LOS ANGELES -- New evidence about the delta variant's ability to infect and spread even among those who are fully vaccinated has been particularly alarming for parents of young children who still are not eligible for the shots.
Many parents who thought their children faced limited risks of getting the coronavirus are now reassessing their stance. Health experts said parents should be extra careful with the highly contagious variant, which is causing infection spikes in Los Angeles County and many other parts of the country.
But several also stressed that it's important to keep the risks in context, adding that children could go back to school with proper precautions.
Dr. Katherine Williamson, a pediatrician in Orange County, said she has seen an increase in coronavirus cases among young patients in recent weeks, as well as an uptick in parents who are vaccinating eligible children -- both of which she attributed to the rise of the delta variant.
"Parents should be making sure that they're doing everything they can to keep their kids safe when they have an unvaccinated child in their family," Williamson said.
Yet the risk of severe illness remains low for those who are vaccinated against covid-19, and the rate of infections, hospitalizations and deaths are much higher for those without the shots.
With the right guidelines and increased vaccinations among those who are eligible, Williamson said, it is still possible to keep young people protected.
Though the delta variant was already known to be more transmissible than the original coronavirus, a new report on an outbreak involving 469 people in Massachusetts found that 74% of infections were among people who were fully vaccinated. And a confidential report produced by the Centers for Disease Control and Prevention pulled together other vexing signs that the variant spreads more easily among fully vaccinated people than previously thought.
Children younger than 12 are not yet eligible for the covid-19 vaccine, and those ages 12 to 17 are still lagging when it comes to obtaining the shots.
The rise of the delta variant has spurred a rash of changes in recent weeks, from new testing and vaccination requirements for federal, city and state employees to the revival of previously abandoned mask guidelines.
West Hollywood resident Jonathan Strauss has two children ages 5 and 2, and said he is "very OK with indoor mask requirements coming back."
Despite the risk, he and his wife are hoping that rising case counts in Los Angeles County won't preclude schools from opening in the fall -- so long as the schools remain diligent about masking, testing and other safety procedures.
Thursday, the Los Angeles Unified School District announced that all students and employees will be required to take weekly coronavirus tests, whether they are vaccinated or not.
Many health experts said moving forward with school reopening plans still makes sense.
"Children need to be in school," said Julie Swann, a health systems engineer at North Carolina State University. "Those of us who have experienced last year, we know it."
Swann recently published a report that found that without masking in schools, an additional 70% of children could be infected with the coronavirus within three months. Her research also shows that even if masking is required in all schools, she still expects 40% of elementary school students to be infected within three months.
Even with that knowledge, she said, schools should reopen, with additional mitigation strategies in place.
"Schools and counties and states can also increase testing of their population and the community, which will also help slow the disease spread," she said.
As the delta variant spreads, public health officials are continuing to keep a close eye on vaccination numbers, which remain woefully low among young people.
"It's crystal clear that vaccination rates among younger people across the board in [Los Angeles County] are much lower than they are for older people, and with more opportunities for intermingling," county public health director Barbara Ferrer said during a news briefing Thursday.
The largest gap remains not only among young people but also among some young minority-group people.
Only 24% of Black people and 33% of Hispanic people ages 12 to 15 had received at least one shot, according to data Ferrer presented, compared with 50% of white people and 76% of Asian people in that age group.
In total, about 50% of teens in Los Angeles County ages 12 to 17 have received at least one dose of the vaccine, Ferrer said, compared with about 70% of county residents overall.
There are signs that the coronavirus surge is stabilizing, Ferrer said, noting that the testing positivity rate is starting to level off. But the 5.17% positivity rate is still far higher than it was June 15, when it was below 1%.
"We still have close to 4 million residents across the county not yet vaccinated," Ferrer said. "This risk of increased spread from this variant within our county remains high."
Not all parents are eager to send their kids back to school.
Deborah Poppink, 57, of Mar Vista, Calif., said that one of her kids prefers learning at home, while the other is looking forward to returning to theater class but unsure of how it will work with masks.
Poppink, who previously worked as a Los Angeles district teacher, also is frustrated with the district's new weekly testing mandate, which she said is essentially asking vaccinated families to carry the weight of the unvaccinated.
"If everyone was vaccinated [there] would be no need for weekly tests," she said. She also noted that there is still a lack of guidance around when and where testing will be done, and how school-related activities will fit in.
"This is a public health crisis and I imagine it's going to get worse rather than better," she said. "Kids are not going to keep their masks on all day long. Even in regular times, kids like to sneak to the bathroom to vape or just do what kids do."
Dr. Gregory Poland, an immunologist at the Mayo Clinic in Rochester, Minn., said continuing outbreaks are probably inevitable.
With unvaccinated kids preparing to once again huddle in classrooms and on buses, a surge in infections linked to school reopenings "can't not happen," he said.
But most experts also agreed that a "safe and sane" approach to covid-19 protocols -- along with more adults doing their part to get vaccinated -- should at least mitigate some of the risk.
Some states have indicated that they probably will heed the federal government's guidance and require masks. Others will leave the decision up to parents.
