As in the early phases of the COVID-19 pandemic, recent media accounts of the decisions again facing medical professionals are harrowing. Confronting concerns over shortages of intensive care beds, a worst-case scenario is playing out over the airwaves: Are doctors again being forced to make unfathomable decisions over who lives and who dies?

A somewhat similar scenario has been playing out for months for the nation’s top state early childhood officials, who face dire decisions regarding the survival of early-childhood programs in their states — programs that enable millions of Americans to participate in the workforce and their children to learn.

Far too many of our early childhood programs have gotten “sick” from the pandemic. Between mandated closures, limited group sizes, purchasing equipment and supplies to ensure a safe environment and parents’ ambivalence about returning their children to group-based programs, providers have suffered “life-threatening” fiscal setbacks.

Since most — with the exception of Head Start — are underwritten primarily by private tuition, their continued viability has relied heavily on the distribution of $3.5 billion in federal relief funds via the CARES Act. But with these dollars all but spent, and Congress and the Trump administration thus far unable to find common ground on an additional COVID-19 relief package, catastrophe is on the horizon. A recent survey by the National Association for the Education of Young Children (NAEYC) shows that 40% of programs are “certain they will close permanently without additional public assistance.” Among those programs trying to hold on, many of their leaders are maxing out credit cards to survive.

Beth Bye, commissioner of the Connecticut Office of Early Childhood, is spending hours communicating with directors of early-childhood programs. “They are on the brink of disaster,” she says. “Before now, it’s been something we all knew was coming. Now with the emails I am receiving, we know it’s here.”

The stories are heartbreaking. “I met with a director of five NAEYC Accredited programs. Only 25% of all programs in Connecticut reach this high level of quality. Two of this director’s programs are unlikely to make it. The hours of her already underpaid early childhood teachers have been cut 25%. This agency has supported children and families for 50 years.” 

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The necessary treatment is clear: Sufficient funding to build a bridge to the other side of the pandemic. Bye says, “I am not sure we have the capacity to save any programs without a new federal bailout.” Like her peers in similar positions of authority across the country, she has unearthed every state dollar possible and has been trying to figure out how to help those most likely to survive.

Who knew the job of being the top early-childhood official in a state would turn into trying to figure out which programs are viable, which programs can live and which must be left to die? How did we get here, especially when most of the governors these commissioners report to recognize that early childhood education is the backbone of their state’s economy and that child-care professionals are seen as part of the essential workforce? In 64% of American households with young children, both parents participate in the workforce. The negative consequences are affecting the workforce and the family.

As working parents try to manage work (at home or at their workplaces) and the care of their children, the situation is shortchanging everyone. For parents forced to juggle work and care, it’s a productivity challenge that extends the traditional workday. But for kids, the results are also suboptimal. The early years are a critical time for children’s development and learning, and we don’t have the luxury of pressing “pause” just because of the pandemic.  

The approaches of some local school districts — many of which began the year with virtual or hybrid approaches in the name of safety and as cases of COVID are expected to surge in the winter months — are exacerbating an already dire situation.

“The child-care field is already teetering on the brink of collapse,” notes Georgia Mjartan, Director of South Carolina First Steps, the state’s comprehensive school readiness initiative. “Yet here, amid diminished capacity, there seems to be a presumption in many communities that these programs will also enroll school-aged children and supervise their remote learning. This is completely unrealistic. Further, we need to be as concerned about the health and safety of these early-childhood teachers as we are about teachers of school-aged children.”

One cause of this crisis can be traced back to the misconception that early-childhood programs are distinct from schooling — with the former providing care that enables parents to work, but only the latter providing education. This notion neglects the fact that all learning takes place through relationships, which involve teachers caring for and about children, creating a sense of belonging and promoting learning that is challenging and meaningful. This is true whether the program serves young children or school-aged children.

Early learning is increasingly recognized as crucial. The brain is built from the bottom up, and 1 million new neural connections are formed every second in the young child’s life. The bottom line: For children, all environments are learning environments.

To keep early childhood officials from acting as ER doctors to a struggling — but essential — sector, states will require the resources necessary to prevent the permanent loss of child-care programs. The amounts dedicated to child care in current federal relief bills range from $15 billion to $50 billion, but until there is agreement on additional COVID-19 relief, a growing number of providers will find themselves in need of life support.