Ask a Pediatrician: Covid-safe ways to celebrate the holidays

Traveling during the holidays is often stressful, especially when traveling with young children. So, how can you keep your family healthy while still enjoying holiday festivities?

We spoke with Dr. Prachi Singh, DO FAAP, about the precautions parents can and should take when traveling this holiday season. Dr. Singh is a pediatric infectious disease specialist, mother of two young children, and Assistant Professor at the University of California, San Francisco,  Department of Infectious Diseases.


November 18, 2021:

(Updated December 8, 2021)

ParentPal:  Dr. Singh, thank you for taking the time to meet with us. We’re looking forward to hearing your take on Covid, both as a physician and a parent. As a mother you understand first-hand the challenges parents are facing these days. It’s a lot. 

What’s your core message to parents about Covid this holiday season?

Singh:  When I became a doctor, I wasn’t yet a parent. I finished medical school and pediatric training in 2012 and didn’t become a parent until 2016. I can say that being a doctor didn’t make me a better parent. But becoming a parent has certainly made me a better doctor.

When I see parents in the office or through telehealth appointments, my message to them is this: We understand Covid so much better than we did one year ago. We know that there are many precautions parents can take to keep their children safe and we know these precautions work.

Kids (and parents) need to socialize, it is a core part of being human. So, have fun but be cautious, follow CDC guidelines, and be patient.


ParentPal:  As of November 18, 2021, nearly 6.8 million children have tested positive for Covid-19 in the United States, which is about 16.9% of all Covid-19 cases. What can you tell us about the pediatric Covid cases you have treated?

Singh:  Covid severity of illness and transmission rates differ between age groups; Covid in a 15-year-old is very different from Covid in a 4-year-old. We know that kids in high school have a much higher propensity to transmit the disease and to get sick. While the Delta variant has resulted in an increase in outbreaks among younger children, most younger children have mild or no symptoms. Anecdotally, it may feel like more kids are getting sicker, but nationally the data has not shown a significant uptick in pediatric cases.

From a personal account, when we started seeing the Delta surge, the children coming into the hospital were obese teenagers, who were unvaccinated and living with unvaccinated adults. Others had underlying conditions that predisposed them to getting severe illnesses, such as lung issues. Most of the youngest children we saw had very mild symptoms.

Currently, severe illness among young children is still rare. However, we know that children with underlying conditions have an increased risk of hospitalization and ICU admissions.


ParentPal:  We see that as the number of cases in adults increases, the number of positive Covid-19 cases among children also increases. How is Covid-19 transmitted to children?

Singh:  Household transmission is the greatest risk to children in the lowest age groups. For non-travel-related cases, we saw a secondary attack rate of 10.4% among household members, compared to 6.2% for non-household contacts.

Mitigation measures, like masking and vaccination, lower transmission rates across the board.

We also know that the risk of transmission when outdoors is much lower. For example, if you are hiking and you pass a person who is Covid positive, your chances of acquiring Covid is greatly reduced. Higher rates of outdoor transmission occur when there have been lengthy, close interactions in crowded settings, such as at concerts.


ParentPal:  Covid rates vary widely from community to community. What can you tell us about how the pandemic looks across the country?

Singh:  This is quite true. There is a different pandemic going on in different communities across our country. We know things like masks, social distancing, and vaccines have a huge impact on how Covid looks community to community. The data shows that when the adult population within a community has a higher instance of vaccination, the number of positive cases among children is lower.

For example, while California has the highest child population in the US, due to high vaccination rates and strict protocols, this state has some of the lowest Covid transmission rates among children under age 5.


ParentPal:  What can we expect this holiday season, Covid-wise?

Singh:  While Delta is more contagious than previous variants, the good news is it is not necessarily more severe in kids, and there has been no increase in the proportion of children in the ICU or those who need mechanical ventilation.

As people travel and expand their social circles, we do see increased rates of Covid. After the 2020 holidays, we saw a December and January peak, which was quite bad, and was a result of being in close quarters with contagious household members, and holiday travel. But we know a lot more about the virus than we did a year ago.

There is also a new variant, Omicron, recently detected in South Africa. It is noted to be more transmissible.


ParentPal:  I’m glad you brought up Omicron. What do we know about this new variant so far?

Singh:  The Omicron variant, recently discovered in South Africa, has rapidly rising case numbers in the South African community, and has been detected in additional countries, including Hong Kong, Australia, and the US. What we know so far is that it appears to be re-infecting individuals who had previously been infected with Covid-19. The scientific community is concerned and watching closely given the number of mutations in this variant. There are still things we need to learn about this variant such as how much more transmissible the virus may be, what is the disease severity, and what is the effectiveness of vaccines.

There are preliminary reports that this variant might be causing higher rates of illness in children, however those reports need closer evaluation. We will have answers to this in the next few weeks.


ParentPal:  What can we do now to protect our families against Omicron?

Singh:  Vaccinate all vaccine-eligible individuals, and continue to practice safe behavior. Vaccinate against influenza, if you haven’t already. Early data suggests rapid antigen tests are able to detect the Omicron variant, and most experts think vaccines will still be effective in mitigating severe infections from the Omicron variant.


ParentPal:  Based on what we do know, can I keep my children safe and still enjoy the holidays with extended family?

Singh:  Yes, with the caveat that there is no end to the story yet and the data continues to come out.

