Rhode Island reopened 666 child care centers in summer 2020 — spread stayed rare

When Rhode Island reopened its child care programs on June 1, 2020, after nearly three months of closure, public health officials watched closely for signs that COVID-19 would spread among young children and their teachers. Over the next two months, possible secondary transmission turned up in just 4 of the 666 programs allowed to reopen — and every one of those cases appeared in the last two weeks of July, when community transmission across the state was rising.

How programs were allowed to reopen

The Rhode Island Department of Human Services (RIDHS) set strict conditions for licensed center- and home-based programs. At first, no group could exceed 12 people, including staff members, and that cap rose to 20 on June 29. Groups had to be stable — meaning the same staff members and students stayed together and did not switch between groups — and physically separated from one another. Adults were required to wear masks at all times. Both adults and children had to be screened for symptoms every day, and programs had to follow CDC guidelines for enhanced cleaning and disinfection.

By July 31, 666 of 891 programs (75%) had been approved to reopen, with capacity for 18,945 children. That represented 74% of the state's January 2020 child care population of 25,749 children. Compliance was checked through 127 unannounced monitoring visits, and it was generally high. Program administrators said the hardest rule to follow was keeping staffing stable, because teachers still needed breaks, vacation, and sick leave covered.

What the case investigations found

The Rhode Island Department of Health (RIDOH) investigated every reported COVID-19 case linked to a child care program during June 1–July 31, 2020. Out of 101 possible cases reported:

• 49 (49%) were ruled out after negative lab tests
• 33 (33%) were confirmed by a positive RT-PCR test
• 19 (19%) were classified as probable based on clinical and epidemiologic criteria without lab testing

Among the 52 confirmed and probable cases, 30 (58%) were children with a median age of 5 years, and 22 (42%) were adults — 20 teachers and 2 parents — with a median age of 30 years.

Confirmed and probable child care–associated COVID-19 cases by week, alongside Rhode Island's overall confirmed case incidence, June 1–July 31, 2020. Credit: CDC

Cases were spread across 29 programs. In 20 of those programs (69%), only a single case appeared with no sign of spread to others. Five programs had two to five cases, but RIDOH ruled out child care transmission based on the timing of symptom onset.

One notable episode involved a 2-year-old who attended child care for 6 days while potentially infectious — 3 days before a parent-reported fever of 100.3°F and chills, and 3 days after symptoms resolved. Ten of the child's 11 contacts were tested a median of 2 days after last exposure; none tested positive. RIDOH confirmed the program had followed RIDHS regulations.

The four programs where spread could not be ruled out

All four cases of possible secondary transmission occurred after July 15.

• Program 1: RIDOH found the program had not followed RIDHS rules, including staff members switching between groups. Ten confirmed cases were identified — five children, four staff members, and one parent. The program was closed, and 60 children and 21 staff members were quarantined for 14 days.
• Program 2: Three confirmed cases came from a single classroom. Twenty-six students and 17 staff members were quarantined.
• Program 3: Two cases had symptom onset dates suggesting possible transmission, but no epidemiologic link was found.
• Program 4: A staff member who moved among all classrooms tested positive, as did a child contact of that staff member. The entire program was closed; 37 students and 16 staff members were quarantined.

The bigger picture

Even with limited identified spread, the impact on families and programs was significant: 853 children and staff members were quarantined in total. The investigators noted that COVID-19 infections in children are easy to miss because children often have mild illness or no symptoms at all, so some cases were likely never detected.

The timing matters, too. Rhode Island reopened when its case counts were relatively low compared with other U.S. states. The four programs with possible spread all appeared as community transmission climbed in late July, suggesting that what happens outside child care walls directly shapes what happens inside them.

Sources

This article is based on "Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs — Rhode Island, June 1–July 31, 2020," published in the Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention; it is a work of the United States government in the public domain.