The Effects of Hygiene Standards Pre- and Post- COVID-19 Shutdown on Fever and Diarrhea Incidence in a Daycare

Background: One of the most broadly available forms of child care in the United States is a childcare program (CCP). Because of the nature of CCPs, children and their caregivers interact closely within confined spaces, creating op-portunities for infectious agent transmission. We hypothesized that a reduction in the room’s population density due to requirements related to the COVID-19 outbreak would lead to a reduction in incidence of disease symptom presentation. Methods: For this observational study, data were collected beginning in January 2018 and lasting until May 2021 from a university-run CCP. Searches of email communications between caregivers and parents were conducted to look for disease exposure notices and phrases related to enteric illness. Zero-inflated Poisson models were used to look for significant influences affecting incidence rates. Results: Our modeling found limited evidence for seasonality in fever and diarrhea incidence rates. However, there was significant evidence that an increase in attendance was associated with a decrease in fever and an increase in diarrhea incidence. The data also indicated lower fever incidence before the COVID-19 shutdown with an increase in fever incidence as time after shutdown increased. Conclusion: This study shows evidence of a relationship between rising attendance and increasing transmission events and begins to quantify the impact of CCPs on disease transmission in infants.