Melissa Young, MD, discusses how she addresses questions from patients related to returning to work or back to school during the ongoing COVID-19 pandemic.
These have been unprecedented times. The coronavirus disease 2019 (COVID-19) pandemic is something none of us have ever experienced. We learn more about the virus and the disease each day and, as new information comes in, recommendations change.
So, it becomes very difficult when patients ask us for advice, particularly about things that are as yet hypothetical. A frequent question that I get is “can I go back to work?”, and I am getting that question more and more as schools prepare to reopen and my patients who are teachers and other school employees are concerned about their safety.
I am not an infectious disease specialist. Nor am I an epidemiologist. I don’t consider myself a front-liner. I am an endocrinologist. And my first-hand experience with COVID-19 has been limited. But, I do know diabetes, and I know that people with diabetes are at high risk of more serious complications of infections, not just from SARS-CoV-2 but from all infections. So when my patients ask me about returning to work, I take that seriously.
Don’t misunderstand me. I have never considered diabetes to be a disability (although some complications thereof can be). However, given the statistics surrounding this current health emergency, I am much more inclined to tell patients’ employers that these people need special consideration. I have had people argue that we can’t excuse every person with diabetes from work.
What about nurses, physicians, EMTs, police officers? Agreed. There are some professions that require people to be physically present and there is no getting around that. Hopefully, those people are being provided with the proper protective gear (many of my teachers are told they have to provide their own) to lessen their chances of exposure. What if someone has a job that can be done remotely or can be otherwise modified to decrease one’s risk, then isn’t it in everyone’s best interest to protect their health and well-being?
My problem, however, with answering my teacher-patients’ question is that the schools don’t even have concrete plans in place yet. So, I can’t give my patients definitive answers. Here is what I tell them I would need to know in order to give them specific guidance:
How many students do you usually have in your room? How big is the classroom?How old are your students?
If masks are required, will they be able to keep them on and wear them correctly?
Will the students be changing classrooms, and where will you be when the student body descends upon the hallways?
Can you keep a physical distance from your students? Do you ever have to touch the students (I have preschool teachers who have to hold students' hands, clean them, etc.)?
What is the school doing about lunch period? Where are you during lunch?
Can you do part or all of your job remotely?
In addition to the questions above, I also wonder what the schools will do if a student or a staff member gets a COVID-19 infection? Will the school close? Do the class and the teacher need to quarantine for 14 days? What kind of disruption will ensue?
I believe that if the class size is small, if the teacher can maintain a safe distance from the students, and if personal protective equipment is provided, then teachers and other school employees may and should return to work. If, on the other hand, precautions cannot be maintained, then it is in the best interest of the teachers as well as their students, that education be provided remotely.
It is a truly difficult situation. I have two high schoolers myself, and I firmly believe that they did not obtain the education they were supposed to during their last marking period. They need a structured environment and interaction with their teachers and their classmates, but I also want them to be safe and healthy. I do not have all the answers, perhaps I don’t have any. I certainly have questions.
Melissa Young, MD, FACE, FACP, is a practicing endocrinologist with Mid Atlantic Diabetes and Endocrinology Associates based in New Jersey. This piece reflects the author’s views and not necessarily those of the publication.
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