“This would be a great job…if there were no kids or their parents.” – Nurse Kevin
Well, that used to be a joke I would say. But, I have to be honest, now I am saying, “This would be a great job…if there WERE kids and parents.” Our first day of school is today…for us contracted staff. Children were supposed to start back next week…but the school year is postponed a week past that, and even so, they will start online for two weeks after that (but I think longer). I am sure most everyone of you has a similar story. I know some of you have kids in your school houses right now…we’ll be watching you and your schools to see how things go.
By the Way
How was your summer? Did you spend too much time on Facebook? Watching the news? Listening to your sister’s husband’s friend’s uncle tell you all about COVID? How many “mask debates” did you engage in? Phooey…we ain’t gonna start the school year off with a COVID article…well…not really. I know you have had your fill with COVID and have conducted your own COVID research. You know what you know based on what you’ve heard, read, or even experienced first-hand. And we will likely let the last three articles of last school year be the conclusion of Go See the Nurse’s COVID-19-focused discussions until we…as a nation…as a WORLD…understand the virus more. Conversations seem to be consumed with this topic, and folks are expressing their dichotomous narratives with extremes on both sides.
My Mother-in-Law Had a Heart Attack This Summer
My mother-in-law called us on the way to the emergency room in late April. The chest pain she was “waiting to see” about had not improved over the past two to three days, and the persistent pain was becoming increasingly intense. My mother-in-law has never waited to seek medical care. She’s a retired nurse who knows the symptoms and knows when to seek medical care. Delaying on getting medical evaluation was not something she makes a habit of (trust me on this one). There was nothing we could do; the hospitals were not letting visitors into the depths of their establishments. Three days later, my wife went to pick up her mother to bring her back home.
She asked her, “Momma, why did you wait so long to go into the emergency room?”
“Well, people are dying of that virus; I didn’t want to catch it.” She had been talking to her peers who, though they didn’t advise her to keep waiting on her chest pain, also shared with her their fears of going to the hospital. This may have inadvertently (along with the barrage of news reports—she keeps the news playing all the live-long day) created a fear of the hospital as sanitariums “dripping” with COVID-19.
The question remains: If given a choice, would you choose a myocardial infarction, or would you choose COVID-19 infection? She chose to wait-and-see while she endured symptoms of MI instead of the perception of increasing the possibility of contracting COVID-19…she inadvertently chose a heart attack over a viral infection.
Trust me…I will get to a point in this article…but there are a few rabbit trails I will lead you down.
A Kid Walks in with COVID-19
“What about advice on what safety measures to take this next school year when the students return?” You ask. And, that’s a great question that I am sure your district has implemented many new policies and procedures for (and many districts didn’t ask for input from their medical professionals [you awesome school nurses]). Like me, you will follow those implemented policies and procedures within the “okay-ed-ness” of your treasured nursing license. There are things we nurses can do, and there are things we cannot do…like diagnose.
In the not-so-old old days, when a child walked in to our office with:
Fever
Cough
Sore throat
Runny / stuffy nose
Muscle / body aches
Headaches
Fatigue
Vomiting / diarrhea
….we school nurses would say, “They are presenting with flu-like symptoms.” But, what do we say now when a child walks in with:
Fever
Cough
Sore throat
Runny / stuffy nose
Muscle / body aches
Headache
Fatigue
Diarrhea
A Kid Walks in WITHOUT COVID-19
After last year’s school year kicked off, and the world had not yet heard of COVID-19, the concern was the “bad flu season.” And the 2018-2019 flu season was a doozie (they are still counting the 2019-2020 numbers)! It’s estimated that 61,000 people died in the U.S. from the flu during that season. They guess that 34,157 died from last year’s flu season (though I am not sure why they are using that specific number when the rest of the presented data is shown in even-number thousands). I won’t speculate on the “maybe-it-was-COVID-19-and-not-the-flu” theories.
The interim estimates of the effectiveness of the 2019 flu vaccine was an impressive 45%. No, I am not being condescending or sarcastic. That 45% is actually an impressive number, considering that in the past 10 years the flu vaccine effectiveness ranged from 19% to 60%. And, the flu season is upon us…as are the other illnesses the CDC is monitoring closely, such as Chikungunya virus and Acute Flaccid Myelitis.
There are going to be children coming to see the school nurse without COVID-19.
Two Extreme Paradigms of COVID-19
Nope. COVID-19 is not political; viruses do not affiliate to a political party. But (didn’t you see that “but” coming), people have made it political. There’s no denying that. Along with the political perspective, there are people who have read, heard, and experienced COVID-19 in some form or fashion and appear to be expressing their political perspectives in the form of their response to the virus – This feels like we are talking about people who’ve HAD the virus and how their bodies handled it… Maybe say “outward response” or “outward reaction” or “behavior in reaction to” or something?. You can tell I am sorta “beating around the bush” here, and safely so; folks tend to get pretty riled up if your perspectives do not match their perspectives.
Now, with this being said, consider the two extremes:
1. The anti-masker that vehemently and sometimes violently refuses to wear the mask
2. The masker who wears their mask, face shield, and goggles—alone in their closed car
Between these two extremes are the rest of us…you and I. As adults making their choices (unless those choices affect me), I don’t care what they do. But, as adults making choices for the children…choices based on emotion and not fact…choices that may result in harm to the child…that I do care about.
I’m going to take you down a rabbit trail to explain my thoughts.
Has COVID-19 Cured Cancer?
