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Blog: Research Studies Help Guide Child Care in the Age of COVID-19

COVID-19 blog series

Last month, a major study on COVID-19 transmission among child care centers made headlines. The research came from a top team at Yale University and was published by the American Academy of Pediatrics, and helped to shed some important light on transmission and mitigation in child care.

First, let’s acknowledge that it is incredibly difficult to build a body of solid, reliable research on COVID-19 in child care centers and schools. The “gold standards” we use in research – randomized control trials, robust recruitment, and long-term monitoring and assessment – are not easy when a virus that didn’t even exist a year ago is the subject. This isn’t to say that research doesn’t exist to help us. State COVID dashboards and data tools have often helped to assess where cases are being transmitted. International studies of school re-openings give us some guidance, though it is hard to know which school climates are similar enough to be comparable to the US’s decentralized education system. And researchers and providers have taken it upon themselves to share data that can help each other, as seen in this crowd-sourced dashboard of school COVID data. There are also many ways to gauge the spread of COVID, with no one metric telling the full story. Researchers can use cumulative or new cases or deaths; transmission rates; or positivity rates for those who are tested.

So how is the new Yale study different? It’s large, with over 57,000 child care providers included; it’s geographically diverse to ensure results aren’t specific to just one community; and it asked enough questions about procedures and protocols to help draw some strong conclusions. It did ask respondents to self-report COVID-19 cases, which given the nature of asymptomatic cases could underestimate exposure levels. Here’s the topline finding:

              “Within the context of considerable infection mitigation efforts in U.S. child care programs, exposure to child care during the early months of the U.S. pandemic was not associated with elevated risk for COVID-19 transmission to providers. These findings must be interpreted only within the context of background transmission rates and the considerable infection mitigation efforts implemented in child care programs.”

Perhaps the most important element they identified is that rates of transmission were low in child care locations, and child care centers were taking a lot of precautions. It’s notable that this study focused on the first 3 months of the public health emergency – while many centers shut down completely, others continued operating to provide necessary care. Providers had to quickly develop new protocols and acquire safety supplies, at the same time that we still had many unanswered questions about the virus itself (for example, the public health emergency was declared early March; the CDC only began recommending masks in early April). Respondents were given about 20 choices of common mitigation efforts to indicate which their centers were using; those reported by 70 percent or more of respondents are listed below.

Source data: Table 2, Infection Control Efforts Reported in Open Child care Programs during April 2020.

In the nearly eight months since the public health emergency was declared in the U.S., researchers and policymakers have learned a lot more about the virus and ways to help slow its spread. However, access to necessary supplies remains difficult for many communities. The mask and glove shortages of the spring which plagued health care providers have certainly lessened, but finding and affording supplies remains a challenge for child care providers who often face tight budgets.

In ICS’s spring survey of South Carolina child care providers, providers reported difficulty in finding both COVID-specific supplies for their centers as well as everyday items for operation like soap, diapers and snacks due to supply chain delays.

“Many providers report difficulty in obtaining cleaning supplies needed for the full disinfecting of their centers to help reduce virus spread, beyond their usual cleaning needs. This includes Lysol, alcohol, bleach, alcohol, paper towels and more. Providers are particularly concerned about accessing necessary Personal Protecting Equipment (PPE), items with which they have no  previous experience in obtaining, including protective masks and gloves…Others note that they have had to find new ways to meet the increased cleaning needs of their center to face a highly contagious virus, including “purchase steam cleaners for doing carpets nightly” and “professional building cleaning and decontamination service.” One provider notes that once reopened, they will “have to close early daily to completely sanitize the  center,” potentially impacting revenue.…

Providers are not immune from the same supply chain issues that many American families have faced, and thus have found themselves unable to buy items they continue to need for regular operations: hand soap, hand sanitizer (for staff, not children), dish soap, toilet paper and baby wipes.”

As experts warn of a growing fall wave of COVID-19 cases – at the same time as traditional cold and flu season – governments and advocates must devise ways to support providers to access the supplies they need should these difficulties arise again. The organization Child Care Aware has developed guidance for child care centers looking for innovative ways to both access and pay for these necessary supplies which they have not previously had to seek out.

The challenges of COVID-19 will continue to impact child care operations well into 2021. ICS has issued an updated survey of South Carolina child care providers to understand the challenges providers continue to face and to better understand how policies can support this vital sector of our economy. Child care providers are welcomed to complete the 10-minute survey and share with others in their network. We have just extended the survey deadline to 5pm on Wednesday, November 11: https://www.surveymonkey.com/r/ChildCareFall20

Megan Carolan

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