The Paediatric & Adolescent Endocrinology & Diabetes Society – South Africa (PEAD-SA) share their position statement on children with Type 1 diabetes mellitus returning to school.
All children should return to school in accordance with government guidelines. Type 1 diabetes mellitus (T1DM) does not seem to increase the risk of acquiring infection or of having COVID-19 severe disease in children and adolescents. Our position as PEAD-SA is that children and adolescents with T1DM should not be prevented from returning to school.
The pandemic of infection with coronavirus (SARS-Cov-2), which has caused corona virus disease since 2019 (COVID-19) has affected all aspects of life throughout the world.
South Africa has not been spared and we are now in the early stages of this epidemic. The carefully considered and courageous decision by government to call for a lockdown was timely and necessary as is the easing to the different levels.
As part of this change, it has been recommended that children and adolescents begin returning to school. Considering concerns raised by numerous people, PAEDS-SA is presenting our position on this aspect of the epidemic.
What does PEAD-SA know about children and infection with SARS-Cov-2?
What we do know comes from very limited information from other countries and from limited local experience.
- Children (under 20 years) do get infection with SARS-Cov-2. In most countries, children make up a small fraction of all the people with infection. Thus, it seems that children and young people don’t contract COVID-19 at the same rate as adults. In China and Italy, children less than 10 years were only 1% of all cases, and those between 10 and 19 years were 1,2% of all cases. In the USA, children and adolescents (under 18 years of age) were 1,7% of all cases reported1,2,3.
- Children do not seem to get severe infection very commonly. This may be the reason why children make up such a small fraction of people with infection, because in most countries, people are only tested when they are ill. It is thought that most children get infected but do not have symptoms. Children rarely require hospitalisation or have severe disease4. (1,1% of cases are critical, 2,2% of cases are severe)5(5,7% of children hospitalised US)3
- Very few children have been seriously ill or have died from this condition. To date, it is thought that 30 children have died from COVID-19.
- Children do not seem to be responsible for the major spread of infection to others. Most children are infected by adults rather than from each other.
- It is not clear that children have the same risk factors as adults for serious illness e.g. hypertension, lung disease, Type 2 diabetes, etc. Reports from colleagues suggest that children with T1DM do not contract Corona virus infection more frequently than other children2 and do not have more severe forms of COVID-19 disease than other children. In China and Italy, no-one under 25 with T1DM landed up in hospital or with severe disease (needing ICU).2
- In South Africa, we are starting to see a few children with COVID-19 disease and the pattern does not seem to have changed from the rest of the world.
- We are seeing increasing numbers of children with stress, anxiety and other psychological, social and emotional issues because of the lockdown.
PEAD-SA, therefore, have taken the position that children and adolescents with T1DM should not be treated any differently from other children in terms of going back to school.
All usual advice for the care of children and young people with T1DM remains valid:
- Better control means better health, particularly in winter when everyone gets sick.
- Children with T1DM should have a flu vaccine.
- Any illness will affect glucose control, which then needs extra attention.
- If children are ill, they or their caregivers should not delay in contacting their healthcare provider because they are afraid of COVID; unmanaged DKA is far more dangerous.
- Hypoglycaemia remains the most urgent problem that must be treated immediately, including at school.
PEAD-SA will continue to monitor reports from international organizations (WHO, ISPAD, ADA), colleagues and from across the world and update this statement promptly as new information becomes available.
Click on the video below to hear The International Society for Paediatric and Adolescent Diabetes (ISPAD) statement on COVID-19 and children with diabetes.
- Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaSummary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Zunyou Wu, MD, PhD; Jennifer M. McGoogan, PhD JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
- Summary of recommendations regarding COVID‐19 in children with diabetes: Keep Calm and Mind your Diabetes Care and Public Health Advice | International Society of Pediatric and Adolescent Diabetes (ISPAD) | Ped diab 2020;21(3):413-414 doi.org/10.1111/pedi.13013
- Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. 422 MMWR / April 10, 2020 / Vol. 69 / No. 14. CDC COVID-19 Response Team
- SARS-CoV-2 Infection in Children Xiaoxia Lu, Liqiong Zhang, Hui Duet alNEJM 18 Mar 2020
- Clinical Manifestations of Children with COVID-19: a Systematic Review Tiago H. de Souzaa, MD, PhD; José A. Nadala, MD, MSc; Roberto J. N. Nogueiraa et al
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