“Little did I know that was the beginning of our descent into hell with RSV,” Embrey, a literary manager with the Lincoln Center Theater, tells Fortune. What started off as seemingly a bit of the sniffles turned into a two-week ordeal, after which Embrey and her husband both caught cases of the respiratory syncytial virus (RSV) as well. 

“[My daughter] wouldn’t eat solid foods. We had to give her Pedialyte via a medicine dropper around the clock. It never got to the point that we had to go to an ER, but she was very, very sick,” Embrey says, adding that her father is a pediatric physician and so she turned to him for advice.

Thankfully, Embrey’s husband—a theater lighting designer—was between shows, so he was able to stay home with their daughter for a majority of the time. But Embrey still took off a day each week while her daughter was sick and worked remotely while dealing with her own case of RSV. Since early September, Embrey’s daughter has missed about 10 days of childcare because of illness; and Embrey and her husband have had to cobble together backup coverage, frequently calling out from their own jobs or trying to work from home. 

Like Embrey, many parents and childcare programs have spent the last three months weathering what experts are calling a “tripledemic” of the flu, RSV, and COVID infections that hit in late 2022—flooding ER waiting rooms with young children and keeping many others home sick. 

This surge is taking yet another toll on parents’ PTO and productivity at work, especially since many childcare centers have instituted stricter protocols and quarantine rules than they had pre-pandemic. The CDC, for example, still recommends those with symptomatic COVID-19 cases isolate for at least five days. But different states and municipalities have varying guidelines for childcare providers—and some centers may follow even more robust procedures than are mandatory. 

All of that adds up to working parents taking more time off of work—a lot of it unpaid. About 51,000 Americans officially missed work in December due to childcare issues, according to the Bureau of Labor Statistics’s latest report released Friday. That’s down from the record high of 104,000 childcare absences in October, but still above pre-pandemic levels. That doesn’t include the many parents who, like Embrey, worked remotely and during off hours to juggle their sick kids and job responsibilities. 

“We are not out of the woods yet,” says Michelle McCready, interim CEO of Child Care Aware of America. “Working parents, in particular, are really struggling to balance the demand of work and the needs of their children.”

The new reality for working parents? 

Professor and New York mother Alexandra Viau says she finally felt safe enough to enroll her child, who is now just over 2 years old, in daycare last spring. A day later, the center sent a notice that a child tested positive for COVID, so the classroom would close for 10 days. 

It’s essentially been a roller coaster ride ever since. The quarantine and isolation rules may have eased slightly when Viau’s son went back for fall semester, but she estimates he’s been out 40% of the time thanks to one bug after another. 

“It's basically been a never ending cycle of, he gets sick, and it lasts one or two weeks and then one of us gets sick and that lasts one or two weeks and then he's sick again. There's always someone sick,” Viau says. 

Viau, who works part-time, and her husband, a physician, have been able to avoid taking too much official time off—about four days so far over the past four months. And while she says the family has been lucky in the sense that childcare issues haven’t affected their ability to put food on the table or face pressures at work, the psychological and practical impact of the constant illness does add up.

There’s also a financial sting. The majority of childcare providers still require payment even if a child is home sick. So, many parents are stuck paying for a service that they can't fully utilize while also needing to take time off work—potentially losing money as a result. “It feels especially silly to be paying all this crazy amount of money. It's a whole salary that goes to these day cares,” Viau says. 

Embrey, on the other hand, says it helps that their family paid in advance for the semester, so she doesn’t do the mental math on how much sick time costs. “I kind of pretend those payments don’t exist,” she says with a laugh, adding that she thinks of childcare as an investment in her health, well-being, happiness, and career. 

“I love my job, I would be sad if I wasn’t working, so we just can't do the math on a regular basis,” Embrey says. “I've never done [the math on] what one day of daycare costs because I don't want to know. I would be tallying up those sick days…and money that has just been set on fire.”

Mothers, unsurprisingly, still are taking on a greater burden of care when schools and early childhood settings are closed or children need to stay home sick. More than half of women, at every level of the corporate ladder including senior management, say they’re responsible for most of their family’s housework and childcare tasks, according to the 2022 Women at Work study by LeanIn.Org and McKinsey & Company. 

That takes a toll. One in four women in corporate jobs reported they considered downshifting their careers and leaving the workforce altogether, according to Deloitte research. 

Childcare issues continue to keep Americans out of the workforce. About 4.2 million Americans reported they were not working as of November 2022 because they needed to care for children not in school or childcare, according to the Census’ Household Pulse Survey. The level of unemployment due to childcare has gone down since May 2020 when the Census Bureau began tracking this metric, but November’s rate still translates to about 7% of parents with children under age 18 out of work. 

To create more stability, McCready says, greater investments in childcare are required.

“We've seen incredible investment over the pandemic, that Congress did step up to ensure that childcare providers had what they needed,” she says. But while the more than $50 billion Congress approved in temporary stabilization grants and funds helped keep providers’ doors open, more is needed, particularly given that many childcare centers and in-home programs are facing more permanent increased operating costs and staff shortages. If more should be forced to close in 2023, it could mean greater scarcity, higher prices, and potentially even more parents leaving the workforce. 

But funding is only part of the issue. Childcare providers may have to shift the way they serve families amid remote work and more flexible working scenarios. 

“The hybrid working model actually makes it really difficult to find childcare,” says Jessica Ray, a senior product manager and mom to an 18-month old son. Despite living in Brooklyn, Ray’s son goes to daycare near her office at One World Trade Center in Manhattan. 

And that can present challenges. “It feels like one of those math problems from a textbook,” she says. “If we select a daycare near my office, it makes my husband's commute longer, and I have to commute in, do daycare drop-off, then commute back home again to start my workday. The daycare providers near our home have more restrictive hours, so if we select a daycare near home, we have to leave the office early to commute back on the super-reliable NYC subway system in time for a 5:30 pickup.” 

For Embrey, no childcare provider has been able to help the couple solve some of the biggest work challenges: extended work hours and navigating very strict COVID protocols that prevent them from bringing employees’ children to the theaters where they work. 

“There have been times, gaps between things, where I'm realizing I'm shelling out more than $200 so I can go to work for a day or for an evening,” Embrey says, adding that she and her husband utilize babysitters in the evenings because of a lack of center-based options with evening availability. 

This kind of “brave new normal of how we work” is likely going to require innovative solutions at the program level, McCready says. Providers that can offer more days and hours, as well as different options like in-home care for parents, may make more sense in the wake of this post-pandemic world. 

“It has kind of felt like we're still in survival mode—we've basically been in survival mode for two and a half years,” Viau says, adding she feels this is the new reality facing working parents. But then again, she says she doesn’t know anything else, having had her son during the pandemic.

 “It's hard for me to think whether this is pandemic-related or whether this is just what it's like to have a young child,” she says. “Being parents has become indistinguishable with being parents of young children in this crazy pandemic time.”