The Relentless School Nurse: Full Circle – 360 Questions About School Reopening

NJ School Superintendent, Dr. David Aderhold has added to his ever-growing list of questions that must be answered before we safely return to school in the fall. This grouping of questions is focused on school health and raises important public health issues.

Public Health Questions Regarding School Reopening

We’ve Come Full Circle

360 Questions about School Reopening

By Dr. David M. Aderhold

Superintendent of Schools, West Windsor – Plainsboro Regional School District

President of the Garden State Coalition of Schools

Updated June 13, 2020

Public Health Must Drive Our Reopening Plans

On Friday, March 13, my district closed our doors with the hopes and expectations of returning during the 2019-2020 school year. Over the past 3 months, over 2 million Americans and over 7.6 million individuals globally have contracted COVID-19. Johns Hopkins University & Medicine has reported 426,268 total deaths across 188 countries/regions. Globally, coronavirus is growing with over 100,000 cases reported a day, with a mortality rate at over 5%. Precautions and continued vigilance is needed.

As school re-entry and reopening strategies are being contemplated, health and medical guidance must be provided. We do not need suggestions or considerations. Clearly articulated guidelines that serve as an industry standard and are applicable across workplace and schools, grounded in science, must be provided in order to ensure the public health. If we get this wrong, people die. Our staff and students will be placed at risk. Our families and school communities will be placed at risk.

Public health may be a policy matter, but it should not be political. Our students and staff deserve the highest safety standards. The absence of clear and concise medical guidelines from state and federal officials is analogous to medical malpractice. Educators and state departments of education are at the mercy of public health officials and the political will of state governments. Only one conclusion can be reached; if clear guidelines are given, health officials know schools cannot meet the standard and would not be able to re-open in the fall. Public health officials know that if school districts are required to adhere to specific and prescriptive guidelines, that the time and money it would take to implement such standards would signal the immediate closure of schools for the Fall of 2020. As such, what inevitably will happen is an inconsistent implementation based upon availability of funds and the lack of adherence to suggested recommendations. If state governments utilize such an approach, we can anticipate a continuous wave of COVID-19 cases.

Here is a link to a comprehensive and constantly updating set of STATE DEPARTMENT OF EDUCATION PLANS FROM AROUND THE COUNTRY, INCLUDING ORGANIZATIONAL AND AGENCY PLANS REGARDING SCHOOL RE-ENTRY.

