Children under 5 are not known to respect personal space or keep germs to themselves – even in the best of circumstances. And when you get many of these little drooling, cuddling, and screaming people together in one space, like daycare, diseases spread quickly, bounce among kids, their families, and back again.
While some childcare centers across the country have remained open during the Covid-19 pandemic, many U.S. states and municipalities have required them to close or limit their services only to parents of health professionals. According to an April survey, about half of childcare centers across the country were completely closed, the Wall Street Journal reported.
According to the Center for the Study of Child Care Employment (CSCCE) at the University of California Berkeley, an estimated 12.5 million children under age 6 attend some form of childcare in the U.S. annually. The closings have thus created a crisis for millions of families who previously depended on out-of-home care.
Now the question of how to restore childcare is critical to helping millions of families get back to work, because “as states rush to open again, childcare is expected to be available,” said Lea Austin, director of CSCCE, to Vox.
Although the rate of severe Covid-19 is low in very small children, the disease does not completely spare them. And a wave of pediatric inflammatory disease has worried doctors about more negative outcomes for the youngest patients. They can also carry the virus that can infect others, even without getting sick themselves.
With so much still unknown about the role of children in the pandemic, nurseries and caregivers should also consider the needs of essential workers (and those of workers who may not be essential, but depend on childcare to make money to get work ) with the largely unknown health risk to their staff, students and families – all with their own often insecure finances. And the federal government hasn’t exactly made the process easy.
“There is a lot of fear of exposure and of taking care of it [child care centers] do things “right,” says Lucy Mullen Davis, consultant and coach at Denver’s Early Childhood Council. Let’s see why weighing the risks and benefits of reopening remains so difficult.
What are the rules for reopening daycare?
The U.S. federal government has essentially left it to states, municipalities, and even individual health center owners to decide if they will be open – and in what capacity they want it.
This has resulted in a patchwork of changing policies across the country, such as the Hunt Institute, an educational research group affiliated with Duke University, documents in a detailed report outlining state rules and recommendations for childcare operations.
For example, California has allowed health centers to remain open, but has issued the directive that they should only be for the children of essential workers; and group sizes are limited to 10. Illinois closed all centers on March 20, except for facilities that have obtained emergency permits to care for the children of essential workers. South Carolina, on the other hand, informed its childcare centers, “It remains your decision as a provider to stay open,” and the state currently has no Covid-19 specific childcare group size restrictions.
So, especially in states that have closed or drastically limited the availability of childcare centers, many families struggle to either do without childcare or seek alternative care so that they can work. (And many older relatives who had previously been first-choice for that role are at higher risk for a serious Covid-19 infection and are advised to limit contact with others.)
Rhode Island, which closed its day worries, recommends looking for a single home care provider, such as a nanny. But such individualized care can cost much more than day care. (And even standard daycare is one huge financial burden on many families.)
As a result, potentially millions of families are wondering when their usual childcare will be active again. And when it is, whether it is safe.
The Centers for Disease Control and Prevention were finally issued in mid-May guidance (which is still largely in line with local guidelines) to help childcare centers, as well as camps, restaurants, bars and other operations, decide whether they can safely reopen. (These documents were expected to be weeks earlier, but had been stopped by the White House.)
The newly appeared decision-making scheme for childcare facilities does not add too much to clarity. It contains a lot of non-binding language, such as “as attainable” and “encourage”.
The CDC [decision] tree is extremely simple, ”says Mullen Davis, whose group in Denver has developed their own complementary decision-making tool for centers that also helps them to evaluate their financial situation.
Austin also points out the main differences between the new CDC guidelines and previous versions that have been leaked but never published. For example, in a previous version, the CDC recommended closing centers if they were in a community that was still in the midst of a significant spread of the virus. Further the decision [making chart] does not require increased screening for children or staff in such communities and instead recommends doing so if possible, ‘she notes. For starters, such guidelines can “give a false sense of security.”
This widespread response for childcare programs was vastly different from that for schools, which are closed across the country, and many are also discussing the move to online learning for the fall.
