Behaviors Children Daycare Social Distancing

COVID19 infections among kids…

Kids (<18 years) make up of 10% of COVID19 infections in the United States. Because of that, it’s taken a bit more time to have enough infected kids for meaningful analyses (compared to adults). The CDC published an important study Tuesday assessing school, community, and close contact exposures associated with child and adolescent COVID-19 infection.

The study took place from Sept to Nov 2020 in Mississippi. 397 parents of children who recently had a COVID19 test completed a phone survey. They answered questions about symptoms, close contact with a person with known COVID-19, school or child care attendance, and family or community exposures ≤14 days before the COVID test. Then, scientists compared the answers across kids with a COVID19- test to kids with a COVID19+ test. There were a couple things they found…

COVID+ kids were MORE likely to have…

  • Had close contact with a person with known COVID-19. And, this close contact was more likely to be a family member than someone at school
  • Attended gatherings with people outside their home, including social gatherings (weddings, parties, funerals, birthday parties), playdates, or to have had visitors at home

COVID+ kids were LESS likely to have…

  • Consistent mask use by students and staff members inside school or child care facilities

Interestingly, there were essentially no difference between COVID+ and kids going to…

  • Sports events or concerts (18% COVID+ vs. 20% COVID- kids)
  • In-person school or child care (62% COVID+ vs. 68% COVID-)
  • Religious services (13% COVID+ vs. 18% COVID-)
  • Restaurants (20% COVID+ vs. 16% COVID-)
  • Travel with others (5% COVID+ vs. 3% COVID-)
  • Household member working in health care (24% COVID+ vs. 21% COVID-)

Before I get the comments, here are a few important notes…

1. This doesn’t mean, for example, you have carte blanche to go to indoor restaurants. This is a study of kids. This does not mean you, as a parent, won’t get it or spread it

2. No, there is no data on teachers or staff. Yes, that would be a needed analysis. I’m sure it’s coming.

3. Yes, masks work. This study showed that adults wearing masks helps kids, especially within schools and child care center. If you need more evidence, check out my previous post (

4. Opening schools is a bit more complex than kids getting infected. Kids are less likely to get sick (and not go get a test), but they harbor the disease and have the potential to spread it to others. Unfortunately, we still don’t know the rate of transmission from kids to adults.

Finally, I would like to take a moment to recognize how quickly and hard these scientists had to have worked to get this information out to the public. Data collection ended November 5, 2020. That means, within a MONTH, they cleaned the data, analyzed the data, came to meaningful conclusions, wrote up the science, sent it up the CDC ranks for approval, responded to feedback, and submitted for publishing. For the record, this typically takes 1-2 YEARS. Absolutely incredible.

Love, YLE

Data Source: Hobbs CV, Martin LM, Kim SS, et al. Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September–November 2020. MMWR Morb Mortal Wkly Rep 2020;69:1925-1929. DOI:

Children Daycare Social Distancing

K-12 School Relative Risk Index

I don’t intend to flood your news feed today, but many (at least in Texas) are headed to school this week.

This infograph categories school activities within a spectrum of risk.

This is based on CDC and National Academy of Science recommendations. The recommendations were summarized and translated by three scientists (two MD’s and one PhD in epidemiology), resulting in this infograph.

At this time, the only thing we, epidemiologists, can suggest is risk reduction. This is an approach that abolishes the all-or-nothing approach to COVID19, acknowledging the lack rigorous data, the lack of a national, coordinated response, and that abstinence-only is not possible for everyone in this long, drawn out process.

Love, your local epidemiologist

Data Source: Infograph

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Estimate COVID19 risk in the classroom

For my teachers and professors (whether in a university or K-12 school)…

A group of scientists at Duke University at the Nicholas School of the Environment created a COVID19 exposure modeler to estimate your COVID19 risk in the classroom. This went live yesterday!

There are several details you will need to fill out, including number of students, duration of your classes, height of classroom ceiling, mask efficacy, and room air ventilation. I didn’t know some of these parameters on the top of my head, but if you press on the parameter, it will explain how to guesstimate.

They are continuing to improve this, but this gives you a general, first idea of your risk. I know the school year is getting closer and closer.


Love, your local epidemiologist

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COVID19 and child abuse

Thought I would sprinkle some of my own research in this blog because…why not?

For those of you that don’t know, I am a violence and injury epidemiologist. My research lab focuses on how violence is contagious (just like infectious diseases) and predictable. Because if it’s predictable, then it’s preventable.

As we ALL know by now, COVID19 has not only caused major medical problems in our community but has caused social problems. The strains and stresses of the COVID-19 pandemic (like job loss, financial struggles, food insecurity, mental health, and lack of social support) have exacerbated the risk of violence at home.

My colleagues and I are continually working to understand how the stay-at-home orders/school cancelled impacts child abuse.

Figure 1 shows the impact of COVID19 on child abuse hospital visits in 2020 compared to 2019. Briefly, we found less kids are going to the hospital for child abuse after stay at home orders compared to last year. Unfortunately, though, we hypothesize that this isn’t because child abuse is getting better, but rather because kids are interacting less with mandatory reporters (i.e. teachers, daycare teachers) and the public.

Among kids that ARE going to the hospital for child abuse, physicians are reporting even MORE severe injuries (traumatic brain injuries, intentional burns) than before the pandemic. Typically, a hospital system has 5-10 child abuse deaths per year. It is not uncommon for a hospital to now report 2 child abuse deaths in one week.

The realities of this crisis are immediate. Researchers and clinicians are working hard to urgently address this public health crisis in real-time. 

Prevention can also start at home. The Prevent Child Abuse America posted some fantastic resources for parents, children, educators and everyone else. This includes tips for staying connected to the community, tips for staying engaged as a family, and tips to manage stress and anxiety. Check it out:

These efforts are especially relevant given that a lot of schools are delaying in-person school. While this delay is desperately needed medically, it will have an impact on kids’ health and safety. 

Love, your local (violence) epidemiologist

Source: Data comes from my lab in which we are working directly with pediatric hospitals. Data is not published; this is only a high-level preliminary report. We are working on it!

Children Daycare


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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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:…/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.

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: Israel study:…/2020.06.03.20121145v1.full.pdf+ht… Chicago study:…/doi/10.1093/jpids/piaa070/5849922 Germany study:…/Charite_SARS-CoV-2_viral… South Korea study: China study:…/…/s12916-020-01596-9 Seattle study:…/10.1101/2020.05.26.20114124v2