How to Fix Child Care Before the Next Pandemic Wave

In January, parents of kids under 5 told me they were in a state of despair and semi-panic; emotionally, they were at the lowest I’d heard them since the pandemic’s beginning in March 2020. The wait for vaccine approval for under-5s (which may be over soon) was a part of that. But another part of their upset was the fact that the expensive child care they were paying for was often unreliable: Children’s day care classes were routinely getting shut down because of too many coronavirus cases or because kids were getting sent home for quarantines of 10 days or longer based on exposure.

To state, again, the obvious: If little kids aren’t in some kind of care situation, many parents can’t work effectively, and many can’t go to work at all. The less-discussed corollary is that even if their kids are quarantined, they typically have to keep paying child care providers in order to hold on to their kids’ spots. For most parents I spoke to, there was no test-to-stay option at the day cares where they sent their kids, so they were often stuck at home with healthy children who didn’t have the coronavirus but were at home bouncing off the walls.

When I spoke to child care providers last week, things were bleak from their point of view as well. “The last two years is nothing compared to the last two months,” said Celine Krimston, the vice president and chief operating officer of Educational Enrichment Systems, a group of child care centers and preschools that serves lower-income families in the San Diego area.

On many days, her phone starts ringing before 6 a.m. with the news that one of her staff members has tested positive for the coronavirus. From there, it’s a scramble to figure out which parents need to be notified that their kids can’t go back to school for several days. She said even two years into this, it breaks her site directors’ hearts to have to close a classroom, because they worry about how the families they serve — many of whom work hourly in-person jobs — are going to pay their bills and feed their kids if they can’t go to work.

As Omicron cases have plateaued and plummeted in some parts of the United States and with vaccines potentially available within the next month or so, the lives of children under 5 and their parents will hopefully improve in the not-too-distant future. However, with experts’ predictions that Covid will become an endemic illness and the possibility of new variants, we need to be prepared for another potential wave. Though a lot of problems with American child care are systemic and in need of an overhaul — we have no universal systems of care, and the costs are out of control (an estimated 14 percent of median household income, according to the St. Louis Fed) — I spoke to experts about smaller fixes that can be made in the coming months that will help make the next wave less horrible.

Pay staff members more. Even before the pandemic, staff turnover was a huge problem in the child care industry. “We have always had a staffing issue because of the wages that we can’t pay our staff. We have generally had 30 to 35 percent turnover every year,” said Krimston. That problem has become even worse over the past two years. Workers are leaving the industry for bigger corporations like Starbucks or Amazon, CNBC reports, or for jobs in the public school system. If there’s already a staffing crunch, the situation becomes only more unworkable when staffers are sick; there’s no slack in the system.

Operators of child care centers can pass along the cost of increasing wages to parents, but they also know that parents are already stretched too thin by the costs. The United States ranks behind our peer nations in terms of spending on early childhood education and care. Elliot Haspel, the author of “Crawling Behind: America’s Child Care Crisis and How to Fix It,” said the good news is that states don’t have to wait for a bill like Build Back Better to be enacted to spend more on child care. “States put in an incredibly small amount of money right now in their local systems,” he said.

State and local governments currently spend only $11.8 billion on early childhood education, compared with the $42 billion parents pay out of pocket each year, according to a 2020 analysis from the Economic Policy Institute. Since some states — such as Colorado, Iowa and Idaho — have money to spare right now, in part because of Covid relief funding, boosting child care wages would be an excellent investment.

Enact common-sense Covid policy. I talked to many parents whose children were in day care for just a few days in the past two months, even though the kids never tested positive for the coronavirus. Isolating a child for 10 days is “a recipe for losing your job,” said Dr. David Rubin, a pediatrician and the director of PolicyLab at Children’s Hospital of Philadelphia (CHOP). “The economic security of our families is a public health issue,” he added.

In January, CHOP put out guidance for managing Covid and other seasonal illnesses in child care centers. These guidelines suggest that symptomatic children who test positive for the coronavirus or who haven’t been tested can go back to care settings five days after they no longer have a fever for 24 hours “without fever-reducing medication (e.g., acetaminophen, ibuprofen) and if their other symptoms are improving.” If children test negative for the coronavirus, they can return to child care after 24 fever-free hours. The guidelines allow exposed children who have no symptoms to continue to go to child care settings, and they recommend that children over 2 wear masks “whenever feasible” and that care centers require staff members to mask, preferably with three-ply surgical masks, “during periods of high community transmission.” CHOP recommends all caregivers be vaccinated and boosted.

Rubin said early childhood education centers should still follow the lead of their local school systems, some of which are switching to five-day quarantines.

Prioritize stability for parents and kids. Many parents are traumatized from the confusion of the past two years, and Rubin acknowledges that shifting to recommendations like the ones from CHOP may be anxiety provoking. But at this point, parents of the youngest kids need a sense of stability. Findings from the RAPID-EC Project, an early childhood and family well-being survey from the University of Oregon that has been taking the pulse of parents of young children across the country since April 2020, show that unending child care disruptions lead to emotional issues for children andparents.

“Parents who experience child care disruptions report higher levels of emotional distress (a composite of depressive, anxiety, stress and loneliness symptoms),” and “in households that experience child care disruptions, parents also report increased behavioral problems in their young children (a composite of fear/anxiety and fussiness) compared to households with no care disruptions,” according to RAPID-EC research.

Philip Fisher, a University of Oregon psychology professor who directs the project, said that there is a lot of research on unpredictability and how difficult it is to function psychologically or biologically in a chaotic environment. As Vox put it, summarizing the research in December: “The human brain doesn’t cope well with uncertainty and defaults to anxiety in the face of a potential threat.”

For kids, if parents are able to keep the basic routines of their lives — mealtimes, bedtimes and caregiver interactions — consistent, it can be protective against anxiety and stress. But when child care is taken out of the equation and parents can’t work, that can upend routines. “Making people’s lives predictable in terms of income, child care, health care will reduce the contextual chaos,” Fisher said.

I don’t envy any people making policy for young kids at this moment. They must weigh competing alternatives against the incredibly high stakes involved in potential outcomes and try to do what is best for most. I doubt these recommendations will make everyone happy or fix child care entirely. As Haspel put it, “There’s not a creative solution to this” because there are so many basic problems. Parents and leaders may be searching for some outside-the-box solution to remedy what ails us, “but we need to have a box first.”

Want More on Child Care?

  • In November, before the Build Back Better bill stalled in the Senate, Claire Cain Miller went through research on early childhood education and summarized what works and what doesn’t. Teacher pay was a major factor in making child care high quality, she found.

  • For an illustration of how out-of-control child care costs are, look no further than this headline from Jason DeParle in October: “When Child Care Costs Twice as Much as the Mortgage.”

  • A summary of studies on the spread of Covid from April 2021, before vaccines were widely available, suggests that “there is little transmission in child care and preschool settings serving children birth to age 5.”

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