July 17, 2020
By Craig Escude, MD, FAAFP, FAADM

Many parents of children, with or without disabilities, are wondering about whether or not their kids should go back to group school settings in the fall. With the numbers of cases of COVID-19 on the rise, that’s a valid concern. One of the biggest problems with making this decision is the lack of hard evidence as to the risks and benefits of either choice. Uncertainty creates fear, and fear creates anxiety. If only we had a crystal ball and could predict the future!

What do we know about COVID-19?

• COVID-19 is easily spread to others.
• At the time of the writing of this article, while the number of total cases has been on the rise, the number of deaths has been declining.
• People with disabilities (such as kids with cognitive disabilities) are potentially at greater risk of serious illness and death should they get a COVID-19 infection.
• The risk of death varies greatly depending on the presence of co-occurring health conditions like lung disease, diabetes, immune deficiencies and others.
• It’s uncertain when a vaccine will be available.
• When a vaccine is available, it’s unclear how effective it will be at preventing illness or how long the immunity will last.
• There are negative effects associated with social distancing and isolation, as well.

How to decide if it’s safe to return to school?

Carefully weighing the risks and benefits to any choice is the best way to make a decision on what path to take. The weight of different factors will be different for each child and parent. Here are a few things to consider when deciding what to do:

1. List the reasons why you think your child should return to school (or other activity). Reasons may include furthering educational goals, socializing with others, lack of daytime supervision, etc. This may seem like a silly question, but it’s important that we have good reasons WHY we do something, not just because it’s what everybody’s always done.
2. Is the activity available in a virtual environment? Can your child attend school through an online platform?
3. Evaluate the current level of infection in your local community.
4. Evaluate whether or not your child can comply with currently recommended protective measures. (Can they wear a mask, keep social distancing guidelines and wash or sanitize their hands when necessary? Do they have difficulty managing oral secretions?)
5. List other risks. (Will others at school comply with distancing, face covering and hand-washing? What’s the school’s policy on sanitation? Do they have a behavior where they put objects or their hands in their mouth that can increase risk?)
6. What medical conditions does your child have? (Lung problems, a heart condition, obesity, diabetes, kidney problems, etc.)
7. What are the negative effects of not returning to school in a live, group setting? (Loss of social skills, missing out on services that they usually receive at school besides education, etc.)
8. What does your child’s primary health care provider think about them returning to school?

Attending school safely amid COVID-19

Once you’ve taken a look at all of these things, make the best decision you can with the latest information available as to whether or not to return to a group setting for school or other activity.

If the answer is: “I’ve weighed the risks and benefits for my child and it’s a YES,” here are some things to consider to keep everyone as safe as possible:

• Follow the standard guidelines to reduce risk of contracting and spreading the disease. These include:
  • Hand washing
  • Social distancing
  • Face coverings when social distancing cannot be achieved
  • Sanitizing of objects and surfaces regularly, including desks, writing utensils, computers, etc.
• Stay home if you have fever greater than 100.0 or any symptoms of illness.
• Stay home if you’ve recently been exposed to someone with COVID-19.
• Learn more from the CDC by visiting FAQs on COVID.

Other COVID-19 considerations

• Make sure anyone who might need to contact you has at least two ways to contact you, such as by phone, text or email, and also add another friend or family member’s contact information.
• Keep a list of people you can call to help you in the event you need to pick your child up from school or need help with longer-term support in case you become ill.
• Ensure an adequate supply of medications, necessary cleaning supplies and basic food items at all times.
• Practice hand washing, not touching their face and wearing a mask. Teach these skills before sending them back to school.
• Use a HEALTH PASSPORT to provide detailed information to others about your child’s health AND social supports that may be needed. A health passport is a great way to let others know about medical, environmental, behavioral, communication and other support needs a person has at a glance. You can download a free one here (at the bottom of the webpage). I designed this one personally for this purpose, and it’s available in English and Spanish. Physicians, nurses, support staff, teachers and others can benefit from having this information available in a concise document.

Whatever decision you make, go forward with confidence that you thought it out well, are taking the necessary precautions and that you made the best decision for you and your child.

Dr. Escude is a board-certified fellow of the American Academy of Family Physicians and one of the few Fellows of the American Academy of Developmental Medicine. He is the president of Health Risk Screening, Inc. which specializes in risk identification and mitigation in people with intellectual or developmental disabilities (IDD) and other vulnerabilities. HRSTonline.com. He is the author of Clinical Pearls in IDD Healthcare and the Curriculum in IDD Healthcare, an online course for physicians, nurses and other clinicians that teaches the fundamentals of IDD healthcare.