School has wrapped up for the year, affording educators a moment to heave a sigh of relief. But now, as they dive into planning for next year, a big challenge looms, and most aren’t facing it: How will they support the students who will struggle daily with long COVID?
Education Week asked several national and regional organizations of school districts and superintendents how their members are planning to manage the needs of students with lingering effects of COVID. They all said the issue hasn’t risen onto districts’ radar yet, even though tens of thousands of children nationally will likely face those struggles. That worries medical and legal experts.
“Schools need to start talking about this,” said Donna Mazyck, the executive director of the National Association of School Nurses. “There may be a ballooning need for accommodations. They need to recognize this and have teams to handle it. We have to be prepared.”
The most common symptoms of long COVID in children are headache, fatigue, and sleep difficulties, but a broad range of other ailments have been linked to the virus. They include “brain fog,” heart palpitations, shortness of breath, joint or muscle pain, gastrointestinal issues, anxiety, and orthostatic intolerance—a drop in blood pressure when someone moves from a prone to an upright position.
Here are key suggestions from medical and legal experts, and those who support families with long COVID, as schools plan for next year.
Recognize that long COVID could affect your students.
About 13.5 million children in the U.S. have had COVID-19, about 19 percent of all U.S. COVID-19 cases, according to the American Academy of Pediatrics. How many will have symptoms for weeks or months afterward isn’t yet clear, but researchers estimate that it could be 20 to 30 percent.
Dr. Sairam Parthasarathy, who is co-leading two studies of long COVID at the University of Arizona’s medical school in Tucson, said more—and better—research is needed to accurately project how many children will battle COVID symptoms once the acute stage of illness has passed. But he believes the field is “hugely underestimating” its prevalence, because many doctors don’t connect children’s symptoms to COVID.
Long COVID “could define a whole sub-cohort of kids within a generation,” said Dr. Mady Hornig, a physician-scientist who is studying long COVID at Columbia University’s Mailman School of Public Health. When asked how it might affect K-12 schools in the next one to five years, she said:
“You know that meme that’s floating around that shows someone saying ‘Everything’s fine!’ when fire is raging all around them? I feel that’s where we are right now.”
Expect more students to seek accommodations, and beef up your process accordingly.
Students with long COVID might need a wide range of accommodations. The Kennedy Krieger Institute in Baltimore, which operates a pediatric post-COVID clinic and a nurse-education program for schools, lists nearly two dozen, from virtual learning and scheduling flexibility to curriculum adjustments and permission to use elevators instead of stairs.
Wise school districts, Dr. Hornig said, will start working now to beef up the teams that evaluate requests for accommodations under federal law: the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973.
To support those evaluations, districts should consider building partnerships with outside experts: pulmonologists, neurologists, physical and occupational therapists, and other specialists who are well-versed in the dynamics of long COVID, she said, since students’ primary care doctors and pediatricians might not be sufficiently knowledgeable about the still-emerging profile of long COVID.
To facilitate consultations with those experts, schools should consider expanding telehealth, Drs. Hornig and Parthasarathy said. Since many online platforms don’t comply with the privacy regulations of the federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, districts could consider buying a HIPAA-compliant platform such as Zoom for Healthcare, Dr. Parthasarathy said.
Train all staff to be aware of the symptoms, so they can make referrals to school health teams.
Every staff member who interacts with children can help identify those who might need support for long COVID, experts said. Schools should consider briefing their staff members on the common signs and symptoms, such as those outlined by the federal Centers for Disease Control and Prevention.
“Educators might be the first ones to notice changes in a student,” said Megan Roesler, a nurse educator at the Kennedy Krieger Institute.
It’s more important than ever to inquire into students’ health and behavior in ways that might connect the dots, experts said. “If a student’s grades are slipping, ask yourselves: is this kid having brain fog?” Dr. Parthasarathy said. A student’s chronic absence could start a conversation that leads to a diagnosis and medical support, Mazyck said.
Don’t require a ‘long COVID’ diagnosis.
Medical organizations have outlined the symptoms associated with long COVID, but there is no test that diagnoses it. Students may have just one symptom, or clusters. Schools should not insist that families produce a diagnosis of long COVID in order to get accommodations, but instead base decisions on the physical or mental issues that students are presenting, said Denise Marshall, the executive director of the Council of Parent Attorneys and Advocates, whose members handle legal issues for students with disabilities.
Accommodations should be “diagnosis-agnostic,” said JD Davids, the co-founder of the Network for Long COVID Justice, which supports families dealing with long COVID and other chronically disabling conditions. “A child who has brain fog, or disabling fatigue for any reason, needs accommodations. We need to err on the side of believing them.”
The Biden administration has made it clear that long COVID is considered a disability under federal law, and that means students with the condition are entitled to accommodations, typically via an Individualized Education Plan or a “504" plan. Marshall said. The U.S. Department of Education issued guidance on that subject last summer.
Requests for accommodations for long COVID are just starting to emerge, Marshall said. Districts’ responses are “all over the board,” 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 need to remember they’re required under the law to look at each individual child and provide what they need,” Marshall said. With millions of federal COVID-relief dollars available, she said, “no one can say there is a lack of resources.”
Build flexibility and energy conservation into students’ plans.
Students’ long COVID symptoms might wax and wane, or disappear for a while and then return. That’s why schools need to prioritize flexibility in their planning for those students, said Roesler of Kennedy Krieger.
Since many children with long COVID struggle with fatigue, it’ll be important for schools to create adaptations that are “oriented toward conserving energy, whether that’s cognitive or physical,” Roesler said. That could mean letting them come to school later or leave earlier, take frequent rest breaks, or use 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 look seriously at home instruction and ongoing remote learning,” Davids said.
Rochelle Rankin’s daughter struggled with long COVID during her sophomore and junior years of high school in Clark County, Nev., managing intense fatigue, migraines, headaches that lasted for months, and leg pains so severe she couldn’t stand at times. If her school hadn’t allowed her a range of flexibilities—letting her speak instead of type a term paper, take a few extra minutes to get to class, and use an elevator—she might have lost a semester or more of credit, Rankin said.
“Her school, her teachers, truly helped in her recovery,” Rankin said.
Use COVID-prevention strategies.
The yearning to go “back to normal” after the pandemic is widespread, but virus-prevention strategies are still important, and can play a role in minimizing the impact long COVID will have on schools and the families they serve, experts said.
Dr. Parthasarathy urged districts to redouble their efforts to persuade families to vaccinate themselves and their children. CDC data show that only 3 in 10 children age 5-11, and 6 in 10 of those 12-17, are fully vaccinated. All school-age children are eligible to receive the vaccine.
“The best way not to get long COVID is not to get COVID,” he said. An ounce of prevention is worth a pound of cure.”