Every morning when Inna Keselman goes to work as a neurologist at the University of California, Los Angeles, she drops her 3-year-old son off at a day care center located on campus. It’s the same routine that she had before the Covid-19 pandemic.
Only now, a few things have changed. Keselman, a single mom, has to say goodbye to her son at the door instead of going in at drop-off. Teachers take his temperature before he walks in. And, even though the day care remains open to all, many of her son’s classmates are not there.
“I could get a babysitter, but I would have to find a person, and I would have to know if that person is good and then find out where that person is coming from,” she said. “At day care, you know they are going to be following some protocols and washing hands. It’s a very personal decision.”
Despite widespread closures of just about everything because of the Covid-19 pandemic, many day care facilities remain open around the United States — either for all children or just for children of essential workers. As of April 1, more than a dozen states had closed child care facilities, while giving them the option to stay open for children of essential workers. Rhode Island shut down all of its day cares for everyone through April 4. New York, California, Washington, Texas and many other states still allow child care facilities to remain open for all.
That has left parents grappling with decisions about whether to send their kids and whether to pay providers if they keep their kids home. (It has also served as a good reminder of the outsized role that day care facilities play in allowing society to function).
There are no simple answers, experts say, and the right thing to do will depend on each family’s situation. For now, research supports keeping kids home from day care if possible, said Dr. David Kimberlin, M.D., a pediatric infectious disease physician at the University of Alabama, Birmingham. If it’s not possible to keep them home (and many people have no choice), parents can take precautions and encourage providers to take precautions as well.
Are day cares even allowed to remain open?
Regulations for child care facilities vary by state, said Dr. Lynette Fraga, Ph.D., executive director of Child Care Aware of America, a nonprofit advocacy group. And like everything else related to Covid-19, rules are evolving rapidly. “It’s really changing, sometimes hourly,” Dr. Fraga said.
To help people figure out what the rules are in their area, Child Care Aware of America offers an interactive map of state policies, among other resources, including a flow chart to help child care centers decide whether to close or stay open. The Hunt Institute, an education nonprofit, also offers up-to-date, state-by-state information.
Some states, including Ohio, offer specific guidelines on maximum group sizes and distancing protocols. States also vary in how they define what an essential worker is. Even in places where child care facilities can remain open for all or for limited groups, Dr. Fraga said, plenty of facilitates have decided on their own to close. (Overall, there are about 115,000 day care centers around the country, according to Child Care Aware of America, not including in-home day cares.)
How at-risk are kids to Covid-19?
To the relief of parents everywhere, this disease has been relatively low-risk for children.
In one study, researchers from China and the U.S. tested the contacts of infected people in China and found that children were just as likely as other age groups to test positive, though none of the infected children developed severe symptoms. A new analysis of cases and deaths in China found an extremely low mortality rate of 0.0016 percent in children up to age 9, compared to nearly eight percent in people 80 and up. Just 0.04 percent of infected children between ages 10 to 19 were hospitalized, compared to about four percent of people in their 40s and eight percent of people in their 50s.
Young people still get sick, and there have been serious illnesses and deaths. Infants are particularly vulnerable, found an analysis of more than 2,100 pediatric cases reported to the Chinese Center for Disease Control and Prevention in late January and early February. About six percent of children had severe cases, the study reported, compared to more than 10 percent of infants and more than 18 percent of adults.
Will sending my kids to day care contribute to the spread of the pandemic?
In a nutshell, yes. Most children who get infected seem to develop mild symptoms or none at all, which makes them potentially ideal vectors. And while contagiousness would likely be higher if more children were coughing and dripping snot everywhere, studies suggest that kids can transmit Covid-19, even if they don’t seem sick, Dr. Kimberlin said.
At the same time, child care facilities are notorious for amplifying the spread of illnesses among children and their families. “Not sending your kids will decrease the likelihood of them becoming vectors for spreading the virus,” said Dr. Justin Lessler, Ph.D., an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health, and one of the co-authors of the Chinese contact-tracing study.
If I do send my child to day care, how can I make sure they are being as careful as possible?
The Centers for Disease Control and Prevention recommends that active child care centers increase cleaning efforts, implement social-distancing strategies, and alter drop-off and pickup procedures, among other adjustments. That might mean frequently sanitizing toys, keeping kids in the same small groups with the same teacher every day, and staggering what times parents arrive to reduce numbers of contacts among families.
Parents should ask providers about their health and safety standards, the kinds of training given to staff, how large the play groups are and the ratios of kids to grown-ups. Lastly, Dr. Fraga said, it’s good to find out what mental health supports are available — for both children and providers.
Should I pay even if I keep my kids home?
If you have money to spare, send some to your child care provider, said Dr. Arthur Caplan, Ph.D., director of the division of medical ethics at the New York University Grossman School of Medicine in New York. Parents who have lost their jobs, or worry they will soon, might be unable to pay. Day care operators worry they may have to close permanently, leading to a domino effect that will threaten the nation’s entire child care system and seriously impact the economy.
“As with many things, the pandemic reveals some of the biggest gaps, weaknesses and inadequacies in our society,” Dr. Caplan said. “Day care for workers is crucial as one way to keep the economy flowing.”
It’s a lose-lose situation that is driving advocacy groups, including Child Care Aware of America, to push for more federal and state funding for an industry that was already struggling before the pandemic struck.
“We need to support the heroes that are caring for the children of our nation’s heroes,” Dr. Fraga said.
Paying closed or struggling child care operators can be as simple as sending a check. Locally, some parents have also organized online fund-raising campaigns, coordinating with the school administrators to distribute the money. More formal drives also exist. In Washington state, where more than 1,000 child care facilities have closed in part because they don’t have essential supplies like diapers and bleach, Child Care Aware of Washington has created a fund to get cleaning and hygiene products to providers.
Wait — will my day care be there when this pandemic is all over?
The most recent stimulus package included $3.5 billion to help the child care system. It’s not nearly enough, said Julie Kashen, director for women’s economic justice at The Century Foundation, a progressive nonprofit think tank focused on equality.
Kashen wants the next congressional relief package to include $100 billion for day care. She said that money could pay for a currently underfunded grant program that provides money to states to subsidize child care for low-income families. It could raise incomes of child care workers, who have long been underpaid and whose jobs have just become riskier. And it could help prevent the system from collapsing so that day cares still exist and the economy can resume functioning when schools and workplaces reopen.
Emily Sohn is a freelance journalist in Minneapolis, who has written for The Washington Post, Nature, NPR, Spectrum, bioGraphic and other publications.
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