To safely return to child care while Covid-19 cases surge, Billie Slade asked all the families she works with to rapid-test their children.
Slade runs Wonder in the Woods, an in-home child care program in Dummerston that serves six preschoolers and four school-aged children. She hoped that if each child was tested before returning to the program Tuesday, she could ensure that students would not spread potential infections from holiday gatherings to other students and to staff.
But finding enough tests has been a challenge, Slade said. Previous state distribution sites quickly ran out of test kits, and availability at Vermont pharmacies has been patchy.
“People are sharing tests with each other — like, ‘I have an extra one at my house if you can come get it,’” Slade said. One parent heard that a pharmacy in Massachusetts had tests in stock and drove 45 minutes each way to get them, she said.
Last week, the state made about 87,000 rapid tests available to parents of K-12 students. Children who attend preschool or child care — most of whom are under five and ineligible for vaccination — were not included.
“I’m really happy to see that they’re taking care of those kids,” Slade said, referring to the K-12 students. “But it also feels frustrating to know that the youngest ones who can’t get vaccinated also can’t get free tests like school-agers did.”
As Covid-19 transmission reaches record levels due to the highly contagious Omicron variant, many parents were wary Monday about sending their unvaccinated children back to settings where others may be returning from holiday gatherings untested.
Parents who have studiously avoided exposing their children to the coronavirus for nearly two years are now faced with the message from state and federal health officials that unvaccinated people are highly likely to be infected during the Omicron surge. And while young children are generally at low risk for severe Covid-19, any exposure or infection will lead to serious disruptions to care, with ripple effects on an already strained workforce.
‘Left behind’
Alyssa Dolge of Shelburne said she was nervous dropping off her 1-year-old and 3-year-old at their child care center Monday morning. Both tested negative for Covid-19, she said, and their school had been proactive and communicative — but Dolge still felt uncertain about the weeks ahead.
“I guess the biggest concern is really just the unknown,” she said. “We don’t know how our kids would react if they did end up with it.”
Dolge and her husband both work full time. Losing child care for weeks at a time “would mean really long, long, long days of juggling care and work.”
But getting snubbed on rapid tests felt consistent with the way the pandemic has recently played out for young families, she said.
On Dec. 17, Pfizer announced its Covid-19 vaccine trials failed to produce a response in participants ages 2 to 5, delaying the expected rollout of a vaccine for young children by months.
State programs should be prioritizing those who now won’t be vaccinated until mid-year, Dolge said.
“It just feels very unfair, and a little bit like this group is kind of getting left behind along with their families, too,” she said.
Throughout the pandemic, guidance for young families and child care providers has often trailed updates for K-12 students, said Anna Daylor, whose 3-year-old son attends preschool in Bristol.
“A change was made, and it would hit the K-12 environment. And it’s like, ‘Well, what about the day care centers? What about preschools?’”
“I think there are a lot of assumptions made about, ‘Oh, well, mom can stay home, or grandma can come over,’” she said. “And I think that there are a lot of working families, particularly if you’re dealing with a single-parent household, that that’s obviously not the case.”
Providing rapid tests to K-12 students was a stopgap, said Anne Sosin, a policy fellow at Dartmouth College. But it does not represent a plan that would keep schools or child care programs open throughout the Omicron surge.
“Child care centers were often flying blind during the Delta surge,” Sosin said. “There wasn’t clear and comprehensive guidance that was put out for them, and many struggled to make decisions. Omicron is just going to make it even more difficult for child care centers to function.”
When it comes to Covid-19 risk, young children are now at the whim of their communities, said Brit Quell, the parent of two toddlers and operator of Signal Pine PlaySchool in Dummerston.
“Community practice has gone to, ‘Well, I’m vaccinated.’ And I’m like, ‘OK, but I’m still living in 2020 until the other half of my family is able to get a vaccine,’” they said.
On Saturday, Quell and Slade launched a petition calling for the state to distribute free rapid tests to families of child care students. As of Monday evening, more than 500 people had signed. They had not received a response from the state, Quell said.
Short supply
The state limited test distribution to K-12 students due to national constraints with the supply of rapid tests, Will Terry, a spokesperson for the state Agency of Human Services, said in an email Thursday.
“However, as more of these take home, rapid tests become available, we’ll get as many as possible, as fast as possible, into the hands of Vermonters — including for families with young children,” he said.
Terry added Monday that the state now plans to expand the “test-to-stay” program, currently in use in about three-fourths of K-12 schools, to prekindergarten and regulated child care programs next week. Additional details are still to be announced.
Better access to testing is an urgent issue for families, said Rebecca Bell, a pediatric critical care doctor at the University of Vermont Medical Center.
“I think there’s going to just be a lot of illness over the next couple of weeks,” Bell said, which will lead to student and staff absences. “We need testing to be able to identify those cases to be able to isolate and also to be able to get people back to work and back in the child care setting once they’re feeling well.”
Bell said expanding test-to-stay to include child care settings could be a challenge. Under that protocol, students who are close contacts of a positive case can remain at school only if they test negative for seven consecutive days.
Currently, testing procedures often fall on school nurses, Bell said, and child care centers typically do not have nurses on staff. Plus, most rapid Covid-19 tests are authorized for ages 2 and up, leaving out a large portion of the child care population.
As the supply of rapid tests increases, the state Agency of Education plans to shift more testing to at-home kits that parents can pick up from schools. Bell said that model would likely be a better fit for child care centers.
Bell said at this point, the threat of disrupted care is far greater than the threat of severe illness for young children. Those under 5 have shown far lower rates of hospitalization and death than adult age groups throughout the pandemic, and early data indicates that does not appear to be changing with Omicron.
Pediatric hospitalizations have, however, increased nationwide during the recent surge. Bell said these hospitalizations in Vermont so far have mostly been among unvaccinated adolescents, not toddlers.
“Of course it can happen,” Bell said, “but I’m not expecting to have our hospital overrun with young children in this age group with severe Covid.”
Still, the sheer number of young children being exposed to the virus right now is likely to lead to some hospitalizations, said Annie Hoen, an infectious disease epidemiologist at Dartmouth College’s Geisel School of Medicine.
“When you have this many cases and this level of spread, that potentially unlikely hospitalization among a younger pediatric age group turns into just large numbers of kids in the hospital, and with more severe disease,” she said.
Hoen recommended that families limit their social activity outside of school to minimize exposure. The Omicron wave appears likely to peak within weeks, she said, which may make it easier for parents to consider some additional short-term precautionary measures.
“I don’t think we need to be isolated at this point,” Hoen said, “but to just step back from doing a lot of events and gathering. It’s a good time to check that stuff and just wait it out.”
There are no easy answers for parents weighing the risks to their young children, said Sosin, the Dartmouth policy fellow.
“I’ve heard from parents in a lot of places, and I’m not sure what to tell them. Because the reality is that many parents depend on child care. They work in person. It’s not an option, really, for them to go remote or to pull their children from child care,” she said. “This is not easy.”
Correction: An earlier version of this story misstated the relative hospitalization rate for children under 5.
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