SARS-CoV-2 infections in day care centres in Germany: social, structural, and hygiene determinants for infection among children and staff in the second and third wave of the pandemic

Abstract

Background: During the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organized children’s attendance variably (i.e., reduced opening hours, emergency support for few children only or full close-down). Further, protection and hygiene measures like fixed children/staff groups, ventilation and surface disinfection were introduced among ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARSCoV-2 infections among children and staff of ECEC centres in light of social determinants (socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated). Methods: Based on panel data from a weekly online survey of ECEC centre managers (start August 2020, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV2 infections in children and staff using random-effect-withinbetween (REWB) panel models for count data in both waves. Results: Centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments among children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave. Conclusions: ECEC centres with a large proportion of children from a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Centres should be supported in maintaining recommended measures over the long run. Preventive measures such as vaccination of staff should be prioritised in centres with large proportions of low SES children.