|A few months into the semester, a pattern is emerging: K-12 schools do not seem to be stoking community transmission of the coronavirus. Elementary schools, especially, seem to seed remarkably few infections.|
|Although children can infect one another, the data, gathered from random testing in the United States and Britain, suggests only limited transmission from young children to adults. One study published in the journal Pediatrics surveyed more than 57,000 child care providers across the nation and found that they were no more likely to become infected with the virus than other adults in the community.|
The COVID-19 pandemic has had an unprecedented impact on child care and schools. Within one week of the World Health Organization’s declaration of a pandemic, 107 countries had implemented national school closures. Within three weeks, the number had grown to 194 countries, impacting 91% of the world’s school-age children. When schools closed in the U.S., so did many child care programs, demonstrated by the loss of more than 35% of jobs in the child care industry between February and April 2020.
These school and child care closures have been controversial regarding their benefits versus costs. Precautionary closure of child care programs was reasonable, given considerable evidence that these programs may be significant vectors for viral spread. However, several studies have indicated that school and child care closures may have had little impact on slowing the spread of COVID-19.
Furthermore, child care and school closures may result in several negative consequences, such as child care providers’ loss of jobs and wages, parents’ inability to return to work, and children’s diminished educational, social, and nutritional opportunities.
Pediatricians are key informers to parents about safety issues regarding child care and school attendance during the pandemic. Central to the debate over child care and school reopening is the uncertainty regarding whether children are efficient transmitters of COVID-19. Although there is
a relatively infrequent risk for multisystem inflammatory syndrome in children, children appear to be far less likely to be infected and more likely to be asymptomatic or paucisymptomatic.
On the other hand, because viral loads may be similar in symptomatic and asymptomatic COVID-19 carriers including children, 9,10 there may be a high risk for transmission to other children and adults through asymptomatic children in settings serving large numbers of children, such as child care and schools.
Unfortunately, most studies examining pediatric transmission risk are limited by small sample sizes of children and were conducted during widespread child care and school closures, when child transmission opportunities were greatly limited.
This study compares COVID-19 rates in child care providers who continued providing child care during the first three months of the COVID-19 pandemic to those who did not, controlling for key individual, programmatic, and community characteristics which may have motivated closure decisions. We conducted a large-scale multi-state canvass of the U.S. child care workforce to identify a sufficient number of cases, given the cumulative incidence of about 0.8% in the U.S. adult population during the first three months of the U.S. outbreak. This is the first known study
to estimate directly COVID-19 transmission within child care programs, while addressing current research limitations by focusing on transmission opportunity through children actively participating in out-of-home programs and therefore not shielded from COVID-19.