Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN 

Pediatric nurse practitioners (PNPs) often evaluate infants, children, and adolescents with a variety of dermatologic presentations that provide supporting evidence for the differential diagnoses and the subsequent final diagnosis. In their article, 

Dermatological findings associated with COVID-19 in pediatric patients

 Dr Schmidt and Ms Chen provide a detailed description of cutaneous manifestations in children and adolescents that most likely are associated with a diagnosis of COVID-19, even in the absence of positive polymerase chain reaction (PCR) or antibody test results.

It is important for PNPs to become familiar with these newly described dermatologic findings to accurately differentiate these skin presentations from ‘somewhat look-alike’ presentations that are more familiar to all providers in pediatric primary care clinical practice, urgent care centers, or emergency departments. Pediatric nurse practitioners need to recognize these newly identified skin manifestations and the relationship to a diagnosis of COVID-19. The conditions identified by Dr Schmidt and Ms Chen included pseudo-chilblains, erythema multiforme-like lesions, multisystem inflammatory syndrome in children, Kawasaki disease, and other non-specific viral exanthems. The authors provide photographs for each of these conditions. Pediatric nurse practitioners should become familiar with each of these photos to diagnose the dermatologic findings in a timely manner and/or make a referral to a dermatologist or other health care providers, as appropriate.

The authors discuss the open registry now available, identified as the Pediatric Dermatology Research Alliance COVID-19 Response Task Force (PDCRTF). This analysis of dermatologic presentations in COVID-19 will be a valuable resource for pediatric providers to identify as many presentations as possible for children who are suspected of having COVID-19 even in the absence of positive PCR, antigen, or antibody testing.

Since the beginning of the COVID-19 pandemic, there have been considerable disagreements about testing for COVID-19. The fact that children are presenting with dermatologic findings that are highly suspicious of being related to COVID-19 and available data showed that many children with these manifestations have tested negative on PCR and antibody testing is a major concern. Were these children living in households where adults were exposed to the virus, and the children were not tested until the dermatologic manifestations were evident? Have children only been tested if they presented with respiratory systems or fevers suggestive of COVID-19?

The lack of a comprehensive national testing plan for adults and children has adversely affected the ability of health care professionals, scientists, and researchers to control many outbreaks that have occurred and are occurring throughout the United States. As children and adolescents return to school, testing is a critical component for the equation of a safe return for the children, adolescents, school personnel, and teachers. Yet, there is no consistent plan for testing. We have already seen some high schools and colleges closing almost immediately after opening and the one commonality has been no testing plan in place. We, as pediatric health care providers, must advocate for a testing plan for children to assure the safety of the children and adolescents, the school personnel and teachers and as they return home each day, for their family members as well.

Articles

Growing evidence indicates that COVID-19 impacts more than the respiratory system. Clinicians should keep an eye out for dermatologic conditions that may be associated with the illness.

Emerging dermatologic conditions in the presence of COVID-19 pandemic

We have been living in uncertain times since the beginning of the COVID-19 pandemic. COVID-19 has controlled our lives, conversations, movement, media presentations, and disrupted our health care systems. We, as health care providers (HCPs), are aware of the potential dangers to individual and community health if COVID-19 surges in the fall and winter months during influenza season. This is 

 for all HCPs to proactively stop this potential public health nightmare by speaking with all parents and adolescents about the absolute need for everyone to receive the influenza vaccine. 

Create plans to administer the influenza vaccine

2 doses of flu vaccine reduce disease burden

 Miranda Hester presents the findings from a study that investigated the effectiveness of 1 or 2 doses of influenza vaccine for children aged 6 months to 8 years. Results revealed that 2 doses of the vaccine for children aged younger than 9 years was more effective than a single dose. This study further supports the recommendations of the Centers for Disease Control and Prevention for 2 influenza vaccines for children aged younger than 9 years, receiving influenza vaccine for the first time. Thus, HCPs should organize a recall system for infants and children who are receiving the influenza vaccine for the first time to assure they receive their second dose 1 month after receiving the first dose. Additionally, all HCPs should establish a plan to schedule their patients to receive the influenza vaccine for the 2020-2021 season. Helping parents, teenagers, and all adults understand the need to prevent a Fall season with the potential for spikes in COVID-19 compounded by influenza is a major responsibility of all HCPs. The messaging for prevention of influenza needs to start now and medical offices, clinics, and pharmacies that administer influenza vaccines all need a consistent and strong message to help everyone understand the need for influenza vaccination.

