Going back to daycare after shelter in place: DAYCARE SAFETY

Many Monterey Bay parents who have been working from home since we began sheltering in place in mid-March are now looking at a return to their workplaces shortly. Some have family in the area to care for their children or one parent staying at home. But for many parents, daycare or another form of childcare is a necessary component to their ability to work outside of the home.

The risk to children and babies, and the role children play in transmitting COVID-19 is not yet completely clear. The rate of confirmed COVID-19 cases among children has so far been low compared to the broader population. According to the Monterey County Health Department, nine children under the age of 18 have contracted Covid-19 as of May 15. But many studies have suggested that children can be asymptomatic carriers of the coronavirus.

In addition, an emerging inflammatory syndrome which may also be connected to the coronavirus is adding to parents’ worries. Pediatric inflammatory, multisystem syndrome, which appears to be related to having had COVID-19, has been diagnosed in 93 New York children and has been reported in a few other states. Overall, though, severe illness has been less frequent in children than adults with COVID-19, researchers say.

Whether you’re sending your child back to the daycare they attended before or require a new center for your children; some basic precautions can help minimize the dangers of transmission.

According to Dr. Mathew Trokel, Medical Director of Pediatric Services at MoGo Urgent Care: “While coronavirus is very transmissible and children are well known for their lack of adherence to social distancing, with just a few simple techniques, daycare centers can reduce the ability for the virus to spread within their facility.”

NEW PROCEDURES FOR CENTERS AND PARENTS

Both daycare providers and parents will need to adapt to a new set of procedures. While centers need to adopt strict new guidelines, it is equally important that parents observe the guidelines for implementation. Parents: don’t rely on the center staff to keep you up to date, ask lots of questions, and observe. They will not be offended to have you taking an active role in your child’s health and wellbeing. If they aren’t forthcoming or you see questionable behavior, you may want to consider changing providers.

WHAT TO ASK BEFORE SENDING YOUR KIDS TO DAYCARE

Care.com is advising parents to add the following questions to caregiver interviews: 4 Have you or anyone on your staff been diagnosed with the coronavirus? 4 Have you or anyone on your staff been in close contact (e.g., shared a household or room or been together for a while) with anyone who has a confirmed case of the coronavirus or is showing symptoms? If someone in the household of you or one of your staff has recently recovered from the coronavirus, do you have proof of medical clearance? Are you aware of the newest guidelines from the Monterey County Department of Health for daycare providers, and have you implemented their procedures?

Parents should take their child’s temperature before leaving their home or upon arrival at the facility.

Children with elevated temperatures–even without other symptoms–should not enter.

Parents should not be entering the facility, greetings should happen outside, and parents should use their pen to sign in their child.

The center should perform daily health checks that include taking the child’s temperature.

Staff should also monitor children for shortness of breath, dry cough, gastrointestinal symptoms, or a skin rash. There should be a rapid assessment and isolation of any person who becomes ill during the day with follow-up to ensure that person stays away from the center until they have fully recovered.

The center should provide hand sanitizer or handwashing stations at the entrance, children and staff should clean their hands before entering. There should be frequent handwashing during the day for children and staff. Dr. Trokel says: “There should be multiple opportunities for the children to wash their hands during the day, especially before eating. Under normal circumstances, children under five-years-old should not use hand sanitizers; however, during the COVID-19 outbreak, this recommendation has been amended. If no soap and water are available, all children should use hand sanitizers.“

When feasible, staff members and older children should wear face coverings within the facility. Cloth face coverings should not be put on babies under age two because of the danger of suffocation.

Regular cleaning and disinfecting of the facilities is imperative. All high-contact surfaces (tables, highchairs) should be cleaned before and after use. Childcare areas should be cleaned several times during the day and disinfected at the end of the day. Special attention should be paid to anything related to eating or drinking.

An effort should be made to circulate as much fresh air throughout the center as possible. Snacks and meals should be individually served, and no food or utensils should be shared. The center should consider removing some furniture from the facility and spacing what remains. It will be easier for staff to keep hard surfaces disinfected, and there is less chance for passing infection.

Children should be in small groups and assigned to one provider. If someone gets the coronavirus, the whole childcare center won’t be exposed, and it will be easier to do contact tracing.

Toys that cannot be cleaned and sanitized should not be used. Each child’s bedding should be kept separate and stored in individually labeled bins, cubbies, or bags. Cots and mats should be labeled for each child.

About Pediatric Inflammatory MultiSystem Syndrome

On May 14, the CDC released a health advisory describing a new syndrome in children. A small subset of children who become infected with the COVID-19 virus undergo a systemic inflammatory response currently called Multisystem Inflammatory Syndrome in Children (MIS-C) or Pediatric Inflammatory Multisystem Syndrome (PMIS). This is a very rare complication and there is very little known about this disorder. Studies are currently underway to get us more information. To date, there are some case reports that have shown that: • All children present with several days of persistent fever. • Around 80% had gastrointestinal symptoms (abdominal pain >diarrhea> vomiting) • 40% had conjunctivitis (red eyes) • Other associated finding include rash, chest pain or racing heart, lethargy or confusion.

If PMIS becomes a concern, the obtaining lab work is vital. While there is no specific blood test that can diagnoses PMIS, lab work is still key to understanding how your child is doing. If the lab work shows no evidence of any inflammation, then PMIS would be very unlikely. If there is evidence of inflammation, then further testing would be needed.

Overall, children do well with this disorder. Of those admitted to an ICU, 30% had a mild or moderate severity of illness and 60% did not require intubation. Unfortunately, some children did become very sick requiring advanced, life saving measures including long term ventilation (up to 10 days), multi organ system failure (8%) and death (4%). As further studies become published, we will know more about this condition and our ability to test, diagnose and treat will improve.

Dr. Mathew Trokel is an Emergency Department doctor at Community Hospital of the Monterey Peninsula, is medical director of pediatric services at MoGo Urgent Care, and also works for Pediatric Group of Monterey.