The parents of the youngest children are not okay

An epidemiologist on the health risks of the omicron variant, child care issues, and the unique pandemic struggles of working parents.

More kids younger than 5 are sick with Covid-19 in the US this month than at any other time in the pandemic. None of these millions of children can be vaccinated yet, and almost half of them are too young to wear a mask. This is bringing a new wave of disruptions and stress for many families — especially those that rely on day care, preschool, and other shared child care — who have already endured almost two years of strain.

Various experts have reassured parents that children are not at high risk for severe disease, hospitalization, or death from Covid-19 (though certain underlying health conditions could raise the risk). Recent data from South Africa and the UK suggests that even among hospitalized babies and young children, the omicron variant seems to cause less severe illness much of the time, infecting the upper airways more than the lungs, the same as adults.

While this should give parents comfort, the sheer volume of cases this month from the super-transmissible variant means pediatric hospitalizations are reaching new highs, including among young kids.

Children younger than 5 have already consistently had the highest hospitalization rate of all children’s age groups for Covid-19. And new data out of South Africa reports higher proportions of kids under 5 being admitted to the hospital after testing positive for Covid-19 during the omicron wave than other ages, including older adults. Newborn babies remain the most vulnerable, and without guaranteed paid parental leave in the US, many parents must send them to day care when they are just 6 weeks old.

Even when Covid-19 infections in young kids are only very rarely severe, they can create havoc at home. With frequent breakthrough infections even among the fully vaccinated and boosted, families must figure out how to protect themselves and others in the household — even more so if there are higher-risk members.

In a two-parent household, should one be the designated caregiver to a sick toddler, while the other isolates themselves? Will other children now be home because of their exposure? Who will be able to take time off of work to watch the kids? And what happens if all of the adults in the household get too sick to care for a baby or child who cannot care for themselves? These questions carry more crushing weight in a single-parent household and those where both parents must work outside the home and cannot afford to take time off.

Even if children who have been exposed to Covid-19 at day care or preschool test negative, in many places, they will still have to stay home for 10 to 14 days. This sudden loss of child care sends millions of families — and, overwhelmingly, mothers — scrambling to figure out how to continue earning money (and pay for the child care they aren’t able to use); care for babies, toddlers, and preschoolers; and keep their families as safe as possible.

Johns Hopkins epidemiologist Genevieve Wojcik, who has a 20-month-old son and a 4-year-old daughter in day care, is a veteran of these struggles. Like so many other pandemic-weary parents, Wojcik has had to take on child care alongside her paid work — typically at a moment’s notice, for days and sometimes weeks at a time. And she is exhausted.

I talked with Wojcik about how she thinks about risk right now for this unvaccinated age group, how studying children, viruses, and vaccines has shaped her risk tolerance, and the toll all of this is taking on her work and life. Our conversation has been edited for length and clarity.

Katherine Harmon Courage

As an epidemiologist, how concerned are you about surging pediatric hospitalizations, while also knowing that the omicron variant tends to cause less severe infections?

Genevieve Wojcik

I understand that the absolute risk of my kid getting sick enough for hospitalization or death is very, very small. But I also know that the relative risk of my kid getting sick or seriously sick isn’t worth going out and eating inside a restaurant. So I get that the absolute risk is small, but I don’t want to risk the relative risk. I will say, full disclosure, I am definitely more on the risk-averse side.

Katherine Harmon Courage

How does your own research impact how you think about these risks to kids?

Genevieve Wojcik

I’ve always done research in kids and what can go wrong with kids — and there are a lot of things that can go wrong. I also have experience working with post-viral-infection syndromes, and I know what can happen to kids, even before Covid and long Covid.

When you give somebody a risk of 5 percent of developing cancer in the next five years, they’re not going to develop 5 percent of the cancer. They’re either going to develop it or not. There’s often that lack of translation between risk and the sort of binary outcome, where it’s like, yes, kids have only a very small percentage chance of being hospitalized or very, very sick. But they don’t just get a tiny bit bad; they get very bad.

I’d rather do everything I can to make sure it doesn’t happen than just give up. There is harm in this whole debate about: “everyone’s going to get it” or “it’s a small risk.” What you’re asking people to do, it’s not that hard. It’s not that difficult to put a mask on.

Matt Roth/The Washington Post via Getty Images

Katherine Harmon Courage

How do you think about the risk of illness right now for kids in day care, like yours?