Public Health Questions regarding School Reopening

In a time of increased responsibilities due to temperature checks and contact tracing, will public school nurses be relieved of their responsibilities to conduct annual public health screenings?
Will the responsibilities on annual health screenings be delegated to pediatricians?
As most states do not require a nurse per school building, but rather a nurse per school district, will states change the nursing staffing ratio requirements for public schools?
If a nurse is absent, and a substitute is unavailable, will a school building need to close for the day?
Will emergency certifications be created to allow retired RN’s and LPN’s to become school nurses?
Will school districts be required to administer anti-body testing?
When a vaccine becomes available, will students and staff members who refuse to be vaccinated be medically excluded from school?
What medical equipment will be required for school districts to purchase? Will we need No Touch Thermometers? Thermal scanners? Isolation shields and protective barriers?
Will districts need to change our standard of care orders for students that need acute respiratory treatment?
What will be the recommended accommodations for staff members and students with underlying medical conditions?
Will states issue guidance on medical exclusion policies?
Currently, a student must be 24-hour fever free in order to return to school. If a student or staff member has a fever in the fall, will 24-hour fever free be the standard or will those individuals need a negative COVID-19 test?
The CDC guidance on “Deciding to Go Out: Venturing Out? Be Prepared and Stay Safe” states that “there is no way to ensure zero risk of infection.” It further states, “The closer you are to other people who may be infected, the greater your risk of getting sick.” What will be the social distancing requirements for schools? What will be the mandated square footage requirements per individual so that we can determine our future school capacities?
Governor Murphy has tweeted, “The evidence is overwhelming and the experts are clear: #COVID19 is more lethal inside than outside.” What will be the allowable length of time students and staff members will be allowed to be inside of a school building?
CDC guidelines state, “Older adults and people of any age who have serious underlying medical considerations might be at risk for severe illness from COVID-19.” What are the acceptable accommodations?
If a staff member is the caretaker or parent of someone who is at severe risk of illness, what legal or contractual allowances be considered?
What is the guidance on the frequency regarding cleaning and disinfecting protocols?
Will temperature checks be required before a student enters a school bus? If so, by whom?
What will be the cleaning protocols between bus runs?
The National Transportation Safety Board has not issued guidance on the use of plexiglass barriers on school buses. What, if any, safety protocols will take place on school buses?
What will be the limitations and social distancing practices on school buses?
Will a standard mask be required to be provided to each student and staff member? How often?
Will districts have liability coverage should an individual become sick or die due to COVID-19 exposure at school?
What volume of PPE should school districts order? How does this requirement differ for school nurses? What type of PPE will be required for staff members (such as Physical and Occupational Therapists) that are required to work in close proximity with students?
What school policies and regulations need to be updated regarding nursing, attendance, medical guidelines, etc.?
If a staff member is suspected of COVID-19, how long are they medically excluded from work?
The CDC suggests that if a health office has had a suspected COVID-19 case visit the office, that the office windows be opened to protect against further transmission. As many school nurses offices are located in inner corridors of schools, will schools be required to redesign or build new medical facilities?
Will nurses be required to take the temperature of all visitors? Will visitors be banned from entering facilities?
Will nurses need to be present at all school events to take temperature checks?
Who is allowed to take and record temperature checks?
In schools, students are often sent down to the nurse for a multitude of reasons. Will teachers be required to administer low-level medical care in their classrooms to decrease exposure? If so, what are the acceptable types of treatments? Band-Aid’s? Ice packs?
Will school water fountains need to be turned off to avoid potential exposures?
Will secondary isolation rooms be needed to avoid cross contamination of nurses’ offices? Who would run those areas?
Will protocols need to change for students who use feeding tubes, catheters or ports?
Can school districts have stricter return to school policies than the suggestions and guidelines provided by the CDC?
County and local health officials have limited authority over school districts. Will regulations be passed to authorize greater health governance?
Will schools need to utilize telemedicine consultation services from the classroom to the health office to limit exposure?
So much of elementary and middle school nursing visits is related to mental health, anxiety, nervousness that presents in belly aches, eyelash plucking, scratching, finger nail biting, etc. Will school districts be provided any additional funds for mental and physical health services? Will state legislatures allow districts to exceed our 2% budgetary thresholds for medical needs?
Many families struggle to pick up their sick children due to work schedules. Will families need to ensure rapid pick-up plans for sick children?
Under the CDC guidelines, nebulizer treatments and suctioning are identified as aerosol-generating procedures requiring a N95 mask fitted to the healthcare worker, goggles, gloves, and a gown. Is there an industry standard that schools will need to follow to ensure our staff and students are safe?
Will guidelines be issued regarding heating, ventilation, and air conditioning filtration systems?
What medical safety protocols will be needed and enhanced regarding emergency plans, shelter in place events, emergency evacuation, etc. Will we need to implement intensified handwashing protocols/hand sanitizer protocols for post drills and/or occurrences?
What will be the cleaning/disinfection frequency of healthcare workstation and isolation areas?
Not all healthcare offices are equal in size and capacity. Will social distancing requirements limit the number of students allowed in health care offices?
Many students utilize the health care office for personal care. Will restrictions need to be put in place to limit exposure? If so, what modifications will need to be made to restroom facilities throughout the school building to ensure school districts are meeting the needs of their students?
Will hand sanitizer be required at every entrance, office, and classroom?
What will be the school district’s role and responsibility in contract tracing?
What happens when someone becomes ill and is suspected of or diagnosed with COVID-19?
What are the communication guidelines for the school community when a student, staff member, or visitor is diagnosed or suspected of being positive for COVID-19? Is the classroom quarantined? The school? The district? If so, for how long? What are the requirements to return?
Will staff members be required to undergo antibody testing? If so, will this be covered by insurance?
When a vaccine becomes available, how will schools be notified that a staff member or student has received a vaccination? What documentation will need to be provided? By whom?
From our nurses, “How will we handle positive cases with students/staff?”
What will the school district’s reporting requirements be to public health officials? What are the structures and mechanisms to make this happen? Will there be a shared database or dashboard? If so, will a database and/or dashboard be provided to school districts? Are there any concerns or violations with sharing information due to HIPAA?
Will there be mandatory medical training and professional development at the beginning of the school year on COVID-19 and new health protocols? Will districts need to submit a statement of assurance? Will specific requirements be made? Will guidance be given?
What alterations will be made to school drop-offs and bus arrival? Often these locations occur in different locations in order to avoid the mixture of cars and buses. If there is only one nurse, who else will be allowed to take temperatures? Will staff members be able to do this simply with a temperature scanner or will a specific protocol and training be required? If a student is found to have a fever, who takes charge of that student so that the temperature tests can continue?
High schools operate during the summer with the arrival of athletes and marching bands. Will school districts be required to have nurses on-site every time students are on school grounds? Will nurses need to do temperature checks every day?
What will be the guidelines given to Athletic Trainers? How will their role be impacted by social distancing requirements? What will their responsibility be regarding after-hour temperature checks of coaches, athletes, and spectators?
Will a school nurse be required to accompany groups on every field trip, sporting event, musical, play, co-curricular event, and evening activity? Alternatively, will all such experiences be significantly reduced or eliminated?
Will childcare facilities and building use groups be allowed to operate on school grounds?
Will the NJDOH provide guidance to school districts and parents regarding the signs and symptoms of multisystem inflammatory syndrome (MIS) in children?
The CDC has stated that if a confirmed case has “entered a school, regardless of community transmission” that school districts are to coordinate with local health officials and dismiss students and “most staff” for 2-5 days. What happens if a school superintendent and a local health official disagree on the next steps? Who has the authority to make the decision? What will be the authority granted by the NJDOE and NJDOH to Superintendents regarding public health-related closures?
If an incubation period for COVID-19 is standard at 14 days, with a median time of 4-5 days from exposure to symptoms onset, why should we monitor for 2-5 days? One study reported that 97.5% of persons with COVID-19 who develop symptoms would do so within 11.5 days of SARS-CoV-2 infection. Only monitoring for 2-5 days seems inconsistent with the data.
As a strategy, in order to coordinate health and safety, the CDC has suggested we limit hallway access. If we limit hallway access, we limit building egress. Do fire officials have concerns about the implementation of this strategy?
In order to ensure that we are not jeopardizing the health of individuals with underlying medical conditions or concerns of exposing loved ones with underlying medical conditions, what considerations will the NJDOE allow for scheduling flexibility, hybrid models, parental choice and selection to remain virtual, etc.?
Currently, OSHA has only issued guidance that are recommendations. Will OSHA issue any standards or regulations to which school districts and workplaces must comply?
Besides daily temperature checks will there be any additional components to daily health screening requirements?
If a staff member states that they have exposure to COVID-19, but the school district questions the facts of the exposure, can a school district or workplace require an employee to come to work over their desire to quarantine? Does the school nurse, local health official, medical doctor, or school physician make the factual determination?
If a staff member becomes exposed to COVID-19 while on school grounds, would that staff member have to file a Worker’s Compensation claim and report for a medical screening?
What medical concerns may surface with socially distancing lunch? If students have to eat in classrooms, what policies and practices will need to be updated regarding food allergies?
The CDC and most state plans indicate requirements for increased handwashing. How do schools meet these requirements when most classrooms do not have sinks? How do staff and students socially distanced handwashing? If it occurs in hallway bathrooms that already will have entrance restrictions, who monitors the social distancing and line cueing as students await handwashing availability?
Should all teachers become certified in first aid and CPR?
Should all teachers become trained in Mental Health first aid?
What medical supplies may we need to keep in classrooms to assist in avoiding exposure and illness?
How will schools train students and parents about the new health standards and requirements?
Should all school administrators and nurses be trained in FEMA incident command protocols?
Who gets to determine the acceptable risk of foreseeable harm, illness, and potentially death in our public schools should we return from virtual instruction to in-person instruction? (Same as #1 – Hence the title, “91 DIVOC: We’ve Come Full Circle – 360 Questions about School Re-Opening”)

Below is a listing of the original questions #’s 1 – 284:

May 22, 2020 – 91-DIVOC: We Cannot Look in the Review Mirror Preparing Our School Districts for Fall 2020 (Original post)

There are over 580 school districts, more than 2500 schools, and over 115,000 teachers serving more than 1.4 million students in New Jersey. Without clear guidance on how to prepare for the fall semester, the public health will be compromised. The planning for September happens now. We cannot wait. We need clear and definitive guidance on re-entry, remaining virtual, or creating a hybrid model now. We need guidance on the amount of state aid that school districts can anticipate. The state aid numbers released in February 2020 are a fallacy based upon a different time, a pre-global pandemic time.

