As summer draws to a close, parents and families affected by type 1 diabetes have been plagued with the question of whether or not to send their children back to school during the time of COVID-19.

Earlier this summer, a report from the NHS was released showing that people with diabetes, especially type 1 diabetes, face significantly higher risk for both complications and death from COVID-19. This study sent shockwaves through the diabetes community, and has left many families with many unanswered questions. Should parents send their children to school and risk contracting the virus? Should families keep their children home, and attempt home-school? Is there a middle ground to help mitigate risk and viral transmission, while still enabling our children to learn well? What critical social and psychological developments would a child miss out on, should they stay out of school for a year, or two, or three? What complications would be prevented if they dodged the coronavirus (and the social ridicule of 7th grade) completely?

There is no national consensus: the President wants schools to reopen. Many colleges and universities are either going completely online, or attempting a sort of hybrid (half online, half in-person) schedule. The Centers for Disease Control and Prevention recently changed its guidance, to better adhere to the Administration’s wishes. Throughout the United States, the issue of schools reopening has largely been left up to the school district to decide, and that can be based largely on city and state politics. The decision is further complicated for families with children with diabetes, because although a type 1 patient’s risk may be higher, it’s been previously noted that most children, should they contract COVID-19, have milder cases and many do not even show symptoms. Keeping a child with diabetes home this fall risks to further ostracize and isolate them. So, how can you make the best decision for this upcoming school year?

If anything, the United States has had the benefit of time throughout the pandemic. The origins of the virus came from Wuhan, China, and Americans watched the epidemic play out and spread throughout Asia and Europe from the comfort of their homes for most of the winter. The United States had nearly 3 months to fully prepare, and the same goes for schools reopening. Many schools throughout Asia and Europe have reopened (with safety precautions) with some success and no community spread. However, no country has had as many live and active case counts as the United States when trying to reopen schools.

Although the risk of returning to school is great, sometimes the social and psychological repercussions are greater: many children have reported an increase in anxiety and depression since the pandemic started; being trapped in homes with domestic violence and abuse wreak havoc on mental health and well-being, and many families living close to the poverty line rely on the daily, free breakfast and lunch programs to help feed their family throughout the school year. Shockingly, 114,000 students in the New York City public school system are homeless; they rely on the warmth and shelter of going to school every day to get by.

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Many families do not have enough (or any) computers at home for remote schooling, and nearly 19 million Americans do not have high speed, broadband internet at home, making remote, teacher-led learning all but impossible. Additionally, having children at home all day often requires a parent to be home, too, and many essential jobs and low-wage workers do not have the option to work from home temporarily or indefinitely. Juggling child care and work has become a critical issue for parents navigating the effects of the pandemic on their families. Furthermore, children need to socialize with other kids their age, and learn to develop social networks for support. Taking that away can and will have lasting detrimental effects.

On the other hand, given the current state of affairs and the rate at which the virus is spreading throughout the United States, children with diabetes face significantly higher risk of exposure and contraction (and complications and even death) should they return to school full-time, for in-person learning. Putting a child at unnecessary risk, in the middle of a pandemic, seems shortsighted and myopic.

Some encouraging research in the midst of turmoil: nearly half of those with type 1 diabetes who contract COVID-19 have managed to treat the virus at home, although hyperglycemia and DKA are common.

Unfortunately, lacking any national guidance for families with children with preexisting conditions like type 1 diabetes, the decision is a personal one. Considerations include your child’s age and ability to self-manage, their mental well-being and ability to cope without friends or in-person learning, your state’s COVID-19 stats and rate of viral decline/increase, and your personal feelings of safety and security with your school’s precautions in regards to COVID-19 risk mitigation. National diabetes organizations have recently released information for returning to school and general COVID-19 guidance, and a town hall was recently held to help parents navigate the decision process.

In closing, any decision you make about your child’s learning needs to be based on your personal circumstances and how comfortable you are with either remote or in-person learning. Reach out to your school’s administrators to see what their plans are for mitigating virus spread this fall: are they limiting class sizes, mandating social distancing, placing hand sanitizers and handwashing stations throughout the school, and requiring masks? Or do you feel your school isn’t doing enough, and you’re willing and able to assist your child in a remote learning situation, where they see other children occasionally for social support? Discuss your concerns and questions with your pediatrician and/or endocrinologist and get their recommendations. Do you have an essential job, where you cannot be home during the day, and you need the school infrastructure for support? Or do you feel overwhelmed with the high risk factor that is type 1 diabetes, and you’re leaning towards homeschooling until there’s a vaccine? There are no perfect decisions here: guilt should not drive your decision. Go with your gut, and what works for your individual situation, and it’ll lead you in the right direction.

Are you navigating back to school (or not!) with your child? What decision has best-suited your family? Share this post and your thoughts below! We love hearing from our readers.

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