Primary prevention strategies more important than ever

Embedded in everyone’s practice protocols are the current evidence-based principles to prevent or impede the spread of COVID-19 during all health care office visits. These protocols will also help to reduce the spread of influenza. However, the influenza vaccine is an available safe and effective vaccine to prevent influenza. Thus, it is our responsibility to convey this message to all of our patients and to the public and to encourage all to take the vaccine.

Some states are planning to have children/adolescents return to school this Fall. Although uncertainty remains about additional problems that may emerge concerning COVID-19 and school reopenings, this is an opportunity to prevent influenza through organized office-based and community efforts to vaccinate all children and adults. Health care providers must be cognizant about ways to speak with vaccine hesitant and vaccine resistant parents and adults and present 1 consistent message concerning influenza vaccine to prevent potential devastating effects of COVID-19 and influenza circulating simultaneously in the 2020-2021 known influenza season.

Responsibilities of school districts and boards

School districts or school boards currently require specific vaccinations for children/adolescents to attend school. In recent years, as some vaccine preventable diseases have emerged in communities, (eg, measles) many school districts, boards, and state legislatures have placed limits on vaccine exemptions. This is an opportunity for school districts and boards to require the influenza vaccine for all individuals who attend or work within the school system. Health care providers should advocate for school districts, boards, and legislatures to act quickly to require influenza vaccine as a prerequisite for school attendance. The time to be proactive and prevent a public health nightmare that will emerge if COVID-19 and influenza are circulating together in our communities is now.

This is the critical moment in time for all health care providers to proactively stop this potential public health nightmare by speaking with all parents and adolescents about the absolute need for everyone to receive the influenza vaccine. 

Let’s proactively stop another public health nightmare!

Over the past 20 years, pediatric and family nurse practitioners (PNPs & FNPs) have been providing primary health care services to children whose lives are often challenged by the social determinants of health (SDOH).

 COVID-19 has adversely impacted the health and well-being of grandparents, parents and close relatives of these children, with an overwhelming number of their relatives succumbing to COVID-19. In the last week of April 2020, the emergence of a new disorder, Multisystem Inflammatory Syndrome in Children (MIS-C)

 was identified in the United States (US) and the United Kingdom, and disproportionately affects children in these vulnerable, multi-ethnic, minority communities.

 Thus, because COVID-19 has demonstrated how adversely it can affect children, critical decisions must be made on the topic of safe ‘return to school.’

The practice of school nursing began in the United States on October 1, 1902, when Lina Rogers, the first school nurse, was hired to reduce absenteeism by intervening with students and families regarding healthcare needs related to communicable diseases.

 One hundred and eighteen years later, in the midst of the COVID-19 pandemic, school nurses still play a critical role in the totality of the management of health, including the prevention and control of transmission of this novel COVID-19 virus for all who return to school, not only the children. Today, school nurses are not limited to the care of children in vulnerable communities. School nurses have leadership roles overseeing the healthcare needs of children and school personnel in schools throughout the United States. The COVID-19 pandemic brings to the forefront the need for legislation that requires every school, throughout the US, to employ an on-site registered nurse (RN). In 2016, the American Academy of Pediatrics recommended that schools have at least one registered available in each school to meet the health needs of the children.

During the 2015-2016 school year, 52 % of public schools had a full time school nurse. Three-quarters or 82% of the schools had a at least one full time or one part time school nurse.5 Thus, school districts that do not have, at a minimum, a RN to oversee the day-to-day healthcare assessments of each child and school personnel will be at a disadvantage over schools that have a nurse to assess the children and staff for COVID-19 risks and make determine appropriate interventions.6 Preparation for return of to school for children with chonic illnesses, (eg, asthma, diabetes mellitus, congenital heart disorders) and children from vulnerable communities adversely affected by the social determinants of health (SDOH) will require NPs in School Based Health Centers (SBHCs) to work alongside school nurses to ensure the health, well-being and safety of both students and school personnel. Nurse practitioners are educationally prepared to critically analyze local COVID-19 data and to share and discuss the analysis with key administrators and school nurses. Shared decision making is a key component in the process of protecting the health of each individual and the entire school community. Nurse practitioners are also prepared to educate school nurses, all personnel, parents and children on the COVID-19 virus, including the most common presenting COVID-19 symptoms and MIS-C, as well as all of the safety precautions that must be in place prior to reopening schools.

