Thread by @WhitneyEpi

🧵1/ How one epidemiologist decided to keep sending her children to in-person group childcare during a pandemic, and what happened

🧵2/ The most consequential and difficult decision I made in March 2020, near the beginning of the US #COVID19 outbreak, was whether to keep sending my then 5-yo and 1-yo to in-person group childcare

🧵3/ I’m reflecting on this here because 1) Personal stories help me make better decisions & maybe it'll help others; 2) I think I can bring context, nuance, and compassion to a conversation that gravitates towards extremes, absolutes, and vilification

🧵4/ So here it is in 5 easy steps!

🧵5/ #1 I made a decision to make a decision.

My daycare never closed. On April 1, @NC_Governor allowed some daycares to remain open to essential workers. My daycare opted in, one of few in my county that did so. And, under the state’s definition, my family was eligible

🧵 6/ I decided in March to make a long-term decision because it was clear to me that nothing would be materially different in 2 weeks or 2 months: community spread was rampant, little #testtraceisolate, vaccines >1 yr off. Better to make a decision sooner rather than later.

🧵 7/ The best writing I’ve seen on this is from @ProfEmilyOster:
“I am not going to tell you what to do…It is precisely bc everyone’s considerations are different than I cannot tell you what to do... you do not need an answer. You need a way to decide.” emilyoster.substack.com/p/grandparents…

🧵8/ The essay is marked by conceptual clarity, even introducing the all-important #epitwitter concept of #counterfactuals:
“You must start by figuring out what, precisely, you are considering doing and, just as important, asking what is the alternative?”
emilyoster.substack.com/p/grandparents…

🧵 9/ The biggest drawback of the post is an individualistic focus and limited concern for effects on others outside one’s family (a critique the essay anticipates).

Luckily the framework is broad and flexible enough to accommodate those concerns.

More on this below.

🧵10/ My alternative was my husband and I trading off childcare & work for a year. Other epidemiologists with small kids at home manage it with nannies, other relatives who help care; some pod; some just don't sleep anymore. I didn't want to pursue any of these options.

🧵11/ #2a I wanted childcare bc I wanted to work. I was an epidemiologist in the middle of a century-defining pandemic. If we’d kept the kids home, I wouldn’t have gotten fired or lost my income. But I wouldn’t have been able to do all the work I’d been training 10+ years to do

🧵 12/ #2b I also wanted the daycare to stay open for others. It's one of few high-quality, low-ratio centers in my county that take vouchers for low-income families & children in foster care. Note: The state makes this a pain (payments are under market value & often late)

🧵 13/ #3 The science. I spent a week scouring the literature and internet to understand all I could about young kids (<10 yo) and #SARSCoV2. This thread is already too long. This is a decent overview on where I landed: dontforgetthebubbles.com/the-missing-li…

🧵14/ #4 It’s about so much more than The Science.

I examined the protocols being put out by the daycare and my state and local public health authorities. I saw that the @NC_Governor & @SecMandyCohen were taking #COVID19 seriously, updating guidelines as the science evolved

🧵15/ So much of US debates about kids and schools are not so much about epidemiologic science but about trust — in mitigation, in care, that other people and institutions will do the right thing. Based on what I was seeing, I trusted the daycare and state and local authorities

🧵16/ Diving into the literature, I concluded that the risk to my household was within my risk tolerance — the daycare’s mitigation was solid, my kids are young (<10 yo), the adults in our household are fairly young, with no complicating health conditions, flexible WFH jobs…

🧵17/ Those in schools & states they don't trust, w/ older kids, in multigenerational households, who can’t afford to miss work when there's a 2-week quarantine from a case at the kids’ school--they face different constraints. I can’t say what I would have decided in their shoes

🧵18/ Given my specific circumstances, my biggest question came down to the possibility of transmission to the staff, as I said in this piece: time.com/5883677/school…

🧵19/ Many staff at my daycare have worked there for 10, 15, 20+ years. Anyone who knows about US daycare staff turnover knows that’s special.

🧵20/ But it means that many of the staff are older… the majority over 50 yo, multiple 60+. These are women I’d known for 5+ years. These are the women I’d handed my 4.5 month-old preemie that I’d spent almost 3 months in the hospital trying to safely bring into the world

🧵21/

These are women I trusted with my most precious thing.

🧵22/ Every single woman in that building had wiped my child’s behind or soothed him when we cried, helped him learn something new & believe that he is a smart, valuable person

🧵23/ Most of you know by now that raising Black sons in the US is not for the faint of heart. You enter knowing most people will not love & see your child’s goodness & potential like you do. I know this & love my boys more fiercely bc of it.

These women see my sons like I do

🧵24/ And, having received that gift from them, it was unfathomable to me to be part of a chain of transmission or a set of circumstances that would end up with one of them alone in a hospital on a ventilator. I knew that it’d be hard to ever forgive myself.

🧵25/ But I dived into the literature for a week, I read the state and facility plans, I participated in Zoom conversations with the staff and other parents — and I decided that it could be “safe” (I know that term is loaded, but it’s the best I can do right now)

🧵26/ #5 I made mental rules for our household. For me, it’s easier to make a rule & stick to it vs making new decisions on fly. To minimize us introducing infection, I decided we wouldn’t see our parents, socialize indoors, be unmasked indoors unless absolutely necessary, etc

🧵27/ I also decided I’d work as hard at an all-out sprint. Not because I necessarily thought there'd be an outbreak at the daycare but because I knew quarantines were likely when families did inevitably have infections and daycare could close at any time bc of a surge in cases

🧵28/ So it’s a year later…. What happened?

The daycare stayed open, there was one family that was positive and one 2-week quarantine, we all got tested and no spread in the center, no staff have gotten infected. And staff get their 2nd vaccine doses this week.

🧵29/ But this is not a victory post. This year has been horrendous. The staff and families at my daycare have suffered heart-breaking losses. Because I had the privilege to work & didn’t want to waste it, I have worked harder than I have ever worked, and I am exhausted.

🧵30/ Mostly I am furious that I was put into the position of having to make one of the highest-stakes bets of my life, on having to play the odds that my reading of the literature, that my synthesis of the data was the right one

🧵31/ It’s a calculus that school directors & principals & superintendents all over this country had to make. Without PhDs in epidemiology. It was cruel and unconscionable to put so many educators & families into this position, to tell all of us that this was our choice to make

🧵32/ My parents are fully vaccinated now. I’ve been surprised by how little relief I’ve felt. Writing this, I realized why. As much as I worry about my family, the lives that have weighed most on me are the lives of the women who've cared for my children this past year

🧵33/ In two weeks, the staff will be fully vaccinated.

Maybe then I will finally have some relief.

🧵34/34 Adding a link for anyone who’d like to donate to the daycare (not tax deductible).

Also, some advice: If you need something done, ask a librarian. Thanks, @EmilyKader1!

gofundme.com/f/support-comm…