In reading your story, what struck me was: 1) her learning spread has changed; 2) this has been impacted by both health and virtual learning considerations; 3) her math foundation is shaky due to these considerations; 4) she has a processing speed that currently is slower, and has general school accommodations that take that into account - but not test accommodations; 5) her self-esteem is currently, as you describe, somewhat “shaky”.
In synthesizing the thread, I’d say that she is a student with clear interests in one area, and a shaky math foundation in the other. A tutor will help her in establishing a stronger math foundation for A) current school work; B) upcoming ACT/SAT potential testing; C) life and the working world.
Explain to her that many parents have children who also are in similar positions - health issues (or not) with kids who did not do well with virtual instruction. She shares similar struggles to many other students, so she should not let her PSAT score define her.
The issue is what to do moving forward. The PSAT is meant to be an early testing diagnostic in many ways, so this is good information to have. Get that tutor so that she can develop confidence in her skills - again, for her course, and upcoming testing, and for life.
What is incredibly important is to understand who she is as a student, and to pick schools that suit her abilities accordingly. Many schools are difficult for full-health, driven students. So find potential schools that will be the right kind of learning environment for her.
Who she is in college doesn’t define who she is in life - but she shouldn’t feel trapped to attend some “impressive” college that doesn’t suit her current learning style and learning needs. She will have lots of physical and mental health growth in the next few years - focus on meeting those needs, for both short and long-terms considerations that are tailored to her, and that’s probably the best way to honor her needs.
You’ve got this. Good luck!