 Nurse practitioners and school nurses are integral to the safe reopening of schools.

Children at increased risk for COVID-19 complications

Extrapolating data for the adult population for children who are chronically ill children, in particular, those with asthma, diabetes mellitus type 1 and 2, heart disease, kidney disease or sickle cell disease, immune compromised children, obese children and anecdotally, adolescents who practice risky behaviors, eg, vaping, or illicit drug use, are at-higher risk than the general pediatric population for complications from COVID-19. Plans for return to school must take into consideration whether the school environment can be designed as a safe environment for these high-risk children. Discussions with the entire team, including parents and older children, teachers, and school administrators must take place to decide on an individual basis whether the child/adolescent can safely return to school.

Update children’s immunizations and physical assessments

The CDC released data from the analysis of the Vaccine For Children (VFC) distribution of immunizations throughout the United States that revealed a significant decrease in the numbers of vaccines ordered by providers when comparing vaccines ordered from VFC during January 7, 2019 to April 21, 2019 to the numbers of vaccines ordered from Januaray 6, 2020 to Aprinl 19, 2020.

 Children aged 24 months and older, were most affected during the first 3-months of the COVID-19 pandemic during the time that parents followed the stay-at-home orders that were in place across the country.

 Now is the time for NPs and school nurses to be vigilant when reviewing immunization and physical exam records. Schools and children do not need the additional crisis of unimmunized or underimmunized children contracting a vaccine preventable disease (VPD) during the pandemic.

Nurse practitioners can conduct telehealth and telemedicine visits which are suitable for assessing the child’s physical status for return to school

 Nurse practitioners in SBHCs can perform a physical assessment once school is in session for children who receive their care in SBHCs. For children who need immunization updates, NPs may offer ‘drive-in parking lot immunization updates’ prior to school openings. Parents can visit local pharmacies that offer on-site immunization updates. Children seen in private pediatric offices or community clinics can contact their providers to be seen at their practices sites. Guidance and best practices for NPs and school nurses to support the safety of students and staff return to school is presented in the following tables.

Planning, assessing, reassessing, and evaluation of potential problems are all critical components of return to school policies that focus on the health and well-being of the children and school personnel. In the COVID-19 pandemic, school nurses should be considered essential personnel for each school.

 Nurse practitioners or school nurses are needed to oversee implementation of public health initiatives to maintain a safe school environment (See Safe return to school: Call to action part 1). These initiatives include masks for all children and school personnel, monitor screening results before child enters school, and monitoring COVID-19 test results of children and school personnel. Management of ill children should be a top priority of every NP and school nurse.

School nurses should work closely with local Departments of Health for contact tracing when a child’s test result is positive for COVID-19.

Nurse practitioners and school nurses play a critical role in the assessment and management of the health care needs of all children and personnel in school systems. Every school, that does not currently have a school nurse as a member of their team, should consider employing a RN to provide the complex assessments that must be implemented to assure the safety of each person who enters the school. School nurses routinely assess school health records, as well as the immunization status and physical examinations of children and take appropriate actions when children are not in compliance with school regulations. School nurses will have even greatere responsibilities during this pandemic. School nurses will have an important role in monitoring best practices for clearing children/adolescents and school personnel to come to school each day. In addition, school nurses will be working with local Departments of Health in the assessment of possible exposures of children or families to COVID-19 with the critical role of prevention of the spread within the school community. The school nurse and NPs will also play a role in the implemnentation and evaluation of safety precautions necessary for personal hygiene, social distancing, and proper wearing of masks and eye protections. The entire medical community, including physicians, NPs, school nurses, and local departments of health are valuable members of the return to school team with the overall goal of health and safety for all children and school personnel.