The public health and the health of our staff and students is paramount. Based upon last night’s guidance, it appears that budgetary reductions will come in waves. If further reductions are coming, we cannot wait until the end of August 2020 to make adjustments with just a week before we open schools. School Districts cannot wait until the Governor’s August 25th budget report. Actions must be taken now. Contracts are appointed now. Staff renewals have already happened.

Summer is coming. Schedules are being built and class rosters created. New student orientations and Fall athletics are upon us. While many are worried about ending the year, we cannot forget that next year’s planning happens now. There are literally hundreds of questions that must be answered in order to ensure the safety of our school communities. Without such guidance, we cannot safely reopen our schools.

The Original 91: (sent Monday, May 25)

Who gets to determine the acceptable risk of foreseeable harm, illness, and potentially death in our public schools should we return from virtual instruction to in person instruction?
What will be the criteria and parameters to reopen schools? When will we receive a re-entry plan?
What will be the COVID-19 testing protocols for students, staff, visitors, etc.?
What will be the budgetary impacts for school districts based upon the economic challenges realized due to the public health crisis?
If someone in the school community tests positive for COVID-19, what will be the next required steps? Will schools need to be closed for deep cleaning? What will the requirements be for contact tracing and testing? How long will staff or students need to be quarantined?
If a school building or school district has a COVID-19 positive case, how long will a closure be to ensure there’s no super-spread to the community?
Will students and staff members be required to wear masks?
If schools return in the Fall 2020, will modifications be made to teaching schedules for staff members that have pressing medical needs?
Will accommodations be made to allow families who wish to keep their children home in the fall? Will those children be allowed to participate in virtual instruction or will they be required to withdraw their children to be homeschooled by their parents?
Will hybrid schedules be allowed for students and staff members?
Will there be modifications to our school day?
1. Virtual school days?
2. Staggered start times?
3. Class size restrictions?
4. Half-day classes?
5. One-day-on, one-day-off schedules?
6. Smaller class sizes?
7. Hybrid model that allows parents to opt to virtual instruction while maintaining in-person instruction?
If modified schedules are a requirement for social distancing to be implemented, will such schedules provide parents the ability to return to work?
What are the contractual impacts to the myriad of possible scheduling solutions?
What are the financial impacts in order to implement social distancing requirements?
1. Additional busing as we will need to transport less students per bus?
2. Additional teachers needed for social distance classrooms?
3. Additional nursing staff?
Will school districts continue to offer extended day care programs (before school and after school programs)?
Do school districts have the infrastructure to meet the social distancing requirements?
Will school districts have the funding to meet the physical modifications and additional Personal Protective Equipment (PPE) needed?
Will districts need to provide PPE to nurses and support staff such as gloves, masks, face shields, etc.?
Will districts receive funding for PPE for students, staff members, and visitors?
Can the supply chain accommodate the massive amounts of PPE that school districts are going to be required?
1. Ex. If required to provide one mask per day for students and staff members, my district alone will need 60,000 masks per week or 250,000 masks per month. This does not include masks for visitors or the potential need of multiple masks per student (especially at the elementary level).
2. Ex. In NJ there are 1.5 million students and teachers. If each student and teacher needs one mask a day, then NJ school districts will need to have access to 30 million masks per month or 300 million masks per school year. (If three masks are needed per day per student, then 900 million masks will be needed).
What equipment and supplies will be required to make schools safe? (Hand sanitizer, face masks, Personal Protective Equipment (PPE), cleaning supplies, gloves, etc.)
For schools and school districts without air conditioning how can you have students and staff members wear masks with certain temperature conditions?
What happens when students sneeze repeatedly due to allergies and sniffles when wearing masks? Do they get a new mask for each time they sneeze?
Since students need to eat and drink during lunch, won’t all safety protocols be violated during that time when masks must be removed for all students?
Will isolation rooms be needed in nursing offices for students or staff with fevers? If so, what are the specifications needed and how long will the physical modifications of these spaces take?
What requirements will need to be implemented for the protection of medically vulnerable students and staff?
Is the expectation that students and teachers will be wearing masks reasonable? Many students have sensory issues, asthma, or special needs that would make wearing a mask for extended periods of times very difficult.
Will modifications be needed for nebulizer treatments? Will nebulizers be allowed in schools?
Will there be standard health care equipment needed in schools? (Such as No Touch Thermometers)
Based upon the new CDC guidelines, what does it mean to screen students?
Must we do a temperature scan prior to students boarding a school bus? If so, who is going to do this?
Will there be standardized screening protocols for staff and students entering school buildings? If so, who will do that?
Should we require a COVID-19 test for any student or staff member exhibiting symptoms?
Will the NJDOH establish clear protocols for disposition of students/staff demonstrating COVD-19 symptoms? Will policies and regulations follow from the NJDOE?
Will we need to limit the number of students in health offices at one time? Will we need separate areas for first aid? If so, who will cover those stations and with what certificate?
How do we socially distance on our buses? Will buses run ½ empty to increase social distancing? What will the cleaning protocols on buses look like? How frequently will this need to occur?
How do you socially distance a bus stop?
Based upon the average age and the persistent shortage of bus drivers, will there be enough bus drivers available to transport all students in the fall?
How will school arrival look in the future?
1. Will students be permitted to enter the building to mass holding areas as currently done prior to the pandemic in most schools?
2. Will schools need to conduct temperature checks at school entrance ways?
  - How many staff members will be needed to accomplish this?
What will music classrooms look like in the Fall 2020?
1. Spit valves on brass instruments?
2. Choir classrooms with vapor particles?
3. What does band class look like?
4. What about concerts?
How do you socially distance physical education classes?
1. How do you socially distance locker rooms for gym classrooms?
