Welcome back! My apologies for my unexplained absence these last two weeks. I’ve been researching information for a post on COVID-19 vaccine development, and I kept telling myself that I would finish it soon and not to start a post on another topic until that one was ready to go, but I’m sorry to say that I let the perfect get in the way of the good. I’ll be back with that post when it’s ready, but in the interim the CDC’s Morbidity and Mortality Weekly Report published a very interesting case series this week describing limited spread of COVID-19 among child care programs in Rhode Island following state requirements for reopening.
First, it’s very important to keep in mind that the findings described in this article will not necessarily apply to all child care programs and schools everywhere, particularly those in areas with higher rates of COVID-19 and/or weaker requirements to reopen. However, it is a good illustration of what may happen when child care programs in areas with lower rates of COVID-19 follow best practices to prevent spread of disease and coordinate with public health.
On June 1, 2020, after 4 weeks of declining cases and hospitalizations of COVID-19 in the state, the Governor of Rhode Island authorized child care programs to reopen as long as they followed these requirements:
- Allowing no more than 12 people (including staff) per group (this was later increased to a maximum of 20 people);
- Keeping the members of each group together and not mixing with other groups (a public health practice called cohorting);
- All adults wearing face coverings any time they are within 6 feet of another person;
- Screening of all staff, families and children for symptoms of COVID-19 every day;
- Frequent hand washing, or use of hand sanitizer when soap and water are not available;
- Cleaning and sanitation according to CDC recommendations; and
- Enhanced drop off, attendance, and pick up procedures.
More information about Rhode Island child care requirements are available here and here. By the end of July, 75% of Rhode Island child care programs, representing 74% of the children that had been in child care in the state before COVID-19, had met these criteria and been allowed to reopen.
The state health department conducted unannounced site visits to 1 in 5 reopened child care centers, and reportedly found that many were following the requirements; their exact findings aren’t summarized in the article, so I can’t speculate whether it was closer to 51% or 99%. The health department also investigated any reported cases of COVID-19; if any cases were found in child care programs then the classroom had to close down for 14 days or until the case was ruled out and any other children or adults in the classroom were sent home and put in quarantine for 14 days after the last date that they were exposed to COVID-19. The health department followed up with all people in quarantine (or parents of children) to find out whether they developed COVID-19.
The results were striking: out of 666 child care programs authorized to reopen, only 29 Rhode Island child care programs had cases COVID-19 in June and July (a total of 52 cases: 30 in children and 22 in adults). We so often focus on the cases, but let’s flip that around: 29 child care programs with cases out of 666 open programs means that 96 percent of child care programs following state public health guidelines did not have any cases of COVID-19. Furthermore, out of the child care programs with cases of COVID-19:
- Two-thirds (20 out of 29) had only 1 case with no further spread;
- Five had 2 or more cases, but the health department was able to prove that they did not spread within the child care center (for example, 2 or more people in the same child care program had both caught COVID-19 from somewhere outside of the child care program); and
- Four had likely or definite spread of COVID-19 within the child care program.
Let’s dig a bit deeper to look at the latter four child care programs. In one program, the health department was never able to find a connection between the two cases, nor rule it out, so let’s set that one aside. In the second program, three cases occurred within a single classroom but COVID-19 did not spread to other classrooms, illustrating how cohorting groups of children helps to prevent COVID-19 spread between groups. The remaining two child care programs did not follow state requirements: in one program, a staff member moved between all classrooms but fortunately only infected one child. When the state health department investigated the fourth child care program, they found that they had not followed several requirements, most notably allowing children and staff from different groups to mix together. That program had 10 cases of COVID-19, the largest COVID-19 outbreak in Rhode Island child care programs.
Bottom line: When Rhode Island child care programs followed strict state requirements, 96% had no cases of COVID-19, and another 3% (for a total of 99%) had only a single case with no further spread. This is a public health victory and shows that there are ways to reopen child care programs – and potentially schools – with minimal spread of COVID-19. However, it will be critical to stick to strict COVID-19 control requirements. One child care program that did not follow these requirements had an outbreak of 10 cases.
Does this mean that return to school is the best choice for every parent? No, not necessarily. It’s important to remember that COVID-19 cases were low in Rhode Island for most of the time described in this study. Cases began to rise again in the second half of July; two-thirds of the cases described in this study happened in those 2 weeks alone. A larger state with more cases of COVID-19 would likely also have more spread in child care centers.
Secondly, Rhode Island had strict requirements for COVID-19 control, and most child care programs described in the study apparently followed the state’s requirements. Unfortunately, not all states are as strict as Rhode Island is.
Check the number of COVID-19 cases and percent of positive tests in your state and local area, check your state’s requirements and speak with your child’s school or child care about how they are going to follow them. If your state and/or school or child care is not at least as strict as the CDC recommendations, and/or if your school or child care can’t assure you that they will follow these recommendations, then that’s a serious red flag. Check my Back to School or Distance Learning? post for additional considerations about whether to return your child to school this fall.
Best wishes for whatever this fall brings you, stay healthy and safe, and I’ll be back next week,
😷 Dr. B