: Based on the overall concern for the children we care for on a daily basis, five PNPs formed a ‘think tank’ engaging in weekly discussions on the preparation for return to school and authored two articles for this edition of Contemporary Pediatrics. In addition to the authors of this manuscript, significant contributors to this work were made by Regena Spratling, PhD, RN, APRN, CPNP, FAANP and Emily T. Cupelli, DNP, CPNP, BCB-PMD

 Both are authors for the manuscript Safe return to school: Call to action, Part 1.

1. Love HE, Schlitt J, Soleimanpour S, Panchal N, Behr C. Twenty years of school based health care growth and expansion. 

https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.05472

2. Hennon TR, Penque MD, Abdul-Aziz R, et al. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. 

Published May 23, 2020. Accessed June 26, 2020.

3. Heale T. COVID-19-related inflammatory condition more common in black kids in small study. 

 Published June 5, 2020. Accessed June 26, 2020. 

https://www.medscape.com/viewarticle/931847

4. Buswell SA, Lechtenberg J, Hinkson E, et al. National Association of School Nurses (NASN). The role of the 21st century school nurse. (Position Statement). Silver Spring, MD. 2016. Accessed June 26, 2020. 

https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role

5. AAP Council on School Health. Role of the School Nurse in Providing School Health Services. 

. Published June 2016. Accessed July 12, 2020. Accessed from 

https://pediatrics.aappublications.org/content/137/6/e20160852

6. Nelson L, McIlraith T. Coronavirus highlights school nurse role in public health preventions and response. 

 Published May 6, 2020. Accessed July 12, 2020. Accessed from 

https://www.wsna.org/news/2020/coronavirus-highlights-school-nurse-role-in-public-health-prevention-and-response

7. Centers for Disease Control and Prevention (CDC). Santoli J, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration. Published May 8, 2020. Accessed TK. Available at: 

https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e2.htm#F1

8. Centers for Disease Control and Prevention (CDC). Maintaining childhood immunizations and well-child care during COVID-19 pandemic. Published May 20, 2020. Accessed June 25, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html?deliveryName=USCDC_2070-DM25408

9. Mendoza MA, Ea E, Tilley C, et al. Telemedicine: Using technology to deliver healthcare at a distance. In Hallas, D. website: An innovative Academic-Clinical Partnership: Primary Care Nurse Practitioner Preceptor Development Program (PC-NP-PDP). Published May 2020. Accessed June 27, 2020. 

10. Blad E. How CDC Guidance Could Shape What Back-to-School Looks Like in the COVID-19 Era. 

https://www.edweek.org/ew/articles/2020/05/29/how-cdc-guidance-could-shape-what-back-to-school.html

 Published May 29, 2020. Accessed June 20, 2020.

11. Centers for Disease Control and Prevention (CDC). Considerations for schools. Preparing for when someone gets sick. Published May 19. 2020. Accessed June 10, 2020. Available at: 

https://www.cdc.gov/coronavirues/2019-ncov/community/schools-childcare/schools.html

12. Cirtoner B. (April 17, 2020). Paper towels better than air dryers to stop virus spread. Published April 17, 2020. Accessed June 20, 2020. Available at: 

https://www.healthline.com/health-news/paper-towels-beat-hand-dryers-for-stopping-virus-spread

13. Thompson D. (June 11, 2020). Will schools reopen this fall? And what will that look like? Published June 11, 2020. Accessed June 25, 2020. Available at: 

https://www.medicinenet.com/script/main/art.asp?articlekey=234690&ecd=mnl_day_061120

14. Servick K. (May 21, 2020). COVID-19 contact tracing apps are coming to a phone near you. How will we know whether they work? 

https://www.sciencemag.org/news/2020/05/countries-around-world-are-rolling-out-contact-tracing-apps-contain-coronavirus-how

 Published May 21, 2020. Accessed June 10, 2020.

As fall approaches, one of the biggest questions is: Can children return to school and be in classroom environments that assure health and well-being for all? Here's how practitioners can help.

