Transcription:
School Nurses and COVID

Welcome to the Peds Ethics podcast, where we talk to leaders in pediatric bioethics about a hot topic or a current controversy. Here’s your host, John Lantos from the Children’s Mercy Bioethics Center in Kansas City.

John Lantos (Host):  Hi, this is John Lantos welcome back to the Pediatric Ethics Podcast coming to you from Children’s Mercy Kansas City and the Children’s Mercy Bioethics Center. We have been doing a number of podcasts about the issue of children returning to school or using some form of distance learning during the COVID pandemic. We’ve been talking with two of our Bioethics Center Faculty Vanessa Watkins and Jeremy Garrett. They are back with us today. we have a special guest Shelby Rebeck who is the Director of Health Services in the Shawnee Mission School District in Kansas is going to tell us a little bit about what things look like from the school nurse and school health side of things. But let’s start with Vanessa and Jeremy. Perhaps you can catch us up on what’s going on with your families and kids and going back to school.

Vanessa Watkins, MPH, FACHE, CHES (Guest):  So, my kiddos we began virtual in our school district and we began last week. Everyone was virtual. So, regardless of the learning mode that you chose. I think that the virtual learning has been really good especially compared to what we had in the spring. The teachers have been fantastic. There have been schedules – it’s a lot more coordinated throughout the day. So there are check in times. In the spring it was more okay these are things you can do during the day and there would occasionally be a check in, but it was definitely not a daily. And so my kids are checking in somewhere between four and seven times per day with live lectures, chances to ask questions, that sort of thing. So, I could imagine that would be something that you could do longer. In fact, I think it went so well that it was hard when the second day of school, we were given a choice of having to decide or asked to decide for the whole year whether or not we wanted to do in person or virtual. And so, it was hard for us to decide. We had to think about that. The district did end up deciding that we would have a little bit more time and if we really wanted to, we could change.

Host:  A lot of uncertainty.

Vanessa:  A lot of uncertainty. Yeah. But I mean so much better. Kudos to all of the teachers that I have. I haven’t heard any bad stories. I think it’s – it’s an activity that’s been great. The learning management system has been great. Yeah.

Host:  Jeremy, how about your kids?

Jeremy Garrett, PhD (Guest):  Well my experience, our experience has been similar but also very different to Vanessa’s in that both of my kids or all three of my kids at two different levels, elementary and middle school, have both gone to school. Our elementary school kids are full time in person and our middle schooler is on a hybrid model where he is going two days a week and kids in another cohort are going two of the other days a week and everybody is online on Wednesdays. So, we have kind of got all of the different options represented in this conversation here. Our experience so far has been pretty positive. The in person has been just like normal other than the precautions that have been taken at school which don’t affect us as parents exactly. The kids seem to be doing well by all reports from the teachers and staff with masking and physical distancing and the school districts put up a dashboard that tracks cases in the district and out of 13,000 students and teachers and staff, actually more than 13,000, they had reported 10 positive cases last Wednesday and we will see the update tomorrow to see if anything much has changed. But I haven’t heard through the rumor mill or through official channels of any large concern with a rise in cases over the past week which has again been also like Vanessa, the first week of school was last Monday and – or last Tuesday, and so they are in their second week of classes right now.

Host:  So, both of you seem to be having pretty positive experiences in this brave new world of COVID education.

Vanessa:  So, I think it’s just because of my experience. We have a second grader and a fourth grader, and I just want to share because I am in touch with neighbors and friends that have kindergarteners and I just want to share that as predicted, kindergarten done virtually is not going well. I haven’t talked to any kindergarten parents that have been – and it’s not I don’t think a fault of the district, I think it’s just that age does not translate well to a virtual learning experience. So, I just wanted to share that perspective because it’s not perspective. Yeah.

Host:  Shelby, can you tell us what things have looked like both over the summer and during the opening weeks of school in Shawnee Mission School District?

Shelby Rebeck, MSN, RN (Guest):  Well summer went fairly well. We only had athletics going for part of the time in the summer. Right now, Shawnee Mission is in the remote or virtual only mode. We are planning to start hybrid at our elementary level on October 5^th. And then we are working toward an all in person model as safety allows us to do. We do have some students with special needs in our buildings every single day. These are students that maybe need speech or PT or OT or, their learning needs need to be met in person. So, while we’re in this virtual or remote model, the teachers are working on masking, and hand hygiene and concepts of social distancing and things like that so hopefully, when we do get into that hybrid model, on October 5^th, with our littlest learners, it will go better. We won’t have to quarantine as many and things like that.

Host:  Tell us a little bit about the district. How many schools, how many students.

Shelby:  So, we have pre-K, all the way up through an 18-21 year old program. We have 48 buildings or learning sites. So, 27,000 students and about 4,000 employees.

Host:  Wow. And everybody is doing distance learning at this point, virtual?

