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School nurses are at the front lines of epidemic as schools reopen

They’re the ones who will be called if a child is showing any symptoms of COVID-19 in class.
Pediatrician using thermometer temperature screening for school child
In addition to their regular duties, school nurses are now screening for symptoms, contact tracing, enforcing mask wearing and conducting disease surveillance.Getty Images
/ Source: TODAY

With wildfires creating a giant mass of smoke in Montana in recent days, school nurse Karen Graf worried about the challenges of assessing kids who were having trouble breathing.

“Is it COVID? Is it asthma? Is it influenza? Is it the smoke in the air? That's just a really hard one to determine,” Graf, 55, who is based in Pioneer Elementary School in Billings and manages the county’s other school nurses, told TODAY.

“Usually, I'm assessing and evaluating in a hallway or a space where we can be close by the classroom and then move them to an area of isolation if need be.”

Schools in Graf’s area have been back in session for a month, with the majority of children attending class in person. The students are assigned to small cohorts of four to six kids who spend all of their time together. If someone in the group were to get COVID-19, only that little bubble would need to be quarantined, not the entire classroom.

Graf’s first week of school was spent addressing concerns from people “freaking out” over the virus, and those who didn’t think it was even an issue and were upset about having to wear a mask, she said.

School nurse Karen Graf assists a student during hand washing class at Pioneer School in Billings, Montana.Courtesy Karen Graf

'School nurse is more important than ever before'

Across the country, school nurses are adjusting to the new normal of the epidemic. They’re still managing everything from skinned knees and allergic reactions, to chronic disease care and mental health issues.

But now they’re also on the front lines of trying to stop the spread of the new coronavirus as schools reopen. They’re contact tracing, enforcing mask wearing, screening for symptoms, conducting disease surveillance, and educating teachers and staff about how and when to use personal protective equipment.

They’re the ones who will be called if a child or teacher is showing any warning signs of COVID-19 in class.

That’s if a school has a nurse at all. A quarter of U.S. schools don’t employ one, according to a survey published in Journal of School Nursing in 2018.

“The school nurse is more important than ever before,” Laurie Combe, president of the National Association of School Nurses, said in a statement in April as she requested government funding for 10,000 more positions.

Purchasing 1,000 thermometers

Juanita Gryfinski has a pool of 1,500 potential patients — the number of students who attend the middle school in St. Charles, Illinois, where she works as a certified school nurse. She had some unusual new tasks this school year, like ordering 1,000 digital oral thermometers and teaching kids’ families how to use them.

Temperature checks are important during the epidemic, but many people just don't keep thermometers at home, she said.

Gryfinski’s district was one of the first ones in the Chicago area to return to in-person instruction in mid-August. High schools remain remote until October, but grade and middle schools are open with many precautions in place.

Students are allowed to enter only after completing and passing a daily online symptom checker. Desks in classrooms are spaced 6 feet apart, kids come in on rotating schedules, hallways are now one-way only and classes are held outside whenever possible, with students sitting on lawn chairs. Masks are mandatory.

A month into the semester, Gryfinski said following up on the daily symptom checker takes up "a big chunk of time," but she and other school nurses are energized about helping to keep in-person instruction going.

“Are we tired? Yes, but we know what we're doing and we're doing it well,” said Gryfinski, 64, who is also president of the Illinois Association of School Nurses.

“I have to say I’m pretty astounded how well the kids have done, even our little ones.”

School nurses as 'first responders'

The parents were one of her biggest concerns. Gryfinski knew there would be COVID-19 cases in schools and worried students’ families would want to return to remote learning quickly when that happened. But even as schools have announced cases and required some students, teachers or staff to quarantine, they’ve been able to demonstrate it’s still safe to attend class, Gryfinski said.

Both she and Graf said they felt safe on the job, and wear PPE — including an N-95 mask, a face shield, gown and gloves — when evaluating a potentially ill student or staff member.

Local mandates provide guidance for the next steps, including contact tracing, notifying the health department of a suspect case, and testing, isolating or quarantining household members.

But some school nurses are worried about their COVID-19 risk while working as “the first responders” in aging school buildings with antiquated ventilation systems, wrote Robin Cogan, a veteran New Jersey school nurse, in USA Today.

“I have a sense of foreboding that we are doing something profoundly unsafe,” she warned.

Bracing for flu season

Flu season may complicate things further. But there’s more understanding now about COVID-19 symptoms in kids — if there are any, Gryfinski said. Many children are asymptomatic or may have abdominal pain and congestion rather than a sore throat, cough and high fever that come with the typical flu, she noted.

The concern is spreading the illness to more vulnerable people in the community. Graf’s school district is constantly monitoring various metrics to decide whether schools should remain open for in-person learning.

Teachers, parents and students are happy they are there, and so is she.

“I get such a sense of satisfaction just hearing the kids giggling on the playground, hearing the violin players start to play for the first time and screeching. I think sometimes I had forgotten what those sounds sounded like,” Graf said.