Back to School with T1d During Covid and Monkeypox

Key Points

This is not a “happy” or toxic positive post, but must-know facts about Covid, Monkeypox and staying safe in school. If you’re short on time like I usually am, kindly read these key points, use what applies to you/your child, and share the knowledge please. Also, if viewing this page on your mobile device, you may want to use the Read Aloud feature when you’re on-the-go or cooking a meal. Pop-in some headphones to listen safely especially if you’re driving. By the time you read this in its entirety, Monkeypox and Covid cases will have hopefully decreased, but we know human behaviors and IQs have worsened since 2020. I do not have the mental energy to update this post frequently, so stay informed by contacting your PCP and/or child’s pediatrician.

• Covid is still here: More highly transmissible Covid variants like BA.2-BA.5 and now, Centaurus, have spread exponentially causing further damage to our healthcare systems, employment rate/economy, and further collapse in society and mental health. Recent ADA studies suggest 1 in 5 Covid infections result in Long-Covid (LC). Those with diabetes remain high-risk for developing LC. Covid causes T1d, T2d, and faster progression from prediabetes to full-blown beta cell damage to diabetes. Please continue masking indoors and crowded outdoor areas, keep vaccinations up-to-date, do not hesitate to contact your child’s pediatrician to ask any questions and schedule their covid vaccinations asap if not done yet [If you don’t actually have a family history of allergic reactions to vaccines, then what are you waiting for].
• Monkeypox update: As of August 18, 2022, there have been over 14,000 MPXV cases reported just in the U.S. An undercount due to insufficient testing sites or lack of access getting there for underserved communities (BIPOC – Native American, and Hispanics). The WHO may declare it another pandemic. Anyone of any age can get Monkeypox. Awaiting more studies to determine how long it can sustain on surfaces. Transmits through prolonged physical contact and aerosols. Wash hands often and maskup! Don’t touch materials of known infected individuals. Sucks we won’t know if someone’s infected until we see the physical rashes/pussy lesions on their skin. Pets can get both Covid and MPXV. STAY HOME IF YOU HAVE A FEVER and/or have participated in risky behavior. Learn more below.
• Update your child’s 504/IEP plans asap: If you don’t have either, make sure to get that done the first few weeks of school. Learn more in my Parents Guide to T1d and School post for some must-do basics and catch up to speed. Does your child’s school still offer distance learning if that’s a better option for you and your family?
• More back to school prep: Time to refresh our T1d child’s diabetes cases in school’s health office and classroom. Get the new teacher’s email to send them a slideshow like the template [user restricted, access granted if you provide your email] I created two years ago. We keep three snap-close bins from The Container Store (not sponsored) with Coral’s low treats, some juice boxes or refillable juice bottles (check amazon), hand sanitizers, KF94 face masks, and her D-kit is always fully stocked. As other Dparents have advised me – keep emails short, concise, clear, and polite for best reciprocation from school faculty [insert goofy face emoji].
• Toxic positivity: Forced positivity is toxic. There’s no denying that T1d, Covid and Monkeypox suck because they’re all disrupting our daily lives, health and/or causing long-term complications which make managing any chronic illness that much harder. Learn more below and share some infographics I designed with proper credit please and thank you. Follow us on Instagram and/or Twitter for more resources!

Recap on This Real Ongoing Pandemic

It’s been nearly three years since we first heard of SARS-CoV-2 causing the chronic respiratory disease known as Covid-19. 1 in 5 Covid cases or 10 to 30 percent of Covid survivors result in Long-Covid, a recent chronic medical condition now covered under the Americans with Disabilities Act (ADA). Individuals with any type of diabetes – especially autoimmune, are four times more likely to develop Long-Covid. Covid is also known to cause multiple autoimmune diseases like Type 1 diabetes, MIS-C, and Kawasaki’s, per many medical journals like Nature and NIH. It can also cause pneumonia weeks to months after exposure even in previously healthy young vaccinated individuals.