Based upon the guidance of the National Federation of State High School Associations’ guidance from the Sports Medical Council, how can we safely open athletics in the Fall 2020?
What does socially distanced contact sports (such as football, wrestling, boy’s lacrosse, competitive cheer, or dance) look like?
How will school districts assess education gaps and remediate learning needs?
What are the building facility cleaning protocols that need to be followed?
Will students have recess in the future? How frequently will schools need to clean the recess equipment?
What protocols will be required for athletic facilities to be maintained and cleaned due to the coronavirus (including surface areas, turf fields, sports equipment, etc.)?
How frequently will school equipment need to be sterilized? What guidelines will be utilized? What industry standards will be used?
Will there be enhanced cleaning protocols for school buses? If so, based upon what criteria and to what specifications?
Will limitations be placed on the number of students that can use bathroom facilities at one time? Will enhanced cleaning protocols be required?
Will COVID-19 increase the needs for additional custodial staffing, nursing, security staff, etc.?
How will fire drills work in a time of social distancing?
Will any changes be required as we implement school district lockdown or evacuation plans?
What revisions will be necessary to modify emergency plans, shelter in place, evacuation, etc.?
What will cafeterias look like in the Fall 2020? How will students pick up and receive meals? Will lunch lines need to be socially distanced? If cafeterias are not used, will meals be served in classroom desks? If in classrooms, there will be coverage concerns as there are not enough lunch aides to cover all classrooms.
What changes will be required for food preparation locations to ensure health and safety?
What will the socially distancing guidelines look like in schools? How many feet between students will be required?
How will we socially distance during passing periods (in hallways)?
How will middle school and high school students report to lockers with social distancing requirements?
Will school districts allow or be allowed to offer extra-curricular activities that require mass gatherings to occur during the 2020 – 2021 school year (indoor track tournaments, robotic tournaments, school musicals/plays, field trips, basketball tournaments)?
Will guest speakers be allowed in the future?
What protocols will visitors need to go through? Will school nurses be responsible to take the temperature of every visitor to a school? If so, how is that even remotely possible without a massive increase in medical personnel in schools?
How will schools govern the entrance and exiting of buildings and the movement throughout school buildings?
What physical modifications will be needed to reopen schools? When will those guidelines be released? Will funding follow?
Will there be staffing reductions as a result of changes in state aid payments?
What liability will school districts have should students, staff, or visitors become ill due to COVID-19 outbreak that is traced back to a school district? What will be the impact on liability insurance? Ultimately, such decisions will come at taxpayer expense.
As the fall brings illnesses such as the flu, respiratory infections, and whooping cough, will modifications be required to medical exclusion policies?
Will there be standard return to school policies and procedures for students and staff who are presumed positive or diagnosed with COVID-19?
How will the implementation of IEP’s for Special Education students be met in a virtual, hybrid, or partial day academic program?
1. What is the state’s guidance for Extended School Year programs for students who receive Special Education services?
Many special needs students, students that need assistance with toileting, or wheelchair bound students require hands on assistance. How can a staff member safely assist these students without creating mutual risk?
Will union/association contracts need to be reopened to seek modifications to provide for flexibility in implementation for varied school schedules?
With decreasing funding, school districts will need to prioritize equitable access to resources for all students. What will school districts’ responsibilities be for providing internet access and devices? Will legislative actions be taken to ensure that all students are connected?
How will districts provide for mental health supports that may be needed for both students and staff that have experienced trauma due to the loss of family members, isolation, suicidal ideations, food insecurity, loss of income, loss of housing, etc.?
What professional development needs will school districts have in order to assist their teacher’s enhancement of virtual instructional practices?
How will we meet the needs of our rising seniors with their postsecondary planning? How will the college application process change?
What protocols will be required for construction projects during the continued pandemic?
Will school facilities be reopened to public use on evenings and weekends? If so, what safety requirements will need to be put in place?
With the purchase of mass amounts of technology during the 2019 – 2020 school year, how will the future replacement of devices be handled without huge infusions of funding? (Operation systems go unsupported on four year cycles which render Chromebooks virtually useless.)
The utilization of devices is only one component of technological costs. Increased servers, cloud storage, security, technological staff, web monitoring security, web-based instructional programs, and hot spots have all been needed. Will school districts be allowed to exceed the 2% budgetary cap for the infusion of technology purchases in subsequent budgets?
How will we assess which students need academic support and remediation?
How will school districts address the digital divide that still exists months into the pandemic?
Will education look fundamentally different post-pandemic or will school systems revert to prior structures?
We can safely assume that there will be some parents that will refuse to send their students to school in the fall. As such, will districts be allowed by the state to run both in-school and remote programs? If so, there are budgetary, contractual, legal, policy, and staffing considerations that demand time and attention to think through now.
What legislative and regulatory changes will occur that impact the transition from 2019 – 2020 school year to 2020 – 2021?
What strategies will need to be employed for the fall to assist teachers in building culture and classroom routines in a virtual environment with students they have not met?
Will modifications for evaluations of certificated staff members continue into the 2020 – 2021 school year?
How will school districts assess, grade, and provide feedback to students during an extended closure?
What will virtual professional development look like for new teacher orientation?
Will there be antibody testing available for staff members and students? If so, who will administer such testing? What are the implications for HIPAA and confidentiality rights?
How will we teach programs that require hands on interactions in close proximity, such as Robotics, Woodworking, Culinary Arts and Fashion Design?
New Jersey’s guidelines state a “substantial increase in testing capacity” is needed before reopening measures move further. What does this mean in relation to schools?

