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Will my child be protected by Thanksgiving?

For many, many months, 7-year-old Alain Bell has been keeping a very ambitious list of the things he wants to do after getting his COVID-19 shot: travel (ideally to Disneyworld or Australia); play more competitive basketball; go to “all the restaurants that have fries, which is my favorite food,” he told me on the phone.

These are very charities for children, and they are finally in sight. On Tuesday night, about as early as anyone in the general public could get, Alain took his first dose of Pfizer’s newly approved pediatric COVID-19 vaccine. The needle delivered “a little poke,” he said, but also a huge injection of excitement and relief. Since his father, an intensive care physician, was vaccinated last December (the first time I interviewed Alain), ‘I’ve been impatient,’ said Alain. “I really wanted mine.” Now he is finally on his way to join the grownups. When he learned his shot was imminent Tuesday, he let out a cry of joy, at “a pitch I’ve never heard him use before,” his mother, Kristen, told me.

There is also a cheerful atmosphere among the adults. “It’s cause for celebration,” said Angie Kell, who lives in Utah with her husband and their soon-to-be vaccinated 6-year-old son Beck. Their family, like many others, has been restraining their behavior for months to accommodate their still-vulnerable child, unable to enjoy the full post-vaccination freedoms so many have. But once Beck is vaccinated, they can get off the mixed immunity: “Maybe we have a chance to live our lives,” Kell told me.

The past year has been a tough test of patience for young children – not always a child’s strongest skill. And there is another immediate hurdle to overcome: the debilitating accumulation of immune defenses. Alain has 15 days left until his second dose; after that it will be two more weeks before he reaches a truly excellent level of protection. Only then, on December 7, will he count as fully vaccinated according to CDC standards and can begin adopting the behavioral changes the agency has given the green light. In the intervening weeks, he and the many other 5 to 11 year olds in his position will remain in a holding pattern. Their wait is not over yet.

The timing of this semi-immune trajectory can be particularly frustrating, especially with the winter holidays approaching: At this time, no young children are scheduled to be fully vaccinated on Thanksgiving or Hanukkah, except for those who participated in clinical trials. One shot can offer one level of protection, but experts advise holding off on behavioral change for a reason – the extra protections put in place about two weeks after the second shot really are that much better and totally worth it.

“It takes time for immune cells to get into a position where they’re ready to strike,” Gigi Gronvall, a senior scientist at the Johns Hopkins Center for Health Security, told me. COVID-19 vaccines teach immune cells to thwart the coronavirus, a process that, like most good boot camps, takes many days. The second shot is essential to capture the lesson in the body’s memory and encourage cells to take the threat more seriously for longer. Immune cells also improve themselves over time – the more, the better in these early stages. Gronvall’s own 11-year-old son is also about to have his first chance, and she doesn’t want to risk tripping so close to the finish. “I’m not sure exactly what his immune system is going to do” after the first dose alone, she said.

Evidence from Pfizer’s original clinical trial, conducted only in adults, hinted that: a first, decent defensive bump grabs after the first shot. Kit Longley, Pfizer’s senior manager of scientific media relations, pointed to that data when I asked how children should approach behavior change at various points along the vaccination timeline. “Protection in the vaccinated cohort starts separating from the placebo arm as early as 12 to 14 days after the first dose,” he told me.

The data from adult clinical trials was collected last year, long before the emergence of the Delta variant. A more recent study, conducted in the United Kingdom, showed that one dose of Pfizer reduced the risk of symptomatic COVID-19 by only 35.6 percent when the cause was Delta, and by just 47.5 percent with Alpha. (And remember, those numbers apply best to a population scale – not for a single individual child.) After adding a second dose, however, effectiveness shot up to about 90 or 95 percent against both variants. “You really need two doses for adequate, good protection,” Samuel Dominguez, a pediatric infectious disease specialist at Children’s Hospital Colorado, told me.

Immunity looks strong in young children so far: In a recent trial involving thousands of children aged 5 to 11, Pfizer’s vaccine was more than 90 percent effective in blocking symptomatic cases of COVID-19, including cases caused by Delta. Longley said Pfizer expects the timing of protection for children and adults to be similar — a first dose should lower everyone’s risk to some degree. But the company’s pediatric trial was busted only a few cases of COVID-19; none of them occurred until about three weeks after the first dose was given, or later. So it’s hard to say anything definitive about when “sufficient” immunity really kicks in for kids.

Some parents count on a measure of early protection from one shot, including my cousin Joanne Sy, whose 8-year-old son, Jonah, had his first shot on Friday. “He’ll have good immunity after one dose,” she told me, hopefully enough to guard him on a two-week trip to New York for Thanksgiving. “We’ll still be careful,” Sy told me: they’ll watch the Macy’s Thanksgiving Day Parade from a hotel room instead of on the street, and wear masks, at least on the plane. “But we just have to move forward.”

The calculus plays out differently for Christy Robinson of Arlington, Virginia, who will “crave” again this Thanksgiving with her husband and two daughters, June and Iris, ages 7 and 5, respectively. households were preparing for full, full vaccination in mid-December, just in time to hold an indoor gathering with their aunts, uncles, and cousins ​​for Christmas. (A quick calculation: To be fully vaccinated by December 25, a child would need his first dose on November 20.) June also likes to “see my friends inside, because it’s cold outside,” she told me — plus to movie theaters, and Build-A-Bear, and a trampoline park, and IHOP, and the nail salon.

Towards the end of this conversation, Robinson looked amused and perhaps a little sorry that my question had led to such an extravagant list. As their mother, she is especially excited about the opportunity to no more quarantine her daughters after viral exposure at school. Tougher decisions are also ahead. She and her husband are still considering bringing their daughters into closer and more frequent indoor contact with their grandparents, who have been vaccinated but could still become seriously ill if someone brings the virus into their midst.

And that risk — of transmission of the virus — is worth bearing in mind, given that so much SARS-CoV-2 is still “circulating,” warns Tina Tan, a pediatrician and infectious disease specialist at Northwestern University. Immunized people have a much lower risk of pick up the virus and pass it on. However, there are still not enough to reliably tackle the spread; recording of recordings among young children is also expect to be slow in the next months. Even fully vaccinated families won’t be completely clear as long as our collective defenses remain weak.

That doesn’t mean Thanksgiving has to be a failure — or even a repeat of 2020, before the vaccines are rolled out. The Bells will gently gather with a few loved ones; all adults present are vaccinated and everyone is pre-tested. “Then they can come into the house with their masks off,” Taison Bell, Alain’s father, told me. None of these measures is completely reliable in and of itself; but together they will hopefully keep the virus out.

The road ahead may feel a bit bumpy for Alain, who is celebrating his 8th birthday at the end of November, a few days after his second shot. (He’s getting the gift of immunity this year, his father joked.) The Bells will do something special “once he gets the full vaccination,” Kristen said, “with something Alain hasn’t been able to do in the past two years.” But Alain, who has asthma, which can exacerbate COVID-19, knows that his own injections won’t wipe the slate clean for him or those around him. Some people close to him have even contracted the virus after being vaccinated, and he understands he could too.

Alain will continue to mask and proceed with caution at school, and even a little at home. His 3-year-old sister, Ruby, has yet to get a shot. (I asked her how she felt about Alain’s vaccine; she replied, almost imperceptibly, “Jealous”.) Until another green light comes, she will still be waiting, meaning her family will be too.