We took safety precautions early on before LA Public Health even announced their mask mandates in March 2020 because we suspected the virus was airborne. Turns out, we and hundreds of epidemiologists were sadly correct. As of this writing, over 1.3 million people have died from Covid just within the United States. The U.S. is averaging ~400 deaths per day as of this week from CDC.gov. Per USAFacts.org, at least 79% (up from 71% back in January 2022) of the US population have received one dose of a certain vaccine. Only 67% of the US population have been fully vaccinated (two-doses of Moderna or Pfizer’s MRNA or Janssens Covid vax – requires booster & okay to mix and match per FDA). Less than 33% have had their boosters – ourselves included in that latter statistic.

I implore everyone to stay informed about the many arising Covid-19 variants such as Omicron BA.2-5 and now, Centaurus (latest Sub-variant of Omicron BA.2.75). Kindly read my previous blog posts reviewed by ER Dr. Calvin Sun. Visit FDA.gov and CDC.gov for general information about side effects of the vaccines and CDC’s Covid Tracker. Speak with your child’s pediatrician and endocrinologist asap to answer any questions you may still have regarding the Covid vaccines. Per Johns Hopkins Medicine and many medical journals, side effects are common with any vaccine and severe side effects are extremely rare. Again, speak with your specialists asap.

Things to Know About Monkeypox

The WHO declared MPXV a Public Health Emergency of International Concern on July 23rd. Unfortunately, just when we thought 2022 couldn’t get any worse, we’re in a Public Health Emergency locally in LA County and CA Governor Newsom has declared a State of Emergency on August 1, 2022 with Monkeypox (Orthopox virus) cases spiking weekly. As of August 19, 2022, MPXV cases reach 14,000 and rising with over 38,000 cases globally. Track cases here. If you don’t reside in CA, then Google your local county health department websites to stay informed independently please.

Where did MPX come from?

There are two main clades, or group of organisms evolved from a common ancestor/original virus – which will soon get a new “non-racist” name by the WHO. The most concerning strain is the Central African (Congo Basin) Clade I or CAC which has a higher mortality rate where ~1 out of 10 people infected die in Africa or suffer more severe disease and higher transmissibility. The least fatal strain, so far, is the West African Clade (WAC) or Clade II. Both were endemic to Africa until 2003 due to an import of infected mammals to the U.S. Since 2018 through 2021, there were at least 12 travel-related incidents *reported* in the U.S. This suggests that the virus may have slowly mutated to be more transmissible through community spread in parts outside of Africa – across the U.S., Europe, Spain, Portugal, and more. Again, awaiting more peer-reviewed studies to develop as to its specific mutations.

*The CDC sucks for public health and prevention, but here’s a good page to check Monkeypox cases.

How does it spread (mode of transmission)?

Monkepox (MPXV) can be spread through any and all of the following:

• Physical contact – touching, kissing, hugging, sexual.
  • Sharing clothing, bedding, towels, linens, or any other fabrics and materials of someone who’s infected with MPXV.
• Respiratory droplets – close contact. Likely less than 6ft. WEAR A MASK correctly over the nose and under your chin, please. A well-fitting KN95, N95, or KF94.
• Anyone of any age can get MPXV – not just gay men. Also, being gay doesn’t necessarily make them more at risk to contracting the virus or more severe disease. Break the stigma and check your behaviors, habits, and lifestyles.

What are the symptoms?

Typical symptoms listed on Yalemedicine.org include, but not limited to:

• Fever, headaches, and chills
• Swollen lymph nodes and then
• Rashes – starts off as red spots and then painful pussy
• Lesions – you MUST self-isolate for 3-4 weeks and mask up properly with a N95/KN95 to avoid exposing others, if having to leave for essentials only. Best to reach out to a friend or social worker for assistance in your area. Research that on your own. Check with your local county health department for more safety protocols.
  • The lesions usually last for about 5-7 seven days before scabbing and falling off.
  • Scabs can remain for about a week before they fall off.

Incubation period?

