Vaccinate and test. That advice isn't much help to parents who have kids under 5.

Just before my son's recent 9-month checkup, my wife and I debated whether to simply postpone it. It's a "well baby visit" but the potential threats to his health felt real. The last time he went to the pediatrician, in November, the air inside the office was stuffy, and the waiting room crowded with children from various schools in and around St. Louis, all waiting to get their COVID shots.

By showing up for the vaccine, they were all following the recommended guidance from the Centers for Disease Control and Prevention, for children ages 5-11. But we were trying to follow the CDC guidance too, and for children too young for the vaccine, that means avoiding crowded or poorly ventilated places — like the pediatrician's waiting room.

As we grappled with the decision, the news was bleak: COVID positivity rates, and hospitalizations, were reaching record levels in St. Louis, and across the country.

We decided to go ahead with the visit after my wife called the office and learned they had moved their COVID testing outside to the parking lot, and we could complete the check-in process over the phone, instead of in the waiting room.

These are the risk analyses we're constantly having to make, while we wait and wait and wait some more, eager to hear when our baby might be eligible for a vaccine. The latest crumb of hope came from Moderna: the company recently said it expects to have data, from clinical vaccine trials for children ages 2 to 5, sometime in March. An actual shot for those kids might come soon after that. But for younger children and infants, like our son, it's still unclear how long they might have to wait.

Meanwhile, it feels like many other Americans are impatient to move on. The omicron surge means safety precautions and mask rules have been rolled back in place, and that has left many people frustrated.

Compliance has always been a problem in many parts of the U.S., but despite the contagiousness of omicron, I still frequently see people without masks in public indoor spaces. There's a particular grocery store clerk whose check-out line we try to avoid. At our neighborhood butcher, there's a guy behind the counter who also refuses to mask up. Not to mention all the shoppers who choose to flaunt the mask guidance on any given day.

My wife Emma spent twenty minutes in line at the pharmacy recently, standing in front of a man who had his mask off, dangling from one ear. She wished she could simply turn around and say "Hey, do you mind putting on your mask? I have a baby at home who's unvaccinated," but that type of request hasn't been well received in our experience: A washer repairman tried to refuse to wear a mask in our house, as did the dishwasher delivery team. (We've had bad luck with our appliances recently.)

To be the parent of an unvaccinated kid these days is to feel constantly at the mercy of the whims of strangers. That's why our son has only been inside 7 buildings since the day he was born. The fact that I can count them on two hands surprises me. It also makes me worry about the experiences and interactions he has never had — all the little things in life he's currently missing.

Laura Swofford is another St. Louis-area parent, and the mother of two kids, ages 4 and 6. For a brief moment last spring, she felt okay taking her kids out, for trips to Target, the library or other everyday destinations that adults might find mundane, but are still "shiny" and exciting to young kids.

"It's a really big deal and it gives you sanity in your day," Swofford says of those little outings and errands.

But that era of freedom was short-lived. Swofford started feeling uncomfortable again in May, after the CDC released new guidance allowing the fully vaccinated to stop masking indoors. There was no enforcement, and masks seemed to swiftly disappear from most faces — even though vaccination rates in Missouri were low at the time (and remain in the bottom third, nationwide).

Then the delta variant arrived, and cases surged again. Then came omicron. Health officials in Missouri urged everyone to be more vigilant about wearing masks, but a lot of residents just ignored them. Missouri has never had a statewide mask mandate, and Missouri Attorney General Eric Schmitt has filed a series of lawsuits against cities, counties and school districts that issue their own mask mandates.

Swofford says she often wishes she could stand up in the middle of a crowd, wave her arms, and remind people that there are parents who can't vaccinate their children.

Friends and family typically understand our plight, but any kind of socializing typically involves detailed negotiating about vaccine status and safety protocols. I got an invitation to the karaoke bar. Sounded fun, but I'm just not comfotable with that yet. Play date with old friends and their kids? Well, maybe we could do something outside, weather permitting.

The arrival of winter just made it that much harder: if you do want to socialize indoors, it's amazing how quickly you can spend $500 on rapid tests for adults. To have another couple over for dinner, you need at least 4 tests. If you want 10 adults to be able to come inside your house for Christmas, that's 10 tests. And at $12 a pop, the costs add up quickly. That's assuming you can even find the rapid tests you need.

The federal government recently launched a new website where Americans can order four free at-home tests. I sure wish that had been an option over the holidays.

Now, as the omicron surge continues to pummel communities and hospitals, the sense of being forgotten has only intensified. From officials, it would be nice to have more specific guidance for parents like us, with kids under two, about what to do.

"Unfortunately, there's nothing revolutionary," admits Dr. Rachel Orscheln, a pediatric infectious disease specialist at St. Louis Children's Hospital. The guidance for families like ours remains the same: to protect unvaccinated kids, everyone around them should be protected to form a cocoon of safety. The surrounding adults need to get vaccinated, get a flu shot, wear a mask, socialize outdoors when possible, and avoid contact with sick people. Collectively, we could all advocate for policies that reduce transmission.

Daycare has become a particularly brutal puzzle for parents right now. Orscheln says when cases surge, families are forced into a balancing game of risk and benefits.

Throughout the pandemic, most kids have had mild COVID cases, although there are very real, if rare, risks of complications that require hospitalization. Some infected children have gone on to develop a post-viral illness known as multi-system inflammatory syndrome in childhood, or MISC. Other kids have shown symptoms of long COVID.

Those risks have to be balanced against other concerns and needs, Orscheln says, like the developmental benefits of socializing or whether it's even possible for parents to alter their child care plans.

Another parent I spoke to, Dr. Ashish Premkumar, works as an OBGYN in Chicago. He has a 4-year-old in daycare and a 1-year-old at home with a nanny. He and his wife considered pulling the 4-year-old out of daycare until the omicron case count eased, but before they could even decide, Covid swept through the family.

Another obstacle is the emphasis on at-home testing. Both Binax and QuickVue are intended for ages two years and older. So if parents suspect a child under 2 might have COVID, they need to go to the pediatrician or a clinic to get a test. Many parents just don't have the time or the job flexibility to arrange that.

"The whole process just is not friendly," Premkumar says, "and this far into a pandemic, it should just be simple: I need a COVID test, can it just be sent to my house? And can I get a result back in a timely fashion to be able to organize my life?"

Families all over the country have struggled with the long waits at community testing sites. Maria Aguilar of Los Banos, California recently spent four hours in line getting a test for her 4-year-old daughter, after the girl's Head Start program closed for two weeks due to a COVID outbreak. Aguilar works as a community health worker in Merced, doing door-to-door canvassing and outreach. Her job allowed her to take time off to care for her daughter, but many of the people she serves don't have that same flexibility.

Is an infected child really that big of a deal? I've encountered that question many times. It's true that most kids who get sick with COVID do not die. They survive. And the symptoms of omicron are supposed to be mild — or at least milder than the previous delta variant. Plus, many people point out that an infection could have a silver lining: It would give your kid some natural immunity, no? While they wait for the vaccine?

We parents have had to respond to these questions again and again. We've also noticed that many Americans are simply shrugging their shoulders now, saying it's inevitable that we all will eventually get infected with the coronavirus.

But we parents are not ready yet to give up the fight. We're not going to shrug off the risks for our baby, however rare they may be. As we enter the third year of this pandemic, we will keep fighting to keep the virus away from him, until he can get vaccinated. We continue to take precautions and we continue to wait. And it seems he might be unprotected for a while still.

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