department of Health is still investigating possible sources of exposure, and it was not clear if the boy contracted the virus while traveling or prior to the trip.
His death has served as a painful reminder that while the country has accomplished record numbers of vaccinations and seen declining case counts, not everyone is in the clear just yet.
And with more and more adults getting inoculated against COVID-19—and many catching the travel bug instead—vaccinated parents face the nightmarish burden of planning a return to normal life around their unvaccinated kids.
COVID-19 deaths among children are extremely rare. Of the more than 570,000 deaths due to COVID recorded in the U.S., fewer than 300 of them have been among people under 18. (The child in the Hawaii case had underlying health conditions, according to officials.) But the Centers for Disease Control and Prevention is still investigating unique responses to the virus in children, and the lasting damage from an infection is unknown.
More pressingly, there is currently no vaccine available for children under 16. While nearly 97 million adult Americans have been fully vaccinated to date, a vaccine for children is not expected to be approved until the end of the year.
“The problem is, until we have a vaccine, there’s still going to be a risk,” said Dr. Aaron Milstone, a pediatrician and epidemiologist at Johns Hopkins. “And then it’s just, what risk are people willing to accept?”
While it remains unclear if the boy who passed away in Hawaii became infected while traveling, the case nonetheless serves as a wake-up call to families who might be planning a long-awaited getaway after more than a year of pandemic hell.
Dr. Richard Malley, a pediatrician and head of the travel clinic at Boston Children’s Hospital, says he advises families to look at two things when planning a trip with their kids: The risk of the travel itself, and the availability of health care in their destination.
The risk of contracting COVID on a plane or train while socially distanced and wearing a mask is relatively low, Malley said (though other experts cautioned that behaviors surrounding these modes of travel, such as eating at airport restaurants, can significantly increase the risk.) But traveling to countries where hospitals are overflowing with COVID patients can pose other risks—namely, lack of quality medical care.
“While the risk of travel itself is manageable and is not very high, it’s very important to consider where you’re going and whether the country could take good care of you and your family should something happen,” Malley said. “If the country where they are is dealing with massive public health emergencies due to COVID-19 then even a simple problem … could end up becoming a much more complicated medical situation.”
Milstone says he advises families to look at the risk of travel rationally: Are they allowing their children to attend sleepover and birthday parties indoors, without masks? Those behaviors are likely more risky than getting on an airplane fully masked. And what kind of transportation will they be taking when they arrive at their destination? Can they rent a car rather than sit in an Uber with a relative stranger?
“I haven’t told anyone not to travel,” he said. “I think people can limit the risks by doing the same things they would otherwise do at home.”
“I’m not an extremist of, ‘You shouldn’t do this,’' he added. “It’s, ‘How can we do things safely, or as safely as possible, so we can keep going?”
The risks also vary depending on the individual family. Dr. Shruti Gohil, a professor of infectious diseases at the University of California, Irvine, recommends that children who are immunocompromised or have respiratory health problems refrain from traveling at this time. And if they are traveling to meet an immunocompromised friend or family member—even one who is fully vaccinated—they should still wear a mask while indoors.
It seems like families may be taking that advice to heart. According to a recent report from vacation rental company VRBO, 82 percent of families have already made travel plans for 2021. But 59 percent of those families said they were more likely to drive than fly on their next trip, and 61 percent said they are more likely to visit an outdoorsy destination than an urban one. Another report from Squaremouth, a travel insurance review website, found 48 percent of insured travel booked this year was for domestic trips—a dramatic increase from 19 percent in 2020.
Meanwhile, both Pfizer and Moderna recently started clinical trials for vaccines in children as young as six months old. The Pfizer study has enrolled 5,000 kids and hopes to have results by the end of the year. The Moderna study plans to enroll approximately 6,750 in its two-part trial, and follow them for 12 months after vaccination.
But for now, Dr. Malley said, sticking close to home is still the safest bet.
“Many of us are thinking, ‘Is it time to start planning our summer vacations?’” he said. “We have to remind people that even though we’re very hopeful that things are going to look better … we’re not quite there yet.”
“Planning extensive trips to Europe for leisure at this moment is maybe a little premature,” he added.