Everyone’s questions are different. You don’t need an answer. You need a way to decide. Framework below.
Key evidence-based issues: mitigate risk and evaluate risk. Mitigate risk: how can we do this activity as safely as possible? Evaluate risk: what is the actual risk of serious illness from doing this?
Grandparents: may be easier to mitigate risk (be creative), serious illness risk higher.
Child care: accept it is very hard to fully mitigate risk, but serious illness risk low.
3500 Words on Grandparents and Child Care
When I teased this last week, a very large number of you wrote to me to either (a) tell me you were excited that I would tell you what to do; or (b) ask could I please make sure to talk through the specifics of a particular situation. In light of these questions, I fear this post will disappoint.
I am not going to tell you what to do, and I cannot go through all of your individual questions. In fact, these points are closely linked. It is precisely because everyone’s considerations are different than I cannot tell you what to do. I could tell you what I did, but who cares? This is unlikely to be relevant unless your situation exactly mimics mine.
What I am going to do, instead, is try to talk through a way to think about any of these types of decisions — day care, camp, grandparents, babysitters, playdates, house cleaner, etc, etc — in the hopes that it can be broadly applied. The bottom line is that you do not need an answer. You need a way to decide.
Before we even get into how to decide, I would urge you to ask a first basic question: Do you need to make this decision now? A lot of you are writing to me with questions like: I am due to give birth in October and my parents want to see the baby; they live two hours away and could drive here. What should I do about seeing them? Unless there are other decisions that depend on this question, I would urge you to put it off, despite what may be daily calls from your parents pestering you. It is tempting to try to plan all eventualities, but this decision doesn’t have to be made now and you really cannot know what is going to be right in October.
The fact is, there are plenty of decisions you probably do need to make right now. And, for those, we can start with a framework.
We’re all struggling with slightly different questions. Should my parents visit from the next state? How about from next door? Camp is open in June, should my kids go? Should we have a play date with the neighbor’s children? In what way?
It will not be too surprising, given that I’m an economist, that I’m going to advocate a form of “compare risks and benefits.” But in this case that basic advice is far too vague. You need a framework, a system, something much more concrete. Here’s my system:
Frame the Question
You will notice that this starts not with risks and benefits, but with framing your question.
That is: you must start by figuring out what, precisely, you are considering doing and, just as important, asking what is the alternative? Many questions are in the space of: Should my kid return to day care when it opens next week? It’s very hard to answer this without knowing what the choice is. Is the alternative returning in two weeks? In September? Never? Getting a nanny? Quitting your job? You will have a much easier time making the choice if you are making a choice of A versus B (or A or B or C) rather than evaluating infinite possibilities.
Beginning with this kind of framing can sometimes reveal holes in your thinking. Sometimes you’ll end up framing the question as : Should we have our nanny come back now (option 1) or re-evaluate in 3 weeks (option 2)? This framing may force you to confront the question: What is likely to be different in 3 weeks? What am I expecting to learn? If you are waiting for a vaccine at the end of June, a quick perusal of the facts would tell you this isn’t realistic.
In addition, being specific about the question may reveal some mismatch in expectations across decision makers. If you see the alternative as seeing your parents now versus three weeks from now, and they see it as now versus when there is a vaccine, those are pretty different conversations.
I would venture that in at least some cases, framing the question alone may be enough to see the answer. If you ultimately decide the question is whether to see your parents for a socially distant visit this weekend or next weekend — i.e. if you decide you’re not waiting on a vaccine, or even waiting another month — that’s a pretty easy question to answer.
Once you’ve framed the question — and assuming that alone wasn’t enough to answer it — you do need to move on to risks and benefits. I’m going to argue that it makes sense to start this by first asking how you can mitigate risk. What is the safest way to do what you are considering? For this, I’d selfishly refer you to our COVID-Explained discussion of the path of the virus. If you understand better how this spreads, it may be easier to think creatively about avoidance.
Once you’ve done that, you can then think carefully about the actual risks (again, the risks assuming you do this as safely as possible). Here, I’d urge you to focus on the risks of serious illness. This is what we are trying to avoid. And then think about benefits. And then, finally, decide.
In the end, you’ll need to make all of these decisions knowing there is no way to be sure they are right, or wrong. That is the uncertainty that we need to accept to move forward.
It would be remiss to move on without talking about societal risks. I’m sure I will get pilloried for this post by suggesting people think only about their own families. And you shouldn’t: we want to think also about limiting virus spread outside of our families. You can do this, in part, by protecting your family directly. If none of you get sick, the virus doesn’t spread. Being careful in particular about people who might get seriously ill is important for saving hospital space.
But probably the most important thing you can do to limit viral spread is to be careful when you go out to wash your hands, to wear a mask and to socially distance.
So, that’s it. A five step process. Useful for any COVID-19 choice. But frameworks are best used with examples, so let’s talk through something that is on many of our minds: grandparents and child care.
