Study reveals child care centres unlikely source for COVID-19 transmission

The findings suggest that recommendations to test symptomatic children for SARS-CoV-2, the virus that causes COVID-19, and keep positive children home from child care for prolonged periods can be revised to align with those for other serious respiratory viruses

Washington DC: According to a study led by the University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh paediatrician-scientists and published in JAMA Network Open, children in child care centres do not spread COVID-19 at significant rates to caretakers or other children at the centre, nor to their households.

The findings suggest that recommendations to test symptomatic children for SARS-CoV-2, the virus that causes COVID-19, and keep positive children home from child care for prolonged periods can be revised to align with those for other serious respiratory viruses.

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“We need to have an open discussion at the national level about the benefit of recommending SARS-CoV-2 testing for every child with respiratory symptoms who attends a child care program,” said lead author Timothy Shope, M.D., M.P.H., professor of paediatrics at Pitt’s School of Medicine and paediatrician at UPMC Children’s.

“No one wants to give up on controlling SARS-CoV-2 spread, but focusing on testing and long exclusion periods for children in child care centres appears to be unnecessary while subjecting families to the expense of frequent testing, absence from work and lost wages, and loss of education and socialization for children.”

Current recommendations from the U.S. Centers for Disease Control and Prevention advise that any child with congestion, runny nose or other respiratory symptoms be tested for COVID-19 and, if positive, be kept home from child care for at least five days. For influenza and respiratory syncytial virus–equally serious respiratory viruses that infect and spread among children in child care centres at higher rates–recommendations are for the child to return to child care when symptoms are resolving and they have been fever-free for 24 hours.

The study included 83 children in 11 child care centers in two cities and their household contacts – 118 adults and 16 children – as well as 21 child care providers. They were followed from April 22, 2021 through March 31, 2022. Participants received weekly COVID-19 testing and completed symptom diaries. Child care centre directors reported weekly, deidentified, self-reported COVID-19 cases for all care providers (402) and children (1,154) at their center.

The research team found that SARS-CoV-2 transmission rates within child care centres was low, about 2 per cent to 3 per cent, indicating that neither children nor caregivers were often spreading COVID-19 to others in the centers. Child care attendance was also a minor cause of COVID-19 in households, since only 17 per cent of household infections resulted from children who got COVID-19 at their child care centres.

Most household cases were acquired from outside the child care centre.

In contrast, once someone in a household had COVID-19, transmission to other household members was high, at 50 per cent for children and 67 per cent for adults.

“It is interesting that such a contagious virus was transmitted at low rates in child care centres and was an uncommon reason for household infections because it goes against conventional wisdom and medical knowledge we have about other serious respiratory viruses,” Shope said.

“In households, the higher rates can be explained by much more prolonged and closer contact, especially with sick children.” In addition, the team found that only 1 in 20 symptomatic children attending child care centers tested positive for SARS-CoV-2.

The researchers explained that the purpose of this study did not include evaluating the efficacy of COVID-19 vaccines because they were not yet available for children under 5 when the study was conducted. Nevertheless, the study’s results point to the importance of vaccinating children against COVID-19, which other research has shown to be safe and effective.

“Though we found COVID-19 transmission was low in child care centres, our study shows that transmission was very high in households, and young children still often contracted COVID-19 from people outside the child care centre,” said Shope. “I strongly recommend the COVID-19 vaccine for young children to disrupt the high rates of transmission that occur in households and the missed school and work that can result.”