May 29, 2020 – The Next 91: Questions 92 – 182

The first 91questions has only generated more questions for our school community. Based upon received feedback, it is clear that the education community is craving guidance so that we can properly plan for re-entry. Superintendents across the state do not anticipate a traditional school opening for the Fall of 2020. Time, money, modifications, safety measures, and public health guidelines will all be required to ensure the safety of staff and students. Critical to the success of any future re-entry will be ensuring staff training and support that will be a critical component of 2020-21 planning. Specific focus must be on the following areas:

Staff and student health, wellness, safety measures, and procedural adjustments.
Additional staff training and support to further enhance best practices for online, distance-learning practices for synchronous instruction and virtual student engagement.
An increase in support for mental health, trauma informed care, mindfulness, and social-emotional supports to assist students in readjusting to impacts from the public health related school closure.
Physical modifications of our schools to ensure physical distancing requirements.

Will school districts be required to track health metrics of COVID positive or suspected cases and report them to a public health authority?
Will school districts be required to utilize containment strategies such as increased testing, isolation and quarantine, and contact tracing?
Will school districts be required to provide daily or weekly health screenings on students and staff members?
1. If so, will there be PPE supply inventory to conduct such screenings?
2. Will the Department of Education purchase the supply inventories?
3. Will purchasing cooperatives be established to ensure the bulk purchasing of equipment?
Will additional medical personnel be needed to enact any such medical plans that will be required?
What medical tracking will be done over the summer to monitor the cases in each community before schools open?
Will school districts continue to maintain food distribution to support our students throughout the summer? Who will fund this? Who will staff this as food service vendors do not currently work over the summer?
Will programs such as school based youth services, guidance counseling services, or other mental health services be available to students over the summer? Will there be funding?
How do we address families that are asking to repeat a grade level?
How will Speech Therapists deliver services if students cannot see their mouths? Will we need to provide clear masks to certain employees? If so, what other professionals will need such masks? World Language? ESL/ELL?
How will Occupational Therapists provide socially distanced therapeutic services?
How does an athletic trainer handle injuries, such as taping a student’s ankle, without violating social distancing requirements?
If school districts must conduct capacity analysis of facilities, what is the square footage allowed for COVID-19 per child?
Based upon a USA Today survey, 20% of teachers say they will not return in the Fall due to concerns over COVID-19.
1. How will we staff our schools?
2. With less teachers, what will be the impact to scheduling?
Will school districts have difficulties finding substitutes upon return to school re-entry? Substitute teachers are part-time per diem employees. How do we ensure that they do not present a risk to the school community, especially since they work between schools and across school districts?
How will we ensure a robust supply of substitute teachers to replace teachers either sick themselves, quarantining in place, or tending to sick family members?
What accommodations will we need to make to support medically compromised staff and/or their family members?
What legislative or regulatory changes are going to need to be made in advance so that we can ensure maximum flexibility in adjusting to remote learning or in-person environments for Fall 2020? If waived by Executive Order, the NJDOE will need to provide guidance for school districts as each change impacts BOE Policy/Regulation and may affect employee contracts.
1. Class size
2. Length of Day
3. Fire Code
4. Security and Safety
5. Facility
6. Transportation
7. Special Education
8. Medical Exclusion
9. Attendance
10. Registration
11. Instructional
12. Licensure
13. Budget
14. State Testing
15. Teacher and Administrative Evaluation
16. ESL/ELL
17. Athletics
18. Certification
19. Graduation and high school credit requirements
20. Etc.
How is it possible that in 2020, New Jersey has over 75,000 students that do not have access to an internet connection? What is being done to address such inequities? Will legislative action be needed?
Can parents opt their children into virtual learning?
If a student enrolls in a virtual learning experience, will the student be eligible for co-curricular and athletic activities?
If a hybrid instructional model is allowed, how will it be defined?

1. Will we implement alternative day schedules (in-school, virtual) based on health department guidelines?
2. Depending on social distancing requirements, will building plans need to serve students who require in-person instruction and supports?