Shelby:  Yes, and except for some of our students with special needs who are in the buildings right now.

Host:  And how did you pick October 5^th and what indicators of risk are you looking at to decide when to go to hybrid?

Shelby:  You know I think that was a lot of our leadership in learning department. I think they were meeting with teachers. We had a significant amount of teachers who are fearful to return to the classroom. And we also implemented a new learning management system called CANVAS and so, not only did the teachers have to learn – they already knew how to teach in the classroom. And they are awesome at that. But they had to learn this whole remote thing and I think as Vanessa said, in the spring, it was sort of haphazard. These are some thing you can do but now, it’s really structured. These teachers are really working hard to make this learning from home easy for students and parents. So, I think we felt that we needed to give our teachers some time to get CANVAS under their belts and then also, just some time for our own staff to adjust to the masking and social distancing and hand hygiene, you know all those things that – it’s just such habit for us to be in rooms together without masks and close proximity. So, we took out time. We’re just taking it slow. Hoping that that will make – we’ll have lower cases.

Host:  Have the schools done any physical modifications, putting in air filters or other changes in ventilation?

Shelby:  Yes. We have a whole department. Our operations and maintenance and our facilities department has been working with Luke Guards, Luke Guards out of Children’s Mercy so we’ve done the marking of the floors, for the three to six foot distancing of desks and especially in the lunchroom where that’s going to be really important because those kids will be unmasked during the time they are eating. We’ve made changes to curriculum especially like PE where you would be doing face to face things. We have teachers rotating instead of students rotating to decrease congestion in the hallways. And then as you mentioned, lots of changes to ventilation, pulling the dampers or set to pull in 30% outdoor air. We’ve got negative air flow rooms for an isolation room and in the nurses office, we also have the – I call them air scrubbers in our band and choir rooms so lots of work has been done on that front.

Host:  And what sort of medical screening for the kids? Does everybody get their temp taken when they come in?

Shelby:  So, Johnson County Department of Health and Environment did not advise mass screenings for our school districts and if you look at CDC and American Academy of Pediatrics, they also did not recommend mass temperature screenings. So, we elected not to do that. But what we did do is we purchased a digital thermometer for each of our families and we’re doing what we call a daily COVID-19 assessment. So, we sent that home currently to our staff and special needs students who are in the building but prior to October 5^th, this will go out to our elementary learners who will be in hybrid mode. But basically it just takes you through that questionnaire of do you have one of these, I believe there’s 14 symptoms listed. It tells you what action to take if you have those symptoms and then just a questionnaire of have you been in contact with a positive case. Are you awaiting test results? Things like that that would clue a person and then almost every time it says please contact your school nurse if you answered yes to any of these.

Host:  So, you may be getting a lot of calls.

Shelby:  Yes. We anticipate that.

Host:  Hasn’t started yet though since they are all still at home, right?

Shelby:  We have a significant number of questions. I think as Vanessa mentioned, we ask our parents to make a decision for the full school year as to in person or remote learning. We’ve since pulled back on that from listening to our parents and how stressful that was going to be to them. But lots of questions about what are you doing in the schools to keep our students safe. Because parents didn’t know what choice to make and so we answered those questions for them. So, a significant amount of communication has been going back and forth.

Host:  So, one interesting thing form this conversation for me is that each of the three school districts represented here has made different choices about what to do this month. Vanessa and Jeremy, do you have any questions for Shelby about whether what your schools are doing is safe?

Vanessa:  I’m going to - I think when I’ve watched the Children’s Mercy town hall, and just sort of been following guidance on what schools should be doing, a couple of the questions I had were, I had understood that it would make more sense to keep the kids in their rooms and then say bring the specialist teachers, special being PR, music, art, that sort of thing into their classroom so that each room kind of maintains their cohort. Similarly, I’ve also heard it’s good for the kids to maintain having their lunch in that room. And so I guess if we could just speak to – I don’t know what Jeremy’s district is doing, or what Shelby thinks – or why –

Host:  How are people doing lunch?

Vanessa:  How are they doing it yeah. Lunch is special too.

Shelby:  So, I’ll answer for Shawnee Mission. I think as much as possible, every building has to do what works for their building according to staffing and student numbers and all of that. But I think for the most part, they’re trying to have teachers rotate to the classrooms for those special type classes. And then for – was you second question about lunch? Eating in their classrooms?

Vanessa:  Yeah.

Shelby:  Yeah. So we are really struggling with that because according to the negotiated agreement with all of our teachers, they get a 30 minute duty free lunch and so, it was going to be really difficult to have lunch in the classroom where the teacher would be required to supervise, and we have all of those kids. So, what I think is happening, at least some of the principals I’ve talked with they are utilizing their cafeteria for as many kids as they can get in with the six feet of personal distance and then they are using outdoor spaces which the kids are thinking that’s super cool and we do have kids on these committees to help us make these decisions but then also flexible seating within the school. So, maybe large multipurpose rooms or hallways, gymnasiums, things like that where one person or a fewer number of people could supervise more children.

