Back to School with Diabetes Amidst the COVID-19 Variants

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

This article was published on August 13, 2021. As of Monday, August 23, the FDA has granted the Pfizer and BioNTech COVID-19 vaccine full approval for ages 16 and up, with the Emergency Use Authorization (EUA) still in effect for ages 12-15 and for booster doses for immunocompromised individuals. Full approval for other COVID-19 vaccines currently under EUA is expected soon.

While hopes were high that we could head back to school for the 2021 school year as though we were closer to “normal,” the development of COVID-19 variants amidst low vaccination rates has thrown a wrench in plans. But when kids need to get back to in-person schooling for quality of life, quality of learning, and socialization, how can we best keep them safe?

To help answer this and other questions about going back to school safely, JDRF—in collaboration with American Diabetes Association and Sansum Diabetes Research Institute—hosted a conversation with doctors and experts from the CDC, ADA, and the Fairfax County Health Department (Virginia).

Moderator Dr. Kristin Castorino, senior research physician at Sansum Diabetes Research Institute, kicked off the event with the most pressing question—is it even safe for students and their teachers who have diabetes to return to in person schooling, particularly for those under 12 who cannot be vaccinated yet?

“I’d change the question from ‘is it safe?’ to ‘is it appropriate?’ and I think it is,” answered Dr. Fran Kaufman, pediatric endocrinologist and chief medical officer at Senseonics. “There aren’t known answers as things change… but we need to get our kids back to school, not only for learning but for socialization.”

Dr. Kaufman stressed that the best way to make school safe is for everyone who can get vaccinated to do so. Dr. Christa-Marie Singleton, MD, MPH, senior medical advisor at the CDC later elaborated, “Vaccines protect folks against serious symptoms, hospitalization, and death. The best way to protect ourselves, our families, and our youngest people is for the adults and kids over the age of 12 around them to get vaccinated.”

“We also know about the importance of masking,” continued Dr. Kaufman. “It’s important to follow the CDC’s recommendation that all children and adults should be masked in the indoor school environment.”

What About the Legal Rights of Kids With Diabetes?

Particularly as some states ban school districts from being able to require masks in indoor learning environments, what legal protections do kids with diabetes have to stay safe in school? Crystal Woodward, MPS, director of the ADA’s Safe at School campaign, stressed “the rights of students with diabetes do not go away during a pandemic. They have legal protections under federal and state laws. Those accommodations may look a little different, but they do not go away.”

Similarly to how the Americans with Disabilities Act protects people with diabetes in the workplace, section 504 of The Rehabilitation Act protects the education of children with disabilities like diabetes. This law allows children with diabetes and their families to create what are known as 504 plans, which clearly outline agreed upon accommodations for students with disabilities at school.

While parents cannot dictate the actions of other students, they can include directives for their own children to stay safer from COVID-19 in 504 Plans, like instructions that their student must always wear a mask or will need extra physical distance in a classroom setting.

“It’s imperative that [children with diabetes] have a section 504 plan,” Crystal explained. “Everyone needs to be clear on what accommodations will be provided and by whom, like the student having the ability to take an exam at an alternate time if blood glucose levels are out of range during the scheduled test time.” Ensuring the student also knows what is in their own 504 plan can help them feel more empowered and comfortable asking for what they need.

For distance learning, 504 plans can dictate that children with diabetes can take snack or meal breaks at times best for the student, or have an agreed upon communication method with the teacher if the student needs to take a break to attend to a low or high blood sugar.

“Bottom line: the rights of students do not go away,” Crystal reiterated. “Students with diabetes and their families should work with schools and everyone needs to understand their role and responsibilities, and the plan should be updated as needed. It’s always better to get it in writing. Put the 504 plan in place while everything is going well—you never know if a principal or a nurse or a teacher is going to be there throughout the year.” Panel members stressed that families who don’t speak English, particularly in public schools, have a legal right to translators who can help establish 504 plans.

