Kerr Report Q&A: Public School Nurse On Covid, Quarantines and Contact Tracing
The latest on pilot program that could lead to a revision of negligent quarantine rules
(Photo Credit: Today Show)
Pre-Covid, when the subject of a school nurse came up, if at all, it would often be of an innocuous nature.
Flu. Headaches. Occasional plugging up of bloody nose from recess.
But since late summer 2020 and the return of in-person learning in the age of Covid, the role of the school nurse has come under heightened interest and scrutiny.
In the spring of 2021, what is the function of a school nurse?
The Kerr Report reached out to several school districts to ask permission to interview their nurses and get a better understanding of job responsibilities in 2020-21 and beyond. One district responded, that of Batavia Public School District 101 in Batavia, IL.
Below is a question and answer interview done with Lori Carbonell, District Certified School Nurse in BPS 101.
The interview was done via email and what is published here is word for word of the exchange. No editing or shortening of answers for length. Thanks to all who submitted questions when requested last week on social media.
Here we go.
The Kerr Report: What is the role of a school nurse on a day-to-day basis with managing COVID-19 response?
Carbonell: One, monitoring students for absences and returning students for release letters. Two, interaction with families and staff over the phone with questions, reports of illness, reports of Covid and Covid exposure. Three, contacting/reporting positive cases with any identified school contacts to the local health department. This includes measuring distances, time factors, and environment to determine close contacts. Four, assessment of sick children and referring them for testing. Includes knowing testing sites, informing family, requesting cleaning per protocols, and collaboration with other schools. Five, explaining/teaching/informing parents of student exposure and the related need for quarantine. Six, helping families access care, testing, and accessing the health department for monitoring and release. Seven, reporting cases to the district office to keep the website statistics current. Eight, advocating to have students return. Advocating and providing documentation for the health department. Nine, one-to-two health department webinars per week for updates. Ten, review daily IDPH updates. Eleven, encourage staff and students to follow known protocols and help problem solve spacing concerns. Twelve, collaborate with staff to support how to assist students to properly wear a mask, hand washing, and distancing.
TKR: What unintended consequences, if any, were created when the CDC reduced social distancing recommendations in schools from six feet to three feet?
Carbonell: When the Illinois State Board of Education (ISBE) and the Illinois Department of Public Health (IDPH) approved closer distancing, they did not change the 6 foot quarantine parameter. Although we strongly advocated for a commensurate guideline, we were told that CDC was following the 6 foot distancing and would likely not change. This caused some confusion and frustration for parents/staff when they were asked to quarantine their students.
TKR: Is quarantining of students leading to the slowing of Covid spread amongst the community? How closely do nurses monitor the mental health of students in quarantine?
Carbonell: The purpose of quarantine is to mitigate the spread of infection. We have had several instances of close contacts (outside of the academic setting) becoming symptomatic and having a positive test. Unfortunately, the transmission risk is difficult to predict, and quarantine proactively does result in quarantining people that do not develop the disease. Mental health services are referred to and closely monitored by our counselors, social workers, and school psychologists.
TKR: CDC/IDPH/and county agencies all publish Covid guidelines. I’ve heard from school administrators that this creates confusion as the agencies often have disparate protocols. Should Covid policy be more centralized?
Carbonell: With the guidelines being different, it does create some tension. Medical providers tend to follow national guidelines and recommendations. Schools are required to follow the local health department guidelines. This then requires us to spend time explaining why there is a difference in the doctor’s direction and what is required of schools specific to county guidelines. It can be difficult to explain why their doctor is not the authority when it relates to isolation and quarantine guidelines. We have been supported by our local health department with clarification to offices and clinics of the expectations.
TKR: Monday, the FDA approved vaccinating kids as young as 12. So now all high school-aged students are eligible to be vaccinated. What is a high school nurse’s role as it pertains to the COVID-19 vaccine? Is it appropriate for a nurse to recommend a student take the vaccine?
Carbonell: We certainly support the prevention of disease. Looking at the typical developmental age of this group, they tend to have more risky behavior, take chances, and do not feel Covid infection will happen to them. We also have students who have family members that are at high risk for COVID-19 complications. This is a way to help protect the family. I am always happy to direct families to information for them to make an informed decision. This is not a required vaccination and individuals have the right to choose what is best for their children and family.
TKR: What is data showing on the pros/cons of contact tracing?
