It’s 9 a.m. on Monday at Berman Hebrew Academy in Rockville, and school nurse Miriam Kotek already has four sick kids in her office.
One boy is sitting near Kotek’s desk, his feet propped on a neighboring chair. His head, lolling toward his left shoulder, rests back against the wall. He perks up momentarily when Kotek hands him a sleeve of saltines and then resumes his earlier position, nibbling a cracker intently.
Two more children are sitting in chairs against the opposite wall, pale faced and withdrawn. Another is inside the office bathroom.
These kids are sick, but during a week when concern about a possible coronavirus pandemic has spiked, a run-of-the-mill stomach virus or flu still sends kids to the nurse’s station. And local school officials say the methods recommended to limit transmission of coronavirus — now officially referred to as COVID-19 — are similar to how they stop the spread of its more mundane relatives.
Last week, state health departments and county school systems sent emails to schools across the Washington area about preparing for the event of an outbreak. In New York, meanwhile, three Jewish day schools closed due to a confirmed case of COVID-19 in the Jewish community.
What’s the risk?
Between Jan. 21 and March 2, there were 43 confirmed or “presumed positive” cases of COVID-19 in the United States, according to the Centers for Disease Control and Prevention. (A presumptive positive case is one that tested positive in a public health laboratory and is pending confirmatory testing at CDC.) On Tuesday, news outlets reported a total of six COVID-19 deaths in the United States, all involving patients over age 50 and living in Washington state, although the CDC’s official death toll was still two at that time.
Maryland, Virginia and District health departments are posting online updates on the number of suspected cases in their coverage areas, as well as a running tally of how many people test negative or positive for the virus. All results, as of March 2, were negative.
Local public schools systems have canceled international field trips and short-term visitations to and from some countries based on CDC guidelines. Last week, Montgomery, Howard, Fairfax and Loudon County Public Schools posted or emailed announcements assuring their employees and communities that they are reviewing existing influenza response plans and revising them as needed to keep schools safely open during a COVID-19 outbreak. They also said they are monitoring the news about COVID-19 and communicating with local health departments.
In the event of a mandated closure, Gesher Jewish Day School in Fairfax is ready for students to learn remotely, according to Director of Development Jennifer Scher. Gesher is a fully-enabled Google for Classroom school, she said, and each student in fourth through eighth grades already has a Chromebook for school use.
At Charles E. Smith Jewish Day School in Rockville, Director of Communications Laurie Ehrlich said two staff members are assigned to monitor COVID-19 developments and prepare an IT response if remote learning becomes necessary.
“We’re staying on top of the news and information that’s coming out” from organizations like the Association of Independent Schools of Greater Washington, she said, and following CDC and Montgomery County Health Department recommendations.
Don’t forget the flu
But as scary as coronavirus sounds, the average American is still at greater risk of catching the flu right now. According to the CDC, there have been at least 32 million flu cases, 310,000 hospitalizations and 18,000 deaths nationally this year.
“At this point, there is a lot of hubbub about coronavirus because it’s new and spreading rapidly and we don’t know that much about it. It is much more likely that people would get the flu,” said Emily “Em” Stephens, respiratory disease coordinator for the Virginia Department of Public Health. “Everybody should be concentrating on preventing the flu at this time, and also preparing for the event that coronavirus starts circulating in their community.”
Pneumonia and flu mortality has been low, but 125 flu-associated deaths in children have been reported so far this season. A school will generally report to the health department with a phone call if there is concern about any type of outbreak, said Stephens. Additionally, however, “there is some surveillance of school absenteeism, so if we see there is a rise above the usual level we might reach out.”
School nurses depend on parents and teachers to pass along the information about student absences due to illness. Teachers don’t always document why a child is absent, and parents don’t always follow the instructions in the school’s handbooks to inform the nurse of communicable illness.
Natasha Oksenhendler, head nurse at Charles E. Smith Jewish Day School, said that the school isn’t required to report flu cases on a regular basis unless they exceed a certain number of cases starting at the same time. She and other nurses said that there isn’t a formal or continuous mechanism for reporting absences due to illness. If something raises a red flag for the individual nurse, it is on her or him to report it.
Why it feels like there is so much illness going around
With no empirical data to share, most nurses, teachers and administrators interviewed for this article said there are not more kids sick at their schools than average for this time of year. But they had some ideas for why it feels like there is so much illness going around.
“I think that is because some flu cases have been mild and therefore some students came to school thinking they just had a cold,” said Kotek.
“The one difference we’re having this year that we haven’t seen before — and this is with teachers, too — people are getting flu strain A and then coming down with flu strain B,” said Oksenhendler.
There were more instances of stomach bugs reported last year, she said, but this year it’s primarily flu and strep, common cold. “Winter crud,” she said.
Liba Golman teaches humanities at Washington Waldorf School, a secular private high school in Bethesda. A teacher for the past eight years, her impression is that more kids are sick, and experiencing worse symptoms, than usual.
“Especially in late January and early February, I had one to three students absent each day due to flu-like symptoms and fevers,” she said via email. “Since returning from the December break, there is always lots of coughing and sneezing in my classroom, with students going through a box of tissues every one to two days. There was one week in early February when about 40 percent of our high school students were absent over the course of the week.”
Each classroom is equipped with hydrogen peroxide sanitizing wipes for surfaces as well as alcohol-based hand sanitizer, she said, and teachers are encouraging frequent hand washing and sanitizing. Custodial staff is also cleaning and sanitizing doorknobs and drinking fountains several times throughout the day.
“I personally ask students to use hand sanitizer when they come into the classroom, and ask anyone with any kind of symptoms to wipe their desk before they leave the room,” she said.
The only school employee who reported observing less illness than usual this year was Rachel Hellman, a kindergarten teacher in Rockville.
“I have a student in my class with seven anaphylactic allergies, so I have to Lysol my classroom every day and students have to wash their hands before they enter the room,” she said.
She believes the effort has reduced the number of students out sick. Stephens at the Virginia Department of Health supported the effectiveness of Hellman’s handwashing/Lysoling approach. “Flu is a relatively weak virus outside of the human body … so it can be denatured with Lysol sprays,” she said. Norovirus, which causes nasty gastrointestinal symptoms, is hardier, but there is a list of EPA-
approved cleaning supplies available online.
“The science is still unfolding on coronavirus,” she said. But even now, a look at the list of EPA-approved cleaning products compiled by the American Chemistry Council’s Center for Biocide Chemistries includes Lysol and Clorox wipes and sprays available at the supermarket, in addition to commercial or hospital-grade products, for use against COVID-19 spread.
Regularly wiping down doorknobs and desktops, encouraging handwashing and sneezing into the crooks of elbows, and tasking janitorial staff with intensified cleaning efforts are not the only way to keep illnesses from spreading at school.
Those interviewed for this story cited the same policy standard: A child who hasn’t been fever-free for 24 hours should not be in class. Same goes for kids who experienced vomiting or diarrhea within the past 24 hours.
Struggling with limited sick days at work and a tenuous ballet of childcare logistics, the temptation is great for parents to send kids to school even when they are feeling less than their best.
“I think they should be really thinking about how their child is acting and thinking overall,” said Oksenhendler. “If they’re not engaged, if they’re not present, it would be a good idea to stay home another day.”
“I try to email parents about the various illnesses that are going around each class/grade so that parents can be better equipped to evaluate their children’s complaints and symptoms,” said Kotek.
“Parents always ask ‘Is there something going around?’ and I say ‘There’s always something going around,’” said Oksenhendler. “But I don’t get the sense there’s heightened concern or panic among parents.”