School Nursing

The Relentless School Nurse: Remember the 5 W’s – For Now, It’s All We Have


We have to ask ourselves, is it safe for school buildings to open this fall? We don’t have a clear answer.  Nevertheless, schools appear to be fearfully moving forward to welcome students back for face-to-face learning despite increasing COVID19 cases and community spread.  Our new chilling reality is that schools are the next frontline of COVID-19 with school nurses as the first responders. 

I have been feeling a sense of foreboding and that we are being asked to do something profoundly unsafe. When I shared my perspective with The New York Times journalist, Apoorva Mandavilli, I summed up my concerns with this statement: “I’m just going to say it: It feels like we’re playing Russian roulette with our kids and our staff.” I don’t like to instill or promote fear but it is irresponsible to pretend that school buildings reopening in the fall is education as usual. We cannot guarantee safety for our students or staff and the wider community at large. If we do not have healthy communities, we will not have healthy schools. 

We need a precision public health approach to protect ourselves and our children from COVID19. We need leaders who center the safety of children, not partisan posturing. Is there anywhere that we can agree that the safety of children is paramount. We are missing a national plan. We have no clear roadmap for testing, tracing, and isolating. We have no large epidemiological studies to fully understand transmission from children and adolescents so that we can make decisions based on evidence.  I haven’t even mentioned the antiquated ventilation systems that plague many aging school buildings or how virus transmission appears to be airborne. Dr. Fauci and Dr. Birx just added goggles and/or face shields to mask-wearing recommendations, but we have no national mandate only a state by state recommendations. Without community buy-in how will we promote compliance in schools? 

Right now, these are the ONLY tools we have in our toolbox to keep our students and staff safe at school. Remember the “5 W’s”:

  • Wear a mask
  • Wash your hands
  • Watch your distance
  • When you are sick, stay home 
  • When the health department calls, answer the phone

I could add a 6th ‘W,’ for windows, opening windows, and doors for improved ventilation. The irony is that we are instructed to lock our doors & windows in response to school shooters & now we need to open our windows & doors to improve ventilation. So which guidelines do we follow? School safety was precarious prior to COVID19. It is now in shambles, propped up with a vague series of ever-changing guidelines from previously trusted sources like the Center for Disease Control (CDC).  School safety has become a political football in a country that cannot even agree that wearing masks should be a national response to this deadly epidemic.

We are witnessing the dismissal of the World Health Organization, watered-down guidelines from the CDC, failed national leadership ignoring the exponential spiking of cases across the country, and lack of national public health response. Consequential decisions are being made that will impact the health and safety of students and staff. And that is why I said what I said. Remember, the question that must be answered is “How will we know when it is safe to reopen school buildings?” Give us the parameters, the metrics, the roadmap. Give us something that we can implement that is more than a guessing game of hope and crossing our fingers and toes that we won’t have an exposure at school.


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