Considerations for Going Back to School
School nurses are key players in helping their school or district determine whether it's safe to reenter the classroom. Their background and expertise make them uniquely qualified to help determine:
- If their school potentially has the resources for and ability to perform daily mass screenings
- The amount of personal protective equipment (PPE) needed to protect students and staff
- Policies and procedures for maintaining healthy practices in the school
- The procedure for when a student or staff member is presumed to have or is diagnosed with COVID-19
- Return-to-school policies and procedures for staff or students diagnosed with COVID-19
- Best processes for managing existing health services
Planning teams may also want to consider different reentry options including:
- Cohorting or podding
- Alternating schedules where students physically attend school certain days of the week or every other week
- Staggered scheduling
- Hybrid scheduling that's a mix of virtual and in-class learning
- Alternative options for staff and students at higher risk for sever illness
- Inclusive programming for children with special healthcare needs or disabilities
Any plan for returning to school should begin with input from the staff and families affected regarding their willingness to return to in-person learning.
Create a parent handbook that outlines all the newly adopted policies that will keep staff and students safe, including PPE use, general hygiene, social distancing, and sick policies. This should incorporate ways of addressing barriers due to differences in language, culture, and abilities. Parents should be made aware of the policies for calling in sick, and how to make that decision. In addition, communicate the decision-making process for when school will be closed or events cancelled due to illness.
Spread Prevention and Infection Response
To help prevent the spread of germs in general, it is recommended that schools require immunizations. Check with the local health department officials to determine the area’s capacity for testing, contract tracing, and infection response. The CDC recommends that anyone immediately leave the premise if they display COVID-19 symptoms or a fever of 100.8 or higher, which means emergency contacts must be up-to-date and transportation should be available for anyone in need. Affected individuals may return to school once ten days have passed since the first symptoms were present, they have been fever-free for at least 72 hours without the use of fever-reducing medicine, and their other symptoms have improved.
It’s going to be hard to avoid bussing in an in-person school situation, but the goals for transportation should be to make it as safe as possible, but to also incentivize the use of personal transportation. Reimbursing parents for driving their children to school will help keep some kids off the bus, but this is not a reasonable option for many parents. For the children who will be sharing this public space, vigilance and reorganization will be crucial.
Before even going to the bus stop, parents should do a visual check on their children to make sure they look healthy, and a temperature check will help ensure they don’t have a fever that they aren’t complaining about. After all, young children can often have fevers and still function fairly normally, as compared to adults. All children riding the bus should also use hand sanitizer either before entering, which should be provided in a dispenser at the top of the entry stairs. And of course, all children and the driver should all be wearing appropriate masks, as currently defined by the CDC.
All bus drivers will need to be trained on identifying students with potential health issues. They should also be provided with methods of taking temperatures without contact. The mask worn by the driver must not interfere with their view of either the road or the children in the mirror, as it will be their responsibility to ensure social distancing is enforced. Students should not be sitting together, and rows should be skipped when possible. Window should be left open when appropriate for both the weather and student safety (students with allergies or asthma may need the windows closed).
To help minimize the number of students on the bus at one time, consider staggering schedules and/or increasing the number of busses available. At the end of every ride, the drivers should be routinely cleaning the seats with a CDC-approved disinfectant.
To help minimize the spread at entrances and exits:
- Stagger start times for different grade levels
- Identify high risk students or staff and designate separate entry points for them
- Create guidelines for parents picking up and dropping off
- Mandate PPE wearing and provide extras for anyone without a mask
The health office and front office will be critical areas to maintain order and safety, as well as all public areas. The following recommendations will optimize safety in these spaces:
- PPE and hand washing stations strategically placed
- Create maximum occupancy in office spaces
- Designate a flow of traffic in hallways and offices
- Ensure adequate ventilation
- Install hands-free biohazard bins for PPE disposal
- Consider using drinking fountains for only filling bottles
- Install HEPA-filters and mold remediation
This is where students will spend most of their time, so the following considerations are very important:
- Assign seating for all students in rows
- All supplies must be individually packaged
- Allow for remote instruction if possible
- Offer first aid kits in classrooms
- Place hand sanitizer in every classroom without a sink
- Install partitions to maintain distancing
- Instead of having students switch classrooms, rotate teachers
- Establish a flow of traffic for dismissal
If it’s possible to avoid having students eat in the cafeteria, this is the optimal solution. Sending individually packaged meals to students who can eat in the classroom is preferred, but this will require supervisors who are aware of any allergies or special needs. For example, those with diabetes will need additional access to food and water.
If eating in the cafeteria, spread the tables out for social distancing and consider eliminating tables. Stagger lunch times so that fewer students are congregating at the same time. Use disposable eating utensils, and make sure the PPE rules are being followed.
Physical Education and Music
Students still need exercise and musical instruction, but these classes will look a little different than normal:
- Use the outdoor facilities when possible
- All equipment should be used individually and not shared
- Create traffic flow and communicate this with signage
- Create small groups for activities
- Ensure adequate ventilation when inside
- Do not allow sharing of musical instrument
- Do not clean mouthpieces
- Reorganize music rooms for choral instruction to distance students when singing
The same rules apply for special education classrooms as other classrooms, with the additional PPE for instructors (including masks, gloves and face shields) when dealing with:
- Oral secretions
- Diaper changing
- CPAP usage
- Gastronomy feeding
- Administering medication or nebulizer treatments
Occupational therapists will need face shields, gowns, hands-free biohazard bins, wheeled storage carts, and additional paraprofessionals. Speech therapists will need additional PPE and barriers.
As a public health specialist, school nurses will be central to the safety of staff and students. They will want to have a large stock of gloves, masks, and disinfectant wipes on hand. They’ll also want to make sure all the files on students are up to date, including their medical history, medications, emergency contacts and care plans. Should they run into a situation in which they are unsure of the appropriate actions, contact the district nurse or administrator.