These programs are also quite different from schools – and not always in a way that makes infection control easier. “Since we are talking about children at very different stages of development, it is important to recognize some of the unique challenges that childcare centers face,” Dan Wuori, director of early learning at the Hunt Institute, told Vox. “Childcare has very different health and safety considerations that should be approached with real consultation.”
For centers that have remained open or reopen, the CDC published relatively detailed guidance in April. Some of these recommendations include measuring the temperature of children on arrival daily (possibly while staff are in full personal protective equipment), not using toys that cannot be disinfected, and using fabric masks for children from 2 years of age.
Many of these recommendations, such as changing gloves for every child’s temperature upon entry, are not always feasible due to availability and prices. (An April survey of more than 2,000 childcare programs in California found that 62 percent had problems obtaining cleaning supplies or personal protective equipment.)
And many other guidelines don’t seem consistent with young children’s behavior and abilities, such as expecting 3-year-olds to wear masks all day.
“It would be difficult to carry children aged 3-5 [masks] reliable all day, ”Allison Bartlett, associate medical director of the Infection Control Program and a specialist in childhood infectious diseases at the University of Chicago Medicine, told Vox. “In addition, children with masks may be prone to removing them, touching their faces, moving the masks, etc., thereby infecting themselves.”
Like the authors of a letter in the European Journal of Pediatrics concluded, “If compliance is difficult, it is better that the child does not wear the mask and other measures are taken to reduce the risk of infection, including staying at home.”
We still don’t know much about the coronavirus in babies and very young children
Part of the problem in deciding best practices for nurseries – and also for schools – is that we don’t know much about the risk of the virus in children.
It has been clear since the onset of the pandemic that children have a lower risk of becoming seriously ill and dying of Covid-19 than adults. But some still get sick and some die. Children with underlying health problems, such as respiratory problems, are at greater risk, as are the youngest children. For example under the age of 1 had the highest number of hospitalizations for Covid-19 among those under 18, according to a report from the CDC. The same analysis found that these infants accounted for as much as 30 percent of documented pediatric ICU admissions.
“Children of all ages appeared susceptible to Covid-19, ”The authors of an article registered in April Pediatrics which analyzed data from more than 2,100 pediatric Covid-19 patients in China. Of the children in their study, 7 percent of infants needed critical care – compared to 0 percent of children ages 6-10.
And there are also increasing reports of serious inflammatory diseases in children who have had the virus – even if they never seemed sick. In New York State, more than 100 children – including some as young as infants and young children – have been diagnosed with this serious condition, and at least three have died.
Nor do we have a good idea how many very young children can carry the virus without ever getting sick.
What role do very young children play in transmitting the coronavirus?
In general, “young children are known culprits in the transmission of other respiratory viruses,” says Bartlett. “The safest assumption until we have good data is that it is also vectors for Covid-19 transmission.”
Research has shown that adults can have a lot of the coronavirus in their system and still feel good, suggesting that the disease can spread even from those who have no symptoms.
“While we are grateful that children are relatively spared from the SARS-CoV-2 pandemic, they are potential vectors of spread to other members of the community,” said Bartlett. “We don’t know much about transmission in young children, but their tendency to put things in their mouth can increase the risk of spreading among children,” she noted.
This freedom with the sharing of germs is exacerbated by interactions at nurseries. April Fools report in Science looked at the change in the number of daily contacts infants and young children had before and during pandemic disabilities in Wuhan and Shanghai, China. They found that there was a decrease in the daily number of contacts between 0-6 years of age of children from about 12 to 2 years in Wuhan and from about 14 to 2 years in Shanghai. Reducing the number of people everyone comes into contact with has been a cornerstone of efforts to slow the pandemic.
Looking at their data on children in general, the authors noted, “While proactive school closings cannot interrupt transmission themselves, they can reduce peak incidence by 40-60 percent and slow the epidemic.”
Protect the safety of childcare workers
Day care conversations also often drop the issue of staff exposure. Given that babies and young children need such practical care – pretty much all day – Austin says, it is essentially impossible for teachers to physically distance themselves from the children they care for.
Some precautions can help reduce the risk of transmission of Covid-19 in close contact, such as “ getting childcare workers to change clothes when spat, etc., and having them wash their necks / arms when they come into contact with child secretions also help, ‘says Bartlett. But these steps should be taken dozens of times a day, especially for those who care for babies.
