THE WHEELS ON THE BUS COME OFF AND OFF — As I type this, I am silently praying that my 2-year-old, asleep in the next room, doesn't wake up from his midday nap. He's home from day care because, for the second time in less than three weeks, another child in his classroom tested positive for Covid. That triggered a mandatory five-day quarantine period for the entire group, per the latest CDC guidelines. Before this past month, during almost two years of a pandemic, neither of my kids had to quarantine — not even during the early days, when childcare providers didn't have access to vaccines nor when Delta swept through the country. There were relatively few Covid cases in their day care and none in their classrooms. Then Omicron came along. Now my 2-year-old has spent a good part of his January mornings watching " The Stinky & Dirty Show" at home on the sofa. The under-5 set is the biggest group of people not yet eligible for a vaccine — at least not for another few weeks. Pfizer and BioNTech asked the FDA today to authorize a vaccine for kids from six months to 5 years old. But the immune response in clinical trials has been lackluster. If approval comes, it would still take months before this group would be considered fully vaccinated. Until then, Covid protocols for the under-5 set are proving to be the trickiest terrain yet in the pandemic. CDC protocols for my sons are still stricter than those for older kids even though risks are generally lower. "What the U.S. preschoolers went through this winter was hell," said Monica Gandhi, an infectious disease specialist from the University of California, San Francisco, about early childhood centers shutting down during the Omicron surge. About a dozen states have moved to a test-to-stay approach for elementary schools and high schools, following the CDC guidance for school-age children, which allows K-12 students to stay in schools after exposure as long as they test negative. Massachusetts is rolling out test-to-stay for child care centers , too, but in most states early childhood centers are on their own to procure tests and navigate guidance. A vaccine for younger kids might lead more states to change their guidance. With vaccines not yet available, it's been harder to design Covid rules for younger kids, said Ibukun Kalu, a pediatric infectious diseases specialist at Duke University Medical Center. Test-to-stay works in the K-12 setting, she said, and it could work in day cares and preschools, with the caveats that toddlers aren't exactly the most diligent maskers. In any case, flexibility is key. "We do not want our youngest children bearing the burden of society as they are trying to grow up," Kalu said. The pandemic protocols for day care are far stricter than what is required for other dangerous and scary respiratory illnesses, said C. Buddy Creech, a pediatric infectious diseases expert at the Vanderbilt University School of Medicine. "For influenza or RSV, we know that we are sending them back to day care with virus in their nose," Creech said. "We have done that for every single respiratory virus, even those with devastating effects." Our day care doesn't quarantine a class if a kid has a runny nose or fever, but tests negative for Covid. They are allowed to come back once they are fever free for 24 hours. And as long as hospital systems and health care providers continue to be overwhelmed with Covid cases, these stricter protocols still make sense, Creech said. Younger kids can be a source of asymptomatic spread to vulnerable adults, even though they aren't really a huge risk to one another. "I have not yet admitted a classroom of preschoolers that all got Covid," Creech said. But Gandhi argues that young kids should be allowed to stay in their classes if they show no Covid symptoms, just like they do with other illnesses. Even a test-to-stay strategy would be expensive and burdensome, she argues. Vaccines are available to protect teachers and older adults. The CDC changed its guidance on kids older than 5 even though vaccine uptake among the group is low, she points out. Less than 20 percent of U.S. kids aged 5 to 11 have been fully vaccinated, according to a Kaiser Family Foundation review of federal data. "It doesn't change anything to keep a two-year-old at home," Gandhi said, meaning that closing day care centers when young kids test positive isn't going to make a dent in the pandemic trajectory. Well, it may not make a dent in El Paso case counts, but it certainly upended our lives this week. At some point this afternoon, our 2-year-old did wake up. We had lunch together and then my mother-in-law came back for the second time today to watch him. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author at rrayasam@politico.com, or on Twitter at @RenuRayasam.
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