Carbonell: It is important to consider a public health generalized position on contact tracing to look at the pro/con. Overall, contact tracing is effective. Unfortunately, it seems at times to be a slow and difficult process for our health departments to handle. Keeping exposed persons in quarantine is much preferred over an entire classroom or sports team. What needs to be considered moving forward is the data we have naturally collected as schools in our county before and after the 3-6 foot distancing requirement be shared with the local health department.
TKR: What data are you and other schools collecting?
Carbonell: Just part of contact tracing- Positive cases, known school related contacts and also when contacts have a positive or negative test.
There are several insightful bits of information to come out of this interview with Ms. Carbonell.
One headline: how schools and health care agencies are not sharing data.
We know school districts are compiling contact tracing data (although not sharing with the general public, except occasionally at school board meetings.) But Ms. Carbonell’s comment, “what needs to be considered moving forward is that the data we have naturally collected as schools…be shared with the local health department,” implying that this information is not being reviewed by county or regional local health agencies, is dumbfounding.
Let me give an example to show how utterly ludicrous this is.
Let’s say I was buying a house, and in the disclosure documents the owner revealed the house to at one time, contain in infestation of wasps. Something that was undetectable during a home inspection. This could be determined to have caused a “material defect” to the house, so the seller decides to take the “better be safe than sorry” route and disclose the issue.
But imagine if that same seller failed to say if they had called the pest control guy to fix the problem. Although disclosing the issue, you, as a buyer, have no idea if the wasps remain somewhere inside the house. You’d wonder why the seller won’t say what they did about the wasp problem and have questions about their integrity. And you probably wouldn’t buy the house.
The analogy applies to contact tracing and sharing of data.
Here, we have data on thousands upon thousands of contact tracing cases involving thousands upon thousands of teenagers, most of whom never tested positive for Covid and yet were unnecessarily quarantined for up to two weeks, losing out on in-person instruction, sports, etc.
Yet, the institution in charge of deciding if contact tracing and quarantines make the public more safe, the local or state public health agency, isn’t interested in reviewing the statistics or if so, won’t reveal what they think of the information or make amendments to public health policy based on what the data tells them.
Huh? Just when we think it’s impossible to reach new heights of absurdity, another clown show premieres at our local public health offices.
And the quarantines continue.
There is some news this week that the tide may be turning as it pertains to quarantines.
At a District 95 (Lake Zurich High School) school board meeting on May 13, D95 Superintendent Kelley Gallt said this:
We have been working very closely with the Lake County Department of Public Health, so closely, that we’ve been advocating and shared our data with the county so they could use it to help us move forward with some new plans as it relates to close contact. So beginning on Monday (May 17)…they are going to run a pilot with IDPH (Illinois Department of Public Health) where they are going to be able to remove quarantine practices as it relates to close contacts that were caused potentially by the classroom
Gallt went on to explain how the “pilot program” would only eliminate quarantines in classroom settings, not in other school-related activities such as sports or riding the bus (which is a big problem and frequent originator of close contact tracing.)
Later in the May 13 meeting, in front of the D95 board, Gallt said this about an upcoming Wednesday meeting (presumably May 20) between Lake County district superintendents and LCHD:
Every superintendent is advocating for us to be able to move forward like other counties...where they are less restrictive
Then, in an email addressed by Dr. Gallt and sent to D95 families, she wrote:
The LCHD has not officially changed quarantine recommendations, but is conducting this pilot program to determine if quarantine recommendations for schools can be revised
So there appears to be some movement in the direction of amending current quarantine guidelines.
But like in so many areas of public policy in this state, any change will come slowly (if at all) and well past any ‘science-based’ expiration date.
Finally…
On the topic of slow playing policy, anyone happen to catch Gov. Pritzker’s comments Monday about mask-wearing?
A quick recap: Thursday, the CDC released a statement that said the following:
The same day that news was announced, Pritzker released the following statement:
Monday, at an appearance, Pritzker said this when asked a question about when he would would follow through with the previous statement to revise the state’s mask rules (Illinois is currently under a five-month mask mandate order) and align them with that of the CDC’s recommendation:
So the mask mandate lives on. Pritzker said he needs time to “work through the changes.”
This is the same politician, whom over and over again, has sourced the CDC in his “data-driven” decision making, following the “science” for placing Covid-related restrictions on businesses, schools and youth sports.
Now, faced with a CDC ruling they didn’t expect or disagrees with, Pritzker and his public health servants need more time and “will be announcing those changes shortly.”
Until “shortly” arrives, the state remains under a silly, toothless mask mandate.
Nah. No politics here.