Examine COVID-19 Pandemic Patterns in Daycare Centers: How Access to Screening Matters

Background: The COVID-19 pandemic highlighted significant health disparities across the United States, with Texas ranking among the lowest in healthcare quality. This study explores the relationship between county-level factors and COVID-19 cases in Texas daycare centers. Unlike broader studies on COVID-19 disparities, this research uniquely examines the daycare population, a critical yet understudied environment, through county-level social determinants of health. Methods: Using 2020-2022 Covid data from the Texas Health & Human Services Commission and the 2020 County Health Rankings, we analyzed COVID-19 case counts among children and staff in licensed daycare facilities across 225 Texas counties. We classified counties into 4 patterns: high child-high staff, high child-low staff, low child-high staff, and low child-low staff. We also examined the association between county-level determinants and pandemic patterns. Results: Counties with higher COVID-19 cases in daycare centers have higher proportions of racial/ethnic minorities, but with better access to primary care physicians, better socioeconomic conditions (eg, % of children in poverty and median household income) and greater urbanization (P < .05). Spatial analysis of child and staff cases show the clustered transmission areas, in which southeastern counties with more Native Indians (1.48%) have a higher number of staff affected by COVID-19 than counties with fewer Native Indians (1.21%-1.26%). Conclusion: These findings underscore the influence of better access to screening on the COVID-19 counts, highlighting the importance of epidemiological surveillance. Improving healthcare access, addressing economic inequalities, and tailoring mitigation strategies are key to closing the gaps in different transmission rates among daycare centers.