Every few weeks, Caryn Cardello and her partner contemplate bringing their son back to day care.
They are stressed and overwhelmed with parenting alone after months of shelter-in-place, and they want their 2½-year-old to have the opportunity for normal social development.
But when the San Francisco couple asked their pediatrician about the coronavirus risks, the doctor did not give a clear recommendation.
“We just wanted someone to tell us what the risk was,” Cardello said. “We don’t know what the hell to do.”
Like Cardello, most Bay Area parents are confused, scared and stressed about the lack of clarity surrounding the risk of coronavirus transmission in day care facilities.
More than 320 coronavirus cases associated with day care facilities have been confirmed in the Bay Area, according to Sept. 3 data from the California Department of Social Services. More than 6,000 day care providers are open in the region, meaning that on average, there have been about five cases reported for every 100 facilities.
But major unknowns remain. Because the state data does not indicate exactly how many children and staff are associated with each day care facility, there appears to be no way to calculate the rate of coronavirus transmission. Without that figure, it is impossible to compare the risk in a child care facility with the overall rate of transmission.
The department “does not make public health determinations as to the risk associated with the number or percentage of child-care related (coronavirus) cases,” wrote Scott Murray, a spokesperson for the department, in an email. Instead, the department reports the data “to help parents and caregivers make informed decisions,” he added.
The state data do not necessarily reflect transmission within the centers themselves, but rather the reported total of cases associated with children, parents, staff members and other adults at day care facilities or within children’s families, multiple experts said.
Some lower-income and essential-worker parents have had no choice but to enroll their children in day care. Some work-from-home parents have decided the risk is low enough to be worth the benefits. And countless others like Cardello, especially work-from-home mothers, are overwhelmed by the competing demands of their jobs, children and personal lives but remain too scared to choose day care.
They all want to know: “Is it safe?”
Most experts agree that the risk of coronavirus transmission is comparatively low for children old enough for day care, and many researchers and health care providers with access to the most recent information have decided to send their own children back to day care.
But the answer to that question is mostly a personal decision, experts and day care providers agreed.
In San Francisco, day care facilities are about as safe as they can be, said Gina Fromer, the chief executive officer of the Children’s Council of San Francisco, a nonprofit that supports child care providers and helps parents find care. She feels confident that the state and county safety rules greatly minimize any transmission risk.
The number of affected child care sites “is still relatively small,” Fromer said.
Kate Shaheed, the director of St. Vincent’s Day Home, one of Oakland’s oldest day care providers, agreed. Despite hosting more than 100 children, St. Vincent’s has not experienced any coronavirus cases.
“But it’s a choice. It’s a hard choice,” Fromer said about parents’ deciding whether to enroll their kids in day care. “There is some risk there, and we just cannot say there is not,” she added.
About 30 of the cases associated with day care facilities in the Bay Area were reported in the last two weeks, according to the data.
Santa Clara County tops the list of Bay Area counties with 94 confirmed cases at child care facilities, an average of five cases per 100 facilities, and Alameda follows with 49 and an average of three cases for every 100 facilities, according to state data released Sept. 3.
In Santa Clara County, at least 30% of the confirmed cases were among children as of Aug. 30. The county is one of the few in the region with enough positive tests among children (29 total as of Aug. 30 data) to report them without violating health privacy guidelines.
“I do think it’s helpful to know the number of cases that have been connected to child care,” said Lea Austin, the director for the Center for the Study of Child Care Employment at UC Berkeley. “But what the numbers don’t tell us is whether any of these cases have actually been transmitted in a child care facility.”
California’s statistics indicate that parents and staff make up about 80% of the state’s child care-related infections, according to Sohil Sud, an associate professor of pediatrics at UCSF. For day care-aged children, the evidence indicates that coronavirus transmission among these children and from children to adults is substantially less frequent than transmission between adults, he added.
Children might just be asymptomatic more frequently than adults, but with frequent testing, “we haven’t seen that children are as likely to get infected as adults,” said Yvonne Maldonado, a professor of pediatrics specializing in pediatric infectious diseases at Stanford, about her own research currently under way.
“A typical story of transmission might be something like an aunt with COVID-19, who gives it to a parent, who gives it to their child, who happens to be in child care,” Sud said.
A Centers for Disease Control and Prevention report that described limited coronavirus transmission in child care facilities in Rhode Island corroborates this evidence, especially when combined with several recent studies conducted internationally, Sud added.
“But of course, low risk is not zero risk,” he added. He chose to allow his preschool-aged daughter to return to her school in June.
“Overall, it appears that young children in particular are less likely to be affected,” Maldonado said.
Many of Maldonado’s colleagues have returned their children to day care, she said.
Because of the constantly shifting science, day care centers have to rely on parents to carefully follow coronavirus prevention guidelines, Shaheed said.
“I think it’s really working because our parents are very very serious about not getting ill,” she added. “It’s a community trust.”
At the Oakland facility, children are kept in stable groups with the same caretakers and same children every day; outdoor play areas are fenced off to allow each group to play safely outside; adults wear masks at all times; and areas are cleaned regularly throughout the day, among many other prevention measures, Shaheed said.
Some parents have expressed confusion and frustration that day care centers and other child care activities are allowed to remain open, but schools cannot.
“It’s almost not fair to compare child care and K-12,” Shaheed said. While many day care centers, which are mostly private, cut capacity in half in order to reopen, such an option is far more difficult for public schools, which must serve all enrolled students.
And the science about coronavirus transmission among children past pre-kindergarten age is much murkier and indicates that older kids could pose higher coronavirus risks, she added.
To compensate for closed schools, some day care centers have begun to accept children ages five to eight for the first time, if they are siblings of younger enrollees, Fromer said. By accepting older siblings, some day care facilities can create more stable child care bubbles, because a group of four children from two families poses a lower transmission risk than four children from four different families, she added.
“It’s about education, and about getting beyond the fear and looking at the data,” Fromer said. Parents can make informed decisions about their child’s safety if they visit the day care they are considering and make sure they feel confident about their coronavirus protection procedures.
“Ask the questions,” she said. “Get the data.”
Cardello is still asking questions. For now she has decided to keep her child at home until she feels more certain about the mixed signals. “There are just too many unknowns,” she said.
Anna Kramer is a San Francisco Chronicle staff writer. Email: anna.kramer@sfchronicle.com Twitter: @anna_c_kramer
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