Typically, 6 to 13 days, but can also incubate between 5 to 21 days. A person is contagious from start of “flu-like” symptoms noted above until all scabs have completely fallen off (approximately 2-4 weeks). Please be smarter than how y’all so-called dealt with airborne Covid (mutates way more rapidly than MPXV) and be considerate for other people’s safety if you are exposed and infected with MPXV. The lesions are especially painful and uncomfortable for children.

While contagious, a person should take the following precautions:

• Cover your skin lesions – try speaking with your PCP or child’s pediatrician for best moisture-wicking, non-clingy fabrics. Wrap them up in a plastic bag separate from regular dirty laundry to prevent cross-contamination.
• Encourage your child to avoid scratching their lesions and touching their face.
• Assign one parent/caregiver to aid the child during their isolation and recovery. Avoid skin-to-skin contact with the child/individual’s rash.
• Isolation – Keep child away from other people and pets. Stay home from school until local public health authorities and your PCP/pediatrician advises so after a follow-up appointment.
• Wear a mask – child should wear at least a well-fitting KF94, KN95 mask and the caregiver should wear a well-fitting N95 or respirator and gloves in case they make contact with contaminated clothing and/or skin during bandage changes.

Does the smallpox vaccine prevent or protect me from Monkeypox?

Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness. Evidence of prior vaccination against smallpox can usually be found as a scar on the upper arm. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. Some laboratory personnel or health workers may have received a more recent smallpox vaccine to protect them in the event of exposure to orthopoxviruses in the workplace.

– World Health Organization, 19 May 2022

Are there vaccines available?

Only two Monkeypox vaccines are currently available in the U.S. I can only speak to the current vaccine supply and distribution phases in Los Angeles County and California from CADPH. No current vaccines available for all children under the age of 18 – only the Jynneos vax for post-exposure. Learn more from the American Academy of Pediatrics. Parents, it’s exhausting, but please stay vigilant. As of now, the CDC is distributing MPX vaccines into three groups as follows:

The JYNNEOS vaccine is being prioritized for the following groups

• Post-Exposure Prophylaxis (PEP) for known close contacts of monkeypox cases who are identified by public health via case investigation, contact tracing, and risk exposure assessments.
• Post-Exposure Prophylaxis (PEP)++  for individuals with certain risk factors who are more likely to have been recently exposed to monkeypox even if they have not had documented exposure to someone with confirmed monkeypox, such as people who attended an event or venue where there was known monkeypox exposure.
• Pre-Exposure Prophylaxis (PrEP) for individuals at occupational risk of monkeypox according to Advisory Committee on Immunization Practices (ACIP) guidance, including: laboratory workers who perform monkeypox testing, and clinical and public health workers who collect monkeypox specimens.

On July 19, California sent a letter to the Centers for Disease Control and Prevention outlining a request for additional doses of vaccine. Additional doses will eventually allow for expansion of vaccination efforts to include PrEP to other individuals, including gay, bisexual, trans and other men who have sex with men who are at high risk of monkeypox exposure. Note: Anyone of any age can get MPXV – a virus doesn’t discriminate. It’s main goal is to infect and replicate within a host.

Again, please double-check your own public health departments for updates and stay informed on your own. No need to private message me updates on your county spread/vaccine availability for my own mental health – I don’t want to get burnout with MPXV cases and such like I did with SARS-CoV-2 in early 2020.

How do we safely send our T1d kiddos back to school now?

Please see my Parents Guide to School and T1d to catch up to speed on some basics and must-do preparations prior and during the first few weeks of school. It’s always nerve-wracking and moreso given the current Covid variants still circulating along with said Monkeypox cases seemingly rising for the past four weeks in LA County.

