School Nursing

The Relentless School Nurse: Dismantling The Plane As We Are Flying


Throughout the pandemic we have heard the explanation “we are building the plane as we are flying it,” as new information and research caused everyone to pivot time and time again. With the overwhelming public sentiment to move from pandemic to endemic life, it now feels that we are “dismantling the plane as we are flying it” or as the comic depicts, “rebuilding the plane, and we all have a piece of it.” I hear the calls that it’s time for COVID to end and the talk of finding the off-ramps, or 10 ways to end the pandemic. The most insulting to those of us who have been on the frontlines of COVID for two years, it’s “we have to learn to live with it.”

While I understand the exhaustion from endless months of dealing with COVID and its variants, I am still sending students and staff home every day who are symptomatic. Thankfully, the numbers are decreasing, but we are still seeing spread and activity in the community. Are we really there yet? Not from my vantage point, as a school nurse in an urban district with lower than average vaccination acceptance. Booster rates are extremely low and our youngest students, more than 2500 in preschool, are not yet eligible for the vaccine.

What is happening on the ground level at school is not necessarily translating into the numbers reported to health departments. For example, home testing with both positive and negative results are not reported. This lost data that impacts community transmission rates, is literally thrown in the trash. Contact tracing has been one of the biggest challenges during the pandemic. A combination of the lack of cooperation from the public and under-resourced local health departments without the staffing to handle the influx of cases, all add to poor participation and gaps in identifying outbreaks. 

When a student is sent home with COVID compatible symptoms, a parent can choose to get the child tested or stay home for the length of isolation/quarantine your state and/or school districts are opting to follow. Sometimes we never know of a confirmed positive case because the student never tested. Often, results are not shared about family members who may be positive, even if it impacts our student or those in their classroom, lunchroom, after school activities, buses, etc; you get the picture.

Connecting the dots of how COVID is being transmitted happens in school, where school nurses are, and have been doing the motherload of COVID testing for communities. My experience tells me that it is because of the attention to details like student or staff symptoms, close contact exposures, layers of COVID precautions especially masks, that schools have been relatively safe. Certainly, we have had to close classrooms, delay sports and other extra-curricular activities in the name of safety.  Some schools have gone to half-days during periods where COVID has impacted staff attendance. We have done it all, and more that many will never know or understand or sadly, not appreciate.

Is COVID in our rearview mirror. Not just yet, but it could be if we follow public health recommendations to get vaccinated and boosted. It is that simple and that complicated.  There are 14 childhood illnesses that you may have almost forgotten about thanks to vaccines. COVID is now a preventable childhood illness, with a vaccine series soon to be available to our youngest children. When that happens, we can all look for the off ramps and check our rear view mirrors. Let’s stop building, rebuilding, or dismantling this plane and follow the science. 


 The following information comes directly from the CDC website:


#1. Polio

Polio is a crippling and potentially deadly infectious disease that is caused by poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis. Polio was eliminated in the United States with vaccination, and continued use of polio vaccine has kept this country polio-free. But, polio is still a threat in some other countries. Making sure that infants and children are vaccinated is the best way to prevent polio from returning. Make sure your baby is protected with the polio vaccine.

Doctors recommend that your child get four doses of the polio vaccine (also called IPV). Your child will need one dose at each of the following ages:

Learn More About Polio

#2. Tetanus

Tetanus causes painful muscle stiffness and lockjaw and can be fatal. Parents used to warn kids about tetanus every time we scratched, scraped, poked, or sliced ourselves on something metal. Nowadays, the tetanus vaccine is part of a disease-fighting vaccine called DTaP, which provides protection against tetanus, diphtheria, and pertussis (whooping cough).

