Child care during the coronavirus pandemic can best be described as clinical.
Temperature checks, hand-washing and face masks are constants now at preschools and child care centers around the country. Class sizes have limits, and some lunchrooms and common areas are off limits. The safety measures pose a constant reminder to families: These are not normal times.
As parts of the country begin to tip-toe back toward more normal routines, working parents are desperate for child care. Still, they must weigh the risks of sending their young children outside of the safety of their homes, to be cared for by someone else.
The big question: Is it safe?
“At this point, anything we do now has risk associated with it,” said Dr. Elizabeth Murray, pediatric emergency physician at UR Medicine’s Golisano Children’s Hospital. “However, there are definitely steps to significantly decrease risk. Families will need to determine their own comfort level and risk tolerance based on their own risk factors.”
Instead, experts say, parents and day care providers must consider the size of the outbreak in their area and commit to health and safety measures recommended by the U.S. Centers for Disease Control and Prevention. The goal: reduce exposure to the virus wherever possible.
“Any place where people gather will be different now,” Murray said. “It’s likely that the daycare room sizes will involve fewer children per room and that might mean fewer children can be cared for in each location.”
While all branches of the YMCA of Greater Rochester closed their doors in mid-March, the agency’s child care centers never stopped operating.
More than 300 local children have been enrolled the YMCA centers throughout the shutdown, though daily attendance has been roughly 60%, according to Kevin Fitzpatrick, the YMCA’s chief operating officer.
Given the highly contagious nature of COVID-19, new facility safety procedures were a must, Fitzpatrick said. Now, all staff members wear masks inside the center, parents must check-in their children in the lobby of each child care center. Children and staff must have their temperatures taken before they are permitted to head further inside the building.
Parents, who are asked to wear a mask when delivering or retrieving their child, are not allowed further inside the building.
“We are using this as a positive learning experience for (the children), helping to alleviate any fears while teaching them about germs and safety and explaining what’s happening in the world around them,” Fitzpatrick said.
For many parents, though, it’s more than a safety decision. It’s an economic one. Many parents cannot work if they cantnot send their children somewhere during the day.
“‘Safe’ is a relative term now,” said Dr. Kate Connor, an assistant professor of pediatrics at Johns Hopkins University and the medical director of The Rales Health Center at KIPP Baltimore, a charter school. Like Murray, Connor said, parents must determine their own comfort level and risk tolerance.
“All of these things are sort of risk-reduction traits essentially, but none of them will be 100%, particularly if COVID is still circulating in the community,” Connor said.
Where you live matters
First, providers and parents must consider the infection rate in their community. There are nearly 1.5 million confirmed cases in the U.S., but the actual number is likely much higher.
Ideally, where child care providers reopen, there will have been at least two weeks of declining or plateauing hospitalizations and deaths, Connor said. There will be enough testing to identify new cases. And there will be enough people in the public health network who are trained in contact tracing: tracking where infected people have been and notifying people who might have been exposed.
All of that is hard for ordinary people to discern on their own. That’s why state-specific information like stay-at-home orders and guidance on phased reopenings is so important. Every day, state officials announce updates and ease restrictions based on what they see.
In New York, many child care centers never closed. Others are just starting to re-open, as the state begins the first phase of re-opening procedures.
“New York State recognizes the vitally important role of child care providers in reopening the state economy,” said Jeannine Smith, deputy communications director for the state Office of Children and Family Services, which oversees day care centers throughout New York.
The office, Smith said, works with local child care resource and referral agencies to “connect families with child care and to address the critical issue of child care for families – including essential workers, first responders and individuals returning to the workplace as part of phase one reopening.”
“OCFS will continue to work with local leaders to support their efforts with technical assistance and guidance to make child care available to families who need it,” Smith said.
Still, if a state is reopening, that doesn’t necessarily mean everything is fine.
Children are less likely to show symptoms of COVID-19 than adults, early numbers suggest. One study found children accounted for less than 2% of almost 150,000 confirmed U.S. cases.
What’s still unclear is how big of a role children may play in spreading the virus to adults. And adults and children with compromised immune systems or pre-existing conditions are always at increased risk.