I spoke with Coral’s pediatrician (remaining anonymous for her privacy) about my concerns a week prior to this blog draft. Here’s what she had to say in addition to some of the precautions listed above, in keeping children safe in school:

• Continue wearing a well-fitting respirator N95, KN95, or KF94 mask both in and outdoors regardless of basically no safety mitigations anymore [no thanks to CDC’s continued failure].
• Continue washing your hands after playing on the playground or possibly sharing school supplies – try to avoid this if you can.
  • Write to your school administrators, teachers, and update your child’s IEP/504 plan accordingly asap. Read my Parents Guide to School and T1d for beginner basics.
  • Backtracking to Coral’s first grade classroom moms who decided to go out and buy the girls a “Good Vibes Only” tshirt and leggings for Spirit Week without giving me at least 24hr notice notice via email nor text [it’s okay to ask], for a group picture. That absolutely cannot happen again with MPXV circulating quickly in L.A. Their intentions may have been well, but not this time around peoples. Coral didn’t want to participate in the first place and understands the severity of MPXV and Covid. We have an honest, open, mother-daughter relationship.
• Keep your child home if they develop a fever or rash. Peds office can only test for MPXV when lesions form. PCR or mouth-swab tests are pending, but not currently available for children. Have doctor write a note to excuse their absence and one for your employer if applicable.
• Organizing/navigating Bday parties – Unless the event organizers are maintaining both Covid and MPXV safety precautions, is it really worth risking your and/or your high-risk child(ren)’s health for one social event? There is nothing wrong with staying safe for our families, friends, and loved ones and asking the host/event organizer these important valid concerns:
  • Are they recommending testing prior to the event?
  • Are they recommending masking if any attendee hasn’t been self-isolating prior to the event?
  • Are all attendees fully vaccinated and boosted? This is a voluntary response and not a “violation of HIPAA” unless, I was another healthcare provider or employer which is classified under different laws like Protected Health Information (PHI – varies by State of Residence). Learn more about HIPAA and vaccination status here.
• Keep your pets safe too by asking others not to pet them – MPXV can transmit from animal to animal and human to animals.
• Learn more about your disability rights here detailed in my Parents Guide to School and T1d. Speak with a Special Needs attorney in your area for legal guidance if you feel you or your child with diabetes are being discriminated against and/or endo’s School Orders and 504/IEP (legally binding documents) are not collectively being met even in the slightest to make you question and concerned about your child’s safety in school. Put aside any ableist thoughts or denial.

Anymore MPXV tips, other than what I’ve listed in this entire post, from your child’s pediatrician or licensed physician are much appreciated. Kindly leave them in the comments below.

What other new advice do you have just regarding T1ds in school?

Yes, we have lots to think about aside from circulating disabling viruses. I made sure to update her T1d Educational slideshow, BG Charts for any new and existing designated caregivers at school, and labels for her Classroom Treat Box and Health office Box (below). We also had to ensure that the District schedule and include our Special needs Attorney to be at the next IEP meeting within the first few weeks of the new school year. As of this writing, we’re waiting for her NEW endo to update her School Orders and possibly sign off on my BG Action Plan Charts. We’re also awaiting approval of the NEW Omnipod5 with needed pre-certification from endo to Aetna insurance. So, be sure to do the same all within a few weeks prior to and after the start of any new school year. Be diligent and try your best to work with school personnel though we know very well from past and current experiences it’s far from easy when many without chronic illnesses can be ableist or blatantly ignorant.

It took me hours to design and perfect the labels for her boxes on Adobe Illustrator over the years she’s been in school. I can no longer provide any of my designs for free download moving forward as a designer by trade. I’m still paying down over $16,000 in student loans from the Art Institutes, grad 2008 when the recession hit hard. Many thanks to those for your genuine support. Remember to give proper credit by tagging me @type1diabetic_life on Instagram OR @t1diabetic_life on Twitter and share the knowledge please. See Original photos, templates, and shoppable links in my Parents Guide to School and T1d post from TK, 2018.

Masked Ray of Sunshine: No Toxic Positivity

If you follow us on Instagram, thank you and this may be familiar to you. It took me days to design these infographics that I don’t mind you sharing with proper credit by tagging me @type1diabetic_life please. I felt the urge to finally express my thoughts on toxic positivity as to how it pertains to T1d, Covid and more virus outbreaks [dare I mention NYC is also in a State of Emergency like CA, ehemm..Polio, and rising cases of e.coli]. For the record: We aren’t living in “fear,” but also not living in denial either. We’ve been traveling safely and responsibly since three of four of us have all received our Covid vaccinations and boosters – just waiting on Kaila’s final 3 of 3 Pfizer dose [seriously, please read my previous blog post, Mental Health…].