Jacqueline McManemin, RN, BSN, certified diabetes education and care specialist (CDECS) and assistant nurse manager for the health services division of Fairfax County Health Department in Virginia, spoke about what they’re continuing to do in their school district (one of the 15 largest in the nation) to keep students safe. “Parents should expect to see much of the same precautions this year that were in place last year. Particularly when students are inside, they should be masked.”

School administrators across the country can work to make schools more safe for all children, particularly those with chronic illnesses like asthma and diabetes, by putting in protective measures like establishing two different health clinics—one for people exhibiting symptoms of COVID-19 or other communicable illnesses and a separate clinic for routine care and injury treatment.  Meals can be eaten outside as weather permits and student interaction in hallways can be minimized by teachers rotating between classrooms rather than groups of students switching classrooms every period. Protocol also needs to be clearly communicated with all staff and parents about what to do if a student starts showing symptoms of COVID-19 while at school.

Getting Kids Mentally Ready for in-Person School

Back to school doesn’t just mean a change of location, it’s a change in schedules, types of interaction and stimulation, and levels of distraction that can also impact diabetes care. Psychologist Cynthia E. Muñoz, PhD, MPH, assistant professor of clinical pediatrics at the University of Southern California’s Keck School of Medicine and president of healthcare and education for the American Diabetes Association, reminded the community that the impact of the pandemic on each individual has been unique and therefore approaches to regain a sense of normalcy must be unique too.

“For parents and guardians, be aware of how you’ve been impacted. Seek support, through family, through primary care, through a therapist. Find ways to talk about your fears or concerns,” encouraged Dr. Muñoz. She went on to suggest ways to get kids mentally and physically ready for school again.

“Now that schools are starting to open, it’s time to start looking at sleep schedules, screen time, and start shifting routines and schedules to get children ready for the new routine,” she noted. “Many people watch a lot of content on social media or television—not just kids, everyone—but it’s a passive interaction with others. Shifting to a more active form of communication with others can be another way to help people ease into the change of a lot more interaction than people have had in the last year or so.”

Helping Kids Who Feel Singled Out

Kids with diabetes often deal with feelings of being the odd kid out, having to visit the school nurse, having to deal with special routines. When COVID-19 is added, kids with diabetes may feel like they’re the only ones taking special precautions, which can be additionally isolating. How can parents help children dealing with these feelings?

“I like to approach this question around the concept of support, building layers of support around the student,” Dr. Muñoz explained. “One level should be ensuring that someone at the school should know that the child has diabetes and knows what kind of support they need. Another category is who could know [the student has diabetes], but doesn’t necessarily have to, like friends. For the student with diabetes, getting support from a friend or classmate they trust could go a long way. If the student feels like they’re going to be the only one wearing a mask, they can ask a friend to wear it with them.”

“I think it’s important for adults to be sensitive to this,” Dr. Muñoz continued. “Saying “everyone has something different” might minimize how a student feels. Acknowledging their feelings and taking the time to ask them what will help goes a long way.”

To get advice from other parents and guardians or to help your student with diabetes find other kids who understand, be sure to join the Beyond Type 1 community.

Learn more about the JDRF – Beyond Type 1 Alliance here.

You Can Watch the Entire Conversation Here:

Source: diabetesdaily.com

A Parent’s Concern: COVID-19 and the School Year

This content originally appeared on Beyond Type 1. Republished with permission.

By Eugenia Araiza/Mariana Gomez

COVID-19 has brought many challenges and struggles to our daily lives. From the beginning we have adopted new habits in order to adapt to this new normal and this new dynamic and way of life certainly includes our environment and our children.

In the case of children with diabetes, the school environment alone already entails interesting challenges that, although they can be solved through teamwork and diabetes education, are scenarios that require some preparation to face.

The new normal includes concerns the caregivers have about going back to school and, although we look forward to that day, we also analyze the risks that it could represent in a population that a lot of the literature considers “vulnerable”.

In our groups and communities in Latin America, we have a similar opinion and we are pleased to see that the community has gotten to work and has quickly become familiarized with #BigLittleChanges that will help slow the spread of the virus. We know as a fact that social distancing, among other things, is one of the key pillars, but… what will happen when school begins?

