Like many people who live in urban areas, I have a small front yard. But it’s painstakingly cultivated. Here is the gate that my husband welded himself, there the strawberry beds. As the weather has warmed up, my preschoolers have spent more time outside on our stoop. On our little patch of land, with even our neighbors held at bay, my kids are as safe as I can make them.
Loosening our social distancing restrictions and rejoining the outside world—one wracked by a global pandemic, a cratering economy, and social upheaval—feels almost scarier than it felt going into lockdown. But my family needs help. A few weeks after schools closed down, still high on adrenaline, I wrote about how we were taking it easy on ourselves.
But three months into social distancing, my house is liberally crusted in yellowing tape. You can’t squeeze in an 8-hour workday if you are also parenting a 3- and a 5-year-old. There’s no room for error, no grace. I don’t have the time or patience to sit calmly with a toddler who is having a rough morning; I can’t play with a preschooler who doesn’t want to get out of the tub. Every time I straightjacket them into bed and stomp out, shouting, “I’m sorry! I have to work!” all of us get just a little more hurt.
We need childcare, badly. In order to figure out how I was to achieve this ordinary thing that now seems fraught and impossible, I talked through my options with two pediatricians and a public health scholar. If you’re a parent reading this, you probably need childcare too. Here is how you might frame the risk/benefit equation.
Your Kid Will Probably Be Fine
First, let us address every parent’s primary concern: Even if they catch Covid-19, they will probably be OK. Currently, early data from China shows that over 90 percent of pediatric cases are asymptomatic, mild, or moderate. (We do warn parents, however, that newborns and children with preexisting conditions do seem to be at higher risk.)
And yes, there are reports of a new “mysterious inflammatory ailment” known as pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C). But again, this is rare—serious cases of Covid-19 are rare in children, and cases of MIS-C are rarer still.
In many ways, MIS-C is similar to other known conditions like Kawasaki’s and toxic shock, as Hayes Bakken, a pediatrician and the lead on outpatient pediatric Covid-19 response at Oregon Health and Sciences University’s Doernbecher Children’s Hospital, pointed out to me. It’s serious, but, again, it’s rare and treatments exist. “This condition is new because we believe it’s associated with Covid, but we’ve already been treating kids with these types of conditions pretty well,” Bakken says.
Of course, if your child has a health condition—a chronic heart or lung issue, or if they just went through chemotherapy—it changes the equation. But Bakken also points out that not all chronic conditions create increased risk. Check with your doctor to help ease your mind.
When thinking about your child’s health, it’s important to consider their holistic well-being as well. Young children need to interact with other children (and other adults!); it enhances brain structure and cognitive function. When your child races around a playground with other kids, they’re exercising not only their bodies, but developing their mental, social, and emotional skills during a critical point in their lives.
And finally, you need to consider the health of the family unit as a whole. “Childcare is what keeps our families going,” said Bakken. “It keeps our lives going.” I desperately want to be able to smile when I see my kids, not snarl and turn back to a computer. Everyone suffers when parents don’t get a break.
“Hopefully we don’t get too myopic about this,” says Hayden Schwenk, the clinical associate professor of pediatric infectious diseases at Lucile Packard Children’s Hospital Stanford. “While it’s important, keeping a child healthy means more than keeping them Covid-free.”
Circle of Friends
Let’s be honest—finding childcare where your kids will thrive, that you can afford, and that works logistically for your family is hard enough. Seen from this perspective, Covid-19 is just one more factor that you have to take into account when doing your best to keep your family safe.
After you’ve considered the risks and benefits to your child, you then have to consider the risks and benefits for the other members of your family, or what Bakken refers to as the protected “Covid circle.” Do you live with vulnerable grandparents? Does one of the parents have a chronic health condition that makes them vulnerable to Covid-19?
While nothing is risk-free, any childcare arrangement that keeps the Covid circle as small as possible is going to be your best bet. A grandparent or nanny might seem like a good fit for childcare, but even that risk/benefit equation could change—for everyone, not just the child—depending on a few different factors.
For example, if both parents are able to work from home, a grandparent who also doesn’t leave the house is at low risk. On the other hand, if a parent is a frontline health care worker, it would be safer for that grandparent to leave. A nanny might seem like a good option, but if they live with friends or family who are frontline workers, you might want to reconsider that as well.
So, camps or day care? If one of the parents has a chronic condition, this option might not work. “Kids aren’t as good as social distancing and handwashing,” says Bakken. “They’re going to share their viruses and bacteria … If you have high-risk people, then the biggest risk is that a child will get it and do fine and bring it home to a vulnerable person in that household.”
If the members of your Covid circle are low risk, the next thing you’ll want to do is check what the epidemiological situation looks like in your area. “Understanding your local situation is really critical,” says Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security and coauthor of a recent paper that recommended research areas for school openings.
“If you live in a state where there’s enough testing, where the test results are less than 5 percent positive, where hospitals have enough PPE and the rate of hospitalization is going down, and the state has enough contact tracers,” Sell says, “then you can feel more confident about going back to day care.”
You can find much of this information by calling your local state health authority; Johns Hopkins also has a national dashboard of coronavirus cases you can check. You can also judge your state’s opening policies; if they’ve taken a slow, measured approach to reopening versus a rushed, willy-nilly one, you might feel more comfortable.
If you decide to send your child back to camps or day care, Sell notes the one most important question: “‘Does your staff have sick leave, and are their jobs safe if they decide that it’s appropriate for them to get testing.’ We don’t want day care centers with staff that will continue to go to work if they’re sick. We want to support people in getting tested and being in isolation.”
As you consider your options for childcare, ask yourself and your family these questions:
What are my child’s health risks?
What are my family’s health risks?
What are our alternatives?
What does the epidemiological situation look like where we live?
What steps is our childcare provider taking to stop the transmission of illness?
Other policies that your camp or day care should be instituting include small, stable groups of 10 to 12 children; a stable group of hopefully masked caregivers who have the ability to isolate if they get sick; washing the children’s hands frequently, especially before eating; and rigorous cleaning practices, particularly in any diapering or toileting areas.
Finally, you should also be able to trust the other parents in your day care’s extended Covid circle; you might want to consider a meeting, a community agreement, or contract that parents could read and sign. “There are a lot of working parents who give their children a little ibuprofen!” says Bakken. “What is our trust level in the other parents in this situation? Are they really going to keep their kids home when they’re sick?”
Dealing With Uncertainty
As a parent, I couldn’t resist the urge to inquire about the decisions of the health care providers that I spoke to, all of whom had children around the same age as mine. All three had returned their children to day care. (Schwenk flew in the grandparents of their 9-month-old and 4-year-old first.)
This process is understandably confounding to many parents. My kids are 3 and 5, and for the vast majority of their lives, I felt like there was so much I could do to keep them safe—making pediatrician appointments, picking diapers that wouldn’t irritate their chubby thighs. As exhausting as it’s been, when everything is falling apart, I’d rather have my kids with me than anywhere else.
But that doesn’t mean it’s the best thing for them. Or for me. “For everything we do, we don’t have zero risk,” says Sell. ”For whatever risk I have, is it worth it for what I want to do? There’s damage that’s being done with kids being out of school so long. We have to balance that against the possibility of making this outbreak worse. We can’t always think of Covid-19 deaths as the only outcome.”
After all that, my family made a decision too. Our day care doesn’t reopen until August, so we decided to go with an in-home nanny share with another family. We can’t hide in here forever. Like a lot of other families, we’re going to have to figure out how to tolerate a little more risk, scrape off all this tape, and put together something new.
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