Risk of COVID-19 Moratlity – All Established Patients
A Special Note on Children with Compromised Immune Systems
According to USA today, "None of the large-scale vaccine trials included people who are immunocompromised, though every indication is that vaccines are safe in this group. Organizations representing experts in cancer, organ transplantation and autoimmune diseases all support vaccination for their patients."6 There is now a national Immunocompromised Collaborative, part of the National Health Council, whose goal is to protect the immunocompromised who are the most vulnerable to infection (See Resources). There are tips for every age from infants, children, and teens, to adults with immune disorders.
Returning to School
Going back to school is even more complex for children with medical issues Although the AAP recommends in-person learning as preferable, special consideration must be given to vulnerable children. Guidelines include, of course, physical distancing and masks, but also consideration of other areas beyond the classroom such as the bus, playground, cafeteria, etc. Disinfecting, screening, testing etc., are all part of the process. Mental health needs to be addressed as some children who didn't have mental health issues developed them during the pandemic, while it also exacerbated preexisting mental illness.
In addition to the IEP, an IHP (individual health plan) becomes even more important during COVID (see previous EP article on IHPs in schools at reader.mediawiremobile.com/epmagazine/issues/203755/viewer?page=34). IHPs detail what needs to be done, healthwise, in order for the student to attend school safely. This includes medical technology such as dealing with tracheotomies, ventilators, g-tubes (feeding tubes) as well as personnel up to and including one-on-one nursing.
Some children with medical complexity will attend school in-person, some virtual, while others use a combination of the two. There must be realistic expectations regarding what a child can learn independently but nothing has changed under IDEA (Individuals with Disabilities Education Act) regarding the legal obligations for the provision of FAPE (free appropriate public education) for students with disabilities.
Other topics covered in the series include COVID-19 testing and CMC, social determinants of health for CMC, vaccines for CMC, emergency preparedness during the pandemic, CMC and masking, policies on parents accompanying children during COVID restrictions, etc.
The AAP released guidelines, "Caring for Children with Special Health Care Needs during the COVID-19 Pandemic." Highlights include:
- Ensuring equity at all levels for children with special health care needs
- Recognition that CMC are "are more likely to have a diagnosis of severe acute biological effects" and require hospitalization or ICU care
- Minimizing risk of infection during the pandemic using masking, PPE, vaccines, telehealth and virtual learning to minimize environmental exposure, etc.
- How medically complex children can accommodate masks
- Testing/screening/contact tracing for CMC for COVID infection
- Home modification to improve ventilation
- Information on accommodations in childcare or school
The AAP also provided guidance to pediatricians caring for children with medical complexity during the pandemic.
Children with special healthcare needs, particularly those who are medically complex, are more at risk of complications of COVID. Families and professionals must be aware of this and use prevention measures to minimize the risk.
ABOUT THE AUTHOR:
Lauren Agoratus, M.A is a parent of a medically-complex young adult and serves as the Coordinator for Family Voices-NJ and as the regional coordinator in her state's Family-to-Family Health Information Center, both housed at the SPAN Parent Advocacy Network at spanadvocacy.org
References
- cmccoiin.app.box.com/s/v91b2hxu2mooibs9o5hhp3vsbrq7ljad
- Ibid
- cmccoiin.app.box.com/s/yc9buu3kx3x1j40jb5wtas88zv7akjel
- cmccoiin.app.box.com/s/nz5iwgf1elqyex9hqhcu4afsi3lhnc95
- catalyst.nejm.org/doi/full/10.1056/CAT.21.0051
- geneticliteracyproject.org/2021/05/26/immunocompromised-and-wary-about-getting-a-covid- vaccine-heres-what-experts-say/
IT'S COMPLICATED : COVID-19 AND CMCs
COIIN TO ADVANCE CARE FOR CMC
The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity: COVID-19 and Children with Medical Complexity ECHO (Extension for Community Healthcare Outcomes)
Caring for Children with Special Health Care Needs during the COVID-19 Pandemic aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/caring- for-children-and-youth-with-special-health-care-needs-during-the-covid-19-pandemic/
CENTERS FOR DISEASE CONTROL & PREVENTION
Toolkit for People with Disabilities
cdc.gov/ncbddd/humandevelopment/covid-19/toolkit-for-people-with-disabilities.html
Easy to Read Materials cdc.gov/coronavirus/2019-ncov/easy-to-read/index.html
IMMUNOCOMPROMISED COLLABORATIVE primaryimmune.org