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Child care has become scarce — just when front-line medical workers need it the most

States and volunteers are stepping in to offer child care to health care workers, but there are still gaps in the system. 

Dorothy Williams cares for a baby at Dottie’s Family Childcare in the Dorchester neighborhood of Boston, Massachusetts, on March 17, 2020. Dorothy normally cares for 10 children but was down to two as parents increasingly started working from home and removing their children from situations in which they could potentially contract coronavirus.
Craig F. Walker/The Boston Globe via Getty Images
Nicole Narea covers politics and society for Vox. She first joined Vox in 2019, and her work has also appeared in Politico, Washington Monthly, and the New Republic.

Ariella Altman, a surgical resident at the University of Minnesota and mother of two, panicked when she heard that Minneapolis schools and day care facilities were closing for at least five weeks starting in mid-March in order to curb the spread of coronavirus.

Altman is contributing to the coronavirus response at the university hospital, which is the only facility in the Upper Midwest specifically designated by the federal government to contain and treat highly infectious diseases like Covid-19. Her husband, Ethan, works full time as a business analyst, so they didn’t know how they would take care of their children Gabriel, 4, and Jonathan, 2.

When Altman saw a link on Facebook for MN CovidSitters, a group founded by University of Minnesota medical students offering free child care to front-line medical workers amid the pandemic, she jumped at the opportunity and was approved for their services within a day.

“I immediately reached out, knowing medical students would be trustworthy and also conscious of socially distancing during this time,” she said. “We just wanted the best option for our kiddos.”

Now, a “pod” of students is assigned to the family so they can share responsibility for child care while also limiting the number of people who come into contact with the family in order to prevent the spread of the virus. They even helped Jonathan craft his own pair of goggles, modeled after the personal protective equipment his mother wears at the hospital.

Ariella Altman, a surgical resident at the University of Minnesota, and her husband Ethan sought the help of student volunteers to help care for their two children, Gabriel and Jonathan.
Courtesy of Ariella Altman

For many medical professionals, these kinds of child care services are necessary to ensure they can continue to do lifesaving work on the front lines of the pandemic. Some states — including Washington, California, and New York, which currently have the biggest outbreaks in the US — are providing free or subsidized child care to essential workers. Others have allowed existing child care facilities to remain open, but many providers have had to shut down nonetheless due to decreased overall demand, limiting the options available to health care workers who need their services most.

Where existing child care facilities or the state hasn’t been able to provide services, volunteers have tried to step in. MN CovidSitters, which has over 300 volunteers serving more than 200 health care families, is expanding across rural Minnesota and has been contacted by dozens of schools looking to start sister organizations across the country. Similar babysitting networks have emerged at Dartmouth, Johns Hopkins, and Ohio State University.

“We have the urge to help where we can,” Kristin Chu, a second-year medical student and co-founder of MN CovidSitters, said. “We did a needs assessment to see where our profession needs us currently — the need for child care became even more present.”

Why child care for medical workers is so essential

At this point, all states have ordered schools closed for the time being, though so far only 19 have extended those closures through the end of the school year. Washington state, the epicenter of the first major coronavirus outbreak in the US, is preparing for even longer closures that could potentially stretch into the fall.

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said on April 7 that he is cautiously optimistic that schools will be able to reopen by fall 2020: “I fully expect, though I’m humble enough to know that I can’t accurately predict, that by the time we get to the fall that we will have this under control enough that it certainly will not be the way it is now, where people are shutting schools.”

In the meantime, however, Colorado State University’s Jude Bayham and Yale University’s Eli Fenichel found in a recent study published in The Lancet that at least one in seven medical workers may have to stay home from work due to school closures to care for children ages 3 through 12. They account for households in which older siblings and other non-working adults can provide child care — but not for households with children younger than 3, who need even more supervision.