Doctors recommend that your child get five doses of the DTaP vaccine. Your child will need one dose at each of the following ages:

Learn More About Tetanus

#3. The Flu (Influenza)

Flu is a respiratory illness caused by the influenza virus that infects the nose, throat, and lungs. Flu can affect people differently based on their immune system, age, and health. Did you know that flu can be dangerous for children of any age? Flu symptoms in children can include coughing, fever, aches, fatigue, vomiting, and diarrhea. Every year in the United States, otherwise healthy children are hospitalized or die from flu complications. CDC estimates that since 2010, flu-related hospitalizations among children younger than 5 years have ranged from 7,000 to 26,000 in the United States. It’s important to know that children younger than 6 months are more likely to end up in the hospital from flu, but are too young to get a flu vaccine. The best way to protect babies against flu is for the mother to get a flu vaccine during pregnancy and for all caregivers and close contacts of the infant to be vaccinated. Everyone 6 months and older needs a flu vaccine every year.

Doctors recommend that your child get the flu vaccine every year starting when they are 6 months old. Children younger than 9 years old who are getting vaccinated for the first time need two doses of flu vaccine, spaced at least 28 days apart.

Learn More About Flu
Hepatitis B

#4. Hepatitis B

Did you know that worldwide more than 780,000 people per year die from complications to Hepatitis B? Hepatitis B is spread through blood or other bodily fluids. It’s especially dangerous for babies, since the hepatitis B virus can spread from an infected mother to child during birth. About nine out of every 10 infants who contract it from their mothers become chronically infected, which is why babies should get the first dose of the hepatitis B vaccine shortly after birth. All pregnant women should be tested and all babies should be vaccinated.

Doctors recommend that your child get three doses of the Hepatitis B shot for best protection. Typically, your child will need one dose at each of the following ages:

Learn More About Hepatitis B
Hepatitis A

#5. Hepatitis A

The Hepatitis A vaccine was developed in 1995 and since then has cut the number of cases dramatically in the United States. Hepatitis A is a contagious liver disease and is transmitted through person-to-person contact or through contaminated food and water. Vaccinating against hepatitis A is a good way to help your baby stay Hep A-free and healthy!

Doctors recommend that your child get two doses of the hepatitis A vaccine. Your child will need one dose at each of the following ages:

Learn More About Hepatitis A

#6. Rubella

Rubella is spread by coughing and sneezing. It is especially dangerous for a pregnant woman and her developing baby. If an unvaccinated pregnant woman gets infected with rubella, she can have a miscarriage or her baby could die just after birth. Also, she can pass the disease to her developing baby who can develop serious birth defects. Make sure you and your child are protected from rubella by getting vaccinated on schedule.

Doctors recommend that your child get two shots of the MMR vaccine. Your child should get one dose at each of the following ages:

Learn More About Rubella

#7. Hib

Hib (or its official name, Haemophilus influenzae type b) isn’t as well-known as some of the other diseases, thanks to vaccines. Hib can do some serious damage to a child’s immune systems and cause brain damage, hearing loss, or even death. Hib mostly affects kids under five years old. Before the vaccine, over 20,000 kids were infected each year. That’s about 400 yellow school busses worth of kids! Of these kids, one in five suffered brain damage or became deaf. Even with treatment, as many as one out of 20 kids with Hib meningitis dies. Get your child vaccinated to help them beat the odds!

Doctors recommend that your child get four doses of the Hib vaccine. Your child will need one dose at each of the following ages:

Learn More About Hib

#8. Measles

Did you know your child can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left? Measles is very contagious, and it can be serious, especially for young children. Because measles is common in other parts of the world, unvaccinated people can get measles while traveling and bring it into the United States. Anyone who is not protected against measles is at risk, so make sure to stay up to date on your child’s vaccines.

Doctors recommend that your child get two doses of the MMR vaccine. Your child will need one dose at each of the following ages:

Infants 6 to 11 months old should have one dose of the MMR shot before traveling abroad. Infants vaccinated before 12 months of age should be revaccinated on or after their first birthday with two doses, each dose separated by at least 28 days.

