Temperature checks are gone from some theme parks and elsewhere. Health experts say that’s just fine

By Jason Hanna, CNN

Just before the CDC’s new mask guidance for vaccinated people became the country’s hot Covid-19 topic, a different feature of the pandemic was falling by the wayside: temperature checks at amusement parks.

Several Florida theme parks — Disney World, Universal Studios Orlando Resort, Legoland Florida, SeaWorld Orlando and Busch Gardens Tampa Bay — said recently they would no longer scan the temperatures of guests or workers upon entry, effective immediately or in days, citing evolving government or medical guidance.

So did every Cedar Fair property in the US, like Ohio’s Cedar Point and Kings Island.

This comes as temperature checks in wider American life, while still required in places, have waned: The CDC ended airport temperature screening for passengers arriving from certain countries in September. Temperature checks are not among the agency’s five key guidelines to reopen schools. A Pennsylvania rule requiring businesses to check employees’ temperatures expires May 31.

And some health experts say that’s OK, not just because US cases are declining, but because temperature checks haven’t been the most useful screening method for this particular disease.

Why many businesses initially did temperature checks

Fever is one of the symptoms that could accompany Covid-19. In the absence of expedient testing, the logical thought that followed was: Find and scrutinize people with fevers to help stem a dangerous and highly contagious disease.

Some reopening businesses — including some office buildings, salons, restaurants, schools, manufacturers and amusement parks — used temperature checks as a condition for admittance, following either state or local rules, or public health advice at the time.

They’d often use noncontact forehead thermometers, either turning away people with temperatures 100.4 F or above — the fever threshold of the US Centers for Disease Control and Prevention — or flagging them for more screening.

Early in the pandemic, the CDC screened inbound international passengers from certain countries at US airports, including with temperature checks.

Where the cracks started to appear

But a problem increasingly became clear: Some people infected with SARS-CoV-2, the virus that causes Covid-19, never show fever or any other symptom — and spread the virus anyway.

Further, some infected with this virus may eventually develop symptoms, but they can spread the virus before they become symptomatic.

By November, the CDC determined 24% of people who transmit the virus to others never develop symptoms, and another 35% of the spreaders are pre-symptomatic.

Also problematic: Many people infected with this virus are at their most infectious before symptoms appear, Dr. Abdul El-Sayed, a CNN contributor, epidemiologist and former health commissioner for Detroit, said.

“When (a disease) shows symptoms sooner, temperature checks are more valuable. When you’re infectious before symptoms, they’re not as helpful,” El-Sayed said.

Accordingly, the CDC found its 2020 temperature and symptom-based screenings at airports weren’t effective.

From January to September, when the program ended, the CDC screened more than 766,000 travelers. Fewer than 300 met criteria for further assessment; 35 were tested for Covid-19; and nine tested positive.

Why so few? Air travelers were on alert and might have skipped flights if they were symptomatic. But also, health experts pointed to factors that defeat temperature checks: An ill person could take pain relief medicine, which treats fever; and a person with SARS-CoV-2 might not have symptoms anyway.

Because so much of this virus is spread by people who will not have fevers, “fever checks are fundamentally ineffective,” said Katelyn Gostic, an infectious disease modeler at the University of Chicago, who has researched the effectiveness of symptom screening for Covid-19 prevention.

“I don’t expect their removal to have a meaningful impact on transmission in public spaces,” Gostic said.

Why not look for feverish people anyway?

Given that a fever can be a symptom of Covid-19, wouldn’t it be reasonable to flag someone with a high temperature?

“I think if businesses want to do it, it’s fine. It’s not going to hurt,” El Sayed said. “But as a measure in the pandemic, it’s not particularly helpful.”

Far more effective and important for controlling the spread have been the use of masks and, more recently, vaccination, El-Sayed said.

Gostic also leans on the latter: “Vaccination is by far the most effective way to reduce transmission and return to normalcy.”

That’s not to say all temperature checks are equal. Covid-19 symptom screening at entrances to health care facilities are much more useful, El-Sayed said.

These places probably have a high concentration of people arriving for treatment of illness including Covid-19, and of compromised patients already there who would be vulnerable.

“The value of any symptom check increases as the baseline prevalence of the disease increases,” so temperature checks at a place where sick people go are more helpful than at a business, El-Sayed said.

Besides missing infected people, what are other problems?

Current CDC guidance says employers should consider health checks of employees before they enter a facility, including symptom and temperature screening.

But, that guidance also says those health checks don’t have to be in-person; they can be self-reported.

If temperature checks aren’t great at identifying Covid-19, then they aren’t worth the problems that they create, some in the labor law and business fields say.

According to attorney Todd Wulffson at CDF Labor Law in California, in-person temperature checks were “all the rage last year” in the Golden State until employers realized:

— Workers must be paid for time in line, and “if they don’t pass the temperature screen, you have to pay them for ‘show up’ pay, which is at least two hours” in California.

— “Chewing on some Tylenol 20 minutes before work eliminates your fever.”

— “If it’s a hot day, and the employees are in the sun, the temperature check doesn’t work as their forehead gets hot.”

California’s Covid-19 regulations still require some type of employee screening. But now, the state generally allows employees to self-screen at home, using employer-provided questionnaires that ask about symptoms like fever — though counties and cities can have stricter rules, Wulffson said.

Temperature checks for guests are also a resource drain, especially for theme parks that might have a worker shortage, said Scott Smith, an associate professor at the University of South Carolina’s School of Hotel, Restaurant and Tourism Management.

“Everybody right now is desperately hiring, especially theme parks, which need a tremendous amount of labor,” Smith, who also provides consulting to the theme park industry, said.

Temperature-checkers are people who instead “could be running rides, selling cotton candy or whatever,” he said.

Temperature checks continue at some theme parks

Though many Florida theme parks have abandoned temperature checks for guests and workers, some of their sister properties in California have not. That includes Disneyland theme parks, Universal Studios Hollywood, and Legoland California.

Legoland California is considering not requiring temperature screening upon entry for guests, said Julie Estrada, spokesperson for the park’s parent company, Merlin Entertainments.

As for employees, including its restaurant workers, the park still has regulations to consider. Restaurant workers still must submit to temperature checks under rules in San Diego County, where the park is.

Smith attributes the Florida-California split in part to different regulatory environments and levels of control at county or local levels. Florida’s state government has been quicker to encourage looser restrictions, and county governments have been quicker to follow, he said.

The California properties, though, aren’t alone. Six Flags parks nationwide also continue to check guests’ temperatures — with infrared thermal imaging cameras as they walk in.

Six Flags will “continue to evaluate the (parks’ infrared thermal imaging) system based on state and CDC guidelines,” said Sandra Daniels, Six Flags’ vice president of communications.

As for Cedar Fair, a group of a dozen-plus amusement and water parks, all its US parks — including Knott’s Berry Farm in California — have stopped temperature checks for guests. Instead, workers generally will screen guests by asking about whether they have symptoms.

The only park still checking employees’ temperatures — Dorney Park in Pennsylvania — will stop doing that when jurisdictional rules lift at month’s end, spokesperson Gary Rhodes said.

Each company above — whether keeping or abandoning the checks — cites state/local guidelines and/or epidemiological advice they’ve received.

“With the guidelines varying from state to state, the practices (for health and safety, including temperature checks) differ from park to park,” Estrada, the Merlin Entertainment representative, said. “The evolution of (Legoland California’s) procedures has been done in consideration with local health partners and officials, as well as CDC guidelines to ensure families can continue to have the confidence to play safely across our resort.”

Smith at the University of South Carolina said he believes more theme parks will soon abandon temperature checks: “With the vaccinations and people being a little more mindful of other precautionary measures, I think if we continue to see this trajectory,” more parks will drop them.

And parks, as soon as it’s safe, will like the message it sends: “Theme parks want you to feel like, ‘Hey, we’re coming back to normal,'” he said.


Dr. Sanjay Gupta: ‘Race for the Vaccine’

By Dr. Sanjay Gupta, CNN Chief Medical Correspondent

In the United States, the finish line for the pandemic as we’ve been experiencing it for the past year-plus is very much in sight — so much so that the US Centers for Disease Control and Prevention essentially said so on Thursday: Fully vaccinated people no longer need to wear masks indoors or out, or socially distance, except in a rare circumstances.