What is Toxic Positivity?

Forced positivity is toxic. Some examples of toxic positivity include ignoring ones
responsibilities, dismissing other peoples difficult feelings or experiences, rhetoric positive quotes in response to hardships, or experiencing guilt for being sad or angry. It isn’t healthy long-term either. When we choose to take a realistic approach to life’s ups and downs, we can then begin to process events & emotions and learn & grow from them.

Toxic Positivity Sounds Like

Some examples of TP can sound like, Just stay positive! Good vibes only! It could be worse. Things happen for a reason. No bad days. There’s always a silver lining. Happiness is a choice…

When we’d really like to hear some better alternatives like, I hear you. I’m here for you. I’m sorry to hear of your experiences. Not all horrible things that happen need a ‘reason.’ Sometimes bad things just happen. How can I help? No, there doesn’t have to ‘always’ be a silver lining. Your feelings are valid. I hope everything works out for you.

Why It’s Damaging

Although people who express toxic positivity may have good intentions, it ultimately makes those of us with chronic illness and/or autoimmune diseases feel unsupported, invalidated, ignored or dismissed in an already messed up society. This also makes it more difficult to advocate for #insulin4all while breaking stigma.

We need to find relief, resolve, love and compassion – a basic understanding of what we’re going through 24/7/365. Co-workers, friends, family, healthcare workers, school faculty should do their diligence in self-education and accept our life is just the way it is. We had to in order to survive and keep our child(ren) alive and thriving.

Realism Vs. Pessimism

Realism is a concern based on facts and rejection of impracticality. It may sound like
“Great. Another virus outbreak right before school starts. Time to do some planning and stock up on wine & supplies. May be write to the school BOE.” Whereas, pessimism is expecting the worst possible outcome without ever seeing a feasible solution or healthy
plan of action. It may sound like “Great. Another virus outbreak right before school starts. This is never going to end. I’ll probably end up getting Covid or Monkeypox and dying.”

Often, those who don’t know us, mistake our realistic points of view for pessimism. Therefore, passing further criticism and judgement on us which isn’t helpful either. We’re not seeking attention from those kinds of people. We just want to feel heard and validated. We’re also capable of taking an optimistic approach to certain life’s challenges when it’s applicable.

My Final Plea

Our, as in the greater diabetes community, children with disabilities have rights covered under Section 504 to feel safe in school. Sadly, that’s not the case when so many refuse to mask up again especially indoors or when receiving close contact notices – we’ve had a few from her school in 2022. “Doing the best we can” should mean wearing masks properly indoors and crowded outdoor areas especially when cases are up or never reaching the Alpha variant baseline again. The goal isn’t to reach “zero cases,” but prevent further deaths and chronic illness as much as possible. Think about our future generations even if you don’t have children.

• Well-ventilated facilities especially in schools, health clinics, office spaces, etc.
• Self-isolating with any kind of illness.
• Weekly testing the more you’re exposed due to occupational hazards.
• Getting and keeping vaccinations up-to-date – vaccine access and equity.
• More effective science-based public health messaging. See this article from the NY Times Magazine, “Covid proved the C.D.C is broken. Can it be fixed?”
• Enjoying time with our true friends and family safely with respect to each others valid health concerns. That’s what “learning to live with Covid” is like. The general public and diabetes community should already have a basic understanding of living with chronic illness. The sad truth is, a lot of “Americans” still do not get it and lucky if they never do.

Here’s to sarcasm, satire, wine, and keeping our loved ones safe! We’re strong, but tired. Please be kind to families like ours. Don’t forget to subscribe and checkout my previous blog post about Mental Health: T1d and Pandemic Burnout. Mahalo for your kokua [cooperation/help].

