A version of this article first appeared in Emily Oster’s newsletter, ParentData.
When I mentioned in my newsletter that I’d be covering the question of seeing grandparents and decisions about summer camp and child care, a very large number of readers wrote to me to either a) tell me they were excited that I would tell them what to do, or b) ask could I please make sure to talk through the specifics of a particular situation.
But I am not going to tell anyone what to do, and I cannot go through all of those individual questions. In fact, these points are closely linked: It is precisely because everyone’s considerations are different that I cannot tell anyone what to do.
What I can do, instead, is talk through a way to think about any of these types of decisions—day care, camp, grandparents, babysitters, play dates, house cleaners—in the hopes that it can be broadly applied. The bottom line is that you do not need an answer from me. You need a way to decide.
Before we even get into how to decide, I would urge you to ask: Do you need to make this decision now? A lot of parents are grappling with questions like: I am due to give birth in October and my parents want to see the baby; they live two hours away and could drive here. What should I do about seeing them? Unless there are other decisions that depend on this one, I would urge you to put it off, despite what may be daily calls from your parents pestering you. It is tempting to try to plan all eventualities, but this decision doesn’t have to be made now and you really cannot know what is going to be right in October.
On the other hand, there are plenty of decisions you probably do need to make right now. And, for those, we can start with a framework.
It will not be too surprising, given that I’m an economist, that I’m going to advocate a version of “compare risks and benefits.” But in this case that basic advice is far too vague. You need a framework, a system—something much more concrete. Here’s my system:
1. Frame the question
2. Mitigate risk
3. Evaluate risk
4. Evaluate benefits
You will notice that this starts not with risks and benefits, but with framing your question. That is, you must start by figuring out what, precisely, you are considering and, just as important, asking what the alternative is. Say you are wondering, Should my kid return to day care when it opens next week? It’s very hard to answer this without knowing what the choice is. Is the alternative returning in two weeks? In September? Never? Getting a nanny? Quitting your job? You will have a much easier time making the choice if you are making a choice of A versus B (or A versus B versus C) rather than trying to evaluate infinite possibilities.
Beginning with this kind of framing can sometimes reveal holes in your thinking. Let’s say you’re wondering, Should we have our nanny come back now? In framing the question, you may realize that the options are: Should we have our nanny come back now, or should we keep her on retainer and reevaluate in three weeks? Clarifying the framing there forces you to consider not the ultimate safety, or even risks and benefits, of your nanny coming back now; instead it leads you to: What is likely to be different in three weeks? If you are waiting for a vaccine at the end of June, a quick perusal of the facts will tell you this isn’t realistic. This may lead you to a decision or to reconsider your two choices, but either way it clarifies your thinking.
In addition, being specific about the question may reveal some mismatch in expectations across decision-makers. If you see the choice as between seeing your parents now versus three weeks from now, and they see it as now versus when there is a vaccine, those are pretty different conversations.
I would venture that in at least some cases, framing the question alone may be enough to see the answer. If you ultimately decide the question is whether to see your parents for a socially distant visit this weekend or next weekend—i.e., if you decide you’re not waiting on a vaccine, or even waiting another month—that’s a pretty easy question to answer.
But if the framing wasn’t enough to resolve the question, you next move on to risks and benefits. I’m going to argue that it makes sense to start this by first asking how you can mitigate risk so that the risks you’re weighing are as small as possible. What is the safest way to do what you are considering? For this, I’d refer you to our COVID Explained discussion of the path of the virus. If you understand better how this spreads, it may be easier to think creatively about avoidance.
Once you’ve done that, you can then think carefully about the actual risks (again, the risks assuming you do this as safely as possible), and then think about benefits. And then, finally, decide. There is no right or wrong answer—no decision is guaranteed to stop anyone from getting sick, and no decision will doom you. But with the hopeful safety of a vaccine possibly years away, we have to accept some uncertainty to move forward.
