What the new CDC mask guidance means for kids under 12

Kindergarten students wearing masks and separated by plexiglass at Milton Elementary School in Rye, New York, on Tuesday, May 18.

(CNN)When the US Centers for Disease Control and Prevention issued its new mask guidance last week, it didn't include guidance to vaccinated parents who have unvaccinated children, leaving many parents confused about what to do.

The new guidance says people who are fully vaccinated against Covid-19 may go without masks in most circumstances and don't have to keep their distance from others. But everyone who is not vaccinated should continue wearing a mask as usual -- and that means everyone under the age of 12, the only group not eligible now for any of the vaccines in use in the United States.
So, should vaccinated parents and older siblings continue to wear masks because of younger family members? Are young children now less safe in public spaces?
      "It's a dilemma. I have two little children, ages 1 and 3, who can't yet be vaccinated," CNN medical analyst Dr. Leana Wen told CNN. "I understand how parents are feeling."
        "Some parents will say, 'The risk of my getting sick and then infecting my kids is very low, and I want to resume all aspects of my pre-pandemic life,'" Wen said. "That's reasonable. Some others are more cautious, especially if they live in areas of high community transmission of Covid-19. That's also fine."
          Whether parents keep their masks on or not, children under the age of 12 should continue to mask up in public places, Dr. Yvonne Maldonado wrote in an article Wednesday, particularly when social distancing isn't possible. Maldonado is chair of the Committee on Infectious Diseases for the American Academy of Pediatrics (AAP).
          Maldonado is the chief of the pediatric infectious diseases division at the Stanford University School of Medicine and is currently leading vaccine trials in children younger than 12.
          Children can take off their masks when they are with family members from the same household, according to Maldonado. They can go maskless at small gatherings with fully vaccinated family members and friends and during water sports like swimming, or activities in which masks could pose a safety risk, such as gymnastics.
          Here's what we know about children, Covid-19 and the factors parents are considering when figuring out how to navigate relaxed restrictions.

          What we know about kids and Covid-19

          Throughout the pandemic, children have rarely become severely ill from Covid-19, and that still appears to be true, the AAP wrote in a report published last week.
          More than 3.9 million children in the United States have tested positive for the virus as May 13, according to the AAP. Among the 24 states and New York City reporting data, children have made up "1.3%-3.1% of total reported hospitalizations, and between 0.1%-1.9% of all child COVID-19 cases resulted in hospitalization," the AAP said.
          Deaths are extremely rare, the data shows.
          "​In states reporting, 0.00%-0.03% of all child COVID-19 cases resulted in death," AAP said.
          Children made up 0.00%-0.21% of all Covid-19 deaths in those 43 states reporting, plus New York City, Puerto Rico and Guam, and nine states reported no child deaths at all.
          Children with underlying medical conditions should continue to be extremely cautious around others, the CDC said, because they are "at increased risk for severe illness" from infection.
          Still, the AAP said, "there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects."
          And even if they don't show any symptoms, children can carry the virus in their respiratory tract -- their throats and noses -- for weeks, silently spreading it to others, a study last year showed.

          Vaccines are being tested now on younger children

          The US Food and Drug Administration authorized Pfizer/BioNTech's coronavirus vaccine for children and teens ages 12-15 on May 10. US Surgeon General Vivek Murthy hailed the move as "a really big deal."
          "We know that protecting the health of our kids is really a top priority," Murthy said at a roundtable discussion this week. "What could be more important than that?"
          Both Pfizer and Moderna are testing their vaccines on children younger than 12 right now. Pfizer's may be available to children as young as 2 in September, when the company said it expects to apply for emergency use authorization of its vaccine for children ages 2 to 11 years old.
          For even younger children, the vaccine may not be available until early next year.
          Pfizer is testing its vaccine on 4,644 children ages 6 months to 11 years in the United States and Europe. The company said it expects results to be available in the latter half of this year.
          "If safety and immunogenicity is confirmed, and pending agreement with and endorsement from regulators, we hope to receive authorization for vaccination of these younger kids by early 2022," Pfizer said on its website.
          Moderna vaccinated the first of its volunteers in a trial that will include 6,750 children in the US and Canada ages 6 months to 11 years, the company said in March.
          The trials involving children this young are "age de-escalation" studies, according to Dr. Anthony Fauci, the nation's top infectious diseases expert. That means the first group of participants will be older, with the youngest participants in the last group.
          "It is likely and almost certain that by the time we get to the end of this calendar year and the first quarter of 2022 that we will have enough information regarding safety and immunogenicity to be able to vaccinate children of any age," Fauci said at a White House briefing this week.
          The FDA will discuss potentially extending authorization of the vaccines for children under the age of 12 at a meeting on June 10.
          Whether parents of young children will actually have their kids vaccinated, though, remains to be seen, with misinformation about the vaccines rampant, especially on social media.
          In a poll conducted in early April, 52% of parents said they would be willing to vaccinate their children against Covid-19.
          For parents looking for a quality source of information on vaccinating their children, the American Pediatric Association's parenting website is a good place to start.
          "The US Centers for Disease Control and Prevention, the US Food and Drug Administration and the vaccine companies have been very open and transparent with the American Academy of Pediatrics on all of the vaccine data, because they know that we advocate for children and parents and families," AAP's Maldonado told CNN.
          "Not only are we pediatricians -- we are vaccine experts, and we have reviewed the data ourselves on all the trials so far, and we will review the additional data," she said.

          What summer camps and school next year will be like

          Without vaccines for children younger than 12, summer camps probably will require the same caution as usual -- social distancing, wearing masks, washing hands, limited object-sharing, and keeping activities outdoors as much as possible.
          That's pretty much the CDC's guidance for now, issued in April and intended to supplement local and/or state regulations.
          And school in the fall? Count on in-person, full-time classes, CDC Director Dr. Rochelle Walensky said, even though most elementary school students won't be eligible for vaccinations.
          "We have the capacity now, between vaccines and testing, screening, we believe schools can and should be a very safe place for people to go back to in the fall," Walensky told ABC last week.
          But in-person school may not look much different than elsewhere, with unvaccinated children required to wear masks and keep their distance from others, although some states, including Texas and Iowa, are banning public school mask mandates.
            President Joe Biden has made reopening schools a priority, and his Covid-19 economic relief package included "$125 billion to help school reduce class sizes, update ventilation systems, implement social distancing, buy protective equipment and hire support staff.
            According to Education Week, which tracks such data, at least seven states have already mandated full-time, in-person learning for the 2021-2022 school year.