Murray urged parents to make sure their children continue to receive routine care – including well checks with pediatricians – to ensure vaccinations up to date, that the child is growing well, making milestones and that the child and family are coping well during this time of uncertainty.
It’s also important to remember that the new inflammatory syndrome impacting children is not contagious, Murray said.
Symptoms linked to the syndrome are not subtle. Parents will know if something is wrong and if that occurs, should seek medical help, Murray said.
What to look for in a day care
Families who need to start using child care again should check with their child care providers to see what mitigation measures are in place, Murray said. This will also help prepare their children for those changes, she said.
Depending on the outbreak in their area, states are taking guidelines from the CDC and translating them into regulations for operation. They have some common traits.
Commonly, class sizes are limited and kept to a ratio of nine children to one adult. The ratio is lower for younger children or infants, and some states, such as Ohio, have created lower class-size limits for children of all ages.
“Maintaining a consistent group will likely be important too as it will lessen the chance of contact with ‘new germs,'” Murray said. “Meaning that if children need to be grouped together, it is best to be with the same small group everyday.”
Child care providers should wear masks where possible, especially when in close contact with younger children. Providers should screen children for symptoms when they arrive each day, by taking their temperature or asking about symptoms. Children and adults who have any symptoms associated with coronavirus should stay home. Everyone should wash their hands, a lot.
Social distancing guidelines are the hardest for child care centers to reinforce. Outside of members of the same own household, the CDC recommends staying six feet away from other people.
But that becomes difficult in small facilities where one adult is caring for multiple children at a time. Plus, young kids by nature play in close quarters with each other. It’s even good for their development.
Under the new coronavirus reality, many child care providers are trying to keep children around a small group of the same people each day. For instance, separate classes no longer have lunches together at a long table or mix on the playground. Providers try to be strict about all the other protective measures, knowing social distancing will be a struggle.
The Browncroft Day Care Center on Atlantic Avenue was among some of the Monroe County day care centers that never closed during New York’s shutdown. But given that many parents were either working from home or lost their job, enrollment dropped to about 25% of the center’s non-pandemic capacity, said the center’s general manager Mike Hofmann.
“We’re extra vigilant as far as the health of the children goes,” he said, adding that the staff thoroughly cleans and sanitizes the center, toys and touchable surfaces several times a day. “We’re doing everything in our power to keep everyone safe and healthy.”
Staff members are required to wear masks inside the building, as are parents who enter the center. While parents are still allowed inside classrooms to deliver their children to staff, only one parent per child is permitted inside the infant room, for example. And parents are asked to restrict their movement inside the building, he said.
Tours of the center have been temporarily halted, to keep strangers away for the time being, Hofmann said. And like many businesses, all deliveries must be dropped outside the building.
Parents sending their children to daycare centers must also prepare a secondary child care plan, Murray said.
“Facilities that may have been able to handle a child with mild cold symptoms will likely no longer be able to do that,” she said. “Any symptoms of illness must be taken seriously.”
The future of child care
Providing child care during a pandemic comes at a cost. There’s the purchase of protective equipment, the limits to class sizes, declining enrollment and therefore revenue — all in a business with notoriously low profit margins. As some centers regroup and reopen, others will stay closed. Down the line, as more and more parents return to work and need child care again, they could find their day care provider is out of business.
“This is a time for advocacy for funding for child care,” Murrsay said. “There is no question that the cost for care will increase due to the increased safety equipment, increased physical distancing and likely small class sizes.”
National child care and early education advocates say child care providers need federal aid, and soon.
An analysis from The National Women’s Law Center estimates Congress would have to allocate $50 billion for less than six months of relief and emergency care. The CARES Act stimulus passed this spring provided money for essential workers to pay for child care, but experts say it’s not enough.
“We are gonna be the biggest part of a comeback, besides people going to work: having a place to put their children that they can trust and feel comfortable with,” said Cindy Lehnhoff, director of the National Child Care Association. “It’s going to be hard if we don’t do something to keep providers open.”
Of the 244,000 licensed child care facilities and in-home care providers in the U.S., 60% were forced to close due to the pandemic, Lehnhoff said. Of those, 30% to 50% are projected never to reopen. The carnage will leave millions of children without a place to go and thousands of workers without a job. And that will put more stress on an already-strained system.