What happens to clubs and activities? Will they be virtual?
If athletic programs must be postponed or cancelled, do we need to invest in e-sport leagues for our students? How do we fund them in a time of fiscal constraint?
What happens to large ensemble gatherings such as band, orchestra, and choir?
How will classroom music equipment be shared in the future?
Will choir and general music teachers be allowed to have students utilize risers?
Will students be required to sing with masks?
How will socially distanced science labs work?
Will we need to provide specialty masks for staff members and students with hearing aids and cochlear implants?
Will specialty air filters be needed for HVAC systems?
Will PTA/PTSA/PTO meetings be allowed to occur in person or will they be virtual?
What happens to book fairs?
What happens to AM/PM childcare?
The National Federation of High School Sports Associations Sports Medicine Advisory Committee released a document entitled, “Guidance for Opening Up High School Athletics and Activities.” Based upon that guidance, how will sports return in the Fall 2020, when the Sports Medicine Advisory Committee that provides guidance to athletic associations across the nation state that there is to be no shared equipment, no more than 10 athletes on a field at any time, and no handing off/pitching/passing/catching a shared ball?
How are we assisting staff members that are experiencing “empathy fatigue”?
What guidance do we need to provide for our librarians about the checkout and return procedures for books?
What happens to library lessons in PK-5 classrooms?
What does “circle time” or “morning meeting” look like in a socially distanced elementary classroom?
Essentially, how do you create connections when you are forced to disconnect?
How do we address the social and emotional impacts of promoting structures that force social isolation and social distancing?
How can we leverage the voice of our classroom or instructional aides to provide greater supports to our students?
Will additional technological resources and platforms be provided through state or federal departments of education that can serve as a digital learning resource for school districts and families?
Will online e-books and e-libraries be made available for summer and fall reading programs?
In secondary schools, would teachers move from class-to-class instead of the students? How would this work with the variety of elective and course sequences?
What does physical restraint look like when there are physical altercations or aggressions?
What does redirection in a socially distanced Pre-K autism classroom look like?
How will school districts address concerns for young students that simply have “an accident” during the school day?
Will we need to create non-classroom guidelines and procedures (e.g., restrooms, cafeteria, hallways, library, playground, bus, etc.)?
What modifications to school safety protocols will need to be adjusted, such as locker or book bag searches?
Will there be a need to alter protocols for drug testing?
Many school counselor’s offices will not allow for meeting with students or families with proper social distancing guidelines due to space constraints. How will individual guidance services be met under social distancing requirements?
Secretaries often are the first point of contact with members of the public. What modifications will need to be made to workspaces and main office locations?
Administrative workspaces are often in high trafficked areas of school buildings. What measures will need to be put in place to protect these staff members from potential exposure?
Do we have enough nursing staff to meet the needs of our school communities?
1. If not, where will we find the additional staff and monies to increase the nursing shortages that we are already experiencing?
2. Will certification guidelines be altered to increase the school nurse pipeline?
3. Would this come at the expense of our greater health care system?
Will nurses need a higher medical grade equipment?
Currently there is a two-month backorder on masks and hand sanitizers. How does the entire educational system acquire the PPE required to outfit the nation while medical facilities and hospitals have shortages?
Since medical treatment cannot be socially distanced, how will we meet the medical needs of children with epilepsy or seizure disorder?
Will high-risk students be medically excluded from school until there is a vaccine?
At some point, there will be a vaccine. Will vaccines be required for staff members? If they refuse to get vaccinated, will they be allowed work in the schools?
Will vaccines be mandatory for students? This would require major changes to legal provisions and has broad societal ramifications regarding parental rights and choice.
How will schools clean and sanitize our schools? What guidelines and what industry standards?
If we believe that proactive antibody and COVID testing is needed to ensure the public health, who is going to conduct such testing and on what frequency? Will this be mandatory? If a staff member or student refuses testing, will they be excluded or suspended? If someone tests positive, what are the next steps? Will schools need to be shut down? Will there be movement to online instruction and 14 day district wide quarantines?
Will districts need to invest in electrostatic sprayers, eye and face protection, and portable sinks?
Will hallway water fountains need to be turned off to prevent the potential spread of the virus?
Will districts be required to hire a third party vendor to check temperatures when employees return to work? If so, who will be checking the vendors? What will return to work clearance and guidelines look like?
Will OSHA be issuing any industry specific standards?
Will districts need to reduce the school week and stagger school start and break times?
What specialized personal protective equipment will be needed for students and staff (Deaf and Hard of Hearing, Down’s Syndrome, William’s Syndrome, Auto-Immune disease, Autism, etc.)?
What accommodations will be needed for audio enhancement equipment that may be affected by the use of masks?
How will psychological assessments be conducted?
What will the opening two-weeks of school look like? Will there be a series of assessments and remediation measures or will the opening of schools be focused on SEL and re-establishing school culture?
What happens in any classroom that has shared equipment and supplies (arts, culinary, technology, athletics, food services, clothing, pre-K and kindergarten, physical education, robotics, etc.)?
Teachers and administrators that are shared between buildings or departments move amongst school buildings daily and weekly. Will limitations and modifications be needed for shared staff schedules?
Do school districts need to have an enhanced cleaning protocol for shared toys in PK and K classrooms?
Disciplines such as CTE, Athletics, Pre-K and Kindergarten with shared equipment and supplies will be disproportionately impacted by requirements for disinfecting and social distancing. How will we ensure the success of such programs?
Many nurses’ offices are limited in size. It seems obvious we will need a space for quarantining students or staff that may become ill and are suspected of being COVID positive. What will the requirements of such space be? What standards? What physical requirements? Do we need modifications of our facilities or just place a mask over the individual?
Will districts be required to establish a student, employee, and visitor contract tracing protocol? If so, how?
Will all district field trips be cancelled for the 2020 – 2021 school year?
Since there was a shortage of bus drivers prior to the global health pandemic, what happens if there is insufficient busing due to inability to find bus drivers? What will happen with school districts’ obligation to transport students?
As buses are used for multiple runs per day, what will be the cleaning protocols in between routes?
Increased staffing and increasing the number of bus routes will be necessary to meet any schedule modification. How is this possible with limited drivers, buses, and finances?
How will a bus aide whose sole responsibility is the monitoring and safety of special education students that have harnessing and restraints, socially distance from the students for whom they are responsible?
How will transition times (hallways) be monitored? Will hallways need to be one-way? If so, will this create a concern with fire code and door egress?
Will cafeteria services be grab and go? Who will monitor the students?
How will school districts address the loss of revenues from facility rentals, AM/PM care programs, and summer camps?
Since many finger print facilities have been shut during the pandemic, will newly hired staff be able to receive finger print clearance in time to begin working?
Will staff members whose certifications that may be expiring for first aid, lifeguard, or life safety be granted exemptions or extensions?
How will students experience socially distanced Driver’s Education?
How will kids walk up and down the stairs if they cannot hold a hand-railing?
What happens to shared-time vocational education programs? Would students be asked to choose between programs?
If nurses only work during the academic school day, who will monitor temperature checks of staff, visitors, and students in after hour programs and evening custodial shifts?

May 29, 2020 – 101 Questions: Considerations for High School Sports

Questions # 183 – 283 * (Regarding High School Sports, Youth Recreation Programs, and Summer Camps)

On Friday, May 29, we learned that Governor Murphy was opening up youth recreation programs and non-contact athletics beginning in July 2020. On Saturday, May 30, Executive Order 148 and Executive Order 149 were signed. Details and guidelines will be forthcoming from the NJ Department of Health and the NJSIAA.

To the credit of the NJSIAA, they have previously started two task forces to create guidelines to address concerns related to COVID-19, which include the COVID-19 Sports Advisory Task Force and the Medical Advisory Task Force.

As guidance is forthcoming, below are some questions that would be helpful to see discussed in the future guidelines from the NJ Department of Health or from the NJSIAA. In an effort to assist, included is also a list of resources to ensure the safe return of our students to the athletes, coaches, spectators, and parents.

Above all else, the guidelines must include clear guidance regarding:

Social distancing
- 4 Dimensions:
  - Distance to others
  - Environment
  - Activity
  - Time spent together
Cleaning and disinfecting equipment
Public health prevention strategies
Hydration
Definition of Non-Contact Sports
Definition of allowable practices plans

NJ Executive Order 148

“The capacity of the gathering must be limited to no more than 25 people at the same time”

“If any physical items, including equipment, are provided, such items may not be shared by anyone except for immediate family members, caretakers, household members, or romantic partners, and such physical items must be sanitized before and after use;”

NJ Executive Order 149

“High school sporting activities under the jurisdiction of the New Jersey State Interscholastic Athletic Association (“NJSIAA”) may resume in accordance with reopening protocols issued by NJSIAA, which shall consider DOH guidance in issuing these protocols. However, these high school sporting activities cannot resume any earlier than June 30, 2020.”

