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Sending Home Any Covid Sx?

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Do you plan on sending every kid home with even just one Covid symptom? Our school nurses in the area have been telling me that’s their plan. I would be sending SO many kids home. With allergies and flu season, everyone will be affected pretty much! The list of symptoms is so long and so similar to multiple other illnesses

I wish covid was more obvious....why can’t you get a purple tongue with it?!

SaltineQueen

Specializes in School Nurse, past Med Surge.

We are told that one sx is enough to send someone home. BUT we have also been told that we can use some judgement. So my plan is to try to make a quick 10-ish minute decision, especially if it’s a kid we know has a history of being a FF or allergies or something. But, yes...I think there will be more kids sent home than normal. Especially early on in the year. On the flip side of that though I worry about the burden that will put on families going back & forth to the doctor for an alternative dx note or lost work type issues. This year is going to be so hard.

nursetlm, ADN

Has 9 years experience.

Agreed- will be difficult at first.

Keeperofbandages, LPN

Specializes in School Health. Has 7 years experience.

My admin and I agreed upon any sx of COVID they go home and must be sx free for 10 days and fever free without meds for 3 days before returning on campus. This was based off the recommendations of our health department.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

3 minutes ago, Keeperofbandages said:

My admin and I agreed upon any sx of COVID they go home and must be sx free for 10 days and fever free without meds for 3 days before returning on campus. This was based off the recommendations of our health department.

In my state, they must be tested and can return if negative and no symptoms for 24 hours without the use of meds. If they choose not to test, 14 days at home before return, unless there is a doctor's visit stating it was medically determined that a test was not needed.

I'm mulling over if we take it any further in our school; I have another discussion scheduled with my school physician next week.

Keeperofbandages, LPN

Specializes in School Health. Has 7 years experience.

23 hours ago, JenTheSchoolRN said:

In my state, they must be tested and can return if negative and no symptoms for 24 hours without the use of meds. If they choose not to test, 14 days at home before return, unless there is a doctor's visit stating it was medically determined that a test was not needed.

I'm mulling over if we take it any further in our school; I have another discussion scheduled with my school physician next week.

We have no school physician and my administration at my school chose to follow what our district is basically doing ( I work in a charter school)

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

On 7/29/2020 at 8:44 AM, Keeperofbandages said:

My admin and I agreed upon any sx of COVID they go home and must be sx free for 10 days and fever free without meds for 3 days before returning on campus. This was based off the recommendations of our health department.

I don't get the lack of any testing in this equation. As previously mentioned the list of potential sx has expanded enough to include almost ANYTHING up to and including pregnancy.

Has common sense left the building, or did it ever reside there at all...?

On 7/29/2020 at 8:44 AM, Keeperofbandages said:

My admin and I agreed upon any sx of COVID they go home and must be sx free for 10 days and fever free without meds for 3 days before returning on campus. This was based off the recommendations of our health department.

Our health dept is saying the same thing lately.

Seriously though, if a kid has a cough and congestion they’re going home and not returning until they’ve been 10 days symptomatic? Then they return to school and allergies hit or flu season and I’m sending them home again......

nursetlm, ADN

Has 9 years experience.

Yep- I’m thinking this is going to be a s**t show. Forgive me, but hard to think positive when I can only envision the parents who will be upset (understandably) when their child has a common cold or other s/s that may or may not be COVID- but has to be picked up and possibly miss so much school. Testing for COVID is hard to come by where we are (small town) and expensive for many.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

On 7/30/2020 at 8:14 AM, Keeperofbandages said:

We have no school physician and my administration at my school chose to follow what our district is basically doing ( I work in a charter school)

I'm at a charter as well. But we do have a school physician (that I championed for a few years ago - I realize how lucky I am that my school listens and respects my medical knowledge and position).

The MA state guidance has thankfully included the following:

"Students/staff should stay if they have any of the symptoms listed:

  • Fever (100.4 degrees of higher), chills, or shaking chills
  • Cough (not due to other known cause, such as chronic cough)
  • Difficulty breathing or shortness of breath
  • New loss of taste or smell
  • Sore throat
  • Headache when in combination with other symptoms
  • Muscle aches or body aches
  • Nausea, vomiting, or diarrhea
  • Fatigue when in combination with other symptoms
  • Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms"

The "when in combination with other symptoms" is helpful to a degree. And in my contact tracing, I didn't come across anyone with just one the three symptoms they list above and nothing else. However, the sudden loss or taste and smell? BIG time. That one and I just go YEP. Get tested. It was most common in younger folks I worked with.

Cas1in72

Specializes in school nursing/ maternal/child hospital based. Has 27 years experience.

On 7/31/2020 at 10:11 AM, Jedrnurse said:

I don't get the lack of any testing in this equation. As previously mentioned the list of potential sx has expanded enough to include almost ANYTHING up to and including pregnancy.

