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Whitaker RC, Herman AN, Dearth-Wesley T. Death From COVID-19 as Context for Early Childhood Education. JAMA Pediatr. 2021;175(11):1176–1178. doi:10.1001/jamapediatrics.2021.2348
During the COVID-19 pandemic, preschool-aged children have garnered less attention than older children. The pandemic may affect preschoolers through its effects on the early childhood education (ECE) professionals who teach them. We describe the prevalence of COVID-19–associated deaths among family members and close friends of ECE professionals. These data may reflect the socioeconomic and health inequities experienced by the ECE workforce. These inequities were present before the pandemic,1,2 may have been exacerbated by it, and affect the quality of education children receive.
Between March 24 and April 12, 2021, an online survey was administered to ECE professionals in Pennsylvania before an online course about developmental trauma. Consent was obtained online, and those completing the survey were given a $20 gift card. The study was approved by the Mary Imogene Bassett Hospital Institutional Review Board.
Participants were asked if they had “a family member or close friend” who had died of COVID-19. They were also asked (with response options of yes or no) whether, in the prior year, they “had any serious ongoing stress at work—things like consistently extreme work demands, major changes, or uncertainties that most people would consider highly stressful.” We assessed 5 areas of economic hardship during the prior year, asking participants if they (1) received Supplemental Nutrition Assistance Program benefits (food); (2) did not have enough money to provide adequate shelter or housing for themselves or their family (housing); (3) did not pay the full amount of the gas, oil, or electricity bills (utilities); (4) did not have enough money to pay for health care and/or medicine for themselves or their family (health care); and (5) currently worked at another (second) job for pay (income). Participants self-reported on their gender identity, race, ethnicity,3 age, and education level. We used a significance threshold of P < .05 (2 sided) and conducted statistical analyses using Stata/MP version 15.1 (StataCorp).
Of the 265 individuals who were administered the survey, 246 (92.8%) completed it. Most participants self-identified as female (233 [94.7%]) and either non-Hispanic White (129 [53.5%]) or non-Hispanic Black (87 [36.1%]). Approximately 40% (n = 101) were 50 years or older, and most (172 [69.9%]) had a bachelor or graduate degree. The death of a family member or close friend due to COVID-19 was reported by 76 individuals (30.9%). Serious stress at work in the prior year was reported by 181 (77.0%).
The prevalence of economic hardships was as follows: food, 10.2% (95% CI, 6.4%-14.0%); housing, 13.5% (95% CI, 9.2%-17.7%); utilities, 26.8% (95% CI, 21.3%-32.4%); health care, 24.1% (95% CI, 18.7%-29.4%); and income, 17.5% (95% CI, 12.7%-22.2%). At least 1 economic hardship was reported by 52.3% (95% CI, 46.0%-58.5%) and 2 or more by 24.3% (95% CI, 18.9%-29.7%). The prevalence of having a family member or close friend who had died of COVID-19 was highest among ECE professionals who identified with racial and ethnic groups other than non-Hispanic White (non-Hispanic White individuals, 21.7% [95% CI, 14.6%-28.8%]; non-Hispanic Black individuals, 41.4% [95% CI, 31.0%-51.7%]; non-Hispanic individuals of other races, 41.7% [95% CI, 13.8%-69.6%]; Hispanic individuals, 38.5% [95% CI, 12.0%-64.9%]; Table). The prevalence of COVID-19 death in a family member or close friend was also higher among ECE professionals who reported 1 or more economic hardships (36.2% [95% CI, 27.9%-44.6%]) than among those who reported no hardships (25.9% [95% CI, 17.9%-33.8%]).
These data, collected a year after the onset of the COVID-19 pandemic, demonstrate the outcomes of COVID-19 on the ECE workforce. Our findings are limited by the use of a convenience sample and lack information about COVID-19 infections in the ECE professionals themselves.
The disproportionate burden of COVID-19 deaths has been on those who are the most socioeconomically disadvantaged or do not identify as non-Hispanic White individuals,4 and this same pattern is reflected among ECE professionals. The ECE professionals who reported COVID-19 deaths may experience ongoing grief from these losses. This adds to their already high levels of workplace stress, which can affect the quality of their relationships with children and their families.5 These deaths also add to and could worsen the ongoing economic hardships experienced by many ECE professionals.1,5
For children to learn well, the ECE professionals who teach them must be well. At a minimum, staff wellness requires wages and health care access commensurate with the respect and attention these essential frontline workers6 deserve for their commitment to their profession and their role in young children’s lives.
Accepted for Publication: May 25, 2021.
Published Online: August 2, 2021. doi:10.1001/jamapediatrics.2021.2348
Corresponding Author: Robert C. Whitaker, MD, MPH, Bassett Medical Center, 1 Atwell Rd, Cooperstown, NY 13326 (email@example.com).
Author Contributions: Dr Whitaker had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Whitaker.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Whitaker.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Whitaker, Dearth-Wesley.
Obtained funding: Whitaker.
Administrative, technical, or material support: Whitaker, Herman.
Conflict of Interest Disclosures: Drs Whitaker, Herman, and Dearth-Wesley reported grants from First Up (grant 210001) during the conduct of the study and United Way of Greater Philadelphia and Southern New Jersey (grant 17958) outside the submitted work.
Funding/Support: This study was supported by First Up (grant 210001).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.