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COVID-19 Transmission in US Child Care Programs
Walter S Gilliam1, Amyn A Malik2,3, Mehr Shafiq3,4
1Yale Child Study Center and walter.gilliam@yale.edu.
Insights
Child care providers working in person during the pandemic did not face higher COVID-19 risks. This study found no link between child care exposure and coronavirus disease 2019 (COVID-19) for providers.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease Transmission
Background:
- The reopening of schools and child care facilities hinges on understanding child transmission of coronavirus disease 2019 (COVID-19).
- Assessing the risk of COVID-19 transmission to child care providers is crucial for informed reopening policies.
Purpose of the Study:
- To investigate the association between direct child care exposure and COVID-19 outcomes in US child care providers.
- To determine if children are efficient transmitters of COVID-19 in child care settings.
Main Methods:
- A case-control study involving 57,335 US child care providers.
- Collected data on COVID-19 positive tests and hospitalizations among providers.
- Employed logistic regression, including propensity score matching, to control for confounders and background transmission rates.
Main Results:
- No significant association was found between exposure to child care and COVID-19 in providers.
- Home-based providers showed a higher association with COVID-19 compared to center-based providers, irrespective of child care exposure.
- Odds ratios (OR) for COVID-19 were 1.06 (unmatched) and 0.94 (matched) for child care exposure.
Conclusions:
- Exposure to child care during the early pandemic did not elevate COVID-19 risk for providers, given mitigation efforts.
- Findings are specific to the context of implemented infection control measures and background transmission rates.
- Further research may explore specific mitigation strategies' effectiveness.
Objectives:
Central to the debate over school and child care reopening is whether children are efficient coronavirus disease 2019 (COVID-19) transmitters and are likely to increase community spread when programs reopen. We compared COVID-19 outcomes in child care providers who continued to provide direct in-person child care during the first 3 months of the US COVID-19 pandemic with outcomes in those who did not.
Methods:
Data were obtained from US child care providers (N = 57 335) reporting whether they had ever tested positive or been hospitalized for COVID-19 (n = 427 cases) along with their degree of exposure to child care. Background transmission rates were controlled statistically, and other demographic, programmatic, and community variables were explored as potential confounders. Logistic regression analysis was used in both unmatched and propensity score-matched case-control analyses.
Results:
No association was found between exposure to child care and COVID-19 in both unmatched (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.38) and matched (OR, 0.94; 95% CI, 0.73-1.21) analyses. In matched analysis, being a home-based provider (as opposed to a center-based provider) was associated with COVID-19 (OR, 1.59; 95% CI, 1.14-2.23) but revealed no interaction with exposure.
Conclusions:
Within the context of considerable infection mitigation efforts in US child care programs, exposure to child care during the early months of the US pandemic was not associated with an elevated risk for COVID-19 transmission to providers. These findings must be interpreted only within the context of background transmission rates and the considerable infection mitigation efforts implemented in child care programs.
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