Summer camp during coronavirus will look a little different

The two dozen boys and girls were coronavirus pros. They knew to sit at opposite ends of tables, knew shared toys had to be disinfected first, and knew they shouldn't suffer through a tummy ache but instead tell an adult right away.

"The kids are like, 'Yeah, this feels a little weird, but we're still having fun.' It's an adjustment obviously," Shal, 22, said.

As the school year comes to an end amid an easing of stay-at-home orders, millions of U.S. parents face the nerve-racking decision whether to send their children to day care and summer camp. And they must do so without any clear data or large studies to guide them about the risks.

The Y, to its own surprise, has had few positive cases and no known outbreaks among its 1,000 locations and 40,000 children in care over the past three months.

Still, some states report worrisome numbers: 14 clusters in Maryland have been linked to child-care centers. But health officials in a half-dozen other states said they have seen no clusters in the centers. That forces parents to make choices on their own.

Economists say their collective decisions will help determine the trajectory of the financial recovery, with child care critical to returning sidelined workers to their jobs.

While some camps have gone out of business or opted to remain closed for the season, the YMCA, a community nonprofit, is welcoming hundreds of thousands of children in the next three months. Its experiences with child care in the first wave of the pandemic serve as a model for what families might expect.

Andrew Noymer, an associate professor of population health and disease prevention at the University of California at Irvine, said that expecting the unexpected, including abrupt shutdowns, is going to be a big part of camp this year.

"The preamble should be that things can change at any time, and parents should be flexible," he said.

When officials at the YMCA - the nation's largest provider of youth services, typically serving 8 million children a year - began in March setting up emergency day-care centers nationwide for essential workers during the pandemic, they were prepared for things to go wrong. Pages of new protocols were put in place for infection control, social distancing, contact tracing and transparency with parents.

But as the months passed, they were baffled by what did not happen.

There were inevitably individual cases of positive coronavirus tests and numerous false alarms leading to temporary shutdowns, but no outbreaks in their facilities.

Heidi Brasher, a senior director at the Y's headquarters in Chicago who is coordinating child-care operations across its affiliates, said she's unsure whether that was because of the organization's aggressive safety measures, or a confirmation that children don't get or spread the virus as readily as adults - or some of both.

"The great thing is we had procedures in place to communicate with parents and to trace everyone's movements," Brasher said.

Health officials in states surveyed by The Washington Post this week offered a more mixed picture.

Arkansas, Massachusetts, Missouri and Pennsylvania said they were not aware of outbreaks in child-care centers over the past three months. In New Jersey, a covid-19 hot spot in March and April, there was a single report of a staff member and child being infected in Burlington County at the same facility.

In Arkansas, where child-care centers never closed, state epidemiologist Jennifer A. Dillaha said there had been 16 cases of covid-19, the disease caused by the coronavirus, in children and 29 in staff members. But contact tracing showed the infections originated from household contacts or elsewhere rather than at day-care centers.

"We've been pleased we have not seen many cases in this setting," she said.

In contrast, Maryland reported outbreaks - defined as two or more cases in a setting - in 11 child-care centers and three family child-care settings among 4,776 facilities open. It was unclear whether that was because of greater testing capability, more aggressive transmission of the virus in the general population, something specific to the operations of those providers or another cause.

Texas logged 242 positive cases (167 staff, 75 children) among the 12,172 child-care facilities that are open. But it was unclear how many, if any, were clusters that may have involved transmission at the sites because officials could not provide more details. As Dallas County on Thursday reported an all-time high in cases overall, officials noted that 17 children and staff in nine child-care facilities had been found positive during the past week.

Likewise, California officials said the state had 202 covid-19 cases related to child-care facilities, with 33,411 open, but declined to provide details "to protect privacy." Jason Montiel, from the state's public affairs office, said, "Thankfully, child care has not experienced any covid-19 deaths."

The largest study on child care and covid-19 is expected to be out in July. Walter Gilliam, director of child development and social policy at Yale University's School of Medicine, said he hopes the data, based on information from 100,000 providers nationwide, will help explain how children spread the virus and what prevention measures might be most effective amid intensifying calls to reopen child-care programs.

"We are asking people to go back to work to a job where they sometimes can't socially distance. That's asking a lot without any real sense of risk," Gilliam said.

Australia, Denmark, Norway, Singapore and several other countries where schools and day-care centers reopened as early as April have reported no outbreaks and no resulting surge in cases in the larger population. In contrast, Israel abruptly shut its schools two weeks after reopening when a cluster of 130 cases emerged at a Jerusalem high school.

The Centers for Disease Control and Prevention has issued guidelines, updated June 19, for the operation of day cares and camps, emphasizing that "the more people a camper or staff member interacts with, and the longer that interaction, the higher the risk of COVID-19 spread."

The science on children and coronavirus has evolved dramatically since the first days of the pandemic, but many unanswered questions remain.

Most children appear to shrug off the virus with only mild symptoms or none at all. A study in the journal Nature Medicine published this week estimated that children may be only half as likely as adults to become infected. But since late April, a small but significant number of healthy children have developed a potentially deadly inflammatory complication linked to covid-19 that resembles Kawasaki disease. Doctors have had no way of determining who might be vulnerable - changing for many parents the calculation of returning to group care.

The larger, population-wide consequences of having so many children so close together in one place has been a source of much scientific - and political - controversy underlying the debate about whether to reopen schools in the fall.

Former CDC director Tom Frieden said that so far, the evidence suggests that "for kids, this pandemic is kind of like a flu season," in which some experience severe illness but most are fine. That supports the reopening of some camps, he said, especially if they are held outdoors where there is a decreased risk of transmission. But before classrooms are reopened, Frieden said meticulous epidemiological studies must be conducted.