Has common sense left the building, or did it ever reside there at all...?

I feel this comment so deeply! Its going to be a very challenging year. Wish there was a symptom that screams "Hey its Covid" but thats not happening. I am all for sending kids home with just 1 symptom, I don't see how we can do it any other way. I've been working with Covid patients this Summer, KIDS DO NO PRESENT like adults. I keep telling people this and feel like Im beating my head against a wall. I even heard from my admin that we " cant send everyone home" UMMMMM until we don't and that runny nose and red eyes turn out to be a COVID case and I sent them back to class. The parents and teachers will flip- rightly so!

This is causing me some pretty funky nightmares, we have 2 weeks to go until school starts, Im hoping we go online. Numbers here continue to climb and other school are opting for online only until October.

Thinking of you all and cant say enough how much I appreciate this forum and support we all have for one another.

MUCH LOVE!

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

17 hours ago, Cas1in72 said:

I feel this comment so deeply! Its going to be a very challenging year. Wish there was a symptom that screams "Hey its Covid" but thats not happening. I am all for sending kids home with just 1 symptom, I don't see how we can do it any other way. I've been working with Covid patients this Summer, KIDS DO NO PRESENT like adults. I keep telling people this and feel like Im beating my head against a wall. I even heard from my admin that we " cant send everyone home" UMMMMM until we don't and that runny nose and red eyes turn out to be a COVID case and I sent them back to class. The parents and teachers will flip- rightly so!

This is causing me some pretty funky nightmares, we have 2 weeks to go until school starts, Im hoping we go online. Numbers here continue to climb and other school are opting for online only until October.

Thinking of you all and cant say enough how much I appreciate this forum and support we all have for one another.

MUCH LOVE!

I'll be sending home a kid with just one symptom. And in my state, they have to get testes, be negative, and symptom free (without aid of fever reducing medication) for 24 hours.

If they don't get tested, 14 days. No if, ands, or butts there. I explained this to my admin and we have built a plan that if the student is well enough, they will flip into our remote cohort during quarantine period.

We are also going to drop $$$ on a pre-screening tool. It won't be perfect, but I can see who didn't do it, pull those kids/staff, screen them right there. My focus and goal is really this: be the gatekeeper of your health. I work with kids in grades 5-12, though. I can perhaps actually get truth and some ownership out of HS kids. But I can also get lies, so it goes both ways....

nursetlm, ADN

Has 9 years experience.

Tell me more about this screening tool please.

I would love to send home with just one symptom and require a negative test before return- but there is no way that would be required in my district.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

3 minutes ago, nursetlm said:

Tell me more about this screening tool please.

I would love to send home with just one symptom and require a negative test before return- but there is no way that would be required in my district.

That call is from state-wide guidance thankfully (I'm in MA), so agreed with it and then get to say to my school - nope, state says it is happening this way :).

Here are two we are looking at:

https://www.ruvna.com/

https://emocha.com/

One is an app, the other is web-based. Emocha is HIPAA compliant, Ruvna is FERPA compliant and about to launch specifically for schools. (You can control level of data seen and by who with both of them).

I'm trying to demo the one out there from Microsoft, but they keep re-scheduling, which is leaving me with a bad taste in my mouth.

Basically, they require folks to answer screening questions, report any COVID symptoms, and take their temp and enter it from home (you can allow the temp piece to be blank if not required by your district and/or you are taking it at entry). I get to see the data in real time and it creates a clearance badge for those asymptomatic and if one symptom pings that is borderline, I can also reach out for follow-up if that person tries to enter or remains home.

So, extra work on my end (!) but also means we would be pre-screening in a way that doesn't take forever.

nursetlm, ADN

Has 9 years experience.

Great- I will look them over. We are doing temp checks on buses and at front door upon arrival is what I’ve heard so far. I’m guessing online or apps won’t be used as many of our students don’t have Internet. 😕

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

1 minute ago, nursetlm said:

Great- I will look them over. We are doing temp checks on buses and at front door upon arrival is what I’ve heard so far. I’m guessing online or apps won’t be used as many of our students don’t have Internet. 😕

That can definitely be an issue and another one we are navigating as well! Ruvna has a text link it sends - so anyone with a smart phone can complete it; no app or computer needed, so may have better luck there. And you can re-send the link on site as well. We are looking at setting up a couple of cleaning-all-the-time kiosks.

The “any symptoms” thing will be a nightmare. I work in LTC and sub in schools. One of our LTC patients had nausea/vomiting/afebrile. She got tested because a patient she was friends with presented with fever/cough/chest pain. Both had Covid19. But what if the nausea/vomiting had presented * first* or *only*? It looked like just a stomach bug...

nursetlm, ADN

Has 9 years experience.

We were told yesterday that a fever on its own just warrants the usual 24 hour exclusion- unless in conjunction with a covid s/s.