ACSD School Nurses' Statement Regarding Return to School for Fall 20-21

important on sticky note

Please click here to view the video message of the statement from the ACSD School Nurses regarding the return to school for fall 20-21.  Additionally, the text of the message is below:

 

My name is Molly Wales, and I work with Heidi Shaw.  We are the TWO licensed school nurses for ACSD, and Heidi is the President Elect of the Ohio Association of School Nurses.  In addition to programs such as the food pantry, staff wellness, and health education, we oversee the daily health of students at all six schools within the district – Preschool, East/West elementary, Morrison-Gordon Elementary, The Plains Elementary, the Middle School, and the High School (roughly 2400 students).


If we go back to in-person education, Heidi and I will be on the front lines of caring for sick individuals, both students and staff.  We will be in charge of creating and implementing policies in an effort to keep everyone as safe as possible. We will be among those who have to dress in full PPE and sit in a small enclosed room with kids with fevers.  
 

Given that we are the only medical professionals in the district, with years of experience on the ground at all six schools, Heidi and I are uniquely qualified to speak to the medical needs of our students.  We prepared this statement to give the Board the school nurses’ perspective, as you weigh the decision about whether to return to school in person, or go entirely online. 
 

Heidi and I have reviewed the ODE Reset & Restart Guidelines, and the Big 8 + Health & Safety Coalition (which is a best practice outline from the Big 8 school districts in the state of Ohio + Ohio Association of School Nurses Executive Team).  We have talked with other school nurses throughout the country and state, talked with parents, including one who is a physician working in a COVID ICU in Columbus, read countless science journals, and met with regional health professionals.  
 

Together, we have brainstormed how to implement each of the health recommendations, given how the needs of our district differ from those of bigger cities, or those with more nurses or larger budgets.  And over and over, we reach the same conclusion:  that from our perspective as your school nurses, we feel it is unsafe if we return to in-person education.  If we congregate in buildings, even in reduced numbers, there are so many barriers to effective infection control* that we cannot, in good conscience, tell parents that their children will be safe or that staff will be safe resuming their normal work responsibilities.
 

Every district in the nation is currently confronting barriers to infection control (for example, how to keep children socially distanced at all times). We are addressing just a few of those here, with concern for barriers specific to ACSD.  
 

Dr. Sally Goza, the President of the American Academy of Pediatrics stated Weds, ?, “the decisions on when and how to reopen need to consider a variety of factors, but a big one is the level of virus in the community.”  As we all know, infection rates in Athens are rising *very* rapidly right now. The Athens bubble that kept us safe throughout the summer, has burst. We cannot predict what is coming, but as OU students return, the numbers are likely to increase far beyond what we’ve seen so far.  It is not a matter of “if” we see COVID in our schools, it is a matter of “when,” and how hard do we get hit.

 

It is also true that we don’t yet have a thorough understanding of this virus, so it is likely to change in ways that will catch us off guard.  During flu season, we know what we’re looking for, and we know how to stop the spread - but with Covid, we are learning as we go.  Our understanding of symptoms to look out for, who is affected, and how to prevent the spread,  is constantly evolving.  How do we, as your nurses, make guidelines to keep the children safe, when we aren’t even sure what “safe” means in this situation? 
 

Another barrier to infection control in our district, is that we have two nurses for six buildings.  Because Heidi and I cannot be everywhere at once, secretaries and paraprofessionals run the clinics in our absence.  Even in normal, non-pandemic times, this asks a lot of those people.  Clinic traffic can be constant.  But now, according to the ODE recommendations, in addition to the clinic, we should have a COVID room (where students with potential symptoms would wait to be picked up by their parents), and potentially even a third location for medication administration.  It was also recommended that, if a student felt ill in class, the nurse should go to the student, instead of having the student walk to the clinic.  So, according to this model, there should be two to three full-time people in each building appointed to health care.  This makes a lot of sense.  But, I remind you, we have six buildings and two nurses.  Which means that non-medical professionals will be asked to do the work of caring for potentially infectious children.
 

How do we make that work?  
 

