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Newark Representative Takes Issue With DHSS’ Private Childcare Coronoavirus Guidance

Newark State Representative John Kowalko is taking issue with the “Guidance for Childcare Providers on Coronavirus” provided this morning. by the Delaware Health and Social Services (DHSS).

Kowalko said the press release from DHSS sent out regarding childcare should be rescinded immediately. It wasn’t sourced adequately and the sources quoted were outdated or inaccurate.

You are doing harm if you encourage daycares to stay open to spread this virus, Kowalko said in an email to the agency. Governor Carney did the right thing closing schools. Policy recommendations should be the same for daycares.

Below is the email Kowalko sent to First State Update.

I received the Press Release from DHSS recommending that PRIVATE childcare settings not be closed.

This was a press release supposedly issuing “Guidance for Childcare Providers on Coronavirus.”

Yet that is NOT what this Press Release is about. This is about telling parents to continue sending their children to child care “for structure” (Odom Walker) and “keeping non-public school childcare open helps reduce the worry” for parents concerned about their employment (Fitzgerald). This is a Press Release written for parents, not for childcare facilities.

Neither of those issues address the needs to reduce transmission of Covid-19. The need just now is to reduce the rates of transmission to populations who are vulnerable, as well as to reduce the number of people going to the hospital so that our health care facilities are not overwhelmed, “lowering the curve”, as we have heard so often over the last week. The practice of social distancing is one mechanism available to us to do this, and is the reason that so many schools have closed. There is no evidence to believe that children in a private daycare are less likely to transmit the disease than children in public school. Thus, if public schools are closing for this purpose, childcare facilities should as well.

Furthermore, the data used in this Press Release is faulty.

I went to the CDC Website you provided. NOWHERE on the website did the CDC separate recommendations for schools and childcare facilities. All recommendations were the same. Further, while schools can actually put some of the recommendations for preventive measures in place, childcare facilities absolutely cannot. Social distancing is impossible with populations under school age. And the DHSS recommendation to “remind children to avoid touching eyes, nose, and mouth” is actually laughable when it comes to pre-school children and babies.

You base your recommendation on the following:

“The data available from 74,000 cases that occurred in China, show that only 2% of individuals under 19 years of age tested positive for COVID-19.” And “Children appear to be less vulnerable to this virus and based upon the science we have now, it does not indicate that closing childcare facilities will help in reducing the spread of COVID-19” (Odom Walker)

I’m not sure why DHSS should refute the wise actions of the governor for closing all public schools when the very study quoted shows no differentiation between 0-5 and 5-19 year olds.

Both statements are faulty and NOT based on current science or the latest studies. “Last week, there was a paper released from the Chinese Centers of Disease Control looking at people getting sick and who they had come into contact with, which suggested the rates of infection in children are just as common as in adults. The new research also suggested that perhaps the virus could be shed in fecal matter from children.”

Let me repeat for emphasis- “rates of infection in children are just as common as in adults” https://www.forbes.com/sites/victoriaforster/2020/03/13/how-does-the-coronavirus-affect-kids-what-we-know-so-far-about-covid-19-in-children/#64ef51a31f30

Furthermore, it appears that the data cited in the release by DHSS was based on old data (though this is difficult to assess, as no citations are included to support the statistics being quoted): “We found a sharply increasing proportion of infected children (from 2% before January 24 to 13% for January 25–February 5; p<0.001), implying that increased exposure for children and intrafamily transmission might contribute substantially to the epidemic.“ https://wwwnc.cdc.gov/eid/article/26/6/20-0239_article

Furthermore, if COVID-19 is indeed less severe in children than in adults, as much of the evidence suggests (http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51), this is more of a reason to close schools and daycares. The suggested ways to decrease transmission in your email include isolating and sending children home once they are sick. However, it has been suggested that people can transmit COVID19 when they are asymptomatic (https://jamanetwork.com/journals/jama/fullarticle/2762028). If this is the case, then places with large number of children in close contact (practicing social isolation in a daycare and keeping people apart at the distances recommended by the CDC is impossible), who could be asymptomatic and thus never sent home, increases risk to everyone in the community. Furthermore, the 2% positive testing result could be erroneous if indeed children are less likely to display symptoms, and therefore less likely to be tested.

In case the purposes of closing schools is unclear to the authors of the email, I am including a source on Social Distancing (which is IMPOSSIBLE in childcare):

“Social distancing is a public health practice that aims to prevent sick people from coming in close contact with healthy people in order to reduce opportunities for disease transmission.

With COVID-19, the goal of social distancing right now is to slow down the outbreak in order to reduce the chance of infection among high-risk populations and to reduce the burden on health care systems and workers.”

“On the broader scale, a number of actions taken in recent days are designed to encourage social distancing, including:

· Schools, colleges, and universities suspending in-person classes and converting to remote online instruction

· Cities canceling events, including sporting events, festivals, and parades

· Workplaces encouraging or mandating flexible work options, including telecommuting

· Organizations and businesses canceling large gatherings, including conferences

· Houses of worship suspending services” https://hub.jhu.edu/2020/03/13/what-is-social-distancing/

I have not found any evidence or recommendations by epidemiologists that suggest that social distancing need only be practiced by children above the age of 5.

Analysis of previous outbreaks suggests, in conjunction with other measures taken, these methods can have positive outcomes:

“Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic.

Early school, church, or theater closure was associated with lower peak excess death rates (Spearman ρ = 0.54–0.56, P = 0.02).” https://www.pnas.org/content/104/18/7582

My conclusion regarding this press release is that the true reasons for recommending private childcare stay open, thereby exposing not only staff in these centers but the community at large to be exposed to the virus is financial. You want as many parents as possible to be able to work. When you make statements, you make this recommendation without regard to the safety of the community, or any scientific evidence. Most importantly, when you do this you risk losing the trust of the community, and this is very dangerous.

Childcare centers are a much riskier environment than nearly any other venue, in spite of the fact that ALL of the recommendations you make for safety are followed routinely in daycare. Thus, my suggestion is that you should be recommending closure.

As we move forward, the state of Delaware will play an important role in protecting our communities as this pandemic plays out. In the future, recommendations based on science, and evaluated by a trained epidemiologist (of neither I nor the authors of this email are), should be used for public health announcements. Further, in my opinion, the state should focus its efforts on things that will reduce transmission and death from this virus (increased testing, tracking, quarantine of those exposed) and provide support to those vulnerable (how about state supported sick leave for hourly employees, free testing for the virus) and that will support our medical caregivers as the burden will fall heavily on them (childcare relief provided by the state specifically for those workers designated as essential working in medical care or in the food supply chain). While I am not a public health official or a trained epidemiologist, it is distressing that I have to make evidence-based decisions to keep my community safe by myself, rather than having the full resources of the state employed to make scientific evidence-based recommendations. One recommendation I would make for DHSS, follow the advice of the experts:

“Children although they get infected, unlike influenza, they do not necessarily at all get serious disease,” Fauci told MSNBC on Friday.

“In fact, if you look at the history of what we’ve seen, children do very well,” he added. “The only problem is when they get infected, and schools can be a breeding ground for that, they go home and infect grandma and grandpa, or a relative, or someone who might be in a more vulnerable position, so that’s the rationale for shutting schools.”” https://thehill.com/changing-america/well-being/487504-children-arent-immune-to-coronavirus-but-theyve-largely-been

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