Could school nurses help lead the way as we transition into a ‘new normal’ with COVID-19?

In the 20th century, school nurses answered questions from worried parents about the threats smallpox, polio, and other serious illnesses posed to their children, and worked with their schools and public health agencies to explain how newly approved vaccines protect children and adults. Schools were often sites for vaccination clinics, with school nurses helping run them.

Now, three health experts who advised President Joe Biden in 2020 on COVID-19 say it’s time for the country to involve today’s school nurses in a nationwide transition to a new normal—that of children and adults living with COVID but with public and private sectors still working to lessen the numbers of infections and hospitalizations through vaccines, boosters, and therapeutics, and developing policies to handle future pandemics. Learning to live with COVID—what some call a “new normal”—is important, they say, because as effective as vaccines are, they do not eradicate SARS-CoV-2, the virus that causes COVID. 

“As the Omicron variant of SARS-CoV-2 demonstrates, COVID-19 is here to stay. School nurses need to be empowered to address the large unmet public health needs of children and adolescents. As polio vaccination campaigns showed, school health programs are an efficient and effective way to care for children,” write, in part, Ezekiel J. Emanuel, M.D., of the University of Pennsylvania; Michael Osterholm, Ph.D., of the University of Minnesota; and Celine R. Gounder, M.D., of New York University in A National Strategy for the “New Normal” of Life With COVID, published in the January 6 Journal of the American Medical Association. 

“There are very few school districts in Missouri that have not offered COVID-19 vaccines. Education and vaccination are our key out of COVID-19,” says Linda Neumann, R.N., retired Webster Groves school nurse and past president of the Missouri Association of School Nurses. Now an independent school nurse consultant, Neumann says the “school nurse practice has been ever-evolving during this pandemic.” Asked how school nurses have responded to the call to aid the transition to a new normal, Neumann says they tend to see it as an extension of what they’ve been doing for the last two years: developing plans to prevent the spread of COVID-19, testing, tracking, and vaccinating students and school personnel. 

Shanetta Harrington, R.N., is the interim coordinator of nursing for St. Louis Public Schools. Of helping their schools and communities move from more of a pandemic approach to that of endemic, Harrington says, “We will do that, while assuming our regular duties and taking care of students.” Compared to previous generations of schoolchildren, increasing numbers of students in Missouri and across the United States have chronic health conditions like diabetes, asthma, and food allergies, according to Harrington and Neumann, who say school nurses administer medicines, shots, and other care during school days.

Missouri state law does not require public schools to employ nurses. The Centers for Disease Control and Prevention recommend schools have one nurse for every 750 students. About 40 percent of U.S. schools actually meet this recommendation, and about 25 percent have no nurse at all, according to the National Association of School Nurses. Some of Harrington’s staff are responsible for more than one school, though district officials say they’re working to hire more school nurses.

“Learning to live with COVID is an important strategy,” says Enbal Shacham, Ph.D., chair of the Department of Behavioral Science and Health Education at Saint Louis University. School nurses would bring first-hand knowledge and expertise to planning and implementing policies, she says. But, she notes, the lack of funding for schools to employ full-time nurses poses challenges. Increasing the numbers of children and adults vaccinated against COVID should be part of the new normal, Shacham says, noting, “Communities throughout the country would be better prepared to manage an endemic infection if more individuals were vaccinated. At the national levels, our vaccine rates seem high enough, yet this is a local and global infectious disease. We have identified that COVID-19 is far more infectious than the traditional influenza.”

Dr. Steven Lawrence, M.D., an infectious disease specialist at Barnes Jewish Hospital in St. Louis, says considerable progress has been made against COVID. He cautions, however, that while infections have decreased in the United States, recent data show COVID is claiming the lives of 2,600 Americans each day. “We have to think through how do we come out of the pandemic, now that we have vaccines that dramatically reduce or eliminate the risk of death and serious illness, what do we need to do? What is the goal? What are we trying to prevent?” he says.

COVID has claimed more than 900,000 American lives. More than 140,000 U.S. children have “experienced COVID-19 associated orphanhood or death of a grandparent or grandparent caregiver during the pandemic,” according to a study published in the October 2021 medical journal Pediatrics and summarized on the website of the CDC. An additional responsibility for schools and their nurses in the new normal may include offering support and care to students who lost a primary caregiver to COVID. Notes the CDC: “Overall, the study shows that approximately 1 out of 500 children in the United States has experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic, and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65 percent of those who lost a primary caregiver due to the pandemic. The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response—both for as long as the pandemic continues, as well as in the post-pandemic era.”

The JAMA authors, in their January 6 piece, say that responses to future public health threats and how to best cope with a pandemic and eventually an endemic SARS-CoV-2, will require, among other things, “a public health implementation workforce, flexible health systems, trust in government and public health institutions, and belief in the value of collective action for public good.” 

Neumann says the number of children under 11 with COVID-19 has increased, and vaccines remain the primary mode of prevention. “The increase in pediatric COVID cases illustrates the need to address vaccine access and confidence in the pediatric vaccine. School health services, when adequately funded and supported, provide an opportunity to address these challenges,” she says.