This new guidance speaks not only to the effectiveness of the vaccines, but also the trust major medical and public health organizations have placed in them. They believe that when the story of this pandemic is finally written, it will be about the vaccines — and the science behind them — that finally rescued us.

My colleagues at CNN and I have been watching the vaccine development story unfold since the very start. Over the last year, we have followed research teams on five continents, documenting their trials and tribulations, their triumphs as well as the crushing defeats. We know how the story began, with the outbreak in Wuhan, China, and we know how it ends, with some of the most effective vaccines in the history of the world.

Now, the behind-the-scenes story of this all-consuming race is being told for the first time in the documentary “Race for the Vaccine,” premiering tonight night on CNN.

On your marks 

On January 10, 2020, researchers in China — where the first cases of an unusual pneumonia were documented — released the entire genetic sequence for the novel coronavirus that appeared to be behind this mystery illness. This action — a simple post on a website used by virologists to share research and data — was like firing a starting gun, and it was heard by scientists ’round the world.

In Australia, Keith Chappell and his team at the University of Queensland jumped into action to develop a tried-and-true protein vaccine. In the United Kingdom, Professor Teresa Lambe from the University of Oxford, got started immediately on a viral vector vaccine. In China, George Gao, director general of China’s Center for Disease Control and Prevention, directed his team to focus on what is considered one of the oldest types of immunization technology: an inactivated vaccine.

And, two teams — one in the United States at the National Institutes of Health, and the other in Germany at a small company called BioNTech — placed all-or-nothing bets on an approach that very few had ever heard of, even in the scientific community: messenger RNA.

When we started filming this documentary, we had no idea how long the race would take, or whether there would even be a winner. Remember, before the pandemic, in the United States creating an FDA-approved vaccine often took more than a decade. This documentary chronicles the lives of the remarkable scientists who, under enormous pressure, did whatever it took to get these vaccines to the starting gate and over the finish line. It explains why certain gambles were taken and follows how their choices unfolded.

A vaccine is born

Truth be told, all of the coronavirus vaccines got their start a long time before January 2020: The so-called platforms — the underlying technology — all existed before the pandemic, and all but one — the mRNA platform — had already been used commercially in the past. All of the vaccine makers had the same goal: create the best delivery system in order to trigger the strongest immune response. It’s that immune response that prepares our body so it can defend itself when it encounters the real virus later on.

That might mean using the whole virus itself, or a weakened version of it. It may mean using just a piece of the virus, or only the blueprint of a viral portion, to teach the body to recognize something foreign, and then attack it.

If you have heard anything about the Covid-19 vaccines, you have probably heard the term spike protein. Think of them as the little nubs that protrude from the surface of the coronavirus and give it its crown-like appearance. Crown — or corona, in Latin — is where this virus gets its name. The spike protein is what the virus uses to latch onto and break into our cells, which it then hijacks to replicate itself.

Viral vector vaccines such as Johnson & Johnson (Janssen), AstraZeneca/Oxford, and Russia’s Sputnik V use another virus — in this case, a common cold virus — to deliver instructions to make the spike protein, which our cells then display on their surface, triggering an immune response.

Protein subunit vaccines — such as Novavax and Sanofi — use genetically engineered insect viruses to infect moths, whose cells then produce the pieces of coronavirus spike protein. These are harvested and made into a vaccine, which is then injected into people.

The oldest vaccine technology — using the whole, killed virus to trigger an immune response — is the approach used by China’s Sinovac.

On the other end of the spectrum, the newest type of vaccine technology is the mRNA vaccine. This method uses mRNA — messenger RNA — to give our cells the instructions to make a piece of the spike protein. Our cells then make that protein over and over again, which then stimulates our immune system to react. It’s the technology used by BioNTech, which teamed up with pharmaceutical giant Pfizer, as well as Moderna, which worked with scientists at the NIH.

The story behind mRNA technology

Many people describe mRNA technology as new, but that is not entirely true. While no mRNA medicine or therapeutic had ever been authorized by the FDA, the science behind the mRNA vaccines is based on concepts developed more than 20 years ago by Dr. Drew Weissman and Katalin Karikó, both at the University of Pennsylvania at the time. During those 20 years, mRNA vaccines have been studied and tested for conditions such as the flu, Zika and rabies, to name a few.

“DNA is the genetic code. It contains everything that makes our body and makes our body work. What RNA does, RNA makes a copy of genes — genes usually encode a protein — so the RNA makes a copy of one protein from the DNA and carries it out to a machine in the cell that makes proteins off of that RNA copy,” Weissman explained to me back in December. “We’re using the body as our protein production factory.”

Weissman said that even two decades ago, they were thinking of using mRNA technology for vaccines, as well as for therapeutic proteins, for gene editing and other applications.

Among the early adapters to study and use mRNA technology is the husband and wife team Dr. Uğur Şahin and Dr. Özlem Türeci. The couple, when they first met, bonded over science — so much so, they headed straight back to the lab after their wedding.

“We have worked hands-on and seen patients and treated patients, and at the same time we were scientists. And what we were basically daily experiencing, as cancer doctors, was that there’s not much we can offer our patients in terms of approved standards of care,” Şahin said on my podcast back in March.

“Yet in the world of science, we experienced that there were so many technologies and knowledge which would provide the opportunity to better treat patients. And this gap and the interest in translating science into survival was what we shared and why at some point we decided to do this journey together,” he said.

The pair founded BioNTech in 2008, which at the time was focused mainly on using new technologies for cancer therapies.

But then in 2020, clouds began gathering on the horizon. Even as early as January, Şahin thought the situation might develop into a pandemic, and he felt he and his wife had the tools to help. In March, BioNTech quickly teamed up with Pfizer, a company they had already been working with on other projects.

The other team working on an mRNA vaccine, Moderna, was an upstart company that had never brought an FDA-approved product to market. The company, whose name is a portmanteau of “Modified” and “RNA,” worked in partnership with the NIH’s Dr. Barney Graham and Kizzmekia Corbett, an immunologist.

Asked during an online interview Wednesday if he felt the pressure, Graham said the Vaccine Research Center, of which he is deputy director, had been under pressure before — for example, during the Ebola and Zika crises. “In this case, we started this project before it was a pandemic. So at the beginning, for us, it was a demonstration project to prove how fast we could go if the need arose. … It didn’t turn into a lot of pressure until the middle of March, when it was declared a pandemic and when we started having a lot more cases around the globe,” he said.

Hitting the jackpot

As the months of 2020 ticked by, the scientists worked almost nonstop to perfect, then test their products. And then the results started coming in. They were almost too good to be true: Early study results showed the Pfizer/BioNTech vaccine was 95% effective, and the Moderna vaccine was 94.1% effective, at preventing symptomatic Covid-19. These preliminary numbers held up as more study results came in.

At the start of the summer, the FDA had said it would require any coronavirus vaccine to be at least 50% effective to win approval (keep in mind that the flu vaccine is between 40% and 60% in years with a good match between circulating virus and the vaccine). Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who was then on the White House Coronavirus Task Force, said he would settle for a vaccine that was 70%-75% effective.

But the mRNA vaccines results blew all that away.

Just last week, a close friend and board member at the CDC told me, “The creators of the mRNA vaccines will likely be nominated for the Nobel prize.”

After a rapid race to the end, it was the two mRNA vaccines that crossed the finish line first and second in the United States, winning FDA emergency use authorization a week apart, in mid-December. It was just 11 months after the genetic sequence had first been shared with the world.

To reach herd immunity globally, though, all of the vaccines that make it across the finish line have a very important role to play. There will be billions of people immunized around the world, and there is a possibility that boosters will be necessary in the future as well.

The thing about races is that they force the impossible: They make us better, safer and, yes, faster than we have ever been before. And this race for a vaccine, under the brutal pressure of a pandemic, may have forever accelerated the pace of medical innovation by showing us exactly how creative, nimble and determined humankind can be.

CNN Health’s Andrea Kane contributed to this report.


Talking on Zoom could help older people stave off dementia

By Rob Picheta, CNN

Talking on video-conference services like Zoom during the coronavirus pandemic has helped older people stave off the effects of dementia, a new study has suggested.

