Sometimes the State of Day Care is like a distant Third World country. It only gets into the paper when something has gone wrong there.

This time it was a study in the Journal of the American Medical Association pointing to child-care centers as a new source of infections and disease. An editorial in the same issue went so far as to warn that the hygiene situation in these centers is "reminiscent of the pre-sanitation days of the 17th century."

It took a few days for coolness to prevail as other doctors turned off the alarm. The increased risk of such diseases as dysentery and hepatitis, it turns out, are real, but small.

Following the course of this story, from the crisis to the calm, I noted how much attention we focus on the relatively minor problems germinating in the lives of those who do have access to day care. By comparison, we easily overlook the problems of those who don't have access.

I am not talking about the horror stories of children without care, although the Children's Defense Fund has collected some pretty grisly ones. There were the two children, 3 and 4 years old, left in a car in a plant parking lot in Wichita because their mother lost day care and was faced with losing work. There were also the children left alone in Michigan who set fire to the house.

I am referring this time to the big picture. As Helen Frank of the Children's Defense Fund says, "The story of day care is what's not going on."

There are currently 81/2 million children under 6 whose mothers are in the work force. These are numbers that have doubled in the past 20 years.

The Department of Health and Human Services says that in 1981, 1.9 million children were in small and large day-care centers and over 5 million were cared for privately in homes other than their own. But behind those neat figures is a rag-tag system of chance and chaos. As Blank notes, "We know that people are doing catch as catch can."

For those families who can afford day care, the issue is one of quality and caring. No one who has watched friends agonize about their decisions could read Deborah Fallows' careless observations in last week's Newsweek without a few gasps. Are these people, as she wrote, imparting a message that "working parents can buy a parent- substitute as easily as they can buy a frozen dinner"? Hardly.

But it's the poor, especially the working poor, who face an increasingly grim picture. In the past year, between the cuts in federal funding and state budgets, families have lost subsidies and centers have lost funds. The single largest day-care program, Title XX, was cut from $3.1 billion to $2.4 billion.

We are now witnessing what the National Council of Churches described in its study of church-related day care as the "gentrification" of day care. In many centers, the children of low-income families are being replaced by middle and upper-income families.

In Grand Rapids, for example, an inner- city center that had 55 low-income children a year ago, now has 31 children, none of whom is subsidized. In Wilmington, Del., a Salvation Army center has just about halved the proportion of children with Title XX subsidies.

What has happened to the low-income families? The CDF, which is preparing a report on the effects of day-care cuts, says that in Johnson County, Kan., 17 percent of the parents who lost day-care subsidies quit work, 10 percent of the children were in unlicensed day care, and 7 percent were in no day care at all.

Even the problems of day-care disease that figured so prominently in the news last week, especially with the call for better hygiene, are related to money. Many states with financial woes have increased the ratio of children to staff, and cut back on staff training and wages. The same states have slashed their own supervisory and licensing staffs. As Blank says, the medical concerns "aren't an excuse for limiting child care but for supporting the system."

Since the end of World War II, the day- care issue has been a pawn in the debate over whether mothers of young children should or shouldn't work. We have left each family to its own hassle.

Today, the economy has wiped out choices for millions of mothers. Should or shouldn't, they simply must work. By 1990 it's predicted that half of all the preschool children, or 11 million, will have mothers in the work force. Will we still be saying, "The story of day care is what's not going on"?