"One of the most important unknowns about the virus is do kids spread the infection prominently," Frieden said. "There has not been any definitive data or even strong data about this."

It was sometime in early May when Tom McHale's children, ages 4 and 7, began to rebel against the idea of "stay at home." They had started to zone out during Zoom classes, and his older one was begging to see friends.

With he and his wife working full time in jobs outside the home - he's a construction manager, she's a hospital technician - the Elkridge, Md., family was in a bind. They made it work, somehow, for two months but weren't sure how much longer they could last.

The McHales were nervous about sending the children to day care, but after researching options and asking a lot of questions, they settled on the Y in central Maryland, which is operating 13 child-care locations in Baltimore and surrounding counties.

They liked that they could transition to summer camp, its proximity to his wife's workplace and its history. In 1885, the YMCA pioneered the country's first-known summer camp in Orange, N.Y., as an escape from what some called the "moral and physical degradations" of urban life.

The day McHale's children were supposed to start at the child-care center, May 13, was a stomach-turner. They received a notification not to come because there was a possible covid-19 case and the center had to close for cleaning and quarantine. Three days later, they were told the suspect case turned out negative, and the health department gave the all-clear so everyone could return.

"We were very uncomfortable," McHale, 45, recalled. Since then, he said both kids adjusted to the new routine and safety protocols and made friends. Life is better for him, too.

"For a while, I was doing my job from home while my wife worked, and it was stressful as heck," McHale said. "When we were able to put them back in child care - what a relief."

The temporary shutdown, YMCA officials say, has become almost a routine part of child care during the pandemic. In most cases, it involves one individual testing positive or showing symptoms but never metastasizes into an outbreak.

Just last week in Wisconsin, a child at the Marshfield Clinic Health System YMCA Child Care Center tested positive for the coronavirus, and 40 staff and children were asked to quarantine. The YMCA in Calhoun County, Texas, last week sent kids and counselors home to quarantine after they had been in contact with an infected child and told parents of other children at the camp to monitor for symptoms. And in Staunton, Va., the YMCA delayed reopening a week to Friday after a part-time staff member tested positive, and it hired a cleaning crew to disinfect the building.

Dana Ashley, who oversees the YMCA child-care programs in central Maryland, said there have been 11 other temporary closures in her region during three months, but none involved transmission at the sites. There were two cases, at different locations, of preschoolers testing positive. Tests showed no other children or staff were infected at those facilities, she said, suggesting transmission took place elsewhere.

All the others were false alarms - with administrators reacting out of an abundance of caution to children sniffling or feeling unwell because of what turned out to be hay fever or other reasons unrelated to the coronavirus.

"Did we overreact? I don't know, but it's better to be overly cautious and safe than the alternative," Ashley said.

At the YMCA in Ellicott City, the coronavirus procedures start at the front door.

Parents are not allowed inside and all kids - most 5 to 12 years old - must undergo a temperature check and go straight to the sink to wash their hands while singing "Happy Birthday" twice. All staff must wear masks. They're recommended for children, too, but counselors discovered early on that wasn't realistic.

"They'll come in with a mask, but an hour later, it's on their wrist, in their hair," Ashley said. So the emphasis has been on social distancing.

Maryland has stringent procedures for child-care facilities during the pandemic, requiring centers to report daily on each child's health. The state has mandated all summer camps be outdoors.

Based on consultations with child development experts in academia and at the American Camp Association and ideas brainstormed on the fly, staff try to make being safe fun. Counselors call out "zombie arms," when reminding the youngest children to leave space and not bunch up.

Brasher, from the YMCA national body, said one priority is making sure to address children's social-emotional needs during uncertain times. "They haven't seen their friends or had a normal playtime," she said. "Add to that their parents' stress about their job, concerns about their health and other trauma."

Everyone is assigned to the same group of fewer than 15 - or whatever number is mandated by local authorities - for the entire week, and groups never merge. At the Y in Central Maryland, for the summer most groups are about eight children.

In the past, hundreds of children might convene, especially during camp season, at a closing rally for songs and chants.

There are a host of other "no's." No family-style snacks. No field trips, no outside guests to teach dance or wow kids with science experiments. No collaborative building of towers with blocks or Legos. No sharing art supplies. And absolutely no games involving touching - not even freeze tag or duck, duck, goose.

"That was a hard one," Shal said, recalling the day he broke the news to his youngest charges. "We had a lot of 4- and 5-year-olds breaking down about that."

On a recent Thursday, Leslie Kroll was racing around making final preparations to welcome as many as 100 kids at a time Monday, fewer than the typical 250. She and her team were setting up tents, bringing in portable sinks and toilets, and rewriting schedules with safety top of mind.

She had had no trouble hiring counselor trainees and staff, most of whom are 15 to late 20s.

At age 28, Kroll has spent nearly every summer of her life at the YMCA. Her parents met at a Y camp, and she had been a camper, camp counselor and now camp director.

Opening camp during a pandemic, she said, is bittersweet. Last year, hallways were packed wall to wall with kids - no more, because of social distancing. Even the smells are different - more bleach. But she hopes that camps, "with all the changes in the world, will be a nice reminder of some normalcy."

"For better or worse," Kroll said, when all this is over, "we will have stronger kids."

In another part of the building, children wrapped up their mindful meditation and stretches and dispersed to long cafeteria tables where each sat alone waiting to make slime. Shal and another masked counselor snapped on gloves to deliver the supplies.

As the group began to stir the gooey mix, there were squeals of delight.

"Let me see," cried one boy in a green shirt who stood up, squinting to get a better look at a friend's experiment about 20 feet away and show off his. Another whose hands had turned blue from the dye exclaimed, "How cool this is!" to which everyone else, including the counselors, nodded.