Researchers found that regular communication helps maintain long-term memory, and elderly people who often use online tools showed less decline in memory than those who don’t.

The study, by the University of West London’s Geller Institute of Ageing and Memory, studied the communication of 11,418 men and women over the age of 50.

They were asked how often they interacted with friends and family online, on the phone and in person, and then completed memory tests that involved recalling a list of 10 words at various intervals.

The participants who only used “traditional,” face-to-face communication showed more signs of cognitive decline than those who used technology to keep in touch with friends and family.

“This shows for the first time the impact of diverse, frequent and meaningful interactions on long-term memory, and specifically, how supplementing more traditional methods with online social activity may achieve that among older adults,” the study’s leader Snorri Rafnsson said.

“With more and more older adults now using online communication so frequently, especially during the past year of global lockdowns, it poses the question as to what extent technology can help sustain relationships and overcome social isolation, and how that can also help maintain brain health.”

As the pandemic has forced people to stay apart, video conferencing tools like Zoom, Skype and Google Meet have exploded in popularity.

In recent months Zoom has emerged as the most downloaded app on the Apple App Store, repeatedly breaking its download records.

A study last year found that negative thinking is linked to dementia later in life. And separate research found that apathy, the decrease in motivation and goal-directed behavior, could also be a trigger in older adults.


How to talk to our kids about traumatic events, according to a 9/11 responder

By Jessica DuLong, CNN

Isaac Rothbart’s twins had always known their daddy doesn’t like fireworks. But he’d never told his kids why.

Then, while celebrating their fifth birthday at Disney World, the family wound up close to an unexpected pyrotechnics show. Rothbart “didn’t react well.” His wife noticed him shutting down and ushered the whole family indoors.

That’s when Rothbart and his wife decided it was time to have the conversation with the kids. Rothbart had recorded an HBO documentary specifically geared toward teaching children about the September 11 attacks. That would be their conversation starter.

Pandemic deaths, insurrections, terrorist attacks and endless video loops of police brutality and hate crimes present parents with continual pressures about how and when to share troubling and traumatizing news with our children. Those pressures are further compounded when we or our loved ones are personally affected.

Only by accident did Rothbart and I wind up discussing how to tell kids about the deadliest terrorist attack on US soil. At the time, Rothbart, chief financial officer of the New York City Police Foundation, was trying to help me locate a photo from that terrible fall day in 2001. The cover art for my book, “Saved at the Seawall: Stories from the September 11 Boat Lift” was due at the printer.

“Could it be one of these?” he’d ask before sending over another file. We were speaking by phone while emailing back and forth as he dug through old hard drives looking for digital contact sheets.

Through all my years working on this book, I had pored over hundreds of photographs from that day. Yet somehow, clicking open this particular image stopped me short. My “ooph” came out involuntarily.

The photo was not the most poignant or revealing I’d ever seen. Taken from an NYPD Aviation Unit helicopter, the image on the contact sheet was tiny, rather dark, cocked at an odd angle. But something about the enormity of the dust cloud photographed from such height and distance brought forth all the horror.

“Sorry,” I replied, to account for my extended silence. “After all this time, I thought I was immune.”

“It’s OK,” Rothbart said. “I was at Stuyvesant High School that day.” That quick disclosure communicated whole worlds of understanding.

“I guess this is why I still hide this history from my kids.”

It has been nearly 20 years since I served at Ground Zero as a marine engineer aboard retired NYC fireboat John J. Harvey. But I still haven’t told my 9- and 5-year-olds about the terrorist attacks — or that I was down there. The countless hours I’ve poured into reporting and writing this book have taken place behind closed doors, where I’m quick to bury the evidence on my desk rather than face questions from my children.

My conversations with Rothbart, however, convinced me that this is the year to share the truth. I have read all the Child Mind Institute tip sheets: “Helping Children Cope With Frightening News,” “Helping Children Deal With Grief,” “Talking to Kids About Racism and Violence.” The subtitle of that last one promised exactly the help I needed: “Supporting children while navigating your own big emotions.” But bullet point three from “Frightening News” — “model calm” — left me far less optimistic.

I reached out to David Anderson, Child Mind’s vice president of school and community programs, who helps parents and caretakers discuss all kinds of difficult topics. I later discovered that Rothbart had intuitively put into practice with his own children many of the approaches that Anderson recommended.

Anderson’s core message for parents struggling with difficult disclosure decisions is quite simple: “Your children are ready to hear about what’s going on in the world — from you.” That’s much better, he argues, than their hearing about it from others — especially someone who’s not “a close attachment figure” with whom children can more easily process their feelings. “The real question is,” he prods, “are you ready to tell them?”

In a word, no. But I’m trying to get there. I recognize that my silence is not serving my need to protect my kids. Rothbart’s story inspired me to look up that HBO documentary. Turns out filmmaker Amy Schatz created “What Happened on September 11” after hearing about a curious third grader who googled “Sept. 11 attacks” with a friend on a playdate. Ouch.

My older son is in third grade. At what point could my efforts to protect him and his younger brother cross over to endangerment? Already my 5-year-old has mastered Google voice commands. My favorite of his searches, “images of invisible goats,” could easily devolve into something more sinister.

“We want kids to have us right there to help them process their emotional reactions,” Anderson insisted, “and only get exposed to content they’re ready for developmentally.”

That last caution tripped me up a bit. How can parents who aren’t child psychologists know what kids can handle and understand?

“Give him a few basic facts, and then see how he’s reacting,” Anderson advised. “What we’re really trying to emphasize to parents is that this process of providing your kid with facts, gauging their emotional reactions, validating those emotions and trying to answer their questions gets repeated thousands of times across their development.”

OK, but what about that “model calm” sticking point? The Child Mind tip sheet cautioned, “If you talk to your child about a traumatic experience in a highly emotional way, then he will likely absorb your emotion.” The PTSD I still experience two decades after September 11, 2001, means that “calm” is not my default setting when it comes to this subject.

Fortunately, Maira Kalman has provided an artful and effective tool for teaching kids about September 11: her picture book “Fireboat: The Heroic Adventures of the John J. Harvey.” I appear as the character Jessica, who stands “at the controls in the noisy engine room.” The signed copy Kalman gave me still smells like diesel from the boat and the pages are wrinkled from some water display mishap.

I have never read this book to my children. I couldn’t bear the page depicting a sky “filled with fire and smoke.”

“Your goal is to avoid encouraging frightening fantasies,” the tip sheet read. How, exactly, could I manage that given the horrific truths of that day — that terrorists intentionally used passenger-filled planes as missiles — that people jumped from the windows of skyscrapers to escape the searing heat of jet fuel-intensified fires — that thousands perished when the towers collapsed?

I took some comfort in Rothbart’s experiences with telling his kids. As a high school senior, he had watched the horrors unspool from south-facing windows in a ninth-floor classroom. “We saw people coming to the windows and waving flags to try and get help,” he recalled. “It was evident pretty quickly they were not getting out.” Along with his classmates, he learned at school that day how to distinguish falling debris from people by the way their limbs flailed on the way down.

“My kids don’t know that,” Rothbart explained, drawing out the last word for emphasis. He was quick to clarify that there are details he has not shared. He used Schatz’s film as a way to broach the topic, inviting his twins, at around age 6, to watch it with him. One son declined, and his parents respected that choice.

“It’s still on the DVR. So, when he’s ready, he’ll watch it.” But the other sat through it with his mother and father, who did their best to answer his questions simply and directly. “He asked to maybe watch it again. We said, ‘Sure, but it might be without Daddy.'”

Instinctively, Rothbart had followed the Child Mind Institute’s recommendation to arrange for backup if a parent is dealing with their own trauma. It’s important, Anderson explained, to strike a balance between modeling calm and letting kids see your real emotions.

“Difficult events in the news, terrorist attacks, acts of racism, these are incredibly disorganizing emotionally for anybody. We want kids to know that it’s appropriate to feel sad or disturbed or deeply affected by traumatic events. At the same time, staying regulated to help your child process their emotional reactions is key.”

Trauma can trigger “re-experiencing,” he explained. If that’s a possibility, it’s wise to enlist help from “another trusted adult who can take over if it’s getting to be too much.”