I would be remiss to move on without talking about societal risks. I am not suggesting that people think only about their own families in this decision-making. But one way to limit the spread of the virus outside your family is by protecting your family directly. If none of you gets sick, the virus doesn’t spread. Being careful in particular about people who might get seriously ill is important for saving hospital space.
But probably the most important thing you can do to limit viral spread is to be careful when you go out to wash your hands, to wear a mask, and to socially distance. And if you decide, working through this process, to not only wave distantly to your parents at a park but to merge your isolation bubbles, then be careful with that new bubble’s boundaries.
So that’s it. A five-step process. Useful for any COVID-19 choice. But frameworks are best used with examples, so let’s talk through something that is on many of our minds: grandparents.
Your question might be: My parents live locally or within a couple of hours’ drive, and we want to see them. Should we, and in what way?
This question could lead to very different decisions by way of framing. It could be: There’s no way we’re going a year without seeing them, so it’s either this weekend or three weekends from now. For someone else, it could be: Should we wait until a vaccine before we see them?
How you evaluate the risks and benefits depends heavily on which of these choices you are actually making. And the adults involved may not all be on the same page about the choice at hand. Get on the same page first, and then figure out the options.
Those options will depend on how you can mitigate risk. There are more and less safe ways to get together, and there are a lot of ways to make helping your parents see their grandchildren safer. Let’s say you’re considering getting your parents and your two school-age children together. You can make this as safe as possible by meeting outside—at a park or going for a hike together—and wearing masks and staying distant. If you do this, the risk of spreading the virus even if one of you is infected is really, really, really small. Is it completely out-of-the-question impossible? No. But it’s likely to be well within the risks that you have implicitly accepted by, say, driving to the hiking location.
Or maybe you’re giving birth soon and you’re deciding whether or not to have your parents drive from their home two hours away to meet your newborn. If they are able to quarantine for two weeks beforehand and so are you, and they drive up without stopping, this would really, really mitigate the risk on both sides.
Some situations are harder. Let’s say your parents would need to fly to see you. Being on airplanes and in transit entails risk to them, and then risk to you. But there are still things they can do. In transit: Wear a mask and wash or sanitize frequently. Do not buy food or eat in the airport. When they arrive: Is there a way to quarantine them even for a few days? Although official quarantine guidelines are 14 days, the median incubation period is five days. Could they self-isolate in an Airbnb for a few days before seeing you?
Or flip the visit. The air transit piece of this is the riskiest. Given that the virus is less serious in younger people, it may make sense for you to travel rather than them, quarantine ahead of time, and then perhaps quarantine briefly again after landing.
It is also worthwhile to think about the timing; this is part of the value to outlining the alternatives. Let’s say you imagine that if camps open, your kids will go to them. They’ll be at higher risk of infection at that point than they are now. In that case, it may be safer to see your parents now, rather than in a month. If you feel you must see them sometime in the next few months, this should be part of the calculus.
Mitigating risks means making the risk as small as possible, but there will always be some risk—otherwise these decisions would be easy. So the next step is to think about how large this risk really is in the best-case scenario.
You can think of that risk as:
[chance of someone infected] x [chance of spread] x [chance of serious illness or death]
It’s important to remember here that these chances are fractions or percentages, and when you multiply fractions by fractions, the result is smaller. If the chance of each of these conditions—infection, spread, and illness—were 1 in 10 (which is way higher than the actual value), the chance of your worst-case outcome would be 1 in 1,000.
So if you think about the risk to your dad of visiting, it really comes down to the possibility you’re infected, the risk of spreading it, and the risk that he becomes seriously ill. And you want to think about this risk for each person. There is a corresponding risk to your child from your parents visiting: the chance your parents are infected, multiplied by the chance of spread to your child, multiplied by the chance your child will be seriously ill.