Genevieve Wojcik

My kids started back at day care in August of 2020, and my oldest was 2 and a half and wore a mask. And then things started opening back up again, and now my younger one is sick constantly. There was RSV; hand, foot, and mouth; a bunch of different colds; and we got a stomach bug as well.

So it’s not even just Covid; it’s everything else that’s circulating that they’re more susceptible to and could be more dangerous for them [if they get them] at the same time. You have these overlapping risks that you’re constantly trying to manage. It makes it a little bit more stressful because they get sicker when things overlap. Especially for our youngest because he doesn’t wear a mask, he puts his hands in his mouth. It’s his first rodeo, and he’s going to get everything that comes through. It’s just relentless.

Katherine Harmon Courage

How do you think about different levels of risk for babies versus kids in this unvaccinated group?

Genevieve Wojcik

At the beginning of this, I had a 2-year-old, and then I gave birth in April 2020. It is very different in the way we navigate with the two kids because they have different levels of being able to wear a mask. Wearing a mask has cut down the number of illnesses my 4-year-old gets an insane amount.

It’s also clear to anybody who’s got young kids that the way they handle illnesses is very different at different ages. And the effects of those illnesses on the parents are very different in terms of stress and sleep deprivation. There’s a reason there’s a lot of hospitalizations for infants — because it’s more dangerous for them.

We’ve been locked down for the past two weeks now. My son had mild congestion around Christmas and then seemed a little better after a few days. Then all of a sudden he spiked a fever and developed pneumonia. It’s not Covid-related, but I can’t have him get Covid while he has pneumonia. He’s 20 months, so he can’t handle more.

The thing we think about now that’s different than the other waves is that people who are fully vaccinated and boosted are also getting pretty sick. Not seriously ill, but enough to get you down for the count for a few days. So if we’re both down for the count with Covid, who’s going to take care of the kids? I’m not worried about my own health, but I am worried about who’s going to feed these kids if I am bedridden. Because in the times of Covid, you’re really on your own.

Katherine Harmon Courage

How do you think about these risks in what you do — or don’t do — with your own family these days?

Genevieve Wojcik

I’m of two minds in the way I manage my family. One is obviously a risk to our own health. It’s not a risk to my husband’s health or my own health, but to my kids’ health. When they can get vaccinated I will feel a lot better given the data we have on vaccines and long Covid and severe outcomes.

You have a certain bucket of risk you can draw from, and so we use all of our bucket of risk for day care when we can. So we don’t do anything else. We don’t go to indoor areas with our kids, we don’t see people socially.

The other part of how I think about risk is for families who don’t have the flexibility to stay home, who might also live in multigenerational households or might have someone who is immunocompromised or medically vulnerable. So if I can swallow some of that burden in protecting our kids from getting sick, then I should do that because it’s for the community. Especially because we wouldn’t know if our kids are infected and transmitting things until it’s too late.

Katherine Harmon Courage

Have you all been through the rounds of day care quarantine?

Genevieve Wojcik

Yes. I’ve been trying to get a Covid extension for a grant, and you need to quantify how much time you’ve lost because of child care. And I have not had a full month of child care in two years. It’s a few days [lost] on a good month.

Either the kids get sick and have to get tested, [or] we have to quarantine. And we’ve been through four rounds of quarantine for exposures and two rounds voluntarily because we decided to have family visit.

In the fall of 2020, we spent 24 days in the house because my son had an exposure in his classroom, and then with our luck, he developed symptoms a few days later. It was horrible. As a probable case, he had 10 days of isolation, then the rest of us, because none of us were vaccinated at that point, we had 14 days after his 10 days.

Our day care policies for quarantine and testing are following the science, and that’s important. I think that’s why we’ve had such low cases [at our center]. But still, you have your schedule, and you have your Zoom meetings scheduled, and all of a sudden, it’s like, oh no, for the next two weeks you’ve got to entertain your kids who don’t know how to entertain themselves yet.

Bill O’Leary/The Washington Post via Getty Images

Katherine Harmon Courage

How do you and your husband manage child care if day care isn’t available?

Genevieve Wojcik

Oh, it’s me. Academia gives me flexibility. My husband works as a school psychologist and doesn’t have time or bandwidth or enough sick days.

The kids have been home since Christmas. I don’t know what we’re going to do. Because on the one hand, I’m losing my mind. But on the other hand, there are still pretty high case numbers.