Learn More About Measles
Whooping Cough

#9. Whooping Cough (Pertussis)

Whooping cough, or pertussis, is a highly contagious disease that can be deadly for babies. Whooping cough can cause uncontrollable, violent coughing, which often makes it hard to breathe. Its “whooping” name comes from the sharp breath intake sound right after a coughing fit. In babies, this disease also can cause life-threatening pauses in breathing with no cough at all. Whooping cough is especially dangerous to babies who are too young to be vaccinated themselves. Mothers should get the whooping cough vaccine during each pregnancy to pass some protection to their babies before birth. It is very important for your baby to get the whooping cough vaccine on time so he can start building his own protection against the disease. Since 2010, between 15,000 and 50,000 cases of whooping cough were reported each year in the United States, with cases reported in every state.

Doctors recommend that your child get five doses of the DTaP vaccine. Your child will need one dose at each of the following ages:

Learn More About Whooping Cough

#10. Pneumococcal Disease

This disease is caused by bacteria called Streptococcus pneumoniae. It causes ear infections, sinus infections, pneumonia, and even meningitis, making it very dangerous for children. The germs can invade parts of the body—like the brain or spinal cord—that are normally free from germs. Make sure you keep kids safe from this dangerous disease by vaccinating.

Doctors recommend that your child get four doses of the pneumococcal conjugate vaccine (also called PCV13). One dose at each of the following ages:

Learn More About Pneumococcal Disease

#11. Rotavirus

Rotavirus is contagious and can cause severe watery diarrhea, often with vomiting, fever, and abdominal pain, mostly in infants and young children. Children can become severely dehydrated from the disease and need to be hospitalized. If a dehydrated child does not get needed care, they could die. Rotavirus is one of the first vaccines an infant can get; it’s the best way to protect your child from rotavirus disease.

Doctors recommend that your child get two or three doses of the vaccine (depending on the brand).

Learn More About Rotavirus

#12. Mumps

Mumps is best known for causing puffy cheeks and a swollen jaw. This is due to swelling of the salivary glands. Other symptoms include fever, head and muscle aches, and tiredness. Mumps is a contagious disease and there is no treatment. Mumps is still a threat today—every year, people in the United States get mumps. In recent years, mumps outbreaks have occurred in settings where there was close, extended contact with infected people, such as being in the same classroom or playing on the same sports team. The MMR vaccine protects you and your family against mumps, measles, and rubella.

Doctors recommend that your child get two doses of the MMR shot Your child will need one dose at each of the following ages:

Learn More About Mumps

#13. Chickenpox

Chickenpox is a disease that causes an itchy rash of blisters and a fever. A person with chickenpox may have a lot of blisters—as many as 500 all over their body. Chickenpox can be serious and even life-threatening, especially in babies, adults, and people with weakened immune systems. Even healthy children can get really sick. Vaccinating kids at an early age is especially important to keep your children healthy.

Doctors recommend that your child get two chickenpox shots. Your child will need one dose at each of the following ages:

Learn More About Chickenpox

#14. Diphtheria

Most of us only know diphtheria as an obscure disease from long ago, thanks to the diphtheria vaccine babies get. This vaccine, called DTaP, provides protection against diphtheria, tetanus, and pertussis (whooping cough). While preventable, diphtheria does still exist. It can cause a thick covering in the back of the nose or throat that makes it hard to breathe or swallow. Diphtheria can also lead to heart failure, paralysis, and even death. Make sure to vaccinate to help keep this dangerous infection from your kids.

Doctors recommend that your child get five doses of the DTaP vaccine. Your child will need one dose at each of the following ages:

3 thoughts on “The Relentless School Nurse: Dismantling The Plane As We Are Flying”

  1. Fantastic summary of the mitigation and elimination of deadly diseases with vaccines. Another stupendous article by an expert public health/school health expert!

  2. When we do finally begin to frame this in the rearview mirror, we’re going to have to take a really long and critical look…..our science was stellar but we failed socially on such a grand scale it’s hard to even comprehend.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.