Why Did An Epidemiologist Send Her Child To Daycare During The Worst Of The Pandemic?
Childcare was one of the many unprecedented and difficult choices the pandemic forced us to make. Working parents found themselves in the impossible position of weighing the risks of exposing their children to COVID with the need to earn an income for their family.
In a recent issue of Insight magazine, epidemiologist Dr. Whitney Robinson described the complex process she went through in order to make this difficult decision.
What is an epidemiologist?
Epidemiologists are scientists who search for the cause of diseases, identify people who are at risk, and determine how to control or stop the spread.
Epidemiologists are often called “disease detectives” because there’s so much guesswork involved in their profession. It’s this comfort with uncertainty that attracted Dr. Robinson and helped guide her decision-making process.
She noted that in epidemiology when there is a good deal of certainty about a disease on the population level, epidemiologists tend to make sweeping recommendations for everyone in order to protect unknown subgroups. The central tension in the field of epidemiology is asking for collective behavior changes that may or may not benefit the individual directly.
Did Dr. Robinson decide to send her children to daycare?
Yes. Early in the pandemic when everyone was withdrawing their children from school and daycare, Dr. Robinson made the unpopular decision to keep her child in childcare.
Because she was publicly discussing her research life, she felt like it was important to acknowledge the support she was getting through paid childcare… especially because so many mothers had dealt with gaslighting and burnout this past year.
She used three principles from her work as an epidemiologist to make this decision.
Look to previous phenomena to know what questions to ask
From research about prior historical events, Dr. Robinson knew that the very oldest and youngest are the most likely to die from influenza. So, her first question was, “Are young children likely to get very sick or die during a COVID-19 outbreak?”
Dr. Robinson had also learned in her doctoral studies that those who are not especially vulnerable themselves to a disease could sometimes be high-risk transmitters. For instance, a flu study in Japan showed that when school-age children weren’t vaccinated, more elderly people died from the flu.
This knowledge led to her next question, “Are young children especially likely to spread COVID-19 to other people?”
Observed versus expected.
Early information from China and Italy was showing that deaths and hospitalization increased exponentially with age, which was considerably different than what we’d expect from the flu. This gave Dr. Robinson an idea of what the absolute risk to children was.
Next, she wanted to understand more about children’s contribution to transmission in childcare and school settings, which wasn’t easy because there was so little data available early on. Because the US was so far behind in testing, she relied on places like Iceland and the Faroe Islands that were conducting extremely widespread testing of current or past infection, regardless of symptoms. In these tests, young children consistently had a low prevalence of infection.
Transmissions in households followed a similar pattern. Young kids in these families were least likely to become infected when there was a positive family member. There was also early indication that children were less likely to be the person to bring COVID to the household.
She gave these studies a great deal of weight because the results were unexpected, consistent, and seemed to please no one.
Despite the early evidence that children under 10 were less likely to contract or transmit COVID, news stories were filled with incidents of COVID outbreaks among children. When Dr. Robinson researched these stories, she found that the media often stretched the truth to make it seem as if children were fueling outbreaks.
But, the lack of verified stories of spread in childcare situations still was not enough proof that children were not high-risk transmitters. Because children tended to get milder cases and sufficient testing wasn’t being done, Dr. Robinson wanted more information before making her decision.
Her research showed that, even with the challenges of limited testing and anecdotal evidence of some families hiding children’s infections, the ongoing relationships that schools and childcare centers have with families and the data infrastructure of reporting that preceded COVID-19 were simply not showing that school-based outbreaks were wide-spread.
Beware of ‘sticky’ priors
Dr. Robinson noted that experts, like any humans, can get too attached to knowledge gained in other settings. She calls this type of knowledge “sticky” knowledge because people have trouble letting go of it. Things that were learned early in our education or observations that are reinforced by personal experience can weigh heavier on us when we are evaluating new situations.
In making her decision about childcare, Dr. Robinson analyzed where her own experiences may have prevented her from integrating new data quickly and shifting her thinking.
How does Dr. Robinson feel about her childcare decision now?
After over a year, Dr. Robinson feels even more confident about the safety of her children. Most of the staff are now vaccinated, mask compliance is high, and the schools have a long, evidence-based handbook of their safety procedures.
But, despite the improved situation, Dr. Robinson knows that there are still risks. Long Term COVID and multisystem inflammatory syndrome in children (MIS-C), along with the new variants have made the situation more complicated.
Dr. Robinson is also aware of her own tendency to lean on her prior knowledge. After the thorough investigation she conducted last spring, she has not done another comprehensive review of the literature, instead relying on her previous knowledge and positive experience to stay with her childcare decision.
And yet, despite the risks and her own limitations, Dr. Robinson still feels like childcare is the right decision for her family. She acknowledges that the high community vaccination levels, her family’s continued precautions, and the precautions at her daycare and school keep her family and school staff at an extremely low risk of infection.
What this means for the rest of us
While not all of us are scientists, we can all use the approaches that Dr. Robinson outlined to help make more informed decisions. Understanding history, paying attention to unexpected information, and being aware of our own biases can help us to figure out what the risks and benefits are in each situation.
The pandemic continues to evolve and change. Using logic and reasoning will help each of us navigate the uncertainty of the next few months in a way that improves our quality of life while keeping us reasonably safe.