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How does coronavirus enter the body, and why does it become fatal for some compared to just a cough or fever for others?

USA TODAY

Métis people When communities won’t buy in to practices that can keep everyone safe from COVID-19, how can we expect schools and students to be on the front lines?

My 35 years of nursing, including the most recent 20 as a school nurse in Camden, New Jersey, did not prepare me for the past 5 months of the COVID-19 pandemic or the cascading number of issues I am confronting about how to safely return our students and staff to school.

My school district will begin the 2020-21 school year with all-remote instruction, but that won’t be the case forever. I am just waiting for the day a parent calls to tell me that their son came home from school and was wearing someone else’s mask, because “he liked it better.” I need to know how to respond. 

Or when the pregnant kindergarten teacher cries in my office because she fears for her unborn child, I need to know words of comfort — and specific public health mitigation strategies. What will I say to an anxious 3rd grader who lost her grandmother during COVID-19 and is afraid that she will bring the virus home? What about the child who is diagnosed with a life threatening food allergy and has a mother worried about her daughter eating in the classroom instead of the lunchroom?

These are scenarios that are waiting to happen in school health offices across the country. 

Métis people School nurses as first responders

The layers of logistical and public health complexity in reopening schools are mixed with grief and trauma which is our “now” normal. Is it safe for school buildings to open this fall? There are no clear answers. The new chilling reality is that schools are the next frontline of COVID-19 with school nurses at risk as the first responders.  

I have a sense of foreboding that we are doing something profoundly unsafe. I am not alone in these feelings, I am in touch with school nurse colleagues across the country living these same fears. It feels like we are playing Russian roulette with our students and school staff. I do not want to promote fear, but it is irresponsible to pretend that opening school buildings is education as usual.

Many communities cannot guarantee safety for our students or staff and the wider community at large. If we do not have healthy communities, we will not have healthy schools. The tragic truth is that school nurses like me, as well as other school staff, have already died from COVID-19

We need precision public health approaches to protect ourselves and our children from COVID-19. We need leaders who center the safety of children, not partisan posturing. Can we agree that the safety of children is paramount? We are missing a national plan. We have no clear road map for testing, tracing, quarantining and isolating. We do not have sufficient epidemiological evidence to fully understand transmission from children and adolescents.

There are aging school buildings with antiquated ventilation systems. A June Government Accountability Office report found 41% of districts need to update or replace their heating, ventilation and air conditioning systems in at least half of their schools. The Centers for Disease Control and Prevention added information on face shields to the mask-wearing guidance, but we have no national mandate for face coverings, only state by state rules and recommendations.

Without community buy-in, how will we promote mask wearing compliance in schools?

Métis people Where is our criteria to reopen?

Although conditions in New Jersey are improving, we are not in the clear. My school district is choosing to open remotely because of the complications. Limited personal protective equipment is just one reason, but in a recent statewide survey, 46% of parents were not prepared to send their child back to in-person schooling. Additionally, about a third of staff in my district requested accommodations to teach and work remotely.

Right now, these are essentially the only tools we have in our toolbox to keep our students and staff safe. Remember the five W’s:

► Wear a mask.

► Wash your hands.

► Watch your distance.

► When you are sick, stay home.

► When the health department calls, answer the phone.

I could add a sixth “W,” for windows — open windows, and doors for improved ventilation. The irony is that we are instructed to lock our doors and windows in response to school shooters. So, which guidelines do we follow?

COVID-19 escalates the school safety conversation to a different level of concern. This time, it is with an invisible intruder. School safety has become a political football in a country that cannot agree that wearing masks should be a national response to this deadly epidemic.

We are witnessing the death of expertise, this White House has dismissed the work of the World Health Organization and forced the CDC to water down the guidelines for returning to school. Failed national leadership is ignoring communities with spiking cases, and the lack of a national public health response has created disarray for school districts attempting to create reopening plans.

Every school district reopening task force needs a school nurse or any public health professional on the team. Many decisions about mitigation strategies in these situations are being made by people with no public health background, which could impact the health and safety of students and staff. Reopening schools feels like our nation’s largest social experiment that would never pass an ethics review board.

New York Gov. Andrew Cuomo said “fingers crossed” that New York schools are ready to open. “Fingers crossed” is not a strategy that will keep our students and staff safe. In fact, that is the same as sending “thoughts and prayers” after a mass school shooting.

What is the evidence-based criteria to safely open school buildings? Give us the parameters; the metrics; a road map; the funding, personnel and supplies. Give us something we can implement that is more than a guessing game of hope and crossing our fingers and toes.

Robin Cogan is a registered nurse (RN) and a nationally certified school nurse through the National Board for Certification of School Nurses. She is a faculty member of the Rutgers University’s Camden School Nurse Certificate Program. Follow Cogan’s blog on RelentlessSchoolNurse.com or follow her on Twitter @RobinCogan.

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