Back to School 2020—Part II: Health Considerations When Students Return to School

In order to address additional questions and topics that weren’t covered by the previous “Back to School 2020” Q&A, Dr. Jim Heise, Chief Medical Officer at Door County Medical Center, and Dr. Amy Fogarty, Pediatrician at DCMC and medical advisor for the Door County school districts, returned to Facebook Live, this time to discuss COVID-19 related issues that might arise once school is in session.

Note: As before, the format that is used below to present questions and answers does not follow the original order and format of the Facebook Live Q&A. Instead, questions and answers have been reorganized so that related topics are covered together. Additionally, content may have been edited for length and clarity.

School protocols: What to expect if a child becomes sick at school

If your child or another child at their school becomes ill during the school day, protocols have been put in place to help school nurses and staff determine whether the child should be isolated and sent home.

COVID-19 flow chart

“In my weekly meetings with the schools and the Department of Public Health,” Dr. Fogarty says, “we discussed a flow chart that the Wisconsin Department of Public Instruction recently released that is similar to other flow charts school nurses and staff use when children develop issues at school—for example, a bee sting, an injury on the playground, or a fever.” In 2020, school nurses and staff will have to determine the nature of a child’s illness—is it seasonal allergies, a serious medical issue that will require immediate hospitalization or is it COVID-19? The new flow chart will help staff make this determination.

The flow chart effectively has three “columns” or sides:

  • The left-hand side discusses protocols for seriously ill children that need immediate medical attention.
  • The middle column discusses new or worsening COVID-19-specific symptoms like fever, cough, vomiting or diarrhea, and loss of taste and smell. These symptoms would automatically result in a request for a parent to pick up the child from school, and would also likely result in a request for a COVID-19 test.
  • The right-hand column discusses milder symptoms that may point toward seasonal allergies or some other illness that won’t require the child being sent home. Additionally, this side asks whether the child has 2 or more COVID-19 specific symptoms—fewer than 2 possibly pointing to something less severe.

Download: Health Office Visit during COVID-19

Furthermore, Dr. Fogarty points out that the Department of Public Instruction will make the flow chart available to parents. “This chart will be very helpful to parents who need to make a decision about whether to send their child to school or not,” she notes, adding, “If your child has COVID-like symptoms—fever, cough, nausea, fatigue, etc.—we would ask you to use the flow chart in the morning to evaluate your child before making that decision.”

Additional protocols

Isolation: Dr. Fogarty states, “Each of the schools is actively working on plans to keep kids who have concerning COVID-19-like symptoms isolated from the rest of the school until their parents can come and pick them up.”

Contact tracing: Once it is determined through testing that a sick child has the SARS-CoV-2 coronavirus, the Department of Public Health will begin contact tracing procedures, and will rely on information like seating charts to establish who was in close contact with the sick child. Once the close contacts have been determined, the Department of Public health will contact the parents of any child that came into contact with the sick child and initiate a series of interviews to decide if testing is needed.

Notification: In addition to being notified of whether or not your child was in close contact with another infected child, and if your child should receive a coronavirus test, the Department of Public Health will also contact you if they think your child should be quarantined. Important! Dr. Heise says, “Make sure your contact information is up to date with the school, and make sure you can respond to the school phone calls in a timely manner. We don’t want sick kids in the school building any longer than they need to be, and we don’t want sick kids coming to school.”

Getting tested: at school or at the hospital?

Door County Medical Center is working with schools so that the samples (nasal swabs) can be taken “in-school” and be administered by a school nurse. However, there are certain limitations to in-school “swabbing”, which include:

  • Time of day—because of availability of couriers and the stability of samples, when the test is taken has to be considered.
  • If the child is at school—if the child is at home, it may make more sense to go to Door County Medical Center for a test.
  • Parent preference—some parents may prefer that the test be administered at the hospital.
  • Location—example: the Sturgeon Bay School District has five locations but only one nurse, so the nurse may not be available to administer the test.

Nevertheless, Dr. Fogarty notes the convenience of in-school testing, “Hopefully this will make things easier for families. And if that can’t happen, then the hospital is committed to keeping its COVID-19 testing site open throughout the duration of the pandemic.”

Symptoms, prevention and quarantine: What you need to know

If my child gets sick, will they need to quarantine?

The short answer is yes. As Dr. Fogarty points out, “The days of ‘I have a little bit of a scratchy throat and a cough, but we’ll just send the kiddo to school anyway’—those days are over.” In particular, she adds that “with respiratory symptoms, and especially if the child has a fever, families will really need to adhere to the recommendations and the rules.”

Additionally, if the child has siblings, they will need to quarantine as well until symptoms clear. “If the Department of Public Health deems that your other children have been in close contact with your sick child, they may need to quarantine,” Dr. Fogarty says, adding, “But asymptomatic students that have not been in close contact do not necessarily need to stay at home.”

How do I determine if my child can return to school? 

If your child has been diagnosed with the SARS-CoV-2 coronavirus and has been recuperating at home, the one symptom to follow is fever. Dr. Fogarty says, “If there is a fever, even after 10 or more days, then they still have to stay home—that’s non-negotiable.”

Dr. Fogarty adds that even in pre-pandemic times, this was a question that came up frequently. In order to find a starting point from which to make an assessment, Dr. Fogarty, in turn, asks parent two questions:

  1. If you send your child to school, are they actually going to get something out of school? Or are they still feeling so ill that they will be sitting in math class wishing they could go home. That speaks to how well a child is truly feeling—whether or not they can sit through a full school day and participate.
  2. Would you be okay if another family, whose child feels as well as your child, sent them to school—to sit right next to your child?

“If a parent can honestly answer yes to those two questions,” Dr. Fogarty says, “then they can move further along the path in deciding whether their child should be at school or not.”

Moreover, Dr. Heise notes that the decision to return a child to school doesn’t need to rest entirely on the parent’s shoulders. “The Department of Public Health,” he comments, “will be in contact everyday with anyone who has been diagnosed with COVID-19 regardless of whether or not they are a child. And, when that person no longer has a fever—without taking fever reducing medication such as acetaminophen or ibuprofen—and they have no other symptoms at all—then it’s listed as recovered. Then it would be safe to return the child to school.”

School Closures

It was pointed out during the Facebook Live Q&A that some schools, in different parts of the county, are coming up with hard, in-school infection rate percentages—like 3% or 5%—to determine when a school should close. “When a school district says, ‘If 3% of our students test positive for the coronavirus we’ll close’—well, there is no science behind this,” Dr. Heise remarks. Dr. Fogarty adds, “Those numbers are truly arbitrary—they’re numbers that administrators made up because they sound good or make people feel better.”

Dr. Fogarty continues, “The truth is that because schools were closed during the initial months of the pandemic in the spring, there is no actual data that says, ‘If we close schools at an infection rate of 3%, we’ll be closed for a shorter period of time.’ Each school district is different, and every school is laid out differently and has a different number of students. So, those decisions are going to be made actively with the people from Door County Medical Center, the Department of Public Health and with the school administrative teams—superintendents and principals. Because, those people really know their buildings and their students the best.”

“One of the biggest things we can do right now is to work together as a community,” Dr. Fogarty says, adding, “We all do the best we can, but, individually and as families, we all should really be aiming for the layered approach we talked about at the last Q&A—masking, washing hands and social distancing—each approach has a role to play. And, everybody needs to participate in this way for the wellbeing of the community. And, we all benefit from that—nobody benefits when schools have to close.”

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