Daycares Don't Have to Be Hotbeds of COVID-19

Brenda Goodman, MA

August 24, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

It's possible to reopen schools and daycares safely in the midst of COVID-19, as long as community spread of the infection is low, according to a new study.

Rhode Island, a state that has kept its COVID-19 outbreak under relatively good control, saw little new transmission of the infection when the state reopened daycares earlier this summer, according to a new study just released by the CDC and the Rhode Island Department of Health.

By the end of May, cases and hospitalizations had dropped in Rhode Island even more than expected, and Governor Gina Raimondo announced the state could confidently move to phase two, which included reopening schools and childcare centers.

Daycares reopened in June with strict new guidelines in place that called for limiting class sizes, preventing different groups of kids from mixing; physical distancing; mandatory masks for adults and teachers; daily symptom screening for kids and adults; increased ventilation; and rigorous cleaning and disinfection.

In total, almost 19,000 kids returned to childcare. They ranged in age from babies up to age 12 because older kids are allowed to attend daycares in Rhode Island during the summer months. Of the total, 101 children and adults were flagged as suspected cases during those two months, and 52 were determined by testing and symptoms to be confirmed or probable cases. Out of 891 programs that were allowed to reopen, just 26 reported any cases of COVID-19. Most of those were a single case that wasn't spread to others at the child care center. Just 5 programs — 15% — had multiple cases, and only 4 had possible onward transmissions, where an infected child or adult who came to school infected someone else there. No one was hospitalized or died as a result of their infections.

In one particular success, a 2-year-old who attended daycare for 6 days while potentially contagious didn't infect any of the 10 other people they were in contact with during that time.

It wasn't all smooth sailing. The daycare experience came with hassles for 853 kids and staff who had to be quarantined as part of contact tracing efforts. That meant schools had to scramble to stay staffed, and parents had to care for kids at home while their classes were closed for 14 days.

On the whole, though, the results were good news. Robert Redfield, MD, director of the CDC, credited the schools who were closely following the safety precautions when they were inspected by the health department and the vigilance of the Rhode Island Department of health in following up on suspected cases.

It's not clear, however, that cities and states struggling with higher rates of community transmission would get the same reassuring results. Most of the cases (75%) recorded in the Rhode Island daycare study occurred from mid- to late July, when cases began to climb in the state.

"Schools are not islands in and of themselves. They are connected to the communities that surround them," Redfield said.

The percentage of COVID-19 tests that come back positive in Rhode Island — which is an indication of how widespread the infection is in a community — has been significantly below the national average, hovering around 2%. Florida, Georgia, Idaho, and Kansas are currently all have positivity rates over 10%. The positivity rate in Mississippi is almost 30%.

"I think this is an example of really opening in a successful way in a community that had low transmission," said Erin Sauber-Schatz, PhD, who leads the Division of Injury Prevention at the CDC.

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