We approached members of the type 1 Diabetes Community from Spanish-speaking families to ask their opinion. This is what we found.

About Going Back to School in August

“August seems too soon for in-person classes, it honestly scares me!” Esther shared with us, who thinks the same as Francisco who added “in my opinion, I do not think it can be possible because we are at a very critical point in the pandemic.”

In countries like Mexico, the rules will depend on the school system (public or private) and even on the state and region. In some schools there will be three options for returning to school: in-person, online or hybrid methodology that involves separating the groups to avoid having several children in a classroom alternating the days of in-person and online education.

Viridiana, Zuri’s mother said, “As Zuri’s mother, who lives with type 1 diabetes, I still do not feel it is safe for her to go back to school and I think that many moms are going through the same thing, the uncertainty of not knowing what will happen in the upcoming school year.”

The British Society of Pediatric Endocrinology and Diabetes States:

  1. Clinically extremely vulnerable children are to remain shielded and not to return to school, even if their year group has.
  2. Clinically vulnerable children who are only under the care of primary care are overwhelmingly likely to benefit from returning to school when their year group does.
  3. Clinically vulnerable children, who are under secondary or specialist care for an underlying health condition are, on the balance of probabilities, more likely to benefit from returning to school when their year group does so. These families may need a conversation with their medical teams to balance the potential risks and any anxiety among family members.
  4. All other children should attend school when their year group returns.

The New Normal and School

Among concerned parents, there has been talk about three options for returning to school: in-person, online or hybrid methodology that involves separating the groups to avoid having several children in a classroom alternating the days of in-person and online education.

Marcela told us “we still have not heard anything about when school will begin, personally I am stressed out about my son returning to school and whether they will take the necessary measures to avoid infections, hopefully, some students will attend some days and others online to be incorporated gradually like some people are saying.”

Others like Cloe have been preparing a little ahead of time and have talked with the principals and those in charge of the schools to let them know the family’s concerns regarding their child’s diabetes, the care and risks that it would involve, to which the teacher responded “This is a situation in which many of us agree because the most important thing is the health of our little ones. The authorities have mentioned that we will be able to make exceptions when school starts. Do not worry, when the time comes, we can explore options, you have my full support.”

In Mexico, the Aprende en Casa program used five means for teaching, among them, free textbooks in digital and printed format, which include the basis of all the expected learning and programs disseminated in several digital outlets, including free-to-air and cable television channels, radio and printed and digital materials.

The Parents’ Conditions

When asked about the requirements they have as parents to send their children to school, Yahaira said “I do not have any because at this moment I think that if it is in-person, my child will not go to school” while Mónica said “I would require them to supervise the students so they have no contact with each other, and they should be very clear about social distance”.

Apparently, all this causes great uncertainty because of a lack of assertive communication in many of our countries by the educational authorities and, as Adriana says “I would like to know all the measures that would be taken when school starts, but so far there is nothing clear enough so that parents and also children and teenagers with diabetes can sit, think, and make clear decisions so they can all feel safe and calm.”

Gaby, like many other participants, told us that she would prefer a hybrid system since “personally, I think my daughter would be affected if she stays at home any longer, she is at an age in which she tends to get depressed, and to stay up late talking to friends she has not seen in months. Now she has to start at a new school, it would be good for her not to spend so much time at home and go back to school with the appropriate care.”

The Opinion of Children and Teenagers Living With Diabetes on Going Back to School

Fer tells us that she wants to return and that “she would always have to have her face mask on, carry hand sanitizer, she would not hug her friends and keep her distance”. Ian cannot wait to go back, and it is very difficult for Mónica, his mother, not to send him. The same happens with Damián who wants to go back to school and see his friends. However, Matteo knows for sure that he does not want to return.

Zuri, who is 10 years old, tells us “I am very afraid of catching it and having complications with my diabetes.” 11-year-old Pablo says: “I will not go back until there is a vaccine.” Mali, who is 13 years old, is the one who shows the most concern on the subject and says just the thought of being surrounded by children and teachers scares her.

