Bright Horizons spokesperson Kristen Raymaakers said the company began to reopen some centers starting in May, but declined to reveal how many of the company’s locations are currently operating.

Such precautions—physically separating children, personal protective equipment and sanitization—require money that many smaller providers say they don’t have. With states limiting enrollment sizes, it means less revenue coming in while paying for new safety measures. Some 70% of providers contend they are spending more every month—ranging from an additional $3,136 at large child-care centers to $500 or more at smaller family centers.

Some states have already distributed grants provided under the $3 trillion federal coronavirus bailout, money that was aimed at funding care for the children of essential workers, such as nurses and other health care professionals, while helping providers weather the pandemic. Alabama is offering grants to child-care providers that agree to reopen by Aug. 17, while Nebraska is giving priority to those that say they will reopen within 30 days, among other prerequisites. New York City is offering $65 million in grants to preschools and daycare centers that reopen by the end of this month.

But even if more aid comes from Congress in a second bailout currently being negotiated, it may not be enough—especially since the pandemic is expected to extend into 2021.

“The cost of child care under these conditions is probably going to be two or three times as much as you would expect under normal conditions, simply because you’re going to have fewer children in the program and fewer children per adult,” said Walter Gilliam, president of the board for Child Care Aware of America,  a nonprofit that advocates for high quality, affordable child care and provides resources for families and providers. The group is calling for $50 billion in additional federal funding.

But for parents, safety likely comes before money. Children age four and below make up 1.4% of all confirmed U.S. coronavirus infections, according to the Centers for Disease Control and Prevention, equaling more than 30,000 of known cases. Multiple studies have found that children typically have more mild symptoms from the virus than adults.

“Children might still have fever, cough, shortness of breath, sore throat, runny nose, muscle aches and headaches similar to adults, but not as many of them might have symptoms or they might be more mild,” said Anna Sick-Samuels, assistant professor of pediatric infectious diseases at Johns Hopkins School of Medicine, in an interview last month.

That does not mean, however, that children are immune or can’t pass the virus on to parents or child-care providers. The risk of transmission between children and adults is not yet known in the commercial child-care setting, Sick-Samuels said at the time.

Marcy Whitebook, founding director of the Center for the Study of Child Care Employment at the University of California, Berkeley, said providers are also weighing the risk of infection of their staff against the needs of families. With no national pandemic strategy, and different rules in different states, the decision on how to provide child care is being left up to individuals, she said.

Gilliam, who is also a professor of child psychiatry and psychology at Yale University’s Child Study Center, said the struggle to reopen child-care services safely—while critical to the economy so parents can work—is a conundrum, because the employees who provide child care will also be at risk. “When we neglect child-care providers, we neglect children,” he said.