Back to School - Immunocompromised Guidance

As students across Canada get ready to head back to school — some after nearly six months of being away — parents have many questions. The first is usually, “Is it safe to send my child back to school during the pandemic?” 

The answer depends on many things. 

The situation in your community:  

The risk of COVID-19 related illness in schools depends on how much virus is in a community. Your local public health authority is the best source of this information and is giving updated guidance to schools as the pandemic evolves.  Right now, the number of people affected with COVID-19 in the Maritimes is very low.  Schools have protocols in place to reduce the risk of transmission, and there are plans to keep school partially open or closed completely if local outbreaks occur. 

The risk of your child getting sick: 

If your child has health issues, you should discuss your child’s risk of COVID-19 related illness with their specialist. Children and adolescents who are potentially immunocompromised include those who have: 

• Chemotherapy currently or within the last 6 months 
• Radiation therapy 
• A bone marrow transplant in the last year or Graft Versus Host Disease 
• Solid organ transplant 
• Sickle cell disease 
• A spleen that does not work 
• A genetic cause for immune dysfunction 
• HIV/AIDS 
• Immunosuppressive medication including: 
• Chronic oral or IV steroid use (> 20 mg/day or >2 mg/kg/day for >2 weeks) o Cytotoxic drugs 
• Calcineurin inhibitors (taken by mouth) o Biological response modifiers o Antibodies that target lymphocytes 
• Other history of immune suppression, as defined by a Physician. 

Generally, immunocompromised patients have higher rates of severe disease and hospitalization with COVID-19.  However, it appears that this risk is similar to other common viruses, like influenza or chicken pox, and is lower in children than in adults. 

Immunocompromised children are more likely to follow public health measures, including isolation, physical distancing, hand hygiene and mask wearing. These remain important safety measures for everyone.  

In general, children who have asthma, diabetes, congenital heart disease, autism, epilepsy, neuromuscular disorder, and other chronic conditions who are not described above are not considered significantly immunocompromised.  If you have questions about whether your child is considered immunocompromised or not, please consult your health care provider. 

Your child’s overall health and well-being:  

School closures, along with other restrictions on activities and socializing, may affect children’s physical, social, and emotional well-being. There are potentially serious consequences for children not attending school.  This is true for childcare settings as well, where optimal language and social development requires interaction with other children. 

With all these considerations in mind, IWK recommends: 

1. While locally there is low spread of COVID-19 and the full school reopening model is in effect, attendance at school is recommended for all children and youth including those with immunocompromising conditions who would usually attend school. 
2. If schools change to a partial/blended model due to increased COVID-19 transmission or risk, children with immunocompromising conditions or those children who require aerosol generating procedures may benefit from remote learning opportunities. We recommend consultation with your child’s specialist health care provider and school health planning teams. In Nova Scotia, these are the School Health Partnership Program and Student Planning Team.
   Considerations related to siblings of immunocompromised students and/or other members living in the home who are immunocompromised should be discussed with your family’s health care providers and with school health planning teams. 
• Bone marrow transplant patients may require specific recommendations and should seek guidance from their specialist. 
3. Hand hygiene, keeping your distance, mask wearing and following other Public Health and Public Health Agency of Canada recommendations are important for all family members. These are the most important measures for decreasing the risk of transmission of COVID-19. 
4. Do not stop chemotherapy, radiation or other medication that interacts with the immune system to try to “strengthen” your child’s immune system.  
5. Please discuss use of any “immune boosting” therapies with your doctor. These may not be safe for your child. 
6. As much as possible, try to avoid other close, high-contact situations, such as bus transportation (by driving, walking or cycling to school), and wear masks when this is not possible. 
7. Ensure all your child’s regular vaccinations are up to date. All family members should receive the influenza vaccine in the fall. 
8. If your child is sick, please do not send them to school or day care, and call your health care team for advice. 
9. New recommendations will change if community spread increases in the Maritimes. Please be   aware of new public health announcements.  

August 24, 2020

This document has been prepared by the pediatric Infectious Diseases Division and the Hematology & Oncology Division of IWK Health, in partnership with the Pediatric Provincial Advisory Group.

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