The controversy is unfolding at a time when many Americans are at their wits' end with pandemic restrictions and others fear their children will be put at risk by those who don't take the virus seriously enough. In a handful of Republican-led states, lawmakers made it illegal for schools to require masks.
In Connecticut, anti-mask rallies have happened outside Gov. Ned Lamont's official residence in Hartford, and lawn signs and bumper stickers call on him to "unmask our kids." The Democrat has said that he's likely to follow the latest advice from the CDC.
Alima Bryant, 33, a mother of four who organizes anti-mask parents in Branford, Conn., said she's not a conspiracy theorist, but she believes scientists have overstated the dangers of covid-19, especially for children. She said she will take her children out of school rather than subject them to wearing masks, which she believes are more likely to make them ill than the virus.
"Especially with little kids, I can imagine how often they're touching dirty things, then touching the mask," she said. "Also, in kindergarten, you have to learn social cues, and even with speech and everything, it's so important to not be wearing a mask."
But parents such as Ryan Zuimmerman of Lenexa, Kan., fear that approach will prolong the pandemic.
In Johnson County, Kan., the state's most populous county, five districts recommend but do not require masks. A sixth district has not yet decided.
Zimmerman, speaking at a recent meeting of country commissioners, said that if masks are only recommended and not required, "95% of kids won't be wearing them."
"This isn't about comfort or control or obedience or your rights. It is not conspiracy or child abuse. It is about doing unto others as you want them to do unto you," he said.
"I ask you this: If it was your kid who was high risk, what if you had to send that kid you had spent your whole life protecting to school in this environment?"
The Pfizer shot is currently the only U.S. vaccine authorized for children 12 years and up. Moderna expects the Food and Drug Administration to rule soon on its application for children in the same age group.
But some parents, such as Bryant, say they will not get their children vaccinated, even after the kids are eligible, until they know more about potential side effects. Bryant said she knows people who have had severe reactions and others who believe it has affected their menstrual cycles.
Young people themselves have been wrestling with misinformation and vaccine hesitancy among parents and peers.
Angelica Granados, 16, of Albuquerque, N.M., finally got permission recently from her mother to get vaccinated.
"I've always wanted to take it," Granados said, describing the shot as a choice between going "back to normal living" or risking infection.
Her mother, Erica Gonzales, stood by as she got the injection and waited with her during an extended 30-minute observation period.
"I didn't want her to take it, but I mean, that's her choice. It's her body. She knows it best," Gonzales said.
The newly resurgent virus could spark 140,000 to 300,000 cases a day in the U.S. this month, fueled by the highly transmissible delta variant and the widespread resumption of normal activities, disease trackers predict.
The nation is already reporting more than 70,000 cases a day, according to The Washington Post's rolling seven-day average -- an increase of nearly 60,000 in the daily average in less than six weeks.
Justin Lessler, a University of North Carolina epidemiology professor who assisted in coordinating pandemic forecasts through the covid-19 Scenario Modeling Hub, said he was "quite concerned... . It worries me that we may have been too optimistic" in projecting lower caseloads into the fall.
The seven-day average of cases nationwide has risen by about 60% in the past week alone. Daily hospitalizations rose by roughly 40% and deaths rose almost 30%, now averaging more than 300 each day.
"It is getting worse, and at least as of right now, it is not really slowing down in the U.S.," said David Dowdy, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.
If there is a silver lining, it is this: Experts do not expect hospitalizations and deaths to rise to the levels they were in the winter. "The people who are getting sick are younger and healthier," Dowdy said.
"The central issue is that people want to put the pandemic and the virus behind them," Columbia University epidemiologist Jeffrey Shaman said, offering as examples unmasked crowds packed into bars and ballparks.
Shaman said his team's most recent model showed a peak in cases in four to five weeks, at which point there would be "a little over a million cases for the whole week" across the U.S. population, which averages to more than 140,000 cases daily.
Modelers at the University of Washington's Institute for Health Metrics and Evaluation predict a rise through mid-August, leveling off at about 300,000 cases daily. In that scenario, deaths rise to a September high of 1,500 daily. But if everyone were to wear a mask -- an unlikely prospect, institute epidemiologist Ali Mokdad acknowledged -- the caseload could be about 10 times smaller.
No scientific approach can cleanly disentangle the effects of delta from loosened restrictions. That's because, in the United States, both things happened in the same window of time. Dowdy said he would hazard a guess "the effect of changes in behavior over the past three to four months has been much greater than the effect of the delta variant."
A familiar pattern has emerged in the U.S. Relaxed behavior is followed by a spike in cases, which in turn spurs people to take more precautions. Americans are much better at reacting to surges than preempting them, Mokdad said.
Information for this article was contributed by Hayley Smith, Deborah Netburn and Melissa Healy of the Los Angeles Times (TNS); by Pat Eaton-Robb, Kelli Kennedy, Cedar Attanasio and Heather Hollingsworth of The Associated Press and by Ben Guarino, Dan Diamond and Jacqueline Dupree of The Washington Post.