Remember my mother-in-law (who is now fine-and-dandy after finally going in to the ER after a few days)? She waited to seek care. But still, others wait longer. “Anecdotal reports suggest a decline in PPCI volumes in the United States and around the world.” Looking at ALL possibilities, the reduction in primary percutaneous coronary intervention ((PPCI) is the standard of care for ST-segment elevation myocardial infarction (STEMI)) is a result of one of the following:
1. COVID-19 has reduced the frequency of myocardial infarction.
2. People with symptoms of myocardial infarction are not seeking medical care.
The first choice seems ridiculous, right? The second one…well…how does that sound? Is there a choice #3? Yes, there are folks who have heart attacks and wait and probably recover. I’ve taken care of people who were surprised to find out they had a heart attack “sometime in the past.” Still, the person who waits-and-sees regarding their chest pain, regardless if it resolves or not, still falls into result #2.
What about cancer? There are lots of folks who have cancer right now and have no tell-tale symptoms that would “force” them to seek advanced medical care. However, eventually…cancer will “announce” its nasty presence and let you know LOUD AND CLEAR that it’s there and has no plans on leaving anytime soon. You’re a nurse; you know what I am talking about.
So, why are cancer diagnoses on the decline? There is some interesting data out there that may suggest why cancer is on the decline. First of all, 10-15% of smokers will develop lung cancer from smoking (unless they die first from a barrage of other nasty killers secondary to smoking—not saying the smoker is nasty…but the disease processes that kill the smoker are) Almost 25% of all cancer deaths are due to lung cancer (“more than breast, prostate, and colorectal cancers combined”). It’s not surprising that with cigarette smoking among U.S. adults having DECLINED from 20.9% in 2005 down to 15.5% in 2016 that cancer rates have dropped. But, dang! For cancer rates to drop more than 46% for breast cancer, colorectal cancer, lung cancer, pancreatic cancer, gastric cancer, and esophageal cancer combined during the pandemic period…Either folks are delaying care, or COVID-19 is the new cure for cancer (now I am being facetious).
Okay Nurse Kevin…What’s Your Point??
Sure, we school nurses take care of children who have subjective “chest pain.” And we do take care of children with already-diagnosed cancer. It’s not likely that we will have children avoid seeking the school nurse because of a real heart attack or from undiagnosed cancer. My references to cancer and myocardial infarction are not necessarily specific to the children we care for. It demonstrates a lack of understanding of the virus as evidence by the very real examples that ADULTS are willing to suffer through a heart attack or cancer rather than contract COVID-19. Our children do not get to make decisions for their health care…most of the time. Their parents and guardians make these judgment calls for their children. My point is: if the parents are fearful, they may postpone care for their children. And, if parents see this as a political issue, they may postpone care for their children. Being aware of this, we may find children in our office this year with a medical need and the parents delaying care either out of an unhealthy fear or an unhealthy disregard of COVID-19.
As a disclaimer: COVID-19 is very real and can be very serious if one becomes infected by the virus. But, given the choice of a very real and serious illness like a COVID-19 or a very real and serious illness like cancer, some folks are choosing cancer!
Parent-Diagnosed Case of COVID-19 That Ain’t COVID-19
We school nurses take care of a kaleidoscope of conditions from a diverse population of kiddos. And with the plethora of information out there on COVID-19, it makes sense that we school nurses focus on the whole picture, with COVID-19 being one of our primary focuses, like we focus on the flu each year and like we focused on the outbreaks of measles and pertussis last year. We school nurses need to encourage and teach methods and practices that promote health and well-being. We need to promote methods to build strong immune systems through nutrition, exercise, and other immune-boosting health behaviors.
You know just as well as I do that there are people out there that are anti-mask, anti-virus, and are treating COVID-19 as being “nothing to be feared.” And we have people out there that preach and shout the “just-shut-up-and-wear-the-mask” message and feel that anti-maskers are selfish idiots. The two polar opposites argue incessantly as they regurgitate the latest “facts” from an ocean of “sources.” Truth is, there are plenty of opposing “facts” that arm these arguments both ways with plenty of ammunition.
We don’t have children in our school buildings yet. Some parents have come in for laptops and other needs that require their physical presences. Some parents are screaming “it’s against my religion to wear a mask,” and another shows up with masks that express and “expletive” in defiance against the district’s mandate of wearing masks in the school buildings. Knowing that there is a political undertone that many are adapting into their paradigm of the virus, you are going to find perspectives to the extreme…on BOTH sides. Yes, there are those that refuse to wear masks, and there are those that will not take it off even while driving around alone in their closed cars or on a mountaintop hike with no one around for miles.
You are likely going to find a child who has COVID-19 symptoms who lives with a parent or guardian that is not going to have the child treated. Is this a bad thing? Depends on the severity of the symptoms, right? But, what I am going to keep a nursing-eye out for are the children whose parents assume that the symptoms presented are COVID-19-similar but may actually be underlying symptoms of a condition that is…well…dare I say: more serious than COVID-19?
I say we focus on keeping the kids, teachers, and everybody in the school safe and healthy. Heck! Let’s shoot for keeping the community healthy. We are going to see children who have COVID-like symptoms this school year. Yes! We are going to see children with asthma, diabetes, cancer, influenza, emotional issues, and lest we forget: LICE! And, chances are…we WILL see a child in our office (probably MANY children) that will test positive for COVID-19. It is inevitable. If they let children back in your school house this year, you WILL take care of at least one child with COVID-19, either knowingly or unknowingly.
We need to focus on community and camaraderie and not an infectious dichotomy. And, that’s what I’m’a gonna do. Yes. I will mention COVID-19 here and there…it’s a real thing, and it’s worth talking about. But, I want to create a safe and welcoming environment that promotes a reasonable respect for the virus and does not treat the child as a nasty little vector worthy of being excluded from school forever and a day. Using proper PPE when the situation warrants and having a preemptive plan to meet the needs of our children with a suspected contagious illness will go a long way to reduce the fear of this virus…or any other illness one of your children may “Go See the Nurse” for.
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