With caveats, hopeful news for preschools planning young kids’ return

Reviewed by James Ives, M.Psych. (Editor)Aug 6 2020

Sabrina Lira Garcia is proud to work as a clinical assistant in the COVID-19 ward of a Los Angeles hospital, but sometimes she wishes she could just stay home with her infant son until the pandemic is over.

Pulling her child from day care has never been an option for Lira Garcia, however. She can't let her career lapse. Her husband was born in Mexico and is undocumented. The family pays monthly legal fees to help him get residency papers. If he were ever deported, she'd have to support Jeremiah, born in October, by herself.

"I couldn't afford to just stay home," she said. "I have no kind of family who lives around me or any source of help."

Lira Garcia and thousands of other essential workers have had no choice but to use day care, and thereby run the risk of exposing their children to possible coronavirus infection over the past several months. In effect, they have been part of an unplanned national experiment of deep relevance to parents weighing the pros and cons of letting their children return to school this fall.

So far, it seems fairly successful. The number of outbreaks at child care centers is low. Research to date has shown that children rarely get sick with COVID-19, and those under 10 seem not to be as efficient at transmitting the disease to older family members. These dynamics, combined with additional precautions schools are taking around masks, classroom adaptations and keeping parents out of school buildings, appear to make day care and school reasonable options for families with healthy younger children.

There are no guarantees, however. An overnight summer camp in Georgia saw an outbreak despite several measures to mitigate risk, infecting 76% of those for whom test results were available. Fifty-one percent of kids ages 6 to 10 became infected, while 44% of those 11-17 were infected as well. Asymptomatic infection was common among the children, who weren't required to wear masks, though adults were.

Still, while a single death tied to a day care center could be devastating to parents in any community, "child care centers are probably reasonably safe," depending on the community transmission rate, said Ashish Jha, the incoming dean of the Brown University School of Public Health. Dr. Robert Redfield, director of the federal Centers for Disease Control and Prevention, currently defines a "hot spot" as an area with a positivity rate of more than 5%.

"If you're in the hottest of the hot zones, and you have massive outbreaks, I'm not sure if you can do it," Jha said of in-person schooling. "Even if the kids are all right, you still need to have teachers and staff in elementary schools."

In California, where most in-person classes have been closed since March, about 33,300 child care facilities were open as of July 22. These facilities have the capacity to care for 720,882 children, although the actual number is probably much lower because of frequent closures and children kept at home during the pandemic.

The state had recorded 1,365 COVID-19 cases linked to child care facilities as of July 22, of which 261 were among children. During the same period, 9% of all California's 425,616 cases were among people under age 18, and there were no COVID-related deaths reported in this age range. Since then, California has confirmed the state's first COVID-19-related death of a teen.

In Los Angeles County, 268 cases — including 75 children — had been reported in the 7,238 day care facilities open as of the end of July. Children under 5 account for less than 1% of all hospitalizations in the county, according to data that public health department director Barbara Ferrer presented at a news conference July 29.

The picture is similar in other states that have collected data on outbreaks in child care centers, including Texas and Ohio.

But the low case counts don't mean COVID-19 "is a completely benign disease in children," Ferrer said. "We still have a lot to learn about the short- and long-term impacts of the virus."

There's a "big void" of information about how the virus spreads among small children and between children and older people, said Dr. Jeffrey Gunzenhauser, chief medical officer of the Los Angeles County Department of Public Health.

"We don't quite understand the infection dynamics, and we don't really know the transmission dynamics," he said, so parents will have to balance the relative lack of information against their own need for child care.

Adding to the stress of these decisions, parents may not want children who are in school or day care to see grandparents or other relatives who have helped watch the children in the past — for fear of passing the virus on to them, Gunzenhauser said.

Uncertainty about transmission is one factor that has led parents to keep their kids at home. Some 18% of U.S. child care centers and 9% of family child care homes remain closed in the wake of the pandemic, according to the National Association for the Education of Young Children. In California, about 25% of child care programs are closed, according to the Center for the Study of Child Care Employment at the University of California-Berkeley.

"Based on what we're hearing from providers, we expect many programs to permanently close in the next two months if they do not receive financial assistance," said Sean Doocy, a researcher at the center.

Ricardo Rizzo, 52, runs a child care center in the Panorama City neighborhood of Los Angeles with his wife and two adult daughters. After the initial statewide shutdown in March, Rizzo and his family closed the center for two weeks to stock up on food and cleaning supplies. They also set up a sanitizing station outside the center and scheduled new cleaning routines.

Despite the new safety plans and added precautions, the center still lost eight children because of layoffs, shortened work hours and parental fear about the virus. Eighteen kids are still in his care, Rizzo said, ranging in age from babies to a 'tween.

The center's families are low-income and receive state subsidies to pay for child care. Nearly all work in positions deemed essential since the pandemic — factory work, gas station clerks, grocery workers and certified nursing assistants. Some have multiple jobs.

"We feel blessed because we're helping them by taking care of their kids," Rizzo said. "I know they go to work knowing their kids feel safe."

So far, the center and its families have been COVID-free, said Rizzo, who finds comfort in "following the protocol" — adult caretakers wear masks, do a deep clean once a day and keep parents outside the facility when dropping off and collecting their children. And he lets his center's families know they should also take precautions.

"I say we have to work together," Rizzo said. "If we do it here, you have to do it at home."

Infections can still break through the child care bubble.

Anna C., a 30-year-old essential IT worker in Kent, Washington, who asked that her last name not be used, tried to keep her 4-year-old and 20-month-old sons home until the toddler fell off a bed and split his lip while Anna and her husband were on separate conference calls.

The couple, realizing they couldn't work and safely watch their sons at the same time, decided to send them back to child care in late April. They had to pull them out again a week later, after the spouse of the toddler's day care provider tested positive for COVID-19. No further infections arose during a two-week quarantine, however, so they sent the kids back again.

"This is going to happen with any day care center or provider," Anna said. "It's just the new reality."