The Official Positions

Sadly, up to the date this article was published, we have not found any information from school authorities or medical societies for our countries in Latin America.

However, on May 20th the Official Position of the Association of Children’s Diabetes Clinicians (ADC) was published, emphasizing the lack of evidence to suggest that children with diabetes are more vulnerable to get the virus than other children, and parents of children with diabetes are called upon to reinforce safety measures such as hand washing and social distancing.

At the beginning of the statement, it says children with diabetes can return to the school environment as long as protective measures are taken. According to the documents, parents should consider whether the children will be able to keep their distance from their classmates, and if someone at home has a greater risk of contracting the virus. In addition, there are other factors that should be considered. Are parents capable of providing quality education from home? Will this distancing have any negative consequences on their development and emotional well-being?

Here are some safety protocols that will be implemented in different countries that you may be able to discuss with your educational authorities if you are a caregiver to a child with diabetes

  • Placement of students by age group: students will attend school in groups or age groups.
  • Students will not interact with other students outside of their age group.
  • A temperature check will be conducted each day before students enter the premises.
  • All staff will wear face shields.
  • Students will have many opportunities to wash their hands daily.
  • Handwashing stations will be created around the premises.
  • Students will not share supplies and materials.
  • Students will be seated at a safe distance from each other.
  • Teachers will be provided with safe cleaning supplies for students to use throughout the day.

Some Conclusions

Viridiana García, Zuri’s mother, perhaps represented what many of us thought and could not put into words “I think that, at the moment, there is nothing more important than the health of our children, and if we weigh the health of our children against their education, their health seems more important. We should remember that nothing is forever, and these moments of crisis will sooner or later pass and we will have time to recover in all aspects.”

While all this goes through the minds of the parents, a question arises, how long are we going to be able to keep the children out of the new normal?

(We would like to thank Viridiana García, Zuri’s mother, for sharing the protocols of her school with us)

About the Authors

Eugenia Araiza Eugenia has a Degree in Nutrition specialized in Diabetes and she is a Diabetes Educator. She was diagnosed with type 1 diabetes 25 years ago, she is the creator of Healthy Diabetes. She really enjoys studying and helping others in managing their different types of diabetes. She loves studying, managing type 1 diabetes, and nutrition. She especially enjoys writing about the impact diabetes has in her life. She lives surrounded by the love of her family, Luis Felipe, who lives with LADA type diabetes and her teenage son, Indigo.

Mariana Gómez Mariana is a Psychologist and Diabetes Educator. She was diagnosed with type 1 diabetes in the summer of 1985. In 2008, Mariana started a blog where she shares her life experience and topics related to living with diabetes and emotional health with others. Mariana worked with the Mexican Diabetes Federation until 2012 and today she is Director of Emerging Markets for Beyond Type 1. She is the mother of a teenager.

For more information on what you can do to protect yourself and others, visit coronavirusdiabetes.org and share the #BigLittleChanges you are making.

Source: diabetesdaily.com

Should My Child with Type 1 Diabetes Go Back to School During COVID-19?

As summer draws to a close, parents and families affected by type 1 diabetes have been plagued with the question of whether or not to send their children back to school during the time of COVID-19.

Earlier this summer, a report from the NHS was released showing that people with diabetes, especially type 1 diabetes, face significantly higher risk for both complications and death from COVID-19. This study sent shockwaves through the diabetes community, and has left many families with many unanswered questions. Should parents send their children to school and risk contracting the virus? Should families keep their children home, and attempt home-school? Is there a middle ground to help mitigate risk and viral transmission, while still enabling our children to learn well? What critical social and psychological developments would a child miss out on, should they stay out of school for a year, or two, or three? What complications would be prevented if they dodged the coronavirus (and the social ridicule of 7th grade) completely?

