allergie and covid

ruby_jane, BSN, RN · Sep 21, 2020

What does your policy say?

Ours says any cough that's worsening or not the student's normal baseline (paraphrasing) goes home. And, since I don't really want to be "that nurse":

I would mask any kid coughing in my clinic as I am attempting to send them home;

I would likely send everything out right now - parent has the opportunity to take the student to provider for "alternate diagnosis" instead of waiting 10 days in quarantine; and

I am really uncomfortable using my "nursing judgment" when I know kids are most likely to be asymptomatic, then febrile, then present with a cough.

Oddly I've spent most of my school nurse life trying to keep kids in school. Not this year. Parents are supposed to be reviewing the symptom checklist and keeping kids home. I would rather send home an allergy cough then let a kid with COVID-19 stay.

Good luck!

Flare, ASN, BSN · Sep 21, 2020

ugh - it's so hard this year. I have been interviewing them to find out all symptoms and duration. I don't want to send a kid home because they coughed 3 times in class. If it seems like a persistent cough, they go. Here it's 14 days, - covid test or md note with alternate dx.

JenTheSchoolRN, BSN, RN · Sep 21, 2020

No mask mandate is rough. I'd mask that student as soon as they enter.

For me, if cough is a baseline, than no, but it is totally okay to send home and require documentation from the student's doctor that is the baseline prior to return. Every pediatrician I've talked with here in MA supports this and has told me that yes, I can use my judgement as I can know the kids very well, but also be conservative and send them out with a pediatrician referral and they will back me up. (We shall see if that lasts...)

BooBooCrew, BSN, RN · Sep 22, 2020

Same as above. This is an exceptional year and while on a typical day I am of the "butts in seats; you're fine" mentality, this year its option A send home. I am not only trying to keep me safe, but also trying to keep every other staff member safe and this school open for students that need it most. I sent out a letter to parents before school asking them to go to the allergist now before school to get it in writing that their child has severe environmental or seasonal allergies for me to use if/when I need to assess them, but regardless if they're a pretty "wet" kid they gotta go.

NotFlo · Sep 27, 2020

I work in primary care and have seen so many, "but it's just my allergies" people test positive for COVID. Many of these people who were outraged they were sent home from work or school otherwise asked to get a COVID test because it's "just allergies" and "people still have allergies you know" etc. etc.

Some of these people have certainly continued working because they were absolutely certain it was just their allergies exposing who knows how many other people.

I'm quite certain no provider at my practice would provide an alternative diagnosis note without negative COVID test unless this was a long-term chronic problem that doesn't come and go.

JenTheSchoolRN, BSN, RN · Sep 28, 2020

On 9/26/2020 at 9:52 PM, NotFlo said:

I work in primary care and have seen so many, "but it's just my allergies" people test positive for COVID. Many of these people who were outraged they were sent home from work or school otherwise asked to get a COVID test because it's "just allergies" and "people still have allergies you know" etc. etc.

Some of these people have certainly continued working because they were absolutely certain it was just their allergies exposing who knows how many other people.

I'm quite certain no provider at my practice would provide an alternative diagnosis note without negative COVID test unless this was a long-term chronic problem that doesn't come and go.

I've finding this is 100% true. In my remote+ model start (just high needs students in person to start, staff can teach from home or their classroom, their choice), I've referred out only 1 student but several staff. With staff, they fail my prescreen and I refer them to their PCP (unless they took the pre-screen being honest about symptoms that are actually their everyday baseline for a documented chronic condition).

Every single PCP has sent them for a COVID test pretty much immediately just to rule it out.

ruralseok, ADN, BSN · Sep 28, 2020

I should say our Elementary requires masks and district requires everyone who rides a bus to be masked.

ruby_jane, BSN, RN · Oct 2, 2020

On 9/26/2020 at 8:52 PM, NotFlo said:

I work in primary care and have seen so many, "but it's just my allergies" people test positive for COVID. Many of these people who were outraged they were sent home from work or school otherwise asked to get a COVID test because it's "just allergies" and "people still have allergies you know" etc. etc.

Some of these people have certainly continued working because they were absolutely certain it was just their allergies exposing who knows how many other people.

I'm quite certain no provider at my practice would provide an alternative diagnosis note without negative COVID test unless this was a long-term chronic problem that doesn't come and go.

That is amazingly reassuring. Thank you for popping on and sharing!