Resources:

Arizona Interscholastic Association Recommended Guidelines for Returning to Athletic Activity

The Aspen Institute. Health, Medicine, and Society Program. Return to play COVID-19 risk assessment tool.

CDC Interim Guidance for Administrators of US K-12 Schools and Child Care Programs

CDC School Reopening Decision Tree

CDC/EPA Cleaning and Disinfecting Decision Tree

CDC Child Care Programs During The COVID-19 Pandemic Decision Tree

CDC Considerations for Youth and Summer Camps

CDC Considerations for Youth Sports

CDC FAQ for Schools and Child Care Facilities

CDC Parks and Recreation Guidance

CDC/EPA Guidance for Cleaning and Disinfecting

CDC Prevention. Coronavirus Disease (2019) COVID-19: How to protect yourself and others.

Georgia Tech Athletics

Guidelines for Reopening: Arkansas Razorback Athletic Venues

Kentucky High School Athletic Association – COVID-19 K-12 Return to Participation in Sports Guidance

Louisiana Believes – K-12 Athletic Sports Reopening

Michigan High School Athletic Association – Sports Reopening Guidance

National Collegiate Athletic Association. Core principals of resocialization of collegiate sport.

National Strength and Conditioning Association. COVID-19: Return to training. Guidance on safe return to training for athletes.

NCAA Core Principles of Resocialization of Collegiate Sport

NFSHSA GUIDANCE FOR OPENING UP HIGH SCHOOL ATHLETICS AND ACTIVITIES

NJ Governor Murphy Executive Order 148

NJ Governor Murphy Executive Order 149

Tennessee Athletic Non-Contact Pledge – Sports Reopening Guidance

USA Swimming Facility Reopening Guidelines

Questions # 183 – 283 (101 Questions: Considerations for High School Sports)

Guidance provided by the National Foundation of State High School Association, NFSHSA, specifically states that there should be “no shared equipment.” Therefore, in baseball or softball if a ball is pitched to a batter, and hit to the field, can it be fielded and thrown back in? Example provided by the NFSHSA Medical Sports Advisor Committee – “Softball and baseball players should not share gloves, bats, or throw a single ball that will be tossed among the team. A single player may hit in cages, throw batting practice (with netting as backstop, no catcher). Prior to another athlete using the same balls, they should be collected and cleaned individually.”
If there is to be no shared equipment, how do two players have a catch in any sport?
Under NJ Executive Order 148, outdoor size limits will be increased to 25 people. However, the NFSHSA guidelines state that in phase one that no more than 10 people may gather inside or outside. As the NJSIAA follows the guidelines from the NFHS, will we be allowed to have 10 or 25 participants?
Whether 10 or 25 participants, what will be the allowable experiences for athletes (by sport)?
Who will determine social distancing rules? CDC? NJDOH? NJSIAA? NFHSAS? Individual school districts?
If participation is outside only, will bathroom or locker room facilities be allowed to be utilized? If so, who cleans the facility and with what frequency?
How do you maintain a scrimmage if each athlete has to be at least six feet apart? Ex/ There could be no holding a base runner, no challenging another athlete for the ball in soccer, and limited experiences for football other than callisthenic/aerobic exercise.
What training will coaches, officials, and staff receive on safety protocols?
What constitutes a “non-contact” sport? Sports that may not be deemed “contact sports” often have contact.
If baseball or softball is classified as a non-contact sport, would the utilization of a catcher when a hitter is present violate social distancing?
While football is a contact sport, can football teams participate in conditioning workouts?
Can volleyball athletes utilize a shared ball to practice?
Cross-country runners often run on roadways in groups in order to promote safety. Will runners be allowed to run in clusters?
Field Hockey is a physical sport. Will field hockey be classified as a contact sport?
While tennis is not a contact sport, it does have shared equipment. In single tennis, will athletes have to use different color tennis balls to ensure they do not share equipment?
What happens to transportation costs as varsity, JV, and freshman teams often travel on the same bus to save costs? Will there need to be a reduction in schedules or loss of sub-varsity games?
Will individual teams need to have staggered practice schedules?
What will the rules be for spectator gathering?
Will visitors be banned from fields for practice?
How do you socially distance a dugout or sideline?
Will hydration stations be allowed or will all students have to bring their own water bottles?
If providing water is prohibited, will that violate any laws? Will this violate heat acclimation guidelines?
Will each sport determine their own social distancing guidelines or will the NJSIAA provide sport specific standards?
Will locker rooms be accessible to athletes?
Will school districts be required to have medical personnel available at every practice?
Will medical screenings be necessary?
What will be the rules for shared equipment?
Will school districts need to provide temperature checks on coaches and athletes?
Will parents be allowed to stay for practice? Will they count as part of the 25 allowed at a practice or gathering?
What will be the protocol for a sick athlete, coach, staff member, or a family member of any of the mentioned?
Will the health department need to contact trace each reported illness?
Will medical clearance from a physician be needed to return to practice? Will there be medical exclusion guidelines?
Will medical physicals be required to participate in summer workouts?
Will medical screening questionnaires be needed at daily practices?
Will guidelines be provided to school district to provide teams to assist with limiting exposure?
Will athletes be allowed to use school district weight rooms?
If so, what will be the cleaning criteria for weight benches, athletic pads, etc.?
Can equipment be shared between athletes?
Can Cheerleaders practice stunts?
Can Marching Bands have summer camps?