Host:  Is there going to be room when everybody comes back with all these social distancing and adjustments? Will there be room for everybody to be there in person every day?

Shelby:  Well I think we’re really glad we’re starting in hybrid because we can adhere to the six feet for the most part in hybrid. But we’re going to have to work on – and we’ve already done a significant amount of work. We’re moving bookshelves and any sort of like extraneous furniture in our classrooms. And storage has been an issue. Where to put all that stuff. But I do think once we get everyone back full in person, we’re going to have to go down to that three feet of minimum distance that the county and CDC and everyone is recommending. And we may even have to get creative even with the three feet numbers.

Host:  What will happen when a child is quarantined when they’ve been exposed or tested positive? Who else will be quarantined? Will you be doing contact tracing and will everybody who has had close contact need to spend two weeks at home?

Shelby:  Yeah, so here in Johnson County, we’re so fortunate that the County Health Department is working closely with all six school districts. But they have provided us with isolation and quarantine protocols. They are easy to follow. And we, here in Shawnee Mission, are doing the exact same thing for whether it’s a student or a staff member, a teacher. So, if we have a case, a positive case in a classroom and we’re notified by the parents that that student has tested positive; we will notify everyone in that classroom that there has been a positive case in the classroom. Of course, we will take care to not personally identify anyone. That is private protected health information. But we will let everyone know, the teachers, the parents, the students know that there was a case in the classroom, that they have been exposed to. However, in Johnson County, the county health department is saying that if everyone is properly masked, wearing it over their nose and mouth, snug to their face, it’s not falling down, that there is no quarantine requirement. So, we are really hoping that as these remote learners work with their teachers, their teachers are doing things like saying okay, everyone go get your masks. We’re going to wear our masks for the next fifteen minutes, we’re really hoping that these learners, these young kids will be able to mask properly in the classroom and so we won’t have to quarantine as many people. But, in the event, that someone is not masked properly, then absolutely, teachers, parents, students, will all be quarantined according to that protocol.

Host:  Here’s the last question for each of you. Knowing what you know now, and looking forward over the next month or two, what keep you up at night? What’s your biggest worry about what could go wrong here? Jeremy, you want to start?

Jeremy:  Sure, I mean I’ll tell you mine for sure is just the confluence of flu season and other viruses in conjunction with COVID at a time when many people are going to be going indoors more as the weather cools and it becomes harder to be outside and it get’s darker earlier, all those things; and the chaos that could ensue from all of those factors kind of happening at once is certainly something that scares me and the thought of spending all winter couped up inside with three kids and my wife and I all together is certainly something I’m not – I’m hoping to avoid. And certainly scared may happen. So far, things seem to be good, but we have a much different situation than we’ll probably have come late October and early November and then we get into the holidays and it just seems like a lot of potential for a spike in transmissions.

Host:  Yeah, we’ll be checking back with you to see how that plays out. Vanessa, how about you?

Vanessa:  Yeah, I mean I echo al the things that Jeremy said. I think parents are probably – a lot of us are in the same boat. I think for us, we have made some decisions about what we’re going to be doing for the year. So, we did actually confirm that we wanted to stay in person for our two children and so, when our kiddos go back, sometime mid-October, you know 100% capacity at the school or whatever percentage of students decided to stay. A little bit of anxiousness about whether or not that was the right choice. I think all of us are just trying to make the best choices we can all of us and all of our situations with all the information we have at the moment.

Host:  Shelby, what’s keeping you up at night?

Shelby:  Yeah, I think I echo what both Vanessa and Jeremy said, the confluence of the flu and then what happens when our numbers – if our numbers reach 15% and we are in that black or all remote kind of that back to the shutdown mode? I worry about that and then I also worry about the frustration that’s going to come about for parents’ scheduling regarding quarantine and isolation. Fourteen days is a long time to have to be at home for an exposure. But we know we’re going to have cases in schools. You can’t bring hundreds of people back into our buildings and not have cases. So, I do worry about that level of frustration from the parents.

Host:  They will be quarantining as will teachers presumably, yeah?

Shelby:  Correct.

Host:  So, there’s going to be some issues both for the parents and for staff and there’s a little outbreak with the teachers. Well thank you all so much for talking about this. It’s an ongoing set of dilemmas and we will be touching base with Vanessa and Jeremy periodically through the fall. Shelby thanks so much for taking the time to catch us up on what’s going on in your very large school district. It sounds like it’s been an adventure.

Shelby:  Yeah. Thanks for having me Dr. Lantos.

Host:  Once again, this is John Lantos with the Pediatric Ethics podcast coming to you from Children’s Mercy Hospital in Kansas City. Thanks for joining us.