1. With appropriate infection mitigation efforts in child care programs, there was no association between child care exposure and COVID-19 in adult child care providers.
2. Community-level transmission was a strong predictor of child care providers contracting COVID-19.
Evidence Rating Level: 3 (Fair)
Study Rundown: There has been considerable discussion on how to safely reopen child care facilities during the current pandemic, with particular concern regarding the efficiency of children to transmit COVID-19 within the community. This study was the first to report on transmission risk in US child-care programs. Researchers found that within the context of significant infection mitigation efforts at the child care centers, there was no increased risk of COVID-19 diagnosis amongst the adult child care providers. The strongest predictor of spread to providers was increased rates of background community transmission. These findings suggest that when local virus spread is low and child care programs implement appropriate mitigation efforts, there is little threat of transmission to the community and closing these programs will do little to hinder further spread. These findings are likely not generalizable to school-age children, where interactions between children and adults may differ significantly compared to child care centers.
In-Depth [case-control study]: This study investigated the spread of COVID-19 in child-care centers that remained open during 8 weeks in the beginning of the pandemic compared with centers that were closed during the same time period. 57,335 child care providers from across the United States replied to an email survey asking about program closures, COVID-19 outcomes (hospitalization or positive PCR test), and program mitigation strategies. 51.4% reported that their child care program remained closed through the time period of interest. The 48.6% of providers that continued in-person child care reported substantial infection mitigation efforts including smaller child group sizes, frequent handwashing, and regular disinfecting of rooms. 81.1% of children in these programs were below the age of 6. In both unmatched and propensity score-matched analysis of these two groups, there was no association between exposure to child care and contracting COVID-19 (OR, 1.06; 95% CI, 0.82-1.38; P = 0.66 and OR, 0.94; 95% CI, 0.73-1.21; P = 0.64). Provider infection was associated with high levels of county-level cumulative per capita COVID-19 deaths (OR, 1.60; 95% CI, 1.19 to 2.15; P = 0.02), stressing the importance of reopening child care programs only when community transmission rates are declining.
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