Across North Carolina, 141 COVID-19 cases have been linked to child care centers in total, with more than half of the cases in children.
The first child care worker in North Carolina died from COVID-19 last week, and 19 facilities are labelled as COVID-19 clusters, meaning they have at least five cases, according to the North Carolina Department of Health and Human Services (NCDHHS).
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As the spread increases, some workers on the inside, like Susan Creary, are concerned.
"A lot us were concerned because with child care there is no real social distancing. I'm with toddlers, so I'm with these kids, they're in my face, I'm in their face and there's no real way for us to be that safe," Creary said.
Creary works at a child care center in the Triangle that her 4-year-old son also attends.
She said her center has taken some steps to combat the virus, but said she wasn't ready to come back to work.
"I was upset and scared. My son is at school with me and I don't have a choice but to bring him," Creary said. "My husband works overnight, and we don't have any other source of care, so I have to bring him to school with me. Whether he feels safe or not, mommy still has to go to work and I still have to bring him."
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Her situation is shared by many other first responders who need to return to work, but have no place but a child care center to watch their kids.
Creary said within in a week of her facility opening back up, an employee tested positive for COVID-19. Creary decided to get tested and quarantine. She tested negative and is back at work but still worried about the risks.
"Every day when I go to work, in the pit of my stomach I feel sick," she said.
The weight of the responsibility to keep both kids and staff safe weighs on Cassandra Brooks, who owns two child care centers in the Triangle.
"I tell everyone we're like a triage nurse in the beginning of the day, so we're a teacher part of the day but we're a triage nurse some part of the day," Brooks said.
Her Little Believer's Academy in Clayton has stayed open throughout the majority of the pandemic to service first responders' children.
Each morning her staff checks temperatures and asks questions about the child and family's health. Staff members wear masks throughout the day and regularly take kids' temperatures. Brooks bought air purifiers and other safety items but still, she said her center in Gardner had two positive cases.
"I hear many people talk about this as an invisible monster. This is an invisible in the sense that I felt like I did everything I was supposed to do at that school to ensure everyone's safety, but this individual was asymptomatic, no fever, nothing, like nothing. I would have never known," Brooks said.
She said immediately after finding out about the case, she alerted all parents, closed the facility and spent $2,000 of her savings to hire a deep cleaning company.
"I just really feel like some places that are just flipping back over--and I know you have to sometimes because of income, and don't get me wrong I get that businesses are trying to survive right now--but I feel like health and safety is more important because I don't want that on my heart and my mind if something happened to someone. I'd rather do the best I can possible to try to help someone," Brooks said.
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Brooks said she feels like her response helped the virus not spread and the center not become a 'COVID-19 cluster.' She admitted she is concerned about the impact of school starting, as her centers also care for school-aged kids.
Dr. Ibukunoluwa Akinboyo is a pediatric infectious disease specialist with Duke Health. She said kids are not immune to COVID-19, but so far it seems like younger children are not as likely to spread the virus.
"But I think we still have a lot more to learn about what happens when we put kids together," Akinboyo said.
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More than 15,000 cases of COVID-19 in North Carolina are linked to children under 17 years old.
Akinboyo said child care centers and other school settings can be doing things to be both open and minimize risks.
"When they are in the school, keeping classroom sizes small so the number of kids you are putting together are in smaller groups, cleaning all shared surfaces, shared toys, limiting shared equipment where you can and of course when appropriate having people wear masks particularly in indoor settings," she said.
Beyond taking initial precautions, Akinboyo said how centers react to a positive case can also make an impact. She said contacting the health department and helping with contract tracing are some of the top things centers should do.
However, decreasing the risk inside child care centers, she said, starts with steps taken at home and in the community to decrease the overall presence of the novel coronavirus.
If you're looking for a child care facility, be sure to check out their inspection history beforehand. Find out what violations centers received here.