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Reopening states after the COVID-19 lockdown raises unnerving questions for working parents who depend on some form of child care, from nannies to day camp.
Instead of coming home with a snotty nose, is your child going to bring back the coronavirus? And how do you know your in-home babysitter or nanny, even your child’s teacher, isn’t a symptom-free spreader?
The short answer is that there are no easy answers. Every family’s budget and needs and risk tolerance are going to be different. ProPublica scoured the latest research and talked to seven infectious disease and public health experts to help think through the issues facing parents.
We were surprised to find the experts were reassuring. In fact, with the proper precautions and monitoring in place, most of them thought parents could safely rely on caregivers, day care centers and perhaps even counselors at sleep-away camp.
There’s also a hopeful nugget of information out of New Jersey. We called the state’s Department of Health to see if COVID-19 had been spreading within the child care centers that had opened April 1 to serve children of essential workers. There have been no reports of outbreaks of two or more cases, an official said.
“That’s more than interesting, it’s absolutely entrancing!” said Dr. William Schaffner, a professor and infectious disease specialist at the Vanderbilt University School of Medicine. “That will encourage us to open the schools. It’s in line with other countries that have not closed their schools, or have only modified their school attendance somewhat.”
But don’t get too excited. Some key questions still can’t be answered because of a frustrating lack of research. For example, it’s hard to say how much children transmit the disease among themselves or to others. And while some child care centers have been open, experts were not aware of any studies taking place about transmission within them.
The dearth of research about the coronavirus and kids is “a huge loss,” said Dr. Ashish Jha, incoming dean of the Brown University School of Public Health. “The idea that we’re not using every opportunity to study this stuff blinds us when making decisions,” he said.
But the experts agreed that economic realities will force most families to make decisions on the safety of child care and school settings long before there’s increased testing capacity or scientific certainty. “We can’t wait for a vaccine; that’s too far off,” said Dr. Caitlin Rivers, an epidemiologist and assistant professor at Johns Hopkins Center for Health Security. “We can’t wait for a therapy to come online to prevent severe illness.”
Here are the questions ProPublica came up with for parents considering child care, with the guidance provided by research and experts.
What Does Science Say About the Health Risks Children Face From Coronavirus?
Let’s start with some good news: We can say with confidence that children infected with the virus do not get as sick as adults. That has consistently been shown in study after study. “Doctors have hospitalized very, very few children with COVID-19,” said Raphael Viscidi, a pediatric virologist at Johns Hopkins University School of Medicine. “That’s been true here and true across the world.”
“When we look at the other objective measure of judging how bad is this — death — it’s extremely rare,” he said.
Of the 23,083 lives lost as of May 21 in one of the hardest-hit regions, New York City, only 14 of the victims were younger than 20. (Ten were between the ages of 10 to 19 and four were under age 9.)
In recent weeks, there have been alarming headlines about a severe inflammatory syndrome in children associated with COVID-19. It’s likened to Kawasaki disease, which is a rare, acute multisystem inflammatory syndrome whose symptoms include fever, low blood pressure, abdominal pain and heart inflammation. Here again, though, the prevalence is extremely rare.
And Dr. Lance Peterson, the recently retired director of clinical microbiology and infectious disease research at NorthShore University Health System, said even if a child develops the syndrome, “There are treatments so mortality risk should be fairly low.”
The trickier questions are whether children are as susceptible as adults to becoming infected and, if infected, how likely they are to spread the virus to others.
At this point, there’s a limited number of studies, and the science is far from conclusive, but three of the four studies ProPublica looked at found that children are not contracting the virus as often as adults.
Two studies out of China show that children had much lower rates of infection. For example, one study of 105 confirmed COVID-19 patients and the 392 people they came in contact with in their households found that the infection rate among adults in the households was “dramatically higher” than that of children, with 20.5% of adults falling sick, compared with 4% of those younger than 18. Another household contacts study, conducted in Guangzhou, China, found similar infection rates in children. That study has yet to be published in a journal, but it was posted online.
In a population study in Iceland of 13,080 residents, 100 (or 0.8%) tested positive for an active infection. None of the 848 children under age 10 tested positive.
Frustratingly, at least one study has had contrary finding: A study in Shenzhen, China, tracked 391 COVID-19 cases and their 1,286 close contacts and found that the infection rate among children under age 10 was 7.6%, similar to the population average of 6.6%, leading the authors to conclude that “children are at a similar risk of infection to the general population.”
OK, maybe you’re not that worried about your kid getting severely sick, since that’s so rare. What you really want to know is if your kid can become a carrier of the virus and bring it home to endanger people living with you who are elderly or have compromised immune systems. Experts say those early studies showing lower rates of infection in children are a positive sign.
But there is another study by a group of German researchers that is causing some concern. It found that children and adults who are infected have similar viral loads. An infected person’s viral load is a measure of the amount of virus being emitted from his or her cells. It’s generally considered a proxy for how infectious a person is — though an imperfect one. “Based on these results, we have to caution against an unlimited re-opening of schools and kindergartens in the present situation,” the authors wrote. “Children may be as infectious as adults.”
Experts are hopeful that more answers are coming as new research begins, including a National Institutes of Health study that will look at what percentage of infected kids develop symptoms, and a study at 35 children’s hospitals across the country that will attempt to determine why children aren’t getting sick in the same numbers as adults. The hospital study will also look at viral shedding in children, a measure which is considered a proxy for how infectious a patient is.
For concerned parents, one quandary posed by the coronavirus remains particularly tough to navigate: Research shows that an infected person can transmit it to others before showing symptoms of COVID-19. This makes it difficult to be certain it’s safe to venture out because screening people for symptoms can still miss carriers of the virus.
How Do I Weigh the Risks COVID-19 Poses to My Family?
Parents can assess their risk on a number of levels: community, household and the emotional well-being of their families.
Dr. Saskia Popescu, an infection prevention specialist in Arizona, said the first step is to look at how many people are continuing to contract COVID-19 in your region. Some states will handle this question for you, because governors won’t lift stay-at-home orders until community transmission has been dropping for several weeks. The White House guidelines for reopening America recommend a 14-day downward trend in cases, and ProPublica has a tool to check the status of your state. State and county health departments may have more specific information that applies to your community.
Your household risk will also be higher if you live with or frequently see an elderly family member, or someone with a compromised immune system. Chronic illness is also a consideration. The U.S. Centers for Disease Control and Prevention says that people with underlying conditions, such as severe obesity, diabetes, kidney disease or heart disease, are at higher risk of severe illness from COVID-19.
For parents who have been juggling full-time child care or Zoom classes at home, there is also a growing worry that seems selfish to say aloud during a pandemic: What are the social and emotional costs of so much isolation? And is there a time when those costs can be considered as risk factors?