To add to the difficult situation, Austin notes that caregivers are often “among the black and brown communities disproportionately affected by Covid-19.” For example, in California, most of these roles are filled by people of color.
Austin and others have suggested that child caregivers with underlying health issues and those over 65 may consider not going back to work – or in a capacity where they don’t interact with children. But these options are not always feasible or financially possible.
My wife is on the board of our (non-profit, non-university affiliated) daycare and listening to the calls where they try to figure out when and how to reopen is equally devastating and disturbing. Here are a few things to keep in mind (a thread):
– Jess Calarco (@JessicaCalarco) May 10, 2020
“Pre-pandemic childcare programs worked with small margins, and staff earned poverty wages,” says Austin. “This crisis is exacerbating these conditions, leading many early educators to risk their lives by continuing to work under current conditions – or risk losing their living if they are not working.” Early childhood education workers earn a national average of about $ 12 an hour, her group has determined.
Some childcare workers have asked for a test if they want to return to work, while others have left their jobs.
Families who still have access to care are concerned
There are also plenty of concerns that come from families who previously relied on group daycare for children so they could make their own money.
In Colorado, Mullen Davis says there are more families requesting school fees for their childcare – “many of whom have never asked for this help before,” she says. “It is clear that many families are currently facing additional financial pressures.”
In addition, she says, “some parents like to take their children with them, while others ask for guarantees that are often beyond the control of the center.”
The stress of the situation has also trickled down to the children, who “have their own fears and anxieties, which can contribute to classroom behavioral problems,” said her colleague, Karen Thiel, leader of quality initiatives at the congregation.
Families – including educators – have also expressed other concerns about the implications of new health and safety guidelines in centers for children and their development. Thiel had families ask, “How are children going to learn to interact in socially appropriate ways if they are expected to stay six feet apart?”
Mullen Davis recently heard from another parent who was concerned about her baby, surrounded by masked staff for 40 hours a week. “She was concerned about how masks affect language and social-emotional development when children can’t see their caregiver’s friendly or responsive face,” she says. “We just haven’t researched this.”
Covid-19 can bankrupt many childcare centers
With all these changes, a large proportion of childcare centers – like so many other small businesses – may not survive the pandemic.
In Colorado, “many center directors are concerned that they will not have enough children to cover healthcare costs if they reopen,” says Mullen Davis. Centers are also experiencing extreme fluctuations in staffing and attendance. And with many states limiting group size to about 10, that takes a hefty chunk of tuition, especially for kindergartens, where classrooms are often close to 17 children.
The CSCCE found that in a recent study 14 percent Of the more than 2,000 childcare programs surveyed in California that are currently closed, will not be able to maintain a closure that ends after the end of May. And for those who stayed open, they found that 63 percent wouldn’t survive a shutdown lasting more than a month.
In the US, there is already a shortage of childcare. Some half of American families with young children have reported problems finding childcare, according to the Center for American Progress, a progressive research and advocacy organization. (The group estimated that in 2016 2 million American parents quit work or have drastically changed their job due to childcare issues.)
“This crisis has brought to light the central role of childcare teachers in our society,” said Austin. “Now is the time to stabilize and invest in this critical part of our infrastructure so that it continues to exist in the future and in a way that protects the wellbeing of children, young educators and communities.”
Some states are taking big steps to ensure that childcare centers can remain solvent for the time being. For example, Vermont uses a combination of state and federal funds to ensure that income centers are lost.
Others are re-examining previous actions. Gov. Mike DeWine in Ohio really stands out, ”Javaid Siddiqi, president of the Hunt Institute, told Vox. “Only [last] He retired a week and acknowledged that the reopening of childcare was simply too important to do haphazardly. He wants their plan to be based on science and safety. That’s a tough attitude to pressure to open again, but it’s clear that he really understands the seriousness of the situation. “The state’s childcare centers have been closed there since March 26 (with emergency care for health workers), but there are now plans to reopen with new measures in late May.
But, as Bartlett notes, “As parents of young children know, even day care centers with the most meticulous attention to hygiene have transmission of infections. There are measures we can take to reduce the risk of transfer, but it will never be zero. ‘