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While the nation continues its bitter, politicized debate about school reopening, there is one group of children who probably should not be in classrooms this fall and perhaps not in the spring either — children who are medically at increased risk of serious COVID-19 disease.
Evidence continues to suggest that children as a group are unlikely to become seriously ill, or even ill at all, if they become infected with the SARS-CoV-2 virus. But for children with some chronic health conditions — including diabetes and obesity — the risk calculus is very different. About 193,00 children have diabetes, and almost 1 out of 5 children and adolescents is sufficiently overweight to qualify as obese. Although data is still accumulating about the role of these and some other chronic conditions in COVID-19 disease in childhood, there is enough concern for the Centers for Disease Control and Prevention to conclude that people of any age with these preexisting conditions are at increased risk of severe illness from COVID-19.
In the rush to resolve school reopening dilemmas for all children, this group of particularly vulnerable students has been largely forgotten. In our nationwide review of state reopening plans, although almost 80% mention that students with chronic health conditions should be “considered,” few offered specifics about what accommodations would be offered or detailed guidance to parents of these children. The main options discussed in the plans were to add at-risk children to preexisting programs for seriously ill children who cannot attend school or to fold them in with children who have individualized educational plans (IEP). However, both these programs have their own problems with resources and quality, exacerbated by the pandemic, and are not well positioned to absorb a very different group of students.
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Some schools are offering alternative instructional plans, such as giving families of medically vulnerable students the choice to opt out of in-person instruction altogether, adopting attendance policies that offer more flexibility, and clustering high-risk students in their own classroom. Remote learning is perhaps the most obvious way to accommodate children at high-risk for severe COVID-19 disease while also maximizing their safety. However, as with all the burdens of this pandemic, equity issues loom large and in ways that makes this option problematic.
Two or more conditions together, such as obesity and diabetes, that place students at risk for serious COVID-19 disease disproportionately affect children of color. African American children are 22% more likely than white children to be obese, and approximately 10 times more likely than white children to have Type 2 diabetes. And in two recent reports, children of color also had higher cumulative rates of COVID-19 associated hospitalizations and mortality than did non-Hispanic white children. Further, their families have already been disproportionately impacted by COVID-19, as well as over-represented on the front lines of the pandemic. The paradox of Black and Hispanic children being the least likely to have family members home during the day to monitor home instruction and concurrently being the majority of children who have the highest prevalence of underlying health conditions is unsettling and worthy of pushing policymakers to do better. Children of color and from low-income neighborhoods have deeply suffered and are likely to continue massive learning loss that could have lifelong effects.
As the highly contested decision about how to safely reopen schools for in-person instruction continues, states and districts must act now to consider the needs of students who are at elevated risk of serious COVID-19 disease. Moreover, states and schools must find ways that work for all families affected, including when parents must work outside the home. That many of these medically vulnerable children are also from communities of color and in many cases also poverty only compounds the urgency. These children have almost everything stacked against them in this pandemic. It is imperative that our schools not let them down.
Nicole Faraci (nicolefaraci@berkeley.edu) is a doctoral student in school psychology at the University of California, Berkeley. Megan Collins (mcolli36@jhmi.edu) is co-director of the Johns Hopkins Consortium for School-Based Health Solutions. Ruth Faden (rfaden@jhu.edu) is founder of the Johns Hopkins Berman Institute of Bioethics.