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Children Daycare

Daycares

Recently there was a lot of press in Texas re: COVID19 cases in daycare. Media sources reported some scary numbers: 950 cases on June 30 compared to 67 cases on May 21 (a 1317% increase). Of the 950 cases, 307 were children. From these reports, it seems like daycares are of particular risk for children. OR is this just a reflection of the widespread reach of COVID19 in Texas?

307 children with COVID19 is devastating. However, like with everything else, it’s REALLY important to also report the denominator. In other words, 307 children out of how many? If this is rate of COVID19 is higher in daycares than the general population, we could be in trouble.

In February 2020, there were 1,100,000 children enrolled in Texas daycares across 12,207 facilities. After the pandemic hit, this number dramatically fluctuated. Daycare enrollment first decreased (was only open to essential workers). Then this number increased as daycares opened up. Unfortunately, I do not know the exact of children who attended daycare during this pandemic. None of the media sources I read reported this. I also have searched high and low for databases. No luck.

So, I ran a few hypothetical scenarios…

If 50% of kids attended daycare during the pandemic (compared to pre-pandemic), this would be 550,000 children. If there were a total of 307 cases at daycares, this would equate to 0.05% of children at daycares infected by COVID19. If 1% of kids attended daycare during the pandemic, this would be 11,000 children. This scenario would equate to 2.79% of children in daycare infected by COVID19.

In Texas as a whole, 0.13% of daycare aged children have been infected by COVID19. So, given the scenarios, this would equate to 20% of children attending daycare during the pandemic. If there were LESS than 20% of children that attended daycares during the pandemic, daycares may be a trouble spot for COVID19. If more children attended daycares during the pandemic, daycares are probably NOT a trouble spot COVID19.

Translation: Are daycares an increased risk for kids? I don’t know. This is likely a testament that the virus explosion is so widespread that it’s touching everyone in our community. HOWEVER, we need more publicly available data (story of my life). Especially if we (parents) need to make data-driven, strategic decisions for our children.

Love, your local epidemiologist

PS. This is a really simple analysis and likely is excluding a LOT of factors. Would love to hear your thoughts. Also, before the hate comes streaming in, this post is ONLY about the risk to kids. Yes, I am of course thinking about the risk to staff/teachers. But this is a whole different story in which we don’t even have CLOSE to the data to even run hypothetical scenarios.

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Children Daycare National changes

AAP statement

A follow-up to my post last week RE: COVID19 and kids, as the American Academy of Pediatrics (AAP) made a splash this week.

Some background… The AAP is a professional group made up of 66,000 pediatricians across the nation. They remain the golden standard of data-driven recommendations. They have laid the foundation for childhood safety and health throughout the years.

The AAP published a report advocating “that all policy considerations for the coming school year should start with a goal of having students physically present in school.” This INCLUDES children with special medical needs.

They make the argument that the benefits of childhood development outweigh the risks: “Schools are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction, social and emotional skills, safety, reliable nutrition, physical/speech and mental health therapy, and opportunities for physical activity, among other benefits. Beyond supporting the educational development of children and adolescents, schools play a critical role in addressing racial and social inequity.”

Their policy is long, but readable (i.e. not science-y) and have some innovative solutions. Here is the link: https://services.aap.org/…/covid-19-planning-consideration…/

This may be useful, again, to our parents, teachers, and administrators who have been working tirelessly to address the needs of children through this unprecedented time.

I recognize there are many angles to this decision. Including the health of teachers and staff. Although this is a pediatric institution, they do include a large section regarding the health (physical and mental) and safety of staff/teachers.

Love, your local epidemiologist

P.S. If you would like to see the science of COVID19 spread among children, see my post from June 19. For some reason, I cannot reshare. There are some fantastic studies in there regarding kid-to-kid and kid-to-adult transmission.

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Children Daycare

COVID19 among kids

One of the pandemic’s biggest mysteries is the infection (and spread) of COVID19 among kids.

In the US, children account for 22% of the population but only account for 1.7% of COVID19 cases. This is VERY odd. Usually kids and elders are hit hardest in endemics and epidemics. HOWEVER, these past two weeks we have been finding more kiddos with infection. Why? The virus explosion is so widespread that it is touching everyone in our community.

There are a few studies (and educated guesses) as to why kids are infected at lower rates than adults:

#1: Children don’t get the disease as easily as adults. A study in New York found that this is because kids have less “open doors” on their cells for COVID19 to enter. One study in Israel found that for every 100 adults that are infected, 9 1-5 year olds are positive under the same circumstances. In a Chicago study, 73% of household infections was adult-to-child transmission, 13% child-to-child; and 13% child-to-adult transmission. Kids are just not as susceptible to the virus.

#2: Majority of children don’t show symptoms of COVID19. So, they aren’t tested. We don’t know the “true” number of kids infected. This hypothesis could get scary, because studies in Germany and South Korea have shown that once a kid IS infected, they are just as infectious as adults.

#3: Along similar lines, kid’s tiny nasal pathways may impact the accuracy of a COVID19 test. In other words, testers just don’t get the right amount on the swab and the disease goes undetected. A China study found that among children who tested negative TWICE, 24% had a CT scan that confirmed COVID19. A study in Seattle found that among children who tested negative, most children had COVID19 antibodities. The kids’ cases were missed.

There are certainly other non-medical factors to consider too. One major concern of ours is the impact of closed schools on childhood development AND safety (i.e. child abuse and neglect). These hypotheses will take a whole lot more time for science to test, but we have lots of studies (pre COVID19) and antidotal evidence (during COVID) that show both are happening as we speak.

Translation: So do we open schools? I don’t know. I have an opinion, but no data-driven answers. I’m just glad that I don’t have to make the decision. All school policies thus far have been emotionally driven rather than scientifically. Which is FINE, these are our babies. But it may be smart to start thinking strategically.

Love, your local epidemiologist

Data Sources: Here are the scientific studies I mentioned above.
New York study: https://jamanetwork.com/journals/jama/fullarticle/2766524 Israel study: https://www.medrxiv.org/…/2020.06.03.20121145v1.full.pdf+ht… Chicago study: https://academic.oup.com/…/doi/10.1093/jpids/piaa070/5849922 Germany study: https://virologie-ccm.charite.de/…/Charite_SARS-CoV-2_viral… South Korea study: https://wwwnc.cdc.gov/eid/article/26/10/20-2449_article China study: https://bmcmedicine.biomedcentral.com/…/…/s12916-020-01596-9 Seattle study:https://www.medrxiv.org/conte…/10.1101/2020.05.26.20114124v2