Malama pono [live well in Hawaiian],
Shelsea

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Sources

American Academy of Pediatrics. “Monkeypox [FAQs for Children]” <https://www.aap.org/en/patient-care/monkeypox/#:~:text=There%20is%20currently%20no%20monkeypox,have%20been%20exposed%20to%20monkeypox.> Last updated August 16, 2022. Accessed 20 Aug 2022.

American Diabetes Association. “Individuals with Diabetes are Up to Four Times More Likely to Develop Long COVID-19” <https://diabetes.org/newsroom/press-releases/2022/individuals-with-diabetes-are-up-to-four-times-more-likely-devlop-long-COVID-19>. June 4, 202. Accessed 20 Aug 2022.

Bajaj, Simar. Smithsonian Magazine. “What You Need to Know About the History of Monkeypox” <https://www.smithsonianmag.com/history/what-you-need-to-know-about-the-history-of-monkeypox-180980301/#:~:text=Since%20it%20was%20first%20identified,present%2C%20in%20ten%20African%20countries.>. June 24, 2022. Accessed 15 Aug 2022.

California Department of Public Health. Division of Communicable Disease Control. “Monkeypox: Vaccines” <https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Monkeypox-Vaccines.aspx>. Last updated August 17, 2022. Accessed 19 Aug 2022.

Center for Disease Control & Prevention. “Covid Data Tracker: Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory” <https://covid.cdc.gov/covid-data-tracker/#trends_dailydeaths_select_00>. Current as of August 18, 2022. Accessed 21 Aug 2022.

Cherry, Kendra. VeryWell Mind. “What is Toxic Positivity?” <https://www.verywellmind.com/what-is-toxic-positivity-5093958>. Updated February 21, 2021. Accessed 18 Aug 2022.

European Centre for Disease Prevention and Control. “Fact Sheet for Health Professionals on Monkeypox” <https://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals#:~:text=Last%20reviewed%2Fupdated%20on%3A%2014,)%20%5B1%2C2%5D.>. Last updated June 14, 2022. Accessed 18 Aug 2022.

HIPAA Journal. “Is it a HIPAA Violation to Ask for Proof of Vaccine Status?” <https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/>. Posted December 25, 2021. Accessed 20 Aug 2022.

Kozlov, Max. Nature. “Monkeypox outbreaks: 4 key questions researchers have” <https://www.nature.com/articles/d41586-022-01493-6>. May 27, 2022. Accessed 15 Aug 2022.

Macmillan, Carrie. Yale Medicine. “Monkeypox: What You Need to Know” <https://www.yalemedicine.org/news/monkeypox-symptoms-treatment>. August 4, 2022. Accessed 19 Aug 2022.

Noriaki Ito, et al. “Can the Omicron variant of COVID‐19 cause pneumonia in young patients without risk factors?” <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066735/>. Published May 4, 2022. Accessed 21 Aug 2022.

Office of California Governor Newsom. “Governor Newsom Proclaims State of Emergency to Support State’s Response to Monkeypox” <https://www.gov.ca.gov/2022/08/01/74502/>. August 1, 2022. Accessed 18 Aug 2022.

Our World in Data. “SARS-CoV-2 Sequences by Variant” <https://ourworldindata.org/grapher/covid-variants-bar?country=CAN~BWA~ESP~ZAF~AUS~GBR~USA~DEU~ITA~BEL~FRA>. Updated August 15, 2022. Accessed 21 Aug 2022.

Psychology Today. “Optimism?” <https://www.psychologytoday.com/us/basics/optimism>. Reviewed 2022. Accessed 21 Aug 2022.

U.S. Food & Drug Administration. “Key Facts About Vaccines to Prevent Monkeypox Disease” <https://www.fda.gov/vaccines-blood-biologics/vaccines/key-facts-about-vaccines-prevent-monkeypox-disease>. Current as of August 18, 2022. Accessed 21 Aug 2022.

World Health Organization. “Monkeypox Fact Sheet” <https://www.who.int/news-room/fact-sheets/detail/monkeypox>. Current as of May 19, 2022. Accessed 21 Aug 2022.