Back in March, when the pandemic was starting its sweep across the United States, Valerie Cortez’s 3-year old twins were shut out of their day care. Cortez, who is a virologist in Memphis, Tenn., spent months juggling work and child care, periodically driving the kids for three hours to stay with their grandparents in Nashville for a week or two at a time.
After a few summer reopenings — and then closings because of outbreaks — her children’s day care is now open. But Cortez said she is frustrated by what feels like a lack of guidance on what to do.
“I feel like we’ve been largely abandoned — we’ve just been sort of like, ‘Well, every family, figure it out,’” she said. “We’re all just sort of limping along trying to make the best choices for our families.”
More than eight months into the pandemic, with flu season looming and coronavirus cases climbing toward a third peak, parents are still anxious about how best to keep their children cared for and safe. Not every family has a choice, but deciding what is or isn’t too risky, with an uncertain situation and imperfect science, has left parents scrambling to make child care decisions that all seem far less than ideal.
To help, I spoke with an epidemiologist, a pediatrician, an economist and two child care experts to get some answers on how best to make decisions about day cares right now.
First of all, are day cares even open?
Back in the spring, at least 17 states required child care facilities to fully or partially shut down and more than half of states recommended various forms of restrictions. Today, while plenty of recommendations remain, there are no formal orders requiring any closures, said Javaid Siddiqi, president and chief executive of the Hunt Institute, an education nonprofit in North Carolina.
But “open does not translate or equate to thriving,” Dr. Siddiqi said.
In a report of U.S. child care facilities released on Sept. 24, ChildCare Aware of America, a nonprofit advocacy group for providers, found that nationwide, 35 percent of nonresidential child care centers and 21 percent of in-home child care facilities that had been open before the pandemic had closed by July.
Among facilities still open, providers are struggling to fill the limited number of spots they have available, Dr. Siddiqi said. They are also struggling to stay afloat. One survey of about 200 providers, performed by the National Association for the Education of Young Children in September, found that 69 percent of in-home child cares and 46 percent of nonresidential child care centers said they had taken on extra debt to stay open.
What risks might day cares pose to my children?
When it comes to transmission of Covid-19 through day cares, data remains scarce.
Nevertheless, studies from several countries have found that, once they are exposed, kids under 10 are about half as likely to be infected as older children and adults, said Justin Lessler, an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
And when they do get infected, they seem to be less likely to develop severe symptoms and die.
However, the risk isn’t zero. More than 740,000 children (some states define a child as anyone up to age 20) have been infected since states started reporting case numbers. And cases have been rising steadily in children since the beginning of the pandemic.
“Every form of social interaction poses a risk in the pandemic,” said Dr. Lessler, who is currently sending his 1-year-old to day care, “and day cares are no different.”
So, beyond my kids, what exactly are the risks for me and my family?
Scientists still don’t know how often kids pick up the virus at day care and then spread it to the people they live with, Dr. Lessler said. But some early evidence suggests that while sending your kids is not risk-free, it might not be as high risk to your family as you may fear.
Over the summer, researchers from the Centers for Disease Control and Prevention and the Rhode Island health and human services departments examined how many people — including children, staff, parents or guardians — became ill after 666 child care facilities in Rhode Island reopened.
Between June 1 and July 30, they found that only 52 people from 29 child care centers had either confirmed or probable Covid-19. Nearly 19,000 children had attended those facilities, and most of the people infected did not spread the virus to others (likely in part because of class closures, quarantines and contact tracing). Seventy five percent of the cases also occurred in mid- to late July, as numbers were spiking across the state.
This suggests that it’s possible for day cares to operate safely, said Emily Oster, an economist at Brown University, who has been collecting informal data on cases and outbreaks in day cares and schools since the pandemic began. In the Rhode Island facilities that had outbreaks, Dr. Oster added, it turned out that they had not been taking adequate safety measures, like wearing masks.
There’s also emerging and limited evidence that young children seem to be less likely than others to spread the virus. In one large study from South Korea, researchers traced more than 59,000 contacts of about 5,700 people with Covid-19 symptoms, and found that children under 10 were less likely to transmit the virus than adults.
But kids can certainly catch the coronavirus at day care and spread it to others, said Dr. Lessler. In September, for instance, researchers from the C.D.C. and health departments in Utah conducted careful contact tracing of 12 children who appeared to have picked up infections from two child care facilities in Salt Lake City. Those children then seemed to have spread the virus to 12 others outside the facilities, including parents and siblings. One parent was hospitalized.
