Thousands of students will face a long COVID. Schools need to plan now

School has ended for the year, giving educators a moment to breathe a sigh of relief. But now, as they dive into planning for the next year, a big challenge looms, and most are not facing it: how will they support the students who will struggle daily with the long COVID?

Education Week asked several national and regional school district and superintendent organizations how their members plan to manage the needs of students suffering from the lingering effects of COVID. They all said the issue has yet to appear on district radars, even though tens of thousands of children nationwide will likely face these challenges. This worries medical and legal experts.

“Schools need to start talking about it,” said Donna Mazyck, executive director of the National Association of School Nurses. “There may be an astronomical need for accommodation. They need to recognize it and have teams to manage it. We must be prepared.

The most common symptoms of long COVID in children are headaches, fatigue and trouble sleeping, but a wide range of other conditions have been linked to the virus. They include “brain fog”, heart palpitations, shortness of breath, joint or muscle pain, gastrointestinal problems, anxiety, and orthostatic intolerance – a drop in blood pressure when someone goes from a lying position to an upright position.

Here are top suggestions from medical and legal experts, and those supporting families with long COVID, as schools plan for next year.

Recognize that the duration of COVID could affect your students.

About 13.5 million children in the United States have had COVID-19, or about 19% of all COVID-19 cases in the United States, according to the American Academy of Pediatrics. It’s not yet clear how many people will show symptoms for weeks or months, but researchers estimate it could be 20-30%.

Dr Sairam Parthasarathy, who co-leads two long COVID studies at the University of Arizona School of Medicine in Tucson, said more and better research is needed to accurately project how many children will fight off symptoms. of COVID once the acute stage of the disease has passed. But he thinks the field is “grossly underestimating” its prevalence because many doctors don’t link children’s symptoms to COVID.

Long COVID “could define a whole sub-cohort of children within a generation,” said Dr. Mady Hornig, a physician-researcher who studies long COVID at Columbia University’s Mailman School of Public Health. When asked how this might affect K-12 schools over the next five years, she replied:

“You know that meme floating around that shows someone saying ‘It’s okay!’ when the fire is raging all around them? I feel like that’s where we are right now.

Expect more students to seek accommodations and strengthen your process accordingly.

Students with long-term COVID may require a wide range of accommodations. The Kennedy Krieger Institute in Baltimore, which operates a post-COVID pediatric clinic and a nurse training program for schools, lists nearly two dozenfrom virtual learning and schedule flexibility to curriculum adjustments and allowing the use of elevators instead of stairs.

Wise school districts, Dr. Hornig said, will begin work now to strengthen teams that assess accommodation requests under federal law: the Individuals with Disabilities Education Act and Section 504 of the Act. of 1973 on rehabilitation.

To support these assessments, districts should consider partnering with outside experts: pulmonologists, neurologists, physical and occupational therapists and other specialists familiar with the dynamics of long COVID, she said, because primary care physicians and student pediatricians may not be knowledgeable enough about the still-emerging profile of long COVID.

To facilitate consultations with these experts, schools should consider expanding telehealth, Drs. Hornig and Parthasarathy said. Since many online platforms do not comply with the privacy regulations of the Federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, districts might consider purchasing a platform. HIPAA-compliant form such as Zoom for Healthcare, Dr. Parthasarathy said.

Train all staff to be aware of symptoms, so they can refer them to school health teams.

Every staff member who interacts with children can help identify those who may need help during an extended period of COVID, experts said. Schools should consider informing their staff members of common signs and symptoms, such as those outlined by the federal Centers for Disease Control and Prevention.

“Educators might be the first to notice changes in a student,” said Megan Roesler, nurse educator at the Kennedy Krieger Institute.

Investigating student health and behavior in ways that connect the dots is more important than ever, experts said. “If a student’s grades drop, ask yourself: Does this child have brain fog?” said Dr. Parthasarathy. A student’s chronic absence could spark a conversation that leads to a diagnosis and medical support, Mazyck said.

Does not require a “long COVID” diagnosis.

Medical organizations have described the symptoms associated with long COVID, but there is no test that diagnoses it. Students may have a single symptom, or clusters. Schools should not insist that families produce a diagnosis of long COVID in order to obtain accommodations, but rather base their decisions on the physical or mental problems that the students present, said Denise Marshall, executive director of the Council of Parent Attorneys and Advocates, whose members deal with legal issues for students with disabilities.

Accommodations should be “diagnosis independent,” said JD Davids, co-founder of the Network for Long COVID Justice, which supports families dealing with long COVIDs and other chronically disabling conditions. “A child who suffers from brain fog or crippling fatigue for any reason needs accommodations. We must err on the side of believing them.

The Biden administration has made it clear that long COVID is considered a disability under federal law, which means students with the disease are entitled to accommodations, usually through an individualized education plan or plan. “504”. Education has issued guidance on this last summer.

Demand for long-term COVID accommodations is just beginning to emerge, Marshall said. District responses are “in all areas,” she said, with some being cooperative and others “spending their energy looking for ways to say no rather than looking for ways to support students.”

“They have to remember that they are required by law to look at each child individually and provide what they need,” Marshall said. With millions of federal dollars in COVID relief available, she said, “no one can say there’s a lack of resources.”

Build flexibility and energy conservation into student plans.

Students’ longstanding COVID symptoms may wax and wane, or go away for a while and then come back. That’s why schools need to prioritize flexibility in their planning for these students, Kennedy Krieger’s Roesler said.

Since many children with long-term COVID struggle with fatigue, it will be important for schools to create adaptations “directed toward energy conservation, whether cognitive or physical,” Roesler said. That could mean letting them come to school earlier or leave later, taking frequent breaks, or using a hybrid schedule that allows them to study remotely for part of the time, said Patricia Fato, another nurse educator at Kennedy Krieger.

“They really need to seriously look at home schooling and ongoing remote learning,” Davids said.

Rochelle Rankin’s daughter battled a long COVID during her sophomore and junior high school years in Clark County, Nevada, dealing with intense fatigue, migraines, headaches that lasted for months and leg pain so severe that she sometimes couldn’t stand up. If her school hadn’t allowed her a range of flexibilities — letting her speak instead of typing an essay, taking a few extra minutes to get to class, and using an elevator — she might have lost a semester or more of credit, Rankin said.

“Her school, her teachers, really helped her recover,” Rankin said.

Use COVID prevention strategies.

The desire to “get back to normal” post-pandemic is widespread, but virus prevention strategies are still important and can play a role in minimizing the long-term impact of COVID on schools and families. they serve, experts said.

Dr Parthasarathy urged districts to do more to persuade families to get vaccinated and their children. CDC data shows that only 3 out of 10 children aged 5 to 11 and 6 out of 10 of those aged 12 to 17 are fully vaccinated. All school-aged children can receive the vaccine.

“The best way to not have long COVID is to not have COVID,” he said. An ounce of prevention is better than cure. »

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