For me, this breakdown is useful because it allows me to think concretely about each of these items. I’m more likely to have my kids see my in-laws now, in our quarantine state, because our current risk of infection is low. A distanced hike is safer than having them in our house because of the very low risk of spread. If you live in a place with very low infection rates, that matters. If the risk of serious infection is higher for someone in your family—because of age or health conditions—that matters too.
This last piece of the equation is probably the most complicated to think about: What is the risk to each person of getting the virus? Note that I’ve framed this as the risk of serious illness. The majority of people who get COVID-19 have mild or even asymptomatic illness. All else equal, we’d rather no one get sick at all, but I think when we talk about being really worried about seeing our families, we must be worried about serious illness.
We do not have a great sense of the actual COVID-19 risks. The available data is limited, and many cases of COVID-19 are undetected, making it hard to estimate these numbers. So most of the numbers we see are likely too high; this includes the estimates below.
But what we do know is that serious illness and death varies tremendously by age. One set of estimates of infection fatality rate comes from a recent Lancet paper. The risk of death (and serious illness) in younger people is much smaller than in older people (it also seems to be lower in women). If your parents are in their early 60s, they are at much less risk than if they are in their late 80s. Your kids are at quite limited risk.
These numbers are not very precise, and we also know that the risks depend on other factors, like underlying illness. But this is part of why it is so useful to frame the question at the start. Even if you cannot be precise about the numbers, you may well be able to think about the relative size of the risks.
But the risks are only half of the equation. We have been so focused on risk in all our COVID-19 discussion that I think we sometimes forget the benefits to seeing others. Only you can really say what these are. The benefits might be practical: Your parents could provide child care. They might be psychic, mental health–related. One of my colleagues has been isolating for two weeks so she can hold her newborn granddaughter for the first time. Joy is a benefit! This is a real thing.
This virus has taken a huge mental health toll, one we probably are only beginning to recognize. Circumstances that seemed bearable a week or two into social distancing may not be sustainable for months on end. It is possible—I would say even likely—that even if there is some risk to interactions, they are still worth it.
It is not easy to compare “0.5 percent risk of serious illness” to “joy.” But in the end, this is what you will have to do. Take a deep breath, look carefully at your risks and benefits, and make a choice.
When it comes to child care decisions, the same approach applies, with new considerations. A big difference is in risk mitigation: While you can make an extremely low-risk visit with grandparents (outdoors, masked, distanced), child care entails sustained, regular contact. The Centers for Disease Control and Prevention has issued guidelines for day cares and camps, which I encourage you to read. They are pretty sensible—monitor kids for fever, do not allow sick children to attend, have staff stay home when sick, wash hands. You should make sure that your child care solution is following something like these guidelines, though recognize that you cannot have a fully socially distant day care or camp—there will always be some risk.
I’d make a similar point about nannies. You can ask your nanny to wash her hands, and you can ask her to maintain social distance. You can learn more about her family situation and, if you have the choice, hire a nanny who lives alone rather than with other people. But you cannot control what another adult does when she is not in your house. (I would argue that trying to regulate a babysitter’s behavior when she is not at your home is a recipe for a bad relationship.) You can consider how you can mitigate the risks to your nanny or babysitter as well, such as by carefully limiting your family’s contact with other people. If you send one child to camp and another is cared for by a nanny, everyone’s risks are higher, including the risk to other people you may encounter at the supermarket or out in the world.
That leaves the benefits to consider. What are the benefits to having your child out of the house or taken care of by someone else? (Are they infinite? I think maybe.) They could include your ability to return to work or to work more effectively at home. They could include your mental health. They could include your children’s mental health and physical, emotional, social, and intellectual development. They could include access to food, if your household is food insecure and food is provided at child care.
None of these decisions is easy. And there are so many others: dentist appointments, cleaning help, play dates, etc. Try to approach them the same way: What is the question? What can you do to mitigate risk? How big is the risk really? What are the benefits?
Most of us are going to have to leave our homes before there is a vaccine. We need to do so thoughtfully, and carefully, but for most of us—and for society—there is no choice to not make a choice.