Written by members of Children’s National Hospital’s Occupational Health COVID-19 Response Team
The continuing rise in COVID-19 cases across the U.S. and the ongoing debate about reopening schools has many asking, “When is it safe?” However, the question that is getting very little attention and should demand more public discourse is, “How can we keep schools safe once doors reopen?”
Public health experts have published policies on how to reduce the risk of COVID-19 exposure on campuses and in classrooms. However, little guidance exists on how to operationalize the recommendations for COVID-19 monitoring. Who do parents call if their child is sneezing or coughing? Who determines if others are at risk for exposure? Who recommends testing? Who clears a teacher to return to work?
As members of the Children’s National Hospital Occupational Health COVID-19 Response Team, we have front-line experience on what it takes to triage and monitor for COVID-19 and promote a healthy workforce to ensure hospital and clinic doors remain open. Below, we share six strategies based on lessons learned during the pandemic with the hope that our experiences will assist others in developing systems to keep our schools safe:
Lead with One Team
Establish a district-wide school health COVID-19 response team dedicated to COVID-19 monitoring and protocol. Comprised of local health officials, clinicians, school nurses and administrators, the team should coordinate with schools and health care providers to triage inquiries, trace, test, support isolation and clear teachers and students to return to campus for the entire district. Although our employees work in locations throughout DC, Maryland and Virginia, they are diligently monitored for COVID-19 by a single team. This allows one voice to foster trust within the entire organization.
A tsunami of phone calls awaits school administrators and nurses as soon as schools bring students back to campus. Parents and staff need to know who to contact. Launch a COVID-19 health hotline (along with email, texting and language services) to be managed by the school health COVID-19 response team. A single point of contact allows communication to be standardized and streamlined.
Establish Standardized Triage Algorithms
Triage algorithms can and should be customized. Follow the CDC guidelines, but tailor them to the school district based on data, infection control measures and available resources. For instance, our team developed a list of screening symptoms using the CDC recommendations and frequency of specific symptoms reported by our employees.
Establish a Database
This is absolutely necessary to make data-driven decisions. The database should be HIPAA compliant and only accessible by members of the school health COVID-19 response team. It can serve as a log and help analyze COVID-19 trends and patterns. Our database has made us nimbler and more responsive to change.
Provide Testing for Students and School Employees
This can be done in collaboration with community testing sites or organized exclusively for schools. Testing is critical to monitor cases and mitigate spread. More importantly, rapid turnaround time of test results (no more than three days) is imperative.
Keep Calm and be Creative with Emotional Support
The bulk of our COVID-19 hotline inquiries do not result in testing. Often, a reassuring voice to discuss symptoms with calm expertise alleviates fears. Our employees recovering from COVID-19 receive care packages and meals to demonstrate our support. The feedback has been overwhelmingly positive. We also provide virtual “information huddles” with our psychology team to educate and support clinic teams worried about someone who has tested positive. This approach tackles anxiety and misinformation simultaneously.
The prevalence of COVID-19 and its varied symptoms has complicated the jobs of parents, teachers, school nurses, physicians and administrators alike. The expected winter colds may trigger confusion, anxiety and disarray if standardized approaches and resources for triage do not exist at a school-district level.
Multiple factors must be considered to keep our students, teachers and staff safe and well. Expert guidance, with funding and resource allocation, will be essential to apply public-health strategies for successful back-to -school planning. We hope others will learn from our experience on the front lines to keep our hospital employees safe and well. Pandemics are unpredictable, but, working together, we can help schools be prepared once doors reopen.
Authors: Amina Khan, M.D., MPH; Kathy Ferrer, M.D.; Lawrence D’Angelo, M.D., MPH; Jennifer Tran, PA-C, MPH; Carrie Golitko, M.D.; Ariel White, M.D.; Jill Board, RN, MS; Carla Montecillo, RN; Erica Samalis, VP of Human Resources; Karen Smith, M.D., Med; Kathy Ferrer, M.D.
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