There is no national consensus: the President wants schools to reopen. Many colleges and universities are either going completely online, or attempting a sort of hybrid (half online, half in-person) schedule. The Centers for Disease Control and Prevention recently changed its guidance, to better adhere to the Administration’s wishes. Throughout the United States, the issue of schools reopening has largely been left up to the school district to decide, and that can be based largely on city and state politics. The decision is further complicated for families with children with diabetes, because although a type 1 patient’s risk may be higher, it’s been previously noted that most children, should they contract COVID-19, have milder cases and many do not even show symptoms. Keeping a child with diabetes home this fall risks to further ostracize and isolate them. So, how can you make the best decision for this upcoming school year?

If anything, the United States has had the benefit of time throughout the pandemic. The origins of the virus came from Wuhan, China, and Americans watched the epidemic play out and spread throughout Asia and Europe from the comfort of their homes for most of the winter. The United States had nearly 3 months to fully prepare, and the same goes for schools reopening. Many schools throughout Asia and Europe have reopened (with safety precautions) with some success and no community spread. However, no country has had as many live and active case counts as the United States when trying to reopen schools.

Although the risk of returning to school is great, sometimes the social and psychological repercussions are greater: many children have reported an increase in anxiety and depression since the pandemic started; being trapped in homes with domestic violence and abuse wreak havoc on mental health and well-being, and many families living close to the poverty line rely on the daily, free breakfast and lunch programs to help feed their family throughout the school year. Shockingly, 114,000 students in the New York City public school system are homeless; they rely on the warmth and shelter of going to school every day to get by.

Photo credit: Adobe Stock

Many families do not have enough (or any) computers at home for remote schooling, and nearly 19 million Americans do not have high speed, broadband internet at home, making remote, teacher-led learning all but impossible. Additionally, having children at home all day often requires a parent to be home, too, and many essential jobs and low-wage workers do not have the option to work from home temporarily or indefinitely. Juggling child care and work has become a critical issue for parents navigating the effects of the pandemic on their families. Furthermore, children need to socialize with other kids their age, and learn to develop social networks for support. Taking that away can and will have lasting detrimental effects.

On the other hand, given the current state of affairs and the rate at which the virus is spreading throughout the United States, children with diabetes face significantly higher risk of exposure and contraction (and complications and even death) should they return to school full-time, for in-person learning. Putting a child at unnecessary risk, in the middle of a pandemic, seems shortsighted and myopic.

Some encouraging research in the midst of turmoil: nearly half of those with type 1 diabetes who contract COVID-19 have managed to treat the virus at home, although hyperglycemia and DKA are common.

Unfortunately, lacking any national guidance for families with children with preexisting conditions like type 1 diabetes, the decision is a personal one. Considerations include your child’s age and ability to self-manage, their mental well-being and ability to cope without friends or in-person learning, your state’s COVID-19 stats and rate of viral decline/increase, and your personal feelings of safety and security with your school’s precautions in regards to COVID-19 risk mitigation. National diabetes organizations have recently released information for returning to school and general COVID-19 guidance, and a town hall was recently held to help parents navigate the decision process.

In closing, any decision you make about your child’s learning needs to be based on your personal circumstances and how comfortable you are with either remote or in-person learning. Reach out to your school’s administrators to see what their plans are for mitigating virus spread this fall: are they limiting class sizes, mandating social distancing, placing hand sanitizers and handwashing stations throughout the school, and requiring masks? Or do you feel your school isn’t doing enough, and you’re willing and able to assist your child in a remote learning situation, where they see other children occasionally for social support? Discuss your concerns and questions with your pediatrician and/or endocrinologist and get their recommendations. Do you have an essential job, where you cannot be home during the day, and you need the school infrastructure for support? Or do you feel overwhelmed with the high risk factor that is type 1 diabetes, and you’re leaning towards homeschooling until there’s a vaccine? There are no perfect decisions here: guilt should not drive your decision. Go with your gut, and what works for your individual situation, and it’ll lead you in the right direction.

Are you navigating back to school (or not!) with your child? What decision has best-suited your family? Share this post and your thoughts below! We love hearing from our readers.

Source: diabetesdaily.com

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