Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at email@example.com.
Dear Dr. Hamblin,
I’m a healthy 72-year-old living in Berkeley, California. My daughter, son-in-law, and grandkids recently moved here across the country, and now we have a bubble together. I offered to help with child care as they work from home.
Now I’m not sure whether I should. My 6-year-old grandson’s school is fully online, and he needs someone to supervise him during class (six hours every day). But our family bubble is slightly complicated now that my 3-year-old granddaughter’s preschool is open.
My doctor said I could monitor my grandson if we both wore masks. But another expert friend said grandparents shouldn’t even try to help out with child care right now. Is there any way to do it safely?
This is a difficult situation, emblematic of one that so many families are facing as schools reopen and carefully curated bubbles slowly burst. When a child is in contact with a dozen other students, and those students are in contact with their families, and their families are in contact with co-workers, the risk of transmission can grow precipitously.
At the same time, socialization is vital to children’s development. School teaches kids interpersonal skills and helps them build emotional resilience, which will serve them throughout their lives—including during future pandemics. Without schools reopened, many people, such as your daughter and son-in-law, are essentially asked to choose between work and child care. Every option involves sacrifices.
The instinctive advice for any doctor or public-health official to give right now is to play it safe. Grandparents and other “high-risk” groups should avoid child care, because reopenings involve too many variables and unknowns. Schools have opened safely in other countries, but none had the degree of community spread that we currently have in much of the United States.
I don’t truly know what that advice means, though. Many families rely on elders to help with child care even in normal times. If you don’t take care of your grandson while he’s in Zoom school, your daughter and her husband will have a much harder time working. If people can’t work, they can’t make money. If they can’t make money, a kid might eventually not have a home from which to school.
In an ideal system, there would be child care for all who need it. As it is, we are dealing with the immediate conditions in the real world, where parents rely on extended family. Your grandkids stand to learn from your presence, and your family would surely appreciate it. So I do think you can justify helping with child care. It just needs to be done carefully.
Once kids are back in school—even one in a family, even part-time—they could carry the virus home to anyone else in the family. There is some evidence of an age gradient, meaning younger kids are less likely to be infectious than older kids. If that proves true, your 3-year-old granddaughter should pose a low risk of seeding an outbreak in your family. But we don’t know the exact odds.
For that reason, I’d recommend behaving as though your family bubble is no longer a bubble at all. Interact with your family at a distance outdoors or in well-ventilated spaces, masked when possible. (I hope this proves too cautious, and that widespread, rapid testing will mean this impersonal way of existing is temporary.)
You’re fortunate to live in Northern California, where the climate is temperate enough to spend a lot of time outside. We still do not have evidence of outdoor transmission happening at any significant scale. So if you have a yard or a patio or a porch with Wi-Fi, use it lavishly. Put out an umbrella or make your family build you a gazebo to compensate you for your time. If they refuse, settle for a pergola.
Even while outdoors, it’s ideal to wear masks and avoid getting too close, especially if you have to be with someone for six hours. Being in close proximity for a long time may mean that a person who is emitting only a small amount of the virus could end up exposing you to enough that you get infected. (It doesn’t help that kids tend to fidget and pull at their own masks, which in many cases are too big for them.)
When you must be indoors, choose a room that’s well ventilated and spacious. Keep windows open if possible. If it gets too cold, put on a sweater. If it gets too hot, use a window fan to help increase airflow. The goal is to dilute any virus that does make its way into the air. If you absolutely must be in a poorly ventilated space, purifiers with high-efficiency particulate air (HEPA) filters can add protection, cleaning the air like the water in a fish tank, so that no virus can linger for long.
These measures are still not being taken in many school districts where systemic ventilation overhauls are a budgetary fantasy. Many ventilation systems are old. Some classrooms have only one power outlet, and a mass deployment of air-purification units is limited by the building’s electrical grid. In cities such as New York, there is not enough space to have class outside. All of this is a concern not just to teachers, staff, and students, but to entire communities surrounding schools. As your situation shows, the convening of a preschool can alter the lives of grandparents. The exact degree of risk involved is nebulous without robust testing and tracing that could identify outbreaks to minimize the losses.
On a personal note, my mother is navigating a somewhat similar situation. She’s a retired elementary-school teacher. She spent her career working with kids who had fallen behind their peers in reading. This semester, the school system asked her to come out of retirement because they urgently needed a reading specialist. She reasoned that as long as the schools were going to be open, these kids were going to need help.
She teaches small numbers of kids, and they wear masks, or try to. Most of the school’s windows don’t open, including hers. I’m concerned for her. I also understand why she felt that she couldn’t leave these kids without a reading teacher. We’re all making compromises. The best we can do is be judicious in deciding which risks we take and vigilant in how we take them.