Lower risk does not always mean low-risk, Dr. Lessler said, and low-risk does not mean no risk.
What risk might my child pose to providers?
According to the largest study of its kind, published in the journal Pediatrics, researchers from Yale and Columbia surveyed more than 57,000 child care providers across 50 states plus Washington, D.C. and Puerto Rico between May and June. They found no relationship between working in day cares and contracting or being hospitalized for Covid-19, regardless of race, ethnicity or other factors.
“Child care providers who reported to work during the first three months of the pandemic were no more likely to contract Covid-19 than those who did not report to work,” said Walter Gilliam, a psychologist and early childhood and education policy researcher at the Yale Child Study Center, who led the study. Most facilities in the study followed careful safety protocols.
But, he added, “If the transmission rate is high in your community, of course it’s going to get into your child care program.”
How can I make sure that my day care is taking adequate safety precautions?
Day cares should be doing all they can do to reduce transmission potential, Dr. Lessler said. This might include limiting the number of kids who spend the day together, screening for symptoms like fever or other signs of illness at the door, and requiring kids and adults to wear masks.
Cleaning policies and ventilation systems also matter, said Dr. Edith Bracho-Sanchez, a primary care pediatrician and an assistant professor of pediatrics at Columbia University Irving Medical Center in New York City.
Ask whether the ventilation system has been recently inspected to ensure that it is properly maintaining indoor air quality, Dr. Bracho-Sanchez advised. Day cares should also open windows and doors to improve indoor circulation as weather allows.
Make sure they are frequently disinfecting toys; removing toys that can’t be easily cleaned (like stuffed animals); frequently cleaning rugs, sheets and blankets; using disposable utensils at mealtimes; and adequately sanitizing any shared utensils. (Check the C.D.C.’s webpage for more guidance.)
Parents should also ask what the facility will do if there is a confirmed or suspected case among students, staff or families. Ideally, Dr. Lessler said, they won’t shut down for every cough or sneeze, but will target quarantines appropriately.
What are the trade-offs of not sending my kid to day care?
While sending children to day care and preschool isn’t the right choice for everyone, there is some value in doing so if it’s possible to do it safely, Dr. Bracho-Sanchez said.
High-quality learning experiences early in life, especially among disadvantaged children, have been linked to reduced chances of needing special education, higher graduation rates from high school and college, and better outcomes in terms of mental health and substance abuse later in life. Kids can get the same benefits in other ways, of course, but day care and preschool are important places for many children to develop key social and emotional skills.
“I really think it makes so much sense to focus our efforts on getting the youngest kids back to school first,” Dr. Bracho-Sanchez said.
For parents, especially moms, there are also career questions to consider. “If you step away from the labor force for a year or two, you don’t necessarily come back to the same path you were on before,” Dr. Oster said, whose children, 5 and 9, are currently attending in-person school.
The bottom line
What you decide to do will depend on your family’s situation, including your resources, flexibility and tolerance for risk. It might also depend on how much virus is circulating within your community.
If you have the option, it can help to make a list of pros and cons and see if the answer seems obvious, Dr. Oster said.
If it doesn’t, there might not be a perfect answer right now, and the right answer may change over time.
That kind of uncertainty can feel precarious for many parents, including Abby Roetheli, a freelance writer in Missouri. Her two children, 5 and 2, are back in school after several months at home, but she continues to grapple with indecision, guilt and the sense that things might fall apart at any moment.
“I feel like this is just a house of cards,” she said. “One step away from everything crumbling to pieces.”
Those kinds of feelings are common, Dr. Bracho-Sanchez said, who encouraged parents not to blame themselves for the lack of good choices.
“We’re asking parents not only to follow complicated, nuanced, and evolving science, but then we’re asking them to immediately apply it and reconcile it with so many other challenges,” she said.
It can be a tough decision to make, and each family needs to make it with their own circumstances in mind, Dr. Lessler said.
“You need to decide what risks you’re willing to take on and how much risk your particular day care may carry,” he said. “But if you have a day care that’s taking things very seriously, I think it’s a perfectly reasonable thing to do.”
Emily Sohn is a freelance health and science journalist and parent of two boys.
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