Safe return to school: Part 2

On the topic of ‘return to school’ this year, anxiety abounds for parents and children, as well as teachers, school staff and nurses, nurse practitioners (NPs), departments of health and legislators.

 Since school is considered “the work of children,”

 we must carefully consider all aspects of ‘return to school’ in light of the current, unprecedented COVID-19 pandemic. Many compelling questions emerge, but first and foremost the question to address is: 

Can children return to school and be in classroom environments that assure health and well-being for all?

The National Parent Union conducted an online COVID-19 survey of 500 parents with children from kindergarten through 12th grade on May 4 and 5, 2020.

 Lowe’s data revealed a significant level of anxiety among parents concerning return to school for their children. A 

 article reported that 6 of 10 parents are considering continuing with home learning rather than sending their children to school in Fall 2020.

 Some of the parental anxiety and decision making by parents may be attributed to uncertainty as the pandemic remains a viable threat throughout our country.

Planning, testing and masks are a critical component for safe return to school

Guidance from the Centers for Disease Control and Prevention (CDC) for opening schools was posted on the CDC website on March, 19, May 19, June, 3, and July 23, 2020.

 The guidance emphasizes the importance of school officials and administrators collaborating with local health officials for decision making regarding return to school and decisions about closing schools, while the most recent statement did stress the importance of reopening schools. The initial interim CDC guidelines

 did not address two major issues, masks and testing, that must be resolved either locally, or nationally by implementation of best available scientifically based health safety measures prior to any child’s/adolescents return to school. However, the CDC guidance on July 23, 2020 does recommend masks for children and staff in school settings, except those under 2 years old, and those with some medical conditions. Since wearing masks has been met with controversy, the work of health care professionals (HCPs) is to gain the support of parents, children and school personnel to wear masks during school. And, while recommendations presented in this paper are consistent with CDC guidelines and supports wearing masks, it also provides more stringent considerations for testing school personnel and children. All HCPs realize the ever evolving and changing health care recommendations as the pandemic moves across the country and the world. Thus, what is considered best practice today based on the available evidence, may be shown to be incorrect tomorrow. Making reasonable changes to tackle the twists and turns that emerge every day in this pandemic is a major challenge. Health care professionals at the local, state, regional, in helping non-HCPs make sensible decisions based on scientific data to protect all individuals. Return to school decisions must be based on the science with the overall goal of the health and well-being of the children/adolescents, the school personnel and the community as a whole. One size and one decision will not fit all.

The CDC guidance on COVID-19 from July 23, 2020 supports using “cloth face coverings” to prevent the spread of the COVID-19 virus, and includes in their practical recommendations that schools put “cloth face coverings on school supply lists and provide cloth face coverings as needed to students, teachers, staff, or visitors who do not have them.”

 Indeed, the scientific evidence from COVID-19 public health measures supports wearing masks as the new norm for all adults and for all children older than 2 years. Thus, we believe that wearing masks is an essential component of safe return to school. However, children with chronic illnesses, including pulmonary conditions, and those with disabilities may be advised by their physicians and NPs, not to wear face masks. Thus, some protection for children, who are too young to tolerate wearing a mask or are unable to wear masks, may be provided by other children and school personnel who can safely wear face masks in school settings.

The CDC guidance of July 23, 2020 also states that “[The CDC] does not currently recommend universal symptom screenings to be conducted by schools.”

 School NPs and school nurses are educated on public health screening measures and are ideally suited to appropriately screen students and all school personnel prior to entering school for the purpose of preventing exposure of individuals with COVID-19 or any communicable disease symptoms from spreading the virus to contacts at the school. The value of having a school nurse for every school was supported by the AAP policy statement in June 2016.

 In this pandemic, the school nurse is an essential part of the healthcare team (eg, private practice physicians, school based health centers, community clinics, and the department of health) overseeing the health of the children and school personnel and should be employed in every school.

Another major concern identified in the original CDC guidance

 is the recommendation to close schools for 2 to 5 days when there is a confirmed case of COVID-19 in the school system. Opening and closing schools for 2 to 5 days will be disruptive to everyone. Testing prior to return to school may prevent schools from opening and closing in a chaotic fashion.