Anderson also said it’s “emotionally healthy” to build yourself an “out” before a difficult conversation. “It’s perfectly fine to say to a kid, ‘Listen, it’s really emotional for me to talk about this. It’s important for you to hear about it, but I’ve also got to make sure that I’m staying in a place where I can have this discussion.”

Also crucial, Anderson said, is properly framing the information. When talking about terrorist attacks or mass shootings, he recommended, “Explain to your child how unusual this kind of event is. Even though it is much more frequent than it has been in the past — disturbingly frequent, in fact — it is still relatively unlikely the child will have that experience.” The same, he explained, cannot be said about racial violence or sexual assault, of course.

Overall, both Anderson and Rothbart reassured me that sharing September 11 with my children won’t require flawless execution. “Life isn’t about reacting perfectly to everything that happens,” Anderson said. It’s about finding “ways that you can cope and be ready for whatever obstacles life throws at you.”

That, after all, is the most important lesson. If we shield kids from every emotional event that could occur, Anderson cautioned, we’ll set them up for “a huge awakening when they get to adulthood.” Instead, our job as parents is to help our children practice talking through emotional topics. “Parents (and caretakers) are the absolute best mediators for building children’s emotion-regulation circuitry.”

This will be the year. I will set up the scaffolding for a calm conversation. I will read Kalman’s “Fireboat” to my kids and show them the picture of Mama working in the engine room. (In a classic writerly maneuver, it will give me a way to hide behind a character on the page.)

I will finally show my children my own book that documents the momentous history of lifesaving actions that have gone woefully unrecognized. I will tell them about the boat lift and the efforts of so many first responders and volunteers that day — that people help one another through disasters, marshaling the goodness, resourcefulness and humanity that calls them to action. I will teach them that hope and wonder light up even the darkest times.

Jessica DuLong is a Brooklyn-based journalist, book collaborator, writing coach and the author of “Saved at the Seawall: Stories from the September 11 Boat Lift” and “My River Chronicles: Rediscovering the Work that Built America.”


The outlook is brighter for the US on Covid-19. It’s why school life may return to almost-normal in the fall

By Madeline Holcombe, CNN

This week marked a major shift for the Covid-19 pandemic in the United States, and much of American life — including the classroom — could soon start to look much the way it did pre-pandemic.

After more than a year in which many students were learning remotely, children and educators should expect to return to in-person and full-time classes, US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky told ABC on Friday.

“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 said.

The US Food and Drug Administration and the CDC this week expanded authorization of the Pfizer/BioNTech vaccine to people between the ages of 12 and 15 — the first vaccine authorization for adolescents and young teens.

And on Thursday, the CDC announced major relaxations to mask guidelines for fully vaccinated people, saying those individuals can ditch the masks indoors and outdoors (except for certain circumstances), introducing a benefit for those who are immunized against Covid-19 and another incentive to those who remain hesitant about getting vaccinated.

“People who are vaccinated should feel perfectly comfortable in going indoors without a mask,” Dr. Anthony Fauci told CNN’s Wolf Blitzer Friday.

But while many things are changing for those who have been vaccinated, those who are not may find things looking much the same as they have for the past year, experts said. And that could extend to students in the classroom.

Children who have not yet been vaccinated will still need to wear masks in the classroom, Fauci said, adding that he could “almost guarantee” most schools will require it.

Even vaccinated teachers may still be wearing masks if they are around unvaccinated students, vaccine expert Dr. Paul Offit said Friday.

“If you’re around a large number of children who are not wearing masks, who certainly can get this infection — roughly 24% of the infections currently in the United States are in children — I guess, were I a teacher, I would choose to wear a mask,” Offit told CNN’s Anderson Cooper.

How do you feel about the CDC’s new mask guidance?

2.4 million children vaccinated

More than 155 million people have received at least one dose of Covid-19 vaccine, including about 2.4 million children under 18, according to data published Friday by the CDC.

That means that 55% of those 12 and older have received at least one dose, the CDC data shows.

Meantime, officials have been strategizing on how to convince more adolescents to get vaccinated, especially as it usually involves having to convince their parents.

Nearly all states require some form of parental or guardian consent for vaccine providers to administer Covid-19 shots to adolescents ages 12 to 15, a CNN analysis finds.

But there are a few exceptions. Five states — Alabama, Iowa, North Carolina, Oregon and Tennessee — either allow some ages in that group to consent for themselves or leave requirements up to individual vaccine providers.

Another focus for officials is ensuring vaccines are given to 12- to 15-year-olds in an equitable way, the CDC’s vaccine advisers said Friday.

Solving social isolation from remote school

The effort to vaccinate children and adolescents could have just as big of an impact on their social health as it does on their physical health.

While many students will recover academically, one the worst aspects of remote learning has been the loss of in-person social interaction, American Federation of Teachers President Randi Weingarten told CNN, and resources will be needed to address that.

“There are some kids who did very well on remote,” Weingarten said. “But what’s really been lost is the peer-to-peer contact. What’s really been lost is the prolonged effects of social isolation.”

She also noted the pandemic has highlighted the huge inequities within the education system and that it was crucial to provide more resources to schools that weren’t doing well before Covid-19.

Where states stand on mask guidance

Following the CDC’s decision Thursday to advise that masks do not have to be worn indoors for those who are vaccinated, many state leaders quickly revised their own guidance.

After holding back to review the CDC guidelines, North Carolina Gov. Roy Cooper said Friday the state is relaxing its Covid-19 measures.

“Effective immediately, we are lifting all mandatory capacity and gathering limits, and social distancing requirements, and most mandatory mask requirements,” Cooper said. “That means, in most settings indoors or outdoors, the state of North Carolina will no longer require you to wear a mask, or to be socially distant.”

Colorado also initially paused any changes. But Friday Gov. Jared Polis announced that the state is moving from a mask mandate to a mask suggestion.

“We are thrilled with the recent CDC guidance,” Polis said during a Friday press conference. “We are able to really embrace this science-based judgment by the CDC, which we agree with.”

Costco also said Friday customers who are vaccinated against Covid-19 can shop without masks at US locations where there are no state or local mask mandates.

Travel hitting pandemic-era highs

Despite relaxed mask guidelines, Walensky made it clear this week that masks are still required for transportation, including air travel. And Sara Nelson, international president of the Association of Flight Attendants, told CNN those rules will continue to be enforced.

“In the airports we have no way of telling who is vaccinated and who is not. The rules have to be the same for everyone,” she said, adding that refusal to comply could carry up to a $35,000 fine and jail time.

But that’s not hindering travelers. Air travel continues to soar, according to the Transportation Security Administration, which reported 1.71 million people traveled through US airports on Friday — the second highest number of daily travelers during the pandemic.

The pandemic-era record for air travel was set Thursday, when the TSA said it had screened 1.74 million people. That eclipsed the previous record set last Sunday by about 36,000, an indication that Americans are increasingly eager to travel.

CNN’s Virginia Langmaid, Lauren Mascarenhas, Deidre McPhillips, Jacqueline Howard, Maggie Fox, Taylor Romine, Kelsie Smith and Hollie Silverman contributed to this report.


How should parents with children younger than 12 use the CDC’s new mask guidelines? Dr. Wen explains

By Katia Hetter, CNN

The US Centers for Disease Control and Prevention’s newly loosened masking and physical distancing guidelines for people fully vaccinated against Covid-19 doesn’t include children under age 12.

That’s because the 49 million US kids younger than 12 don’t yet qualify for any of the Covid-19 vaccines.

The CDC’s guidance says that unvaccinated people still need to wear masks, which means all of those in the under 12 age group.

We turned to CNN Medical Analyst Dr. Leana Wen to see what parents and their younger kids can do next. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s also the author of the forthcoming book “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: What does the CDC’s Thursday decision on masking mean for children younger than 12?

Dr. Leana Wen: It’s a dilemma. I have two little children, ages 1 and 3, who can’t yet be vaccinated. I understand how parents are feeling.

The CDC’s new guidance only applies to people who are fully vaccinated. That means my husband and I, who are now both fully vaccinated, no longer need to wear masks or distance when we’re out in the public around others. The CDC is saying that those who are unvaccinated should still wear masks and socially distance, so nothing changes for our children.

CNN: To confirm, children younger than 12 still need to wear masks, right?

Wen: Correct. The CDC hasn’t changed guidance for unvaccinated children — or anyone who is unvaccinated. At the moment, unvaccinated children still need to mask when they can’t keep 6 feet away from others.

I would modify this a bit. We know that outdoors is much safer than indoors. I’m fine with my kids playing outdoors with other unvaccinated children, without masks, even if they’re within 6 feet. But if they are indoors, they should definitely wear masks, and so should other unvaccinated people.

CNN: How should vaccinated parents approach the new CDC guidance, if they have unvaccinated children, including those under age 12, who can’t get the vaccine yet?

Wen: This gets complicated. Here’s what we know, based on the science. We know that getting the vaccine protects you from getting infected with Covid-19. Even if you get infected, you have a much lower chance of spreading it to others. But that risk still exists.

How vaccinated people should approach changing their behavior depends on their risk tolerance. 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.” 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.

For my family, where we live in Baltimore still has high Covid-19 spread, and the rates of vaccination are low. We still want to be cautious. That means my husband and I will attend any outdoor event without reservation, but indoors, we will still wear masks unless we are certain the people we’re in close contact with have also been vaccinated.

We’d go to indoor dinners with our vaccinated adult friends. We’d go to outdoor restaurants or relatively uncrowded indoor restaurants. We’d get on a plane where masks are required. But we wouldn’t go to an indoor exercise class where maskless people are breathing heavily, in close quarters, and we don’t know if they’re vaccinated. For church services, when we’re around others of unknown vaccination status, we’d keep our masks on, and the same when we go to the grocery store.

CNN: What about people who have children 12 and older who get the vaccine, and children younger than 12 who can’t yet? Should everyone mask up?

Wen: If there are people in the same family, some of whom have had the vaccine and some have not, they don’t need to mask around one another. The family, as a unit, should decide what your risk tolerance is when out in public.

Let’s say that there is a 15-year-old who is now vaccinated, but a 10-year-old who’s not yet. If the family has the same low risk tolerance as my family does, then they might decide that the 15-year-old should still stay safe and reduce risk by having indoor, maskless get-togethers only with other fully vaccinated people. Sleepovers can happen, but only with other vaccinated friends. If they went shopping and there are lots of unvaccinated, maskless people around in a crowded mall, they should still wear masks.

CNN: What if my unvaccinated 11-year-old has asthma or is otherwise immunocompromised?

Wen: You should have a lower risk tolerance as a family. Everyone in the family, even the people vaccinated, should take a bit more caution. To me, that means being very careful in settings where there are unvaccinated people in close proximity to you, indoors, without masks.

If everyone is outdoors, there’s very little risk — I’d try to be outdoors whenever possible. If they are indoors, they should either be vaccinated, or wear masks. If it’s crowded, indoors, and with people without masks or vaccination, that might be the kind of setting that members of your family (even the vaccinated ones) stay away from.

The key is to protect the unvaccinated 11-year-old. That child should definitely try to avoid these crowded, indoor settings where people are unmasked.

CNN: What if your younger children want to visit their vaccinated grandparents? Is that safe to do without masks?

Wen: Yes. This was one of the first guidelines the CDC came out with when they relaxed their restrictions. The only caveat here is if there is someone in the group who is severely immunocompromised. If that’s the case, you could consider seeing them outdoors only, without masks. But in nearly all cases, grandparents should be able to enjoy time with their grandchildren, without masks or any other restrictions.

CNN: Can our younger unvaccinated children play with other unvaccinated children?

Wen: Yes, though I’d really try to do this outdoors only. My 3-year-old has playdates with other kids his age without masks. Indoors, though, there’s higher risk, and if they were to be indoors, they should wear masks.

CNN: What do we know about the dangers of Covid-19 on younger children? We hear it’s not as dangerous, but some children are becoming Covid long-haulers and some still die from it.

Wen: Since the beginning of the pandemic, 3.85 million children have tested positive for coronavirus. More than 300 have died. Thousands have been diagnosed with multisystem inflammatory syndrome, a condition that could have long-lasting impacts on multiple organ systems.

The likelihood of a child becoming severely ill from Covid-19 is low — hospitalization rates are about 0.8%, according to the American Academy of Pediatrics. Some parents could look at these statistics and say that they are willing to take the risk to resume normal life for the entire family. Other parents will want to continue to be more cautious.

CNN: Are we supposed to trust unmasked strangers to be vaccinated when we know many people never wanted to wear masks in the first place?

Wen: This is my major concern with the new CDC guidance. The risk to the vaccinated is low, but there is a real risk to the unvaccinated if they are exposed to people who are maskless and unvaccinated.

I think the CDC has just made it less safe for unvaccinated people, including children under 12, to be in public places. What we should be doing is creating incentives to encourage people who are eligible for vaccination. Vaccines are what will protect the most vulnerable, including those who cannot yet be vaccinated like our children.


CDC facing formidable challenges in convincing conservatives to get Covid-19 vaccines

By Elizabeth Cohen, CNN Senior Medical Correspondent

Public health experts at the US Centers for Disease Control and Prevention are facing challenges — even struggling — as they try to figure out how to convince hesitant Republicans to take the Covid-19 vaccine, federal officials familiar with the situation told CNN.

“It’s kind of a mess to figure out with this particular audience what resonates with them, because they see vaccines as taking away their freedom,” said one official. “It’s a hard climb for everyone in public health. It’s moving a rock up a mountain.”

According to a Kaiser Family Foundation survey in April of more than 2,000 people in the US, 42% of Republicans, but only 19% of Democrats, are less than enthusiastic about getting the Covid-19 vaccine.

“There is a real concern at CDC that much sooner rather than later we may get to the point where we’re stalled in our vaccination efforts because of hesitancy,” another federal official said.

The CDC announcement Thursday that vaccinated people can take off their masks indoors and outdoors won’t necessarily sway many conservatives, the sources said, because many believed former President Donald Trump when he said last year that Covid-19 wasn’t so dangerous.

Republicans aren’t the only vaccine hesitant group in the US — others, such as Black people and Latinos, have also shown some reluctance to roll up their sleeves. But since December, when the Covid-19 vaccines were first offered, vaccination rates in those two groups have risen more sharply than among Republicans, according to the KFF survey.

“When did vaccines become a partisan issue? When did any of this become a partisan issue,” a third federal official said. “This is really tough.”

The officials asked for anonymity because they are not authorized to speak about the CDC’s strategy.

In a statement, a CDC spokesman acknowledged hurdles to overcoming vaccine hesitancy in the US.

“This is an unprecedented and complex public health challenge,” wrote Jason McDonald, the agency spokesman. ”CDC continues to balance both the need to educate and inform people of safe behaviors once vaccinated as well as keep in place public health recommendations to prevent further spread of COVID-19 that could threaten our gains.  We know there are people still deciding whether to get vaccinated.  We encourage them to talk with their healthcare provider, who can address questions about safety or efficacy.  As more people get vaccinated, we will be able to turn the corner on the pandemic and country can begin to return to a more normal way of life.”

A ‘rift’ between conservatives and the CDC

The relationship between the CDC and conservatives may have been doomed from the start of the pandemic.

From the very beginning of the pandemic last year, “a rift” started to grow, with a perception among many conservatives that CDC cared only about getting coronavirus under control and not at all about keeping the economy going, another federal official said.

“I think the challenge is, from early on it was like public health was pitted against the economy,” the official said. “If you agreed with public health, you disagreed with keeping America open.”

Throughout last year, Trump deepened that rift.

While the CDC was cautioning Americans to use masks and practice social distancing, Trump repeatedly said the virus would “disappear” on its own or “just go away.”

“In Trump country, if you want to call it that, there are still significant numbers of people who aren’t sure [Covid-19] is a real thing,” a former senior Trump administration official told CNN.

Or as one advertising executive put it, Trump “galvanized a group of people around a common belief, and that common belief is that this pandemic was a hoax.”

For those Trump followers, the vaccine became a symbol of Democrats “infusing the Democratic way of thinking into people,” said Mike Rutstein, who specializes in health care advertising. “To them, that is the ultimate breach of loyalty, to get vaccinated.

“When you consider all these different aspects, it’s not surprising at all that Republicans are resistant to getting vaccinated,” he added.

Slow growth for vaccine enthusiasm

Data paints a rough road ahead for CDC.

In the KFF survey, 80% of Democrats said they had already gotten a Covid-19 shot or intended to do so as soon as possible. For Republicans, that number is only 55%.

Among Republicans, 20% said they would definitely not get vaccinated, 14% said they would wait and see, and 8% said they would only get vaccinated if they were required to do so.

These differences play out quite clearly in vaccination rates from state to state. According to data from the CDC, the 22 states with the highest percentage of vaccinated people all voted for President Joe Biden. Among the 17 states with the lowest vaccination rates, all but one voted for Trump.

Among all groups, enthusiasm for the vaccine has increased since the shots were rolled out five months ago, but enthusiasm has grown more slowly among Republicans.

In December, 28% of Republicans indicated they had already received at least one dose of the vaccine or would get it as soon as possible, according to the survey. By April, that number almost doubled to 55%.

During the same time period, that metric for Black people almost tripled. In December, 20% of Black people had already received at least one shot or intended to get vaccinated as soon as possible, and by April that went up to 59%.

There’s hope that the CDC’s new mask guidelines announced Thursday will serve as an incentive for Republicans to change their minds. A federal official said while it might tip the scales for some conservatives, many others will not be swayed.

“I still think there’s a pretty significantly large group of conservatives that just don’t believe that Covid is such a big deal,” the official said. “The CDC can’t give up on those individuals.”

‘I don’t know how to reach people like that’

Biden administration officials know they need to reach out to conservatives to get the vaccine message across.

“We’re trying to get messages to them through trusted messengers,” Dr. Anthony Fauci, Biden’s senior medical adviser, told CNN on May 4. “They could be people in the community, they could be clergy, they could be sports figures, people who they trust, even — probably even more importantly, their local family physician to tell them the reason why it’s so important for them to get vaccinated.”

The agency has not articulated a plan for reaching these trusted leaders — or even figuring out who they are.

In contrast, the CDC has many decades of experience at communicating health messages to specific subpopulations in the United States. The agency has a national program called REACH — Racial and Ethnic Approaches to Community Health — to “carry out culturally appropriate programs to address a wide range of health issues” among Black, Latino, Asian, and other groups, and longstanding relationships with leaders in those groups.

But the agency has no such program and no such relationships to connect with conservative White Americans, the federal officials said.

“We’re not used to messaging to that part of society,” said Dr. Nelson Michael, director of the Center for Infectious Diseases Research at the Walter Reed Army Institute of Research, who has done extensive work in vaccine development and community engagement.

Michael said there’s not much of a blueprint for CDC to follow as they attempt to reach out to conservative Americans.

“This is a very vexing problem. We don’t have a ‘smart book’ for it,” added Michael, a retired Army colonel, referring to published guides for soldiers as they plan operations.

The federal officials interviewed for this story expressed skepticism that simply explaining the science — that vaccines dramatically decrease the chance you’ll catch coronavirus and spread it to others — would convince a large proportion of vaccine hesitant conservatives to roll up their sleeves.

“It can feel selfish when someone says they don’t want to get vaccinated. It’s almost like they’re telegraphing a message saying, ‘I’m invulnerable, and I don’t care about you.’ I don’t know how to reach people like that,” one of the officials said.

Finding the road ahead

Michele Andrasik has some ideas for how to start.

Andrasik is director of community engagement for the Covid-19 Prevention Network, a group assigned by the National Institutes of Health to help run US-government funded Covid-19 clinical trials, and has decades of experience formulating public health messages.

She said it would useful if conservative leaders made public service announcement urging their constituents to get vaccinated.

Some of Trump’s closest advisers have been encouraging him for weeks to do a PSA, and he hasn’t.

That means the CDC will have to think of other ways to reach conservatives.

“I think it will be really critical to sit down and listen to leaders in this community, to have an open dialogue, to get to a place where we can sway some of the folks in this group,” said Andrasik, a psychologist and senior staff scientist at the Vaccines and Infectious Disease Division of the Fred Hutchinson Cancer Research Center. “It would be easy to do surveys, to do focus groups and group Zoom sessions and collect this data.”

She said it would be crucial to drill down on exactly why so many conservatives are so hesitant. She suspects it’s more than just political rhetoric — more than just a desire to defy Democrats.

“I have several family members that fall into this group, and in my conversations with them, it’s more like what is being taken away from them — they feel that their freedom has been taken away, like their right not to wear a mask,” she said. “As a psychologist, I think that comes from a place of loss. So many things are changing, there’s this sense of loss, a sense of being overlooked while other people are being focused on. Why are we not the focus? Why aren’t we front and center?”

Listening — with respect — is key, according to Republican pollster and strategist Frank Luntz, who has held focus groups with Republicans about the vaccine.

“The key is not to demonize them and to recognize and respect that hesitation, that concern,” Luntz told CNN May 4.

A federal official agrees.

“It all starts with publicly acknowledging how these individuals feel. If you don’t acknowledge someone’s feelings, they’re certainly not going to be open to listening to you,” the official said. “If we keep just trying to jam down their throats that Covid is bad – that’s not going to work. It’s going to be challenging, but we’ve got to continue to try to better understand how they feel and why they feel the way they do.”

Until then, the official said, “it’s going to be really hard to convince them to get vaccinated.”

CNN’s John Bonifield, Michael Nedelman and Justin Lape contributed to this report.


Most states require parental consent for Covid-19 shots for ages 12 to 15, but not all. Here’s the list.

By Jacqueline Howard and Virginia Langmaid, CNN

Nearly all states require some form of parental or guardian consent for vaccine providers to administer Covid-19 shots to people ages 12 to 15, a CNN analysis finds. But there are a few exceptions.

Five states — Alabama, Iowa, North Carolina, Oregon and Tennessee — either allow some ages in that group to consent for themselves or leave requirements up to individual vaccine providers.

CNN reached out to all 50 states about their laws regarding parental consent to vaccinate people ages 12 to 15. The US Food and Drug Administration authorized the emergency use of Pfizer/BioNTech’s coronavirus in 12- to 15-year-olds in the United States on Monday and on Wednesday, the US Centers for Disease Control and Prevention recommended using the vaccine in that age group.

Expanding authorization to people 12 to 15 opened Covid-19 vaccination to another 5% of the US population, nearly 17 million more people. But not all parents of people in that age group want their children to be vaccinated against Covid-19

A Kaiser Family Foundation poll taken in April — before a Covid-19 vaccine for young teens was authorized — found that 30% of parents of people ages 12 to 15 said they would get their child vaccinated right away, and 26% said they would wait a while. However, 18% said they would get their 12-to-15-year-old vaccinated against Covid-19 only if it was required by schools and 23% said they definitely wouldn’t.

Parental consent requirements for vaccines are decided by states.

“The federal government does not actually govern over what kind of consent or assent you need for these teenagers,” CDC Director Dr. Rochelle Walensky said during a virtual event with The Economic Club of Washington, DC, on Thursday.

“Each person has to go to their state,” she said. “Many places will say, ‘Your parent doesn’t need to be there, but your parent needs to have information or your parent needs to have signed off.’ So it really does vary by state.”

In North Carolina, teens can consent for themselves for Covid-19 vaccines, “if they have the ability to understand and make decisions about their health,” Bailey Pennington, a spokesperson for the state’s Department of Health and Human Services, told CNN in an email.

“It is expected that in the majority of instances, communication is shared with parent and guardians and parent/guardian consent is obtained for COVID-19 vaccination for people under 18,” the email said in part, adding, “As part of normal development, most children are able to understand and make decisions about their health some point before the age of 18. There is no one age at which this always occurs; it varies from child to child. Some vaccine providers may ask for written consent for people under age 18 who are consenting on their own.”

In a couple of states CNN contacted, Alabama and Tennessee, teens 14 and older can be vaccinated without needing parental consent.

“The Alabama Department of Public Health (ADPH) requires consent for vaccines for persons up to 14 years of age. Of course, ADPH wants parents and guardians engaged in the healthcare of their children,” Dr. Karen Landers, a health officer within the department, wrote in an email to CNN.

In Oregon, children 15 and older may give consent without a parent or guardian. In Iowa, CNN was told that individual health care providers or health systems consult with their legal counsel regarding requirements and documentation needed to administer Covid-19 vaccines.

Among the states that require parental consent to administer Covid-19 vaccines to ages 12 to 15, some noted rare exceptions to the requirement include if the person in that age group is married, pregnant or legally emancipated from their parents.

Where parental consent is required

Based on CNN’s outreach to health departments across all 50 states, here’s a list of where parental or guardian consent is now generally required for Covid-19 vaccinations among people ages 12 to 15:

  • Alabama — Yes for younger than 14
  • Alaska — Yes
  • Arizona — Yes
  • Arkansas — Yes
  • California — Yes
  • Colorado — Yes
  • Connecticut — Yes
  • Delaware — Yes
  • Florida — Yes
  • Georgia — Yes
  • Hawaii — Yes
  • Idaho — Yes
  • Illinois — Yes
  • Indiana — Yes
  • Iowa — “It is up to each individual health care provider/health system”
  • Kansas — Yes
  • Kentucky – Yes
  • Louisiana — Yes
  • Maine — Yes
  • Maryland — Yes
  • Massachusetts — Yes
  • Michigan — Yes
  • Minnesota — Yes
  • Mississippi — Yes
  • Missouri — Yes
  • Montana — Yes
  • Nebraska — Yes
  • Nevada — Yes
  • New Hampshire — Yes
  • New Jersey — Yes
  • New Mexico — Yes
  • New York — Yes
  • North Carolina — No for teens
  • North Dakota — Yes
  • Ohio — Yes
  • Oklahoma — Yes
  • Oregon — Yes for younger than 15
  • Pennsylvania — Yes
  • Rhode Island — Yes
  • South Carolina — Yes
  • South Dakota — Yes
  • Tennessee — Yes for younger than 14
  • Texas — Yes
  • Utah — Yes
  • Vermont — Yes
  • Virginia — Yes
  • Washington — Yes
  • West Virginia — Yes
  • Wisconsin — Yes
  • Wyoming — Yes

Additionally, some private businesses or pharmacies have their own rules.

For instance, CVS Health announced on Wednesday that Covid-19 vaccine appointments for adolescents ages 12 to 15 were available for scheduling at more than 5,600 CVS Pharmacy locations nationwide — but parental or legal guardian consent is required, and children must be accompanied by an adult.

In general, there’s “state-by-state variation” in terms of what is required for routine childhood immunizations, Jill Rosenthal, senior program director at the National Academy for State Health Policy, told CNN.

“It does look like it varies in terms of the age of the child, the issues facing the child, for instance if they were emancipated,” she said. “So it does seem like in terms of routine childhood immunizations, it really varies quite a bit.”

It comes as no surprise that the same variation is emerging in the rollout of Covid-19 vaccines for ages 12 to 15, said pediatric hospitalist Dr. Lisa Costello, of WVU Medicine Children’s Hospital in West Virginia and a member of the American Academy of Pediatrics’ Committee on State Government Affairs.

“As a pediatrician, this is certainly not a new issue,” Costello told CNN about parental consent.

“Every state has different rules that they follow,” she said. “Each state has a little bit of differences — and that’s why individuals work at their local level to determine what is needed for their community.”


What’s the science behind CDC’s decision to say fully vaccinated people don’t need masks?

By Maggie Fox, CNN

A fresh batch of data from a big study of health care workers across the country helped prompt the US Centers for Disease Control and Prevention to say fully vaccinated people can go without masks in most circumstances, the agency said Friday.

The study found that real-life use of the Moderna and Pfizer vaccines provided 94% protection for the front-line workers immunized at the beginning of the vaccine rollout. A single dose provided 82% protection, the CDC-led team reported in the agency’s weekly report, the MMWR.

It was the findings from the new study, on top of earlier studies, that pushed CDC to decide to loosen its advice on who needs to wear a mask and when, CDC Director Dr. Rochelle Walensky said.

“This report provided the most compelling information to date that COVID-19 vaccines were performing as expected in the real world,” Walensky said in a statement Friday.

“COVID-19 vaccines are effective at preventing COVID-19 disease, especially severe illness and death,” CDC says on its new web page describing guidance for the fully vaccinated.

“COVID-19 vaccines reduce the risk of people spreading COVID-19.”

After weeks of telling people that even fully vaccinated people might carry virus in their noses, mouths or throats and breathe or spit it out onto others, the CDC says the evidence shows this is unlikely.

The reason — viral load. At least three major studies have shown that fully vaccinated people are not likely to test positive for coronavirus, which indicates they are not carrying it in their bodies, whether they have symptoms or not.

Last March 29, a network of researchers released a study via the CDC that involved nearly 4,000 health care workers who tested themselves weekly. That’s the only real way to tell if people become infected with the virus without developing symptoms.

Reduced viral load

About 63% of them were vaccinated.

Only about 11% had asymptomatic infections, the research team found at the time. Those who got both doses of either Pfizer/BioNtech’s or Moderna’s vaccine were 90% less likely to get a positive test and those who got only a single dose had 80% protection.

A similar study from Israel, published on the same day in the journal Nature Medicine, found vaccinated people who got infected had a lower viral load — fourfold lower than unvaccinated people.

“In this analysis of a real-world dataset of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results after inoculation with the BNT162b2 messenger RNA vaccine (Pfizer’s) we found that the viral load was substantially reduced for infections occurring 12–37 days after the first dose of vaccine,” Roy Kishony of the Technion – Israel Institute of Technology and colleagues wrote.

“These reduced viral loads hint at a potentially lower infectiousness, further contributing to vaccine effect on virus spread.”

The latest study was released Friday.

“This assessment, conducted in a different study network with a larger sample size from across a broader geographic area than in the clinical trials, independently confirms U.S. vaccine effectiveness findings among health care workers that were first reported March 29,” the CDC said in a statement.

“This study, added to the many studies that preceded it, was pivotal to CDC changing its recommendations for those who are fully vaccinated against COVID-19.”

The study involved more than 1,800 workers and compared people who tested positive for coronavirus to those who tested negative.

“Health care personnel are at high risk for COVID-19,” the report reads. “The early distribution of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) to health care personnel provided an opportunity to examine vaccine effectiveness in a real-world setting,” they added.

Real-life data shows little risk of breakthrough infection

“The first U.S. multisite test-negative design vaccine effectiveness study among health care personnel found a single dose of Pfizer-BioNTech or Moderna COVID-19 vaccines to be 82% effective against symptomatic COVID-19 and 2 doses to be 94% effective.”

With more Americans being vaccinated, the risk of infection is dropping, said Dr. Peter Hotez, a vaccine expert and dean of the school of tropical medicine at the Baylor College of Medicine in Houston.

According to CDC data, nearly 47% of the US population has received at least one dose of Covid-19 vaccine and about 36% of the US population is fully vaccinated.

“The transmission rates are going way down,” Hotez told CNN’s Alisyn Camerota and Victor Blackwell on Friday.

“And I think the other piece that’s really important is the data coming out of real-life situations like Israel, showing that anyone who does get breakthrough asymptomatic infection — which is very uncommon — has dramatically reduced virus loads and virus shedding, so this really is interrupting transmission, which is just such good news and so exciting.”

In theory, if only fully vaccinated people went mask-free, there should be little risk of the virus spreading. But most US states have dropped mask mandates and more are dropping them after the CDC guidance.

Some critics have complained that the CDC has made no provision for people who have not been vaccinated but who will not wear masks.

“While we all share the desire to return to a mask-free normal, today’s CDC guidance is confusing and fails to consider how it will impact essential workers who face frequent exposure to individuals who are not vaccinated and refuse to wear masks,” United Food and Commercial Workers union president Marc Perrone said Thursday.

And President Joe Biden confirmed that Americans will be on the honor system for making sure they are vaccinated before discarding face masks. “We’re not going to go out and arrest people,” Biden said in remarks Thursday.

There are some caveats to the science behind the new guidance. Right now, it looks like the authorized vaccines are very effective against new variants of the virus that are arising—but that’s not certain.

“Early data show the vaccines may work against some variants but could be less effective against others,” the CDC notes.

Other unknowns include how well the vaccines protect people with weakened immune systems, including cancer patients and people with autoimmune disorders who take immunosuppressive medications.

Plus, the CDC says, it’s not clear how long coronavirus vaccine protection lasts, although studies indicate it’s at least six months and likely longer.