Considerations for Summer Camps

How will camper’s belongings be separated from others’?
How will camps ensure adequate limited use of supplies and equipment from one group of campers at a time?
How frequently will high-touch materials need to be cleaned? (e.g., assign art supplies or other equipment to a single camper)
Will campers be allowed to use sinks and water fountains?
For campers that require naps, will they each have assigned mats?
Will indoor camps be allowed?
What happens on weather emergency days? Will camps be allowed to go inside or will they be cancelled?
How will busing work for camps? What is the allowed distance between students?
Who is training and regulating camps on transportation guidelines?
What physical guides will camps need to install to ensure physical social distancing requirements? Signage? Floor tape? Physical barriers?
Will playgrounds be allowed to be utilized by camps?
Will community pools be allowed? If so, how about bathrooms at community pools?
How will camps feed campers? What are the arrangements and facilities for meals?
What will be the nursing requirements at summer camps?
Will medical campers and staff members be required to have a medical note to return if they have been ill?
Will temperature checks be required? If so, by who?
Will campers and staff need to report illness and fevers? What will the medical exclusion policies be?
Will there be size limits for the number of campers? Assuming 25 campers and staff members, will there be a required ratio of staff to campers?
How will camps ensure the limitation of community spread? Will staff members be required to be hired from the local community?
How will be regulating the camps to ensure they are following medical guidelines?
Will there be staggered arrival and drop-off times?
Will different cohort groups of 25 be allowed on the same campus or the same facility?
If someone gets sick, will the entire team be medically excluded?
Can camps go on field trips?
Will camps have to follow the same athletic guidelines as recreation and youth sports?
Will camps need a designated contact for COVID-19 reporting?
What happens if a member of the camp staff’s family member becomes ill? Will the staff member then become excluded? If so, with pay or without?
What will staff training look like? What will be the new safety protocols?
Will staff members be subjected to daily health checks?
Since camps usually run out of shared facilities, will all organizations be required to follow the same guidelines?
Who will review and approve camp safety plans and/or guidelines?
Will overnight camps be allowed?
How will summer camps transport students when sick?

Considerations for Youth Sports

How will youth recreation leagues guard the safety of their athletes?
How will youth recreation leagues address shared equipment such as helmets, balls, bats, gloves, etc.?
What limitations will be placed on coaches regarding physical demonstrations for athletes?
Will recreation sports focus on skill building drills or team based drills?
If skill building, short of calisthenics and aerobic workouts, how is this done if we cannot share equipment?
Will team based practice be allowed?
Will competitions be allowed?
Will competitions or team based activities from outside the geographic area be allowed?
Will events outside of the region be allowed?
As every sport has different challenges, will sport specific guidance be provided? If so, by what governing agency?
What time limitations will be provided for youth recreation teams?
Will sports programs have a decreased number of competitions?
Will players need to wear masks during summer programs?
What will be the guidance on hydration, summer heat, and masks?
Will social distancing requirements be waived for softball and baseball dugouts?
Will the number of athletes participating camps change based upon the age of the recreation programs?
Will there be guidance on shared water bottles?
Will youth recreation sports need to adopt medical exclusion policies?
As youth programs often run on township, county, and school district facilities, will recreation departments follow the guidelines of those other public entities?
Will youth recreation programs need to bring portable hand washing stations?
What strategies will be required for youth sports organizations to maintain healthy environments? Who will be the governing agency ensuring compliance?
What will be the cleaning protocols for equipment? Will those protocols be different by sport? How frequently will equipment need to be cleaned?
As most youth recreation coaches store their equipment in the trunk of their cars between practices, what are the storage requirements for cleaning products for COVID-19?
Can players share any supplies, towels, water bottles, equipment or is there a 100% prohibition?
Can players high five? Can they fist bump? Handshakes?
What kind of signage is necessary around fields and facilities?
Will students with health challenges be excluded from participating?
Who will insure that there is a proper supply of PPE for youth recreation sports? (Ex/ soap, hand sanitizer, paper towels, tissues, disinfectant wipes, cloth face coverings)

June 4, 2020 – Question # 284 (Student Question(s): One Question in 27 Parts)

Questions below were received from NuYu and Heal (middle and high school student groups at WWP):

Is it safe to reopen schools?

Are you sure it is gonna be safe?

Are we going to screen everyone before they get on a bus and then again at the school?

Will teachers get tested before coming back? Will students get tested? How often?

Will there be (middle schools) team days?

What do we do about music lessons and practices?

Will there be PRISM (Gifted and Talented Program)? We go there for our research track and lunch bunch. Will that still happen?

How will lunch and recess work? Will we have smaller lunches? Will there be less people per a table?

How will we socially distance?

Will we still be able to go on field trips?

When will things return to normal?

Will we still see our friends?

Will there still be after school clubs?

When will we go back to school?

How will gym work? Will gym be required for all, and will we need to wear masks while running?

How will inherently social times, such as lunch be changed to limit the risk of COVID?

Is it practical and prudent to reopen schools?

If it is deemed safe and necessary, maybe we can do half on school grounds, half-virtual?

Pre-screening, daily health checkups, etc.?

How would the schools hold all of the students? There are 25+ kids in each class and there is not enough space to socially distant even with all the rooms in the school.

What if the coronavirus is still going strong in the fall? When will we reopen?

Will we have to wear masks daily or maintain some social distancing in the reopening of school?

How do we know that all students and staff will be safe? Will there be precautions taken to stop the spread? If so, what kind of precautions?

What would the locker areas look like, as we currently only have 3 minutes to get to class and I doubt that kids would wait outside the locker area for every other person in their locker row to finish using their locker.

Also another concern is the hallways as while people are at their lockers there are other kids walking through the hallways. And the thing in the morning where you go to the auditorium or cafeteria or gym before being released to go to 1st period or your lockers, will that be removed, because how can one physically distance in that scenario?

What were to happen if we would have to re-start virtual learning again next school year in the winter?

How can the district ensure that the student and staff will remain safe?

1 thought on “The Relentless School Nurse: Full Circle – 360 Questions About School Reopening”

Anne Buggy says:

June 19, 2020 at 3:50 pm

Thanks for sharing Dr. Aderhold’s updated 360 list of questions regarding school reopening in NJ. I sent the link to the other 10 nurses in my district. I hope it gets shared with our administration. It is a great guide for what questions need to be answered before opening.

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The Relentless School Nurse: Full Circle – 360 Questions About School Reopening

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Published by Robin Cogan, MEd, RN, NCSN, FNASN, FAAN

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