Essential health care workers are defined as anyone who works at the offices of physicians or other health practitioners, outpatient care centers, hospitals, nursing care facilities, and residential care. That may include people delivering direct care to patients, such as doctors, nurses, pharmacists, and medical technicians, and all the workers needed to keep a medical facility running, from administrative to cleaning staff.

Many of these workers can’t afford child care to begin with. According to the Center for American Progress, a liberal think tank, their median personal income is $42,340, but the annual cost of care for two young children is more than $20,000 on average. A 2014 Pew Research Center survey found 22 percent of grandparents regularly provided child care at no cost, but now that option may no longer be safe because seniors face elevated risk of complications from the virus due to their age.

The impact of health care workers staying home isn’t just economic; it could also increase cumulative mortality rates due to staffing shortages.

“Health-care workers spending less time providing patient care to look after their own children can directly influence the development of an epidemic and the survival of those patients,” Fenichel told Science Daily. “Understanding these trade-offs is vital when planning the public health response to COVID-19 because if the survival of infected patients is sufficiently sensitive to declines in the healthcare workforce, then school closures could potentially increase deaths from COVID-19.”

State and city governments have tried to step in to incentivize medical professionals to continue showing up for work by providing child care services in some capacity. And many states have also allowed day care facilities to remain open and are subsidizing them to make up for lost income.

In places like New York City, child care is free at one of the 93 regional centers serving children of health care workers, first responders, grocery store and pharmacy workers, transit employees, and other city agencies. The centers have capacity for about 40,000 children as young as 3 and up to 12th grade, including those with disabilities. Children younger than 3 can continue to attend day care if their parents are essential workers, but many day care facilities in the city have shuttered amid the pandemic.

But in Washington, free child care options amid the pandemic have gotten off to a bumpy start. Gov. Jay Inslee had initially called on local school districts to start providing child care to essential workers, but it’s taken time for schools to adjust. In Seattle, teachers refused to show up, claiming it would put them at risk of infection, and in other districts, the programs still weren’t up and running as of early April, forcing parents to turn instead to other local nonprofits providing child care.

Other states, such as Ohio, are issuing special pandemic licenses to day care facilities that allow them to stay open with reduced capacity to serve essential workers, though not free of charge. About 1,500 day cares were approved for those licenses as of late March, roughly 20 percent of existing facilities. North Carolina has similarly allowed day cares to remain open, but it is also offering to pay for emergency child care through May for health care workers under certain income thresholds.

Child care facilities are struggling to stay open

While many states have allowed private child care facilities to stay open amid the pandemic, few have done so because their customer base has disappeared now that most parents are caring for their kids at home. That means parents in the health care field may struggle to find child care providers if their city or state does not offer its own services.

According to a survey by the National Association for the Education of Young Children and the Early Care and Education Consortium, attendance at day care facilities declined almost 70 percent in a single week amid the pandemic. Many providers said they couldn’t survive without a week of income and would have to close — in some cases, for good. More than 60 percent said they could stay afloat for no longer than a month absent government aid.

The US is already seeing massive closures of child care facilities. More than half of the child care facilities in Florida had shuttered as of April 11. More than 1,000 child care facilities in Washington, with the total capacity for over 48,000 children, had closed as of April 2.

Some states are offering financial support to child care providers who are losing income amid the pandemic. The coronavirus relief bill signed by President Donald Trump last month, known as the CARES Act, provides $3.5 billion in discretionary funds for them to do so, but experts say that might not be enough. Kim Kruckel, executive director of the Child Care Law Center, told Vox’s Anna North that the need is closer to $50 billion.

In Minnesota, for example, child care providers can apply for a monthly grant of $4,500 if they remain open and can qualify for an extra $1,000 if they serve children with special needs or who don’t speak English, or if they stay open outside normal business hours. Child care facilities with capacity for more than 10 children can qualify for up to $15,500 in grants.

But it’s not clear how many child care providers will be able to stay afloat for the working parents in health care and other essential fields — and for the rest of the public when the economy reopens.