Walensky denies the changes were made to motivate people to get vaccinated — although many public health experts had urged CDC to make the changes as an incentive.

Back in April, when the CDC said fully vaccinated people should still wear masks inside when around other people, the agency did note that encouraging people to get vaccinated might be a legitimate factor in changing guidance.

“In summary, relaxing certain prevention measures for fully vaccinated people may be a powerful motivator for vaccination, and thus should be an important goal of the U.S. vaccination program,” those guidelines, still up on the CDC site, read.


What to make of the CDC’s new guidelines for vaccinated people? Dr. Wen explains

By Katia Hetter, CNN

The US Centers for Disease Control and Prevention announced that people fully vaccinated against Covid-19 do not need to wear masks or practice physical distancing in virtually all indoor and outdoor settings.

This was an abrupt shift from the CDC’s previous guidance, which had detailed color-coded pictures that many criticized as being too confusing and too strict. Previously, vaccinated people were urged to wear masks in some outdoor settings such as crowded get-togethers and most indoor settings, such as worship service, the gym and restaurants.

Now, people who are fully vaccinated don’t need to wear masks in these settings, though they still are required to on buses, trains and planes and in hospitals. Unvaccinated people and those with a weakened immune system should still wear masks, the CDC says.

How do people know who’s vaccinated and who’s not? What if some people still want to wear masks? And what about people who are not yet vaccinated, like young children?

We turned to CNN Medical Analyst Dr. Leana Wen to see what to do next. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s also the author of the forthcoming book “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: What do you think of the CDC’s Thursday decision on masking?

Dr. Leana Wen: Frankly, I was shocked. For months, I’ve been pushing for the CDC to give clearer, more practical guidance on what fully vaccinated people could do. They’ve been moving so slowly and cautiously, and I expected for them to say something like, fully vaccinated people can now get together with other fully vaccinated people, not just in informal settings like small dinners at home but formal settings like workplaces — I was thinking a conference room where fully vaccinated colleagues can all take off their masks.

Instead, the CDC removed virtually all restrictions on fully vaccinated people. On the one hand, this is a great affirmation of just how effective the vaccines are. I do think there is a great story to tell, that the vaccines are so powerful at protecting against illness and preventing vaccinated people from spreading coronavirus. On the other hand, this is such a sudden reversal. I don’t think people fully understand why the change was made — it feels like we went from zero to 100 overnight.

My concern is not for those who are fully vaccinated. Those people are well protected (with the exception of individuals who are immunocompromised). My concern is for those who are not yet able to be vaccinated, who are now potentially exposed to a higher level of risk because they will be around unvaccinated people who choose not to wear masks.

That’s because we can’t possibly know who’s vaccinated and who’s not. If you’re in a grocery store, and most people aren’t wearing masks anymore, what if some people aren’t vaccinated? If you yourself are vaccinated and pretty healthy, this is not a problem for you. But what if you’re not vaccinated — not because you don’t want to, but because you can’t?

I have two little children, ages 1 and 3, who can’t yet be vaccinated. Or what if you’re immunocompromised and the vaccines may not protect you as well, so you still have to be careful, even if you keep your mask on? I’m worried that the new CDC guidelines make it less safe for those who are already more vulnerable.

CNN: When should people who are vaccinated wear masks?

Wen: The CDC requires that people wear masks in planes, trains and other public transportation, regardless of vaccination status. They should also keep wearing masks in high-risk settings like nursing homes, hospitals and prisons. And they should follow the law of their state and local officials, as well as abide by any rules set by individual businesses.

We need to have a bit more nuance than this. I’d encourage people to consider their own medical risks. If they are being treated for cancer and are on chemotherapy, or an organ transplant patient on immunosuppresants, I agree with the CDC that these people really need to keep masking in public settings if they are around potentially unvaccinated people. The chance of your carrying Covid-19 and transmitting it to others is also much decreased if you’re vaccinated, but that risk is still there. If you live at home with someone who is vulnerable, you may also want to use some additional caution.

In my case, I’m healthy but I live with two unvaccinated children — they can’t be vaccinated yet. I’d probably still be a bit cautious. I certainly wouldn’t need to wear a mask outdoors, but if I’m in a full-capacity, indoor church service where everyone is singing, and I’m not sure that people around me are vaccinated, I’d probably still wear a mask. Others may make a different choice, and that’s OK.

CNN: What about unvaccinated people? When should they wear masks?

Wen: Unvaccinated people must still wear masks whenever they are spending time around someone who is unvaccinated or people of unknown vaccination status. If they are around someone who is definitely vaccinated, they don’t need to mask. But if they are in public, and it’s not clear if people around them are vaccinated, they should wear a mask.

The key is that vaccinated people are well protected, but the unvaccinated are not. The danger to them is not from the vaccinated, but from others who are not yet vaccinated. My concern with the CDC guidelines is that they don’t distinguish between who’s vaccinated and who’s not.

The unvaccinated are now at higher risk, because previously people around them were masked, and now some others who are unvaccinated may be unmasked and not keeping up with distancing.

CNN: What if people have underlying conditions or are somehow immunocompromised? What should they do?

Wen: Those who have underlying medical conditions should be vaccinated. The vaccine may not provide them with optimal protection, but it will provide them with some, and it’s especially crucial for these individuals to get that protection.

I’d advise that they continue to use an abundance of caution, recognizing that their level of immune protection may not be as high as others without their condition. If they are around people who are potentially unvaccinated, they should keep masking and distancing.

CNN: If fully vaccinated people live with unvaccinated people who are at high risk for serious disease and death from Covid-19 — because of diabetes, heart disease, any other compromising condition — should fully vaccinated people still go maskless in places where they are allowed to?

Wen: This is a really tricky situation. Your chance of contracting Covid-19 if you’re vaccinated is very low, and your risk of passing it on is even lower. But it’s not zero.

The best thing to do is to try to get these individuals who are at high risk for severe outcomes vaccinated. This may not always be possible — for example, children under age 12 can’t yet get vaccinated. If high-risk individuals are vaccinated, you can breathe a sigh of relief because at least they have some protection. If they are unvaccinated, though, you might still want to use caution.

With my family, if it’s indoors and without masks, I am still choosing to see only fully vaccinated people. I just wouldn’t feel comfortable, say, going to a packed exercise class with other maskless people who are potentially unvaccinated. After being careful for so long, I wouldn’t want to risk the small chance of bringing back coronavirus and infecting my 1-year-old.

CNN: Some people are very nervous going into crowded places now, especially if people are unmasked. What would you advise them to do?

Wen: I really understand where they are coming from! It’s been a traumatic time for all of us, and for many, it will take time to ease back into our old routines.

That’s another reason I wish the CDC was less abrupt with their guidance. They should give us time to adjust to a new normal. Wait until infection rates decline more, then ease the guidance.

It’s completely OK for people to take things at their own pace. If you’re nervous about seeing random maskless strangers in crowds, start with seeing people you know and love, indoors, without masks — ideally people who are also fully vaccinated. Work your way up. Perhaps take your mask outdoors on walks, and, if you wish, indoors in settings where you can still keep physical distancing. Even though it’s safe for you to do something doesn’t mean that you need to. If you still wish to avoid crowds of possibly unvaccinated people, it’s absolutely your right to do so.

CNN: What if you still have unvaccinated children, including those under age 12, who can’t get the vaccine yet?

Wen: This is a big reason I don’t like the CDC guidance. It puts our children at higher risk to now be around adults who may or may not be vaccinated.

Every family needs to decide the level of risk you are willing to tolerate for your children. It’s true that kids tend to get much less severely ill from Covid-19 than adults, but children can and do get ill. For our family, we are fine with our kids playing outdoors with other kids, without masks, but indoors, they should still wear masks if there are adults or children around them who are unvaccinated. And we, as vaccinated parents, still take extra precautions that we wouldn’t if not for the kids.

CNN: How much longer are we going to be in this strange state of not knowing what to do?

Wen: We are in this strange in-between place for sure. The CDC has made things clearer in some ways, but I think also more confusing in others. The way that I interpret the guidelines is that it’s really now up to us. We have to decide what level of risk we are comfortable with for ourselves and our families. There is no one-size-fits-all answer. We need to decide what’s most important to us.