We know that vaccinated people have symptoms for a shorter amount of time and shed a lower viral load, meaning they are less likely to spread infection. Breakthrough cases are possible, but being vaccinated greatly reduces the length and severity of symptoms, lowers the risk of fatality, and reduces transmission rates.

Masks and social distancing prevent transmission, as does frequent hand washing. Efforts should be taken to avoid crowded spaces. Personally, I keep my mask on, even when interacting with vaccinated people, unless they are close household members. If the weather is nice, try to meet and greet outdoors as much as possible.

So, when participating in congregate settings, try to be outdoors as much as possible. Rapid antigen testing can be utilized on the day of meeting extending family members as an additional safety measure.


ParentPal:  What about air travel? Should parents be concerned about flying with young children?

Singh:  There is no evidence that being in a plane itself increases risk. On planes, people are generally masked and the airline staff is vaccinated. But parents should still be cautious.

For young children who are not yet vaccinated, airline travel safety depends on how good your child is about masking. If your child does well wearing a mask for a long period of time, you should be ok. If your child does not do well with masks, their risk of contracting Covid increases.

Remember to avoid areas with high foot traffic and close contact spaces, such as lines, corridors, and bathrooms. Wash or sanitize your hands frequently and avoid touching your face. I also suggest taking rapid tests before traveling, 2-3 days into your travels, and then within 24-hours after returning home.


ParentPal:  How should we prepare for family holiday visits?

Singh:  Get the family vaccinated. Unvaccinated people are 11 times more likely to get Covid and transmit Covid at a higher rate. Vaccines have been approved for all people ages 5 and up, and boosters are now available to all adults.

Get tested before visiting. Rapid antigen tests are available at local drugstores, and free PCR testing sites are available throughout communities. Get tested before traveling and ask that family members who you will be closely interacting with also get tested.

If you experience symptoms, isolate yourself immediately and get tested as soon as possible.”


ParentPal:  Covid symptoms are very similar to the flu and other common colds. How do I know when I should test my kids?

Singh:  Kids get runny noses. Whether it’s allergies, a cold, or too much crying, a runny nose is a very common symptom among young children. Personally, I use rapid antigen tests to get peace of mind. If my kid has a runny nose and I’m not sure if it’s because she was crying for an hour or because she is sick, I’ll use a rapid test, get the results, and monitor her symptoms. If the rapid test is positive, or if I am really worried, I’ll get a PCR test administered.

If your child develops additional symptoms such as a sore throat, coughing, or fever, call your pediatrician and get your child tested as soon as possible.


ParentPal:  A lot of parents are concerned about vaccinating their children. What’s your advice?

Singh:  When the vaccines first came out, my reaction was similar to that of many parents, which was, ‘Wow they came out with that fast.’ But, the truth is, the Covid vaccine is built upon over 40 years of medical research and technology. The research into coronavirus virology is based on the knowledge that came from scientific work involving HIV and other common viruses, such as RSV in the 1980s.

Science has always been there. Because of the pandemic, money poured into the research and scientists were able to do the kind of large-scale testing and manufacturing needed. In the past, we simply didn’t have the funding for this kind of rapid development.


ParentPal:  What about the vaccine side effects?

Singh:  During testing, a small percent of children experienced side effects following an mRNA vaccine. These side effects were seen mainly in teenage boys, after the second dose of the vaccine. But 100% of cases recovered quickly and do well post-recovery.

I have seen teenagers become much sicker with Covid than they do from vaccine side effects. I don’t worry about a healthy teenage boy developing myocarditis because of the vaccine; it is very rare. I do worry about an obese teenager getting Covid-19 because they are the ones who end up in the ICU.


ParentPal:  We had some great news for child vaccines this week, with Pfizer and BioNTech announcing that their COVID-19 vaccine was 100% effective in preventing infections in 12- to 15-year-olds. What’s next for pediatric vaccine rollouts?

Singh:  Vaccines have recently been approved for children ages 5-11. That’s huge in terms of ending this pandemic. And more vaccines are coming.

We expect vaccines to be approved for ages 2-5 sometime in January 2022, and available for children under age 2 around summer 2022. Trials for infants 6 months and over are currently underway and we are getting new data every day.


ParentPal:  This pandemic has been difficult for everyone, but is there a silver lining?

Singh:  I would say yes. We know so much more about disease transmission and people are so much more aware and involved in public health. We’ve seen a boost in funding for public health programs and infectious disease research. The work we’re doing regarding vaccines and virology today will impact the future of medicine in a positive way for many generations.


ParentPal:  How will you be celebrating the holidays this year?

Singh:  With family and friends. We will try to limit gathering closest family members and encourage everyone to get rapid-tested prior to meeting indoors. Thankfully, California weather is nice, which allows us to do lots of things outdoors. My kids are looking forward to Oakland Zoo’s Glowfari which we will go to with my brother and his family.


ParentPal:  Thank you, Dr. Singh for your valuable insights. It’s been a pleasure speaking with you. Happy holidays!

Singh:  Thank you, Katia. It was lovely speaking to you as well.


If you or your child develop any symptoms, call your pediatrician, and get your household tested as soon as possible.


Dr. Prachi Singh, DO FAAP is a pediatric infectious disease specialist, mother of two young children, and Assistant Professor at the Department of Infectious Diseases, University of California, San Francisco.

The views and opinions presented in this article reflect those of Dr. Singh. They do not purport to reflect the opinions or views of UCSF, Teaching Strategies, LLC, or their members.


Additional sources: