School nurses aren't used to being the bad guys.
They want to keep children in class – and save parents unnecessary trips to school – but those goals seemed difficult when the wide-ranging list of coronavirus symptoms came out last year, said Sheri West, corporation nurse for Northwest Allen County Schools.
The school nursing team armed itself with information to decide which ailments merited sending students home as they adopted the role of infection control officers like never before.
“We understood the weight of our decision,” West said.
School clinics annually log thousands of visits from students needing medication as well as those seeking aid for conditions including allergies, asthma, diabetes, illness and injury.
Nurses also conduct vision and hearing screenings, and they ensure students have the required routine vaccinations to be in school.
During the pandemic, school nurses have crammed more responsibilities into their day. A positive COVID-19 case means school nurses must contact trace, determine quarantines, notify exposed students and parents, complete a report for the Allen County Department of Health and complete the district's tracking records, said Abby Koroncevicius, health service coordinator for East Allen County Schools.
Almost every northeast Indiana school has reported at least one COVID-19 case to the state's voluntary coronavirus dashboard. Together, public and private schools in the 11 counties have reported more than 4,200 student and adult cases as of the dashboard's Monday update.
That update, which reflected information as of Feb. 26, also showed schools statewide have reported 40,525 coronavirus cases, including 28,272 among students.
“This year we are doing more 'phone nurse,' ” Koroncevicius said by email. “Our building administrators and staff have really stepped up in helping us to make phone calls, monitor students, etc. It definitely takes a lot of team work to get through the day smoothly.”
Mary Hess, the lead nurse at Fort Wayne Community Schools, provided a public lesson on the novel coronavirus two days before the World Health Organization declared COVID-19 a pandemic on March 11 and four days before Allen County school districts announced plans to close.
Hess, the health and wellness director, spent about 10 minutes at a school board meeting reviewing coronavirus symptoms; prevention strategies, including social distancing; the differences between quarantine and isolation; and the factors – no vaccine, treatment or herd immunity – that made the coronavirus worrisome.
Schools remained closed to in-person learning for the rest of the 2019-20 academic year.
West, the corporation nurse for NACS, recalled the scariness of the situation. Alarming stories were coming from Italy, cases were spiking in New York, and there was no cure for the novel coronavirus – an invisible enemy.
“Our full classrooms seemed like sitting ducks,” West said.
Although buildings closed, she said, NACS school nurses kept busy monitoring temperatures of food service employees as that department worked to get meals to students.
Over the summer, local education leaders met with Allen County Department of Health officials. Everyone agreed reopening and keeping schools open was important, said Erika Pitcher, the department's director of community health and case management services.
“We knew it was going to take a massive effort on everyone's part to step up and meet the challenges each day,” Pitcher said by email.
School nurses – trusted people within the schools – reinforced the health department's guidance, Pitcher said.
“Having them work in tandem with us and mirror messaging for things like isolation and quarantine requirements, even though these are not often things trained medical professionals have experience with, has been very helpful,” Pitcher said.
Hess – who is also a member of the Allen County Board of Health – was realistic about the challenges facing FWCS as it prepared to resume in-person learning in August.
At the Aug. 10 school board meeting, Hess acknowledged the guiding principles for reducing virus spread – stay home when sick, social distancing, assigned seats, mask requirements, hand washing and disinfection – weren't as simple as they seemed.
“It's more than just understanding the concepts, but it's applying them and really trying to get behavior change,” Hess told the board. “Anybody that's tried to lose 10 pounds knows that that's not as easy as it sounds.”
COVID or not?
When classes resumed in August, an unexplained runny nose could keep a student or employee home.
So could about a dozen other symptoms, including a cough, sore throat, 100.4-degree fever and headache.
Such ailments were common in school clinics before the pandemic. Last academic year, for example, EACS logged 21,191 clinic visits for acute illness, which includes headache, sore throat, fever, body aches and diarrhea, according to the annual health services report for the 10,000-student district.
School nurses envisioned the number of people they would have to send home under those early coronavirus guidelines, West said.