This is another barrier.  If a nurse can’t always be present, then we must have water-tight guidelines that ensure that these aides and secretaries NEVER have to make a medical judgment call.  And the only way we can figure out how to do this, is to say that any child who exhibits or complains of *any* of the symptoms on the COVID list, must be sent home immediately and cannot return for 14 days.  Those symptoms include:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Confusion
  • And more

 

Normally, if a child comes to the clinic saying they have a belly ache, or asks to rest because their head hurts, we talk to them about how they’re feeling and give them a quiet place to rest - and much of the time, they go back to class feeling fine, problem solved.  But no more.  Since we - nurses, parapros, or whoever is attending that child in the clinic - cannot differentiate between a Covid sore throat and a throat that is scratchy from allergies, if a child tells us their throat hurts, we will send them home with instructions not to return for 14 days. According to the CDC and the Athens City-County Health Department, even if the student or staff member receives a negative test, they will still be required to stay home for the 14 day minimum because the test can’t be relied on 100%.
 

I’m sure teachers are thinking, but then no one will ever be in school!  That is our concern as well.  But in the effort to keep everyone - students, staff, families - as safe as possible, we will act conservatively and decisively, erring every single time on the side of caution. 
 

And let’s not let the issue of student health overshadow that of staff health.  We don’t have time to go into it here, but staff health is of equal concern. 

 

We all go home to friends and families.  Even if we personally are not in high-risk categories, that does not mean our loved ones are safe from what we might bring home.
 

One more issue to consider is PPE (personal protective equipment).  Heidi and I have not yet sat down to figure out exactly what we need and in what quantities, but in general, we will need PPE for students, teachers, bus drivers, custodians, secretaries, cafeteria workers, special education teachers, paraprofessionals, nurses, administrators, etc.  Depending on the person and their exposure, this can range from just needing a mask, to needing N95 masks, eye protection, face shields, gloves, and gowns.  And to follow best practice, NONE OF THIS would be able to be reused, meaning these costs would be everyday.  In addition, we need truly reliable thermometers, a couple for each building.  All of these things tend to be expensive, and in short supply, but we must not cut corners in this regard. Thousands of dollars will need to be spent just to reopen the buildings. 
 

In addition to the concerns I’ve already raised, there are many, many more things to consider.  For the sake of time, let’s look at what is likely to be a typical scenario within the first few days of school:
 

A second grader at Morrison tells his teacher he isn’t feeling well.  The teacher calls the clinic, and the newly appointed clinic aide goes to the child after they “gown up” in head-to-toe PPE. He has a 102 degree fever. The aide (who, I remind you, does not have a medical background), takes the child to the Covid room, and sits in that closed room with the child, waiting for their grandparent, who may or may not show up promptly. In the mean time, what about the child’s teachers? Their classmates?  Their bus mates? How many people were exposed, and what do we do about it? Do we have the right to alert families, and if so, how?  How many confirmed cases of Covid will it take to shut down a classroom?  A whole school?  What if multiple teachers in one building come down with it, or their families do, and they have to stay home for weeks?  What if Heidi, I, and the clinic staff get caught in an outbreak?  Who will run the clinics then, and who will be training them on a moment’s notice?  
 

How do we possibly prepare ourselves so that we are not caught UNDER-prepared, and understaffed?
 

We understand that many, if not most parents are in a very, very tricky situation, having to juggle children and jobs.  And Heidi and I are, like all of you, very worried about our most at-risk kids.  Our kids who are falling behind, who are hungry, unsafe, or experiencing other kinds of trauma without school as a safe place to land.  We are worried about them, and we are ready to do what we must to take care of them.  But without physical health, there is no learning.  Without physical health, there is no mental health.  And maybe, instead of spending our time and resources scrambling to implement infection control that isn’t likely to work well given our limitations, we could instead put our energy into finding creative, realistic, and interactive ways to support our most at-risk kids within the safety of their homes.  Dr. Gibbs recently had an idea that we think would make the very best out of this awful and unpredictable situation: might the nurses, counselors, paraprofessionals and others team up and concentrate our efforts on meeting the psychosocial (emotional and mental well being) needs of our most vulnerable kids?  That seems like a much wiser option than spreading ourselves thin attempting to manage infections among thousands of students and staff.
 

You, board members, are making this call.  And if you decide to do in-person learning, Heidi and I will work tirelessly to do our very best.  But we want to be clear:  From your school nurses’ perspectives, a return to the buildings is irresponsible and unsafe, for students, staff, and every single individual in our district.
 

We would be glad to talk more about this with any of you. Thank you for your time and attention.

 

Molly Wales RN BSN & Heidi Shaw RN

Licensed School Nurses
Athens City School District





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