6 top questions about COVID-19: What a school nurse has to say

My concerns about COVID-19 fall in line with the work I’ve done over the last several years focused on school safety, including the impact of gun violence and active shooter drills on children in school. I felt that the voice of school nursing was not being heard, so I started my blog, The Relentless School Nurse, in 2017 to speak up.

Since then, I’ve used social media to create collaboration across different professions around child health and school safety.

Here in the Camden City school district in New Jersey, we hoped to be physically back in school for in-person instruction. But like many other school districts across the country, we are beginning the school year remote.

The first reason is structural: Our heating and ventilation systems are simply not up to par, so we can’t safely bring people back into buildings. We’re not alone either: about half of all districts need to update or replace multiple systems—heating, ventilation and air conditioning (HVAC) or plumbing—according to the U.S. Government Accountability Office.

Secondly, we don’t have enough personal protective equipment, like face masks and shields, for staff.

Thirdly, and perhaps most importantly, both parents and staff don’t feel comfortable. More than half of parents in my school district chose remote learning because they are fearful, and close to 40% of staff asked for accommodations to teach and work remotely. In New Jersey, the districts that have chosen to open up in a hybrid model are already running into issues as their schools scramble to shift to remote learning after one of their students tested positive for COVID-19.

Do I think it’s safe to go back? Right now, no.

I believe that every decision we make as a school district should be centered in science and data. If we, as a country, can’t even agree to all wear masks to protect one another, how can we safely return to school in possibly the biggest social experiment ever to occur in our country? How can we safely put teachers and students back into school buildings when we don’t have routine rapid testing and contact tracing?

Without a robust national response, school districts are left to their own devices. We’re making the best decisions we can with limited information, budget and resources in an era that has never happened before in this country.

That being said, there are circumstances where going back to school appears safe—in very small, very controlled preschool or early childhood programs that limit the number of kids enrolled and pod them into little bubbles. Otherwise, we simply don’t have the resources to bring in larger groups of children and teens.

Not knowing who is an asymptomatic spreader.

The right testing protocols are only available right now for the elite in this country. If you’re a professional athlete, for example, you can get a rapid COVID-19 test. The rest of us can’t, reliably.

Another stumbling block is that, as a nation, we aren’t collecting data on in-person school reopenings and outcomes. We don’t know enough yet about how the virus is spread among children.

At first, we thought it didn’t affect them, but new research suggests they may be able to spread COVID-19 as easily as adults, even if they aren’t showing symptoms. If we don’t know at what rate they’re infecting their teachers, we can’t gauge the safety of school reopenings.

The only thing that would truly make me feel safe is a vaccine. Short of that, I’d feel better if we had a robust rapid testing program.

The problem now is that we don’t know who’s safe to be in school buildings, so we have to require universal protection, such as masks and social distancing, because we have to assume everyone has it. As a result, school begins to feel medical and sanitized, and all the things we love about school, particularly in childhood—the cute rugs, the toys, the sitting in a circle for story time—have to be removed.

I don’t think keeping kids home is good for their emotional health, but I also don’t think keeping them six feet apart, while their teacher wears a mask and face shield is good for their development either.

There’s a tremendous amount of anxiety. Part of this stems from the feeling that they are being constantly questioned.

They are trying to implement very conservative protocols to keep everyone safe, but they’re getting pushback, both from parents and other teachers who feel they’re either doing too much or not enough. It’s a no-win situation, because there’s no national response that instructs us to follow certain policies and procedures, based on evidence.

What’s particularly concerning is that many school nurses don’t appear to have medical grade-level personal protective equipment. One nurse sent me a photo of the gown her school provided for her and it looked like a trash bag.

Even more concerning is that about a quarter of all schools don’t have a nurse at all, according to the National Association of School Nurses. Without or with only a part-time nurse at a school, who will do the COVID-19 assessments in case a student or staffer begins to display symptoms?

Understand that you have power in your voice. Your positions and concerns have merit, and you should feel comfortable in expressing them, whether it’s to your district superintendent, the principal at your child’s school or at school board meetings.

It’s also important to realize that school districts are doing their best to implement new rigorous screening strategies, but we can’t discern whether or not your child’s runny nose is due to a cold or COVID-19, so they’ll have to stay home until we know for sure. There will be increased absenteeism, but it’s all for the safety of the greater group.

The one bright light in all of this is that it’s really brought to the forefront how valuable our school nurses are. Our purpose has never been so urgent and important. We’re the ones on the front lines at schools, doing the assessments and initiating the contact tracing if someone in the building tests positive.

It’s crucial to listen to us, too.