Medical Considerations: Back to School During the COVID 19 Pandemic

Jill Matson, MSN, RN, CPNP, Pediatric Nurse Practitioner, Clinical Specialist & Navigator Manager
Autism Alliance of Michigan

With the end of summer approaching, there have been a lot of questions and concerns raised from parents, educators and school administrators about the upcoming school year.  One of the most frequently asked questions has been, “Is it safe for students and staff to go back to school?”.  The answer to that question will most likely depend on the current status of the spread of COVID 19 in each community and whether or not schools are able to implement measures to minimize the risk of infection and make in-person learning safe.

Coronavirus is primarily spread from person to person by droplet

transmission from coughing or sneezing and although no single action or set of actions will completely eliminate the risk of transmission, physical distancing, frequent hand washing, face coverings and disinfecting frequently touched surfaces can all greatly reduce the risk of transmission of coronavirus and should be implemented in the school setting whenever possible. 

Keep in mind that for young children or children with special needs, social distancing and face coverings may not be feasible or developmentally appropriate and although some kids may be comfortable wearing a face covering, it may end up causing more harm than good if they are frequently touching their face or the mask.

For kids who have difficulty wearing a face covering and it’s not medically contraindicated, behavioral strategies and social stories can be helpful in getting them to eventually tolerate wearing one.

It’s also important to be aware of American Academy of Pediatric guidelines which state that face coverings should not be worn by children under two years of age or by anyone who has trouble breathing, is unconscious, incapacitated or is unable to remove their face covering without assistance.

Does a child with autism have a higher risk of catching Covid 19?

Autism doesn’t in and of itself place kids at higher risk for becoming infected with or having severe illness from coronavirus. Rather, it’s the cognitive or behavior difficulties frequently seen in children with autism that may impact their ability to understand and participate in protective measures, putting them at greater risk for infection. Some kids with autism may also have a serious underlying medical condition that doesn’t necessarily put them at greater risk of getting Covid 19, but may increase their risk of serious illness if they do contract the virus.

How do you manage the health risks of medically fragile students and the staff who work hands-on with these students?

Many of the recommendations from the CDC related to reducing the spread of COVID-19 also apply to medically fragile students, teachers and school staff. These students may need closer supervision and frequent reminders about social distancing and hand washing. Face shields combined with a mask are recommended for teachers and staff if a medically fragile student is unable to wear a face mask. Face shields are also recommended when staff cannot maintain physical distancing. Additional personal protection like gowns and gloves may also be needed by staff when providing personal care for medically fragile students. 

For students who have asthma, inhalers are preferred over nebulizer treatments whenever possible because aerosols generated by nebulizer treatments could potentially be infectious, increasing the risk of transmission of the virus.

Through collaborative planning between primary care providers, families and school staff, many students with autism who have medical comorbidities can attend school safely if additional safety precautions and accommodations are implemented. Keep in mind though, that even with safety steps in place, there will still be some students with high-risk medical conditions who will need to continue distance learning.