They felt “tremendous pressure” when deciding who could be at school, she said. They decisions have gotten easier as nurses learned more about the coronavirus.
For instance, West said, headaches are a common complaint, so NACS nurses researched the characteristics of headaches associated with the coronavirus. They learned sudden onset, severe headaches were bad news.
“When I saw a little elementary student just sobbing in tears, I knew that was COVID,” West said.
Calling the county health department daily – even on weekends – has become routine for Hess.
“It's been a wonderful collaboration,” she said. “Not all counties have that blessing.”
The health department generally discusses day-to-day operations – such as issues related to quarantine and isolation – with nurses or other school staff while big-picture topics like new guidelines involve superintendents and administrators, said Pitcher, a director at the county agency.
Nurses also call the health department's school hotline with questions, she added.
Having a nurse for every school is common for EACS, NACS and Southwest Allen County Schools. FWCS doesn't have a registered nurse in every building, but its nursing team was expanded in the past year.
FWCS added eight nurses for a total of 40 school-based nurses along with 13 health aides, a relatively new position before the pandemic.
The aides began helping high school nurses last year, and the expansion benefitted nurses assigned to two schools, Hess said.
When a student or school employee tests positive for COVID-19, nurses must conduct a case investigation – a process that requires lots of talking to determine whether that person was at school while infectious and, if so, whether they were in close contact with anyone, Hess said. Close contacts are asked to quarantine.
Building-level nurses typically run the case investigation, Hess said, but health aides can contribute.
“Sometimes we have to go and measure desks to see who really was close enough,” Hess said.
Kelly Dawson, the head nurse for SACS, didn't know what to expect when in-person classes resumed.
Her team began planning for the extra responsibilities last spring, she said, and ensured schools had a way to separate clinic visitors so those with COVID-19 symptoms wouldn't infect others.
Case numbers have been lower than Dawson imagined, she said.
“We've been pretty lucky,” she said.
Many local schools have fewer than five COVID-19 cases among students, teachers or adults. This makes it impossible to calculate exact totals for schools and districts because the state, which provides information by school, suppresses totals of five and fewer by category – students, teachers and staff.
The Journal Gazette replaces “five and fewer” with “one” when calculating totals.
Using this method for data available Monday, FWCS has had at least 291 student COVID-19 cases; EACS has had at least 158; NACS has had at least 174; and SACS has had at least 88.
This represents about 1% of FWCS' enrollment; 1.6% of EACS' enrollment; 2.2% of NACS' enrollment; and 1.1% of SACS' enrollment.
In comparison, about 2.5% of the state's 1.1 million students have tested positive for COVID-19, according to the school virus dashboard as of Monday.
Districts with higher rates include Whitley County Consolidated Schools, 6%; Wawasee Community School Corporation in Kosciusko County, 5.4%; Warsaw Community Schools in Kosciusko County, 4.9%; and Huntington County Community School Corporation, 3.6%.
“It has not been easy,” Pitcher said, “but we could not be more proud of our schools and their ability to pivot on a moment's notice to adapt to the ever changing public health guidelines and regulations.”
Hess couldn't speak for other districts' coronavirus protocols, but she said FWCS has tried to follow health recommendations as best as possible.
The district has been well served by following four basic mitigation strategies – mask wearing, social distancing, hand-washing and sanitizing, Hess said.
In the few cases where the virus has spread among students or staff, she said, it's usually because one of those protocols can't happen regularly, such as on an athletic team or confined work space.
“I can't say enough about how much our teachers have really stepped up to the plate and were pushed to do things much differently than they've ever been asked to do things before,” Hess said. “I really do think that's our success.”
COVID-19: Caught in the Grip
The coronavirus outbreak was declared a global pandemic a year ago in March.
This story is part of a Journal Gazette series about changes prompted by the virus – at least temporarily – as individuals and communities rallied to respond and learned to cope.
You can find other stories that are part of this series at www.journalgazette.net by clicking “Sections,” then “COVID-19: Caught in the Grip.”