The other bad news is that I’ll bring them back, and maybe they’ll be there for a day or two, and then there will be another case at day care. And then we’re home for two weeks. Because even if it’s just one of the kids, it extends. Because if one kid gets sick, then the other one has to start their quarantine or isolation after that, so they’re staggered.

So do I just keep them home for another week and then send them back? That’s a little bit less of a risk. But I’m human, and I don’t know how much I can take. It’s like, do you want to suffer now, or just punt it down the road? Because it’s going to come.

Katherine Harmon Courage

How has all of this been impacting your work as a public health researcher?

Genevieve Wojcik

A lot of the more administrative work you can sort of struggle through. But the majority of the other work, in terms of scholarship, it’s really difficult because I need uninterrupted time to think, and I cannot have that. I’ll get to my work I want to do, and inevitably, because the universe is a funny, funny, funny person, they’ll be like, “Oh, now there’s another exposure,” or, “Your kid’s sick now and has to be home for a few days because they have a fever.” It’s just been really difficult.

You’re constantly in survival mode, and survival mode is not conducive to creative thinking and scientific progress. I do wonder if people who have kids under 5 have a very different kind of burnout than other folks. Because I’m exhausted, I’m absolutely exhausted. But I want to do the work. I deeply care about the work that I do. I just cannot do it. There’s a little bit of sadness around that. It’s something you uniquely value and care about, that you’re good at, you can’t do because your brain is just tired. Because kids, they just don’t stop making noises.

Katherine Harmon Courage

How do you see the challenges for this age group and their families exacerbating existing equity issues that the pandemic has laid bare?

Genevieve Wojcik

There are massive gaps in terms of who’s being affected by this. One example is in Maryland, there is Prince George County and Montgomery County, and Montgomery County is much wealthier and has half the positivity rates as Prince George County. And in terms of who is vaccinated, who has access to resources, and who can’t stay home is huge. And that exacerbates who’s having higher case rates, who’s being hospitalized.

Also there’s a massive difference in terms of, for zero- to 4-year-olds, their child care. It’s a question of who has their kids in day care versus who has a nanny, versus who has a stay-at-home mom — and the reasons why they have a stay-at-home mom. If you have a nanny for your kids, you’re really hoping that nanny doesn’t get Covid. But if your kids are in day care, you’re reliant on the community way more [to keep case numbers low].

Katherine Harmon Courage

How are you feeling about the vaccine progress and prospects for these final age groups?

Genevieve Wojcik

I have to be honest, the results [of the clinical trial of a Pfizer vaccine for kids 6 months to 5 years] were absolutely gutting. And now the Moderna trials expanded and so they got pushed out another month or two.

You get through by saying, “Just a little bit longer.” And then after two years, that little bit longer just draws out. It’s also that everybody else 5 and above has access to vaccines at this point, and they’ve moved on. They’re not as worried about things. That’s the whole point. And I’m happy for them.

But I’m still stuck. And at the exact moment that you have this massive wave, somebody is pulling that life raft farther away from you.

But there’s no option to give up, right? There’s no option to say, “Well screw it, I’m going to do whatever I want to do.” Because you’ve got these tiny children to take care of.

When I tell people we’ve had the kids home for weeks, and my son has pneumonia and I want to make sure his lungs are healthier before he is possibly exposed to Covid, they say, “You need to take a break.” And I’m like, “It doesn’t matter what I want. That’s not a possibility.”

I think most people who have kids under the age of 5 are not asking for everything to shut down. I just want you to be okay with the fact that I’m going to take longer to get things to you or that I’m not going to be able to work at that level, or to be patient with me — or be a little bit more empathetic.

Katherine Harmon Courage

Do you have any advice for families with kids under 5 for the omicron winter?

Genevieve Wojcik

No, I don’t. People ask me all the time, “How is this going to play out?” The models have ceased to be informative for my day-to-day life. I just don’t know, and as an academic, not knowing is horrible!

I don’t have any advice because I’m flailing as well. Some people give me the advice of “you need to hunker down and take care of yourself.” And I’m like, “I have nothing left of myself to take care of.” It’s been two years of this. Having two kids these ages during a pandemic is a lot.

So I don’t think there’s any hack or spin that will make the next few weeks bearable. It’s just going to have to pass at some point. It’s just a matter of doing everything within your power to keep your family safe — and trying to let go of the things that you have no power over.

You will do whatever’s right for your family and whatever you can do for your family. There should be no judgment one way or the other because we’re all just trying to get by in a world that’s not built to support us.