Frame the Choice
Regardless of your specific grandparent question, it is imperative that you start by framing the choice. Your question might be: My parents live locally/within a couple of hours drive and we want to see them. Should we and in what way?
Think about these two possibilities.
Choice 1: we feel we must see them within the next month, so it’s either this weekend or three weekends from now.
Choice 2: It’s either this weekend, or we wait for a vaccine.
How you evaluate the risks and benefits depends really heavily on which of these choices you think you are in. And you may not all be on the same page about the choice you see yourselves making. Get on the same page first, and then figure out the options.
There are more and less safe way to get together. A key part of this choice is to figure out how you can best mitigate risk.
Here is the bottom line: There are a lot of ways to mitigate risk in particular situations.
Example: You are considering meeting your parents for a hike outside. You can make this as safe as possible by wearing masks and not touching each other. If you do this, the risk of spreading the virus even if one of you is infected is really, really, really small. Is it completely out of the question impossible? No. But it’s likely to be well, well within the risks that you have implicitly accepted by, say, driving to the hiking location.
Example: You are considering having your parents drive from their home two hours away to meet your newborn. If they are able to quarantine for two weeks and you are able to quarantine for two weeks and they drive up without stopping this would really, really mitigate the risk on both sides.
Some situations are harder. Let’s say your parents need to fly to see you. Being on airplanes and in transit entails risk to them, and then risk to you. But, still, there are things they can do. In transit: wear a mask and wash or sanitize frequently. Do not buy food or eat in the airport. When they arrive: is there a way to quarantine them even for a few days? Although official quarantine guidelines are 14 days, most infections seem to show up within the first five. Could they find an AirB&B for a couple of days before seeing you?
Or flip the visit. The air transit piece of this is the most risky. Given that the virus is less serious in younger people, it may make sense for you to travel rather than them, and perhaps quarantine briefly on the other end.
It is also worthwhile to think about the timing; this is part of the value to outlining the alternatives. Let’s say you imagine if camps open, your kids will go to them. They’ll be at higher risk of infection at that point than they are now. It may be safer to see your parents now, rather than in a month. If you feel you must see them sometime in the next few months, this should be part of the calculus.
Risk mitigation focuses on how you can structure this to make the risk as small as possible. The second step is to think about how large this risk really is in the best case scenario.
What do we mean by risk here? Well, I’d venture what you have in your mind is something like:
Chance Someone Infected X Chance of Spread X Chance of serious illness or death
That is: if you think about the risk to your dad of visiting, it really comes down to the possibility you’re infected, the risk of spreading it, and the risk that he becomes seriously ill. And you want to think about this risk for each person. There is a corresponding risk to your child from your parents visiting: the chance they are infected multiplied by the chance of spread to your child, multiplied by the chance your child will be seriously ill.
For me, this breakdown is useful because it allows me to think concretely about each of these items. I’m more likely to have my kids seem my in-laws now, in our quarantine state, because our current risk of infection is low. A distance hike is safer than having them in our house because of the very low risk of spread. If you live in a place with very low infection rates, that matters.
The last piece of the equation is probably the most complicated to think about: what is the risk to each person of getting the virus? Note that I’ve framed this as the risk of serious illness. The vast majority of people who get COVID-19 have mild or even asymptomatic illness. All else equal, we’d rather no one get sick at all, but I think when we talk about being really worried about seeing our families, we must be worried about serious illness, not about a cold.
We do not have a great sense of the actual COVID-19 risks. The available data is limited and is mostly from China. Many cases of COVID-19 are undetected, making it hard to estimate these numbers. So most of the numbers we see are likely too high; this includes the estimates below.
But what we do know is that serious illness and death varies tremendously by age. One set of estimates of infection fatality rate, from a recent Lancet paper, are below. The risk of death (and serious illness) in younger people is much smaller than in older people (it also seems to be lower in women). If your parents are in their early 60s, they are at much less risk than if they are in their late 80s. Your kids are at quite limited risk.
Again, these numbers are not very precise, and we also know that the risks depend on other factors, like underlying illness. This is part of why it is so useful to frame the question at the start. Even if you cannot be precise about the numbers, you may well be able to think about the relative size of the risks.
We have been so focused on risk in all our COVID-19 discussion that I think we sometimes forget the benefits to seeing others. Only you can really say what these are. The benefits might be practical: your parents could provide child care. They might be psychic, mental health related. Joy is a benefit! One of my colleagues has been isolating for two weeks so she can hold her newborn granddaughter for the first time. This joy: this is a real thing.
This virus has taken a huge mental health toll, one we probably are only beginning to recognize. It is possible — I would say even likely — that even if there is some risk to interactions, they are still worth it.
Compare Risks and Benefits, Decide.
It is not easy to compare “0.5% risk of serious illness versus joy.” But in the end, this is what you will have to do. Take a deep breath, look carefully at your risk and benefits, and make a choice. You cannot know if it is the right one, but there is no option not to choose.
