First it was the EMTs, emergency room doctors and hospital nurses who found themselves battling a public health crisis the likes of which had not been seen in a century.
Now, as schools in New Hampshire continue to reopen, school nurses are joining them on the front lines.
The state’s public, private and charter schools all have their own plans for reopening, but they have one thing in common: When children get sick, they go to the nurse’s office.
That’s nothing new — nurses are trained for that. But these days, what may look like a common cold could be a deadly virus.
“This is a new time now,” said Paula MacKinnon, president of the New Hampshire School Nurses’ Association, which has 377 members. “Instead of our mission being to facilitate education by keeping them in school, we’re now on the other end of the coin where, for public health reasons, we’re going to be more cautious about who we send back to the classrooms.”
Kids have always come to school with coughs and colds, MacKinnon said. “But if the child is complaining to the teacher that they don’t feel well, or is excessively coughing or sneezing, those are the ones we’re going to be more concerned about,” she said.
“It’s where the nurse’s judgment comes in,” she said. “We just want to be very careful.”
MacKinnon said school nurses have gotten tremendous support from state health experts, including weekly video calls that will continue into the school year. They also participated in a virtual town hall with the New Hampshire chapter of the American Academy of Pediatrics.
All that, she said, has helped to calm nerves and share critical information.
Proceed with caution
Public health officials want schools to err on the side of caution, according to Dr. Benjamin Chan, the state’s epidemiologist. “One of the things that we’ve learned throughout the course of this pandemic, especially early on, is that the pandemic was perpetuated by people with mild symptoms that were in the communities,” he said. “And that’s exactly what we’re trying to prevent in our school systems.”
So the state recommends that schools exclude anyone with “new or unexplained symptoms,” and that those children be tested for the virus, Chan said. “But then that raises additional challenges, like how do we get testing for all of the mildly symptomatic kids that are out there?” he said.
“We’re looking at how to support communities and implement more rapid point-of-care testing in schools and communities,” he said. “This is going to be an ongoing evolution of our response to the pandemic.”
At Crossroads Academy, a K-8 independent school in Lyme, a child must go through layers of COVID-19 checks before even getting to the classroom, said Kathleen Barth, who has been a school nurse there for 19 years.
Parents are the first line of defense. It’s their job to screen their kids every morning for symptoms and fever. Once students arrive at school, they are asked whether they have done their morning screening. If not, they’re off to the nurse’s office.
In addition, all classroom teachers have infrared thermometers to use for spot checks, Barth said.
Students started classes at Crossroads on Aug. 26. The next day, Barth sent her first student home. She has sent home a handful of others since. All have tested negative for COVID-19, she said.
Under state guidelines, children must stay home until they’re symptom-free for 24 hours and fever-free without fever-reducing medicines for the same period of time.
There’s a good reason for that, Barth said.
If a child comes to school with a sore throat or runny nose, even if they test negative for COVID, it’s likely they’ll spread that illness to other children — who will then have to be tested, she said.
“You can’t just say oh, well, she probably just caught that cold,” Barth said. “No, if they have new symptoms, they still get tested.”
Feeling the weight
Nurses are feeling the responsibility. “Parents are relying on us to keep their children healthy by having people who are unhealthy stay home,” Barth said.
“Obviously, the main concern is keeping the virus out of school, and I feel a huge responsibility for keeping track of any new symptoms and making sure that it’s addressed so that we can keep the community healthy,” she said.
“What keeps me up at night is that I’m going to miss a case,” said MacKinnon, the NHSNA’s president. “And then we find out there was someone who was positive and we didn’t do everything we should have.”
School nurses will have to assess each child’s symptoms in light of any chronic conditions the child may have — a history of allergies or migraine headaches, for example — and then make a clinical decision, Mac-Kinnon said. “And it’s not an easy one to make,” she said. “It requires a lot more phone calls and conversations with parents, so that’s how we’re trying to do it.”
The current crisis may change the public’s perception of school nurses, MacKinnon said. “Many times they think it’s a nice lady behind the desk passing out Band-Aids and cough drops and patching boo-boos,” she said. “The reality is nurses are facing kids every day with chronic conditions, conditions that need to be managed. It’s a very complex job, dealing with the whole child, and being the liaison between the parent and the school.”
The pandemic has only made things more complex. Quicker testing would help a lot, nurses said.
It took two days to get the test results back for one Crossroads Academy student, Barth said. For another, it took nearly a week.
The state health department is trying to purchase 25 new rapid-testing platforms that screen for antigens (particles of the virus), Chan said. Those could be deployed at testing sites around the state, which would help schools and parents find out within minutes whether a student has COVID-19.
Another new technology recently authorized by the federal government for emergency use employs single-use cards to test for antigens, Chan said. If New Hampshire could obtain enough of those, he said, they could potentially be distributed to schools to test students quickly.
Crossroads Academy’s Barth, who has been a nurse for 35 years and a school nurse for 21 years, said parents and teachers had a lot of anxiety before classes started. But that has eased as everyone gets used to the new protocols, she said.
She said the kids have been good about wearing masks, washing their hands and keeping their distance. “I think after being out of school since March, they’re just thrilled to be able to come to school,” she said.
“And I think even teachers who were anxious in the beginning are settled down and feeling like, ‘OK, we can do this.’”
Chan said parents and school staff need to understand that some people will be diagnosed with COVID-19 in school settings. And public health providers will continue to investigate every case and conduct contact-tracing to identify anyone who might have been exposed, he said.
His message for parents: “Please don’t send your symptomatic kids to school.
“Even if they are mild symptoms, even if they’re symptoms that we normally would ignore in the past, it’s really no longer acceptable to send kids with new, mild cold symptoms into a public setting like school,” Chan said.
He also urged everyone to get a flu vaccine this fall — not because it will protect anyone from COVID-19. “But we know influenza will be out there, and in order to decrease the burden of respiratory viruses in our communities, to decrease the burden on our health care system, influenza vaccine is an important component of responding to the pandemic this season.”
Barth said she understands the stress parents have been under for the past six months. “We certainly want to help parents do their job, but we’re trying to do ours too,” she said.
“Please be patient. Be kind and respectful in your communication with the school nurse. And if you get a call to pick up your child, be supportive and follow through,” Barth said. “Call your physician and get the test.
“The common goal is to keep COVID out of school.”
MacKinnon believes some older nurses have retired for fear of getting sick.
At 64, she thought about it herself.
“I strongly, strongly considered not coming back this year,” she said. “At the 11th hour, I decided no, I’m going to do it. I’m coming back.”
MacKinnon has friends who worked in hospitals during the early weeks and months of the crisis. Now as the front lines have moved to the schools, she feels an obligation to do her part, she said. “This is just so important that nurses are here,” she said.
Here’s what she wants parents to know:
“We’re on their side. We know they want their children in school, and we as nurses just want to provide the safest environment that we can.”