Plans to reopen schools must be based on local and state public health data as well as primary and secondary prevention strategies that minimize the potential for viral spread, and avoid a cycle of frequent opening and closing of school systems due to outbreaks of COVID-19.

 The authors believe that testing of students and school personnel prior to reopening schools is the cornerstone of primary and secondary prevention strategies. And while the most recent CDC guidance does not recommend universal testing of children and staff, it however, proposes other testing strategies based on local and state data.

When the pandemic began, data from other countries led health care providers to believe that children were less affected by COVID-19 but may be asymptomatic carriers.

However, as the pandemic spread in the United States and Italy, there were news reports of chronically ill children hospitalized with severe symptoms. The most troubling occurrence is the new presentation of the COVID-19 complication of the syndrome, Multisystem Inflammatory Syndrome in children (MIS-C).

 The etiology of MIS-C remains unclear. According to reports from the CDC, children who developed MIS-C may have been infected weeks before the appearance of MIS-C symptoms, and/or were symptomatic carriers.

Thus, based on these presentations of COVID-19 in children, testing strategies for children must be considered on all levels to protect all children, school personnel, and the communities in which they live. As of this writing, data for widely testing children for COVID-19 in the United States is non-existent.

Innovation is an outcome of a crisis. New, non-invasive methods for testing for COVID-19 in children should be developed. Saliva sample testing may be a reasonable solution that can be developed, and, as of this writing, is under investigation as a point-of-care test.

Once testing policies and methods are in place, only then can we proceed with developing other policies that address a safe school environment for children and adolescents, and all school personnel that work every day to educate and care for our children/adolescents.

Screenings are critical to safely reopen schools

Children have been out of school since March 2020 and may not have had their usual access to health care throughout this pandemic. Screenings to identify problems in physical, emotional, social, and behavioral health are a critical strategy for the design and implementation of effective strategies for healthy children. Thus, we encourage all HCPs, including school nurses, to assume a leadership role in the design and implementation of screenings for the identification of children and school personnel who may present with problems that may have arisen during stay-at-home orders (eg, anxiety, school phobia, etc.).

Screening is a critical part of the process for prevention of transmission of COVID-19 within school systems. An innovative, reliable method for screening children and school personnel prior to going to school each day should be implemented. Some health care systems and other clinical practices have already implemented the use of a web-based application or ‘app’ that can be used to screen for temperature and emerging symptoms one-hour before reporting to work each day. This screening tool asks the individual to report the morning temperature, and also asks other pertinent questions about symptoms and possible exposure to an individual with COVID-19. If negative, the employee reports to work. If any portion of the screening is positive, the individual does not report to work that day. For parents who do not have access to cell phones or apps on their devices, a plan should be in place for the parents to call into the school and report the information to be reviewed by the school nurse prior to the children leaving for school. Once at work (school) and before entering the workplace (school environment), a second temperature screening is recorded. Such an app for school-based screenings for children and school personnel can easily be developed and implemented as best practice for early identification of possible COVID-19 exposure and/or infection for healthy children.

It has been theorized that COVID-19 viral shedding may persist for longer periods of time through the gastrointestinal tracts of in children.

 It is believed that children may be asymptomatic carriers and may shed the virus for days or even weeks, but too little testing has been done. Schools must be vigilant in preparation of the bathroom space of children and school personnel, preparing for the worst-case scenario. It is important for school systems to be proactive, rather than reactive. Leadership of school nurses and nurse practitioners is essential in policy preparation and enactment of policies for bathroom use.

Frequent cleaning and maintenance of modern bathrooms will reduce risks shedding and must be instituted prior to opening schools, and continue throughout the school day. Measures to help children become comfortable in the bathroom must be part of the curriculum. Soap, running water, and a clean toilet must be established.

 Bathrooms may increase risk of disease transmission without structural change (proper toilet design, adequate soap and water, frequent cleanings). Proper implementation of a plan will enable children and staff to better understand how to prevent other diseases (including influenza and other common gastrointestinal diseases), which should also help change attitudes and establish new norms.

COVID-19 brought to the forefront nationwide educational inequality. As HCPs, we know the importance of being lifelong learners and the importance of early childhood education and continued excellence in education throