Healthcare worker absenteeism, child care costs, and COVID-19 school closures: a simulation analysis

Elizabeth T Chin; Benjamin Q Huynh; Nathan C Lo; Trevor Hastie; Sanjay Basu

Our models estimated generally high rates of unmet child care needs across different assumptions (> 7%), and our transmission models projected reduced peak ICU bed demand from school closures. However, since it is highly likely that hospitalizations and ICU bed demand would still far exceed bed capacity for many hospitals 26 despite the effectiveness of school closures, we observe a need for an intervention to reduce absenteeism in the event of school closures. Because we observed large variance of our estimates between counties for all of our county-level analyses, identifying needs and interventions at the county-level is likely to be more effective at mitigating harm than a nation-or state-wide strategy. Our regression analysis estimated that counties with higher percentages of diabetes prevalence, rurality, and Black/Hispanic populations would also have higher rates of unmet child care needs from school closures. Early data have shown that patients with diabetes have higher COVID-19 mortality rates 6 , and that African Americans are disproportionately represented in COVID-19 death counts. 2 Furthermore, rural counties are more likely to lack adequate hospital capacity than urban counties. 33 Without a way to mitigate absenteeism, counties that are likely to be most vulnerable to COVID-19 are also estimated to be more vulnerable to absenteeism from school closures, illustrating exacerbated geographic disparities in the absence of adequate child care. 2 To identify a potential approach to reducing absenteeism, we estimated that a majority of counties (71.1% to 98.8%) could save money by providing child care to their healthcare workers with children in the event of a school closure (ω > 1). Although it is likely that many child care avenues would also be closed in the event of school closures, subsidized child care costs could still prevent absenteeism by (1) incentivizing work attendance with extra wages, and (2) alleviating the financial burden on the entire household, enabling other family or household members to participate in child care.