Some parents of students with underlying conditions that could put them at greater risk for COVID-19 are concerned about the city’s plan to exclusively offer in-person learning this fall. Some said they’re struggling to navigate the public school bureaucracy to find out what additional protections could be in place for their kids, while others are calling for a remote option.

Maria Villalobos’s daughter Zoey Nieves, 12, has Alveolar Rhabdomyosarcoma, a form of pediatric cancer in the soft tissue of the muscle. Villalobos said her daughter’s doctor recommended Nieves continue to stay home through the fall.

“I get that there is a portion of students who didn’t do well in remote learning,” she said. “But what happens to the ones that need a remote option?”

Danielle Filson, a spokesperson for the education department, said students with underlying conditions can apply for Home Instruction. “Our home instruction program, which benefits a small number of children who are medically unable to attend school, will continue as it did pre-pandemic, and we will work with families to tailor the instruction based on the medical needs of each child,” she said.

Home Instruction involves a teacher visiting students for an hour a day, sometimes more, five days a week. In the past, it has served about 1,300 students on average, a tiny slice of the public school system, and the arrangement is usually temporary. Some students have Home Instruction after surgery or when they break a bone. Others get Home Instruction because of emotional and psychological issues.

According to the education department website, in order to apply for Home Instruction, parents must submit paperwork, and each student will be evaluated on an individual basis.

But parents and administrators said they don’t know what the eligibility for Home Instruction is during COVID. Mark Cannizzaro, the president of the Council of School Supervisors and Administrators, said principals are fielding requests from parents and are still waiting for direction from the education department. “School leaders have not yet received guidance on how to handle students with underlying medical conditions for the upcoming school year,” he said.

The Centers for Disease Control and Prevention (CDC) list a series of conditions that might put children at risk for more severe illness from COVID-19, including asthma, chronic lung disease, diabetes, sickle cell disease, heart disease, immunosuppression, and obesity.

However, experts said it’s unclear how much more at-risk those children are.

Dara Kass, Associate Clinical Professor of Emergency Medicine at Columbia University Medical Center, said she sent her immune-compromised child to a city public school last year because precautions were in place and there was so little transmission. “Schools are among the safest environments for kids if they follow the right protocols,” she said.

Kass said the key is ensure schools take robust safety measures, with masks, mandatory vaccinations, and quarantines as needed. “Kids belong in school,” she said.

Kass said she’s planning to send her three children to public schools this year, although she would probably keep them home if she lived in Florida, or another jurisdiction that didn’t follow science and federal guidelines.

But she said, ultimately, parents need to feel confident in those precautions, adding it would be helpful if schools were able to publish the proportion of vaccinated staff at each site. “If you’re talking about New York City public schools writ large, it’s hard to tell parents what they should feel comfortable with,” she said. “Parents need to be empowered to make choices for their kids.”

Dr. Mundeep Kainth, a pediatric infectious disease physician at Cohen Children’s Medical Center at Long Island Jewish Medical Center, said it’s about balancing potential health risks with the other risks associated with staying home from school.

“We actually found with the initial version of COVID-19 in our hospital … that the immunocompromised population of children did not seem to be at much higher risk for severe infection than the general pediatric population,” she said.

Kainth said the delta variant could change that prognosis, although ​​there’s no evidence to suggest it causes more severe disease, only that it’s more easily transmitted.

She said for many students, even those with underlying conditions, the social and economic risks of staying home from school could be as high or higher than the physical risk of exposure, particularly since transmission within schools has been very low. Kainth said she believes it’s generally better for students to be back in schools, if those schools are taking every safety precaution possible.

On Monday, Mayor de Blasio announced all school staff must be vaccinated or get tested weekly. He also has said the school system plans to follow CDC guidelines on social distancing, require masks in schools, and continue surveillance testing and quarantines when there are positive cases.

“While there might be a handful of exceptions to the majority rule, the majority rule would be that it’s ultimately in the best interest of all children to go back to school in person," Kainth said.

Zoey Nieves might be one of those exceptions. She’s vaccinated for COVID-19, but her mother said her chemotherapy has wiped out many of her other inoculations, leaving her immunosuppressed. At a recent virtual roundtable with education department officials, Nieves made a plea for a remote option.

“Remote learning was a success for me,” she said. “I became more independent and reliable, less stressed and anxious, and I got more sleep. Please consider bringing remote learning back into our schools.”

Nieves has received Home Instruction in the past, for a year and a half after she was first diagnosed with cancer in 2018.

But her mother, Villalobos, said she’s not comfortable with a teacher coming into her home at this point. “That still doesn’t make me feel safe because the instructor is not only for us,” she said. “The instructors are still traveling and going to different places.” And she wanted to know whether there would be similar accommodations, such as home instruction, for Zoey’s siblings, who are not immunocompromised, but could bring risk into their home.

Plus, Villalobos said she found Home Instruction insufficient. “They only give you five hours a week for home instruction, and that is the max,” she said. “It’s not enough time to go through every single subject.”

Lori Podvesker, Director of Disability and Education Policy at INCLUDEnyc, said that at one or two hours of instruction a day, the city’s Home Instruction program shortchanges students, and there isn’t much transparency on how it works. “We do not really know who is receiving what and when and that’s problematic,” she said.

Podvesker, who also sits on the Panel for Educational Policy, said now is “the perfect time” to revamp Home Instruction, supplementing it with some of the lessons learned during the recent immersion in online school and making it more available to families who don’t yet feel comfortable sending their kids back to classrooms.

She said there should also be a remote option for all students who need it — physically, psychologically, or emotionally — with the potential to re-evaluate in six months. “The majority of the students in our system and their families will most likely be okay with going back to school in person this September,” she said. “But there also will be students who won't be for valid reasons."