In some ways, the day care/nanny choice is easier than the grandparent choice because the COVID-19 risks to children are small (not zero, small; see my many other writings on this). In other ways, it’s harder because risk mitigation is challenging. A socially distance hike is a very low risk activity. Day care is, even in the best situation, a medium risk activity. Having your nanny in your house entails exposure. If she has COVID-19, there is a good chance it will spread.
But you still need to choose. How to do it? Same approach, new considerations.
Frame the Choice
Your day care is opening next week. Should you send your kid back? Start with the frame: what is the alternative? Is it sending them in a month? Is it re-evaluating in two weeks (and what do you think will be different then?) Is it hiring a nanny? Is it your parents in with you?
Same issues come up with summer camp. If your kids do not go to camp this summer, what will they do? Will you need to hire a babysitter? Will you let them just run feral around the neighborhood (full disclosure this is 100% my plan, sorry neighbors).
Try hard to narrow your options: Should we do A or should we do B?
When it comes to child care, it is simply difficult to fully mitigate risk. We will move forward a lot faster if we recognize this. The CDC has issued guidelines for day care and camps, which I encourage you to read. They are pretty sensible — monitor kids for fever, do not allow sick children to attend, have staff stay home when sick, wash hands. You should make sure that your child care solution is following something like these guidelines.
But: children often have mild or asymptomatic COVID-19 infection. They also interact a lot. You cannot have a fully socially distant day care or young child camp. You can be more distant, more hand washing, more vigilant about illness. But you cannot get to a place that is like a socially distant grandparent hike.
I’d make a similar point about nannies. You can ask your nanny to wash his or her hands, and you can ask them to maintain social distance. You can learn more about their family situation, and think about whether there are ways to mitigate risk there. You can make sure she doesn’t come in when she’s sick. But: you cannot control what another adult does when they are not in your house. And, although people will disagree with this, I would argue that trying to regulate your babysitters behavior when he or she is not at your home is a recipe for a bad relationship.
None of this is to say that we cannot make risks smaller; you can. But unlike in the case of grandparents, where there are some basically no-risk options (wave to them across that backyard), there are no no-risk options here.
The risks here are the familiar COVID-19 ones. As above: you want to think about the chance of infection and the consequences of that infection. One piece of this is the risks for your children. Frankly, if your child is otherwise healthy, these are small. Yes, kids can get seriously ill, but it is very rare. Children seem less likely to be infected in general, and the infection tends to be more mild. I will not review all of the evidence on this here: see some explainers here and here.
This extends to very young children, although as with all illnesses infants may get sicker than older kids. And the risks seem to be roughly increasing with age, so teenagers are at slightly more risk than younger kids (but still very, very limited risk).
There are also risks to other people in your house — you, others who live with you (elderly parents?). Given the low infection rates in kids, there is some debate about how significant they are as a viral vector. I wrote about this here. The bulk of the evidence we have so far seems to point to children being a relatively limited source of infection, which is good, but it doesn’t mean they couldn’t in principle spread the virus. Just that that risk is small.
This school-camp-daycare calculus is different, I think, than the nanny calculus. Your nanny is in your house, and he or she is presumably an adult. If they are infected, they may pass the virus directly to you. It would make sense to incorporate this more directly.
To be completely honest: if you are healthy young-ish adults, with young children, the risks of exposure through day care, camp and school are likely to be small. They are not zero! Going out will entail risks. But this is a fundamentally different level than with elderly parents.
What are the benefits to having your child out of the house or taken care of by someone else? (Are they infinite? I think maybe).
These could include your ability to return to work, or work more effectively at home. They could include your mental health. They could include your children’s mental health, physical, emotional, social and intellectual development. They could include access to food, if your household is food insecure and food is provided at child care.
Exactly which benefits are relevant depend on the decision. A nanny or babysitter may help you return to work, but may not deliver as many social benefits.
Compare Risks and Benefits, Decide.
Again, this isn’t an easy comparison. You have to recognize you are taking some risk of illness if your child returns to day care or your nanny comes to your house. It’s also worth recognizing that for many families, this risk is probably small. And the benefits may be large (or they may not be!) Frame the choice, make the lists, decide.
There are so many others: dentist appointment, cleaning help, playdates, etc, etc. Try to approach them the same way. What is the question? What can you do to mitigate risk? How big is the risk really? What are the benefits?
And above all recognize: there is no easy way to make these choices. Most of us are going to have to leave our homes before there is a vaccine. We need to do so thoughtfully, and carefully, but for most of us - and for society - there is no choice to not make a choice.
No, Seriously, What Do you Do?
Yeah, yeah, okay. Even though I know I will be crucified, I will tell you.
Our nanny has continued to come; she works a half day. She lives alone and we have asked her to socially distance. I trust her, but do not police her behavior.
If camps open, I will send my kids.
We saw my parents, who are older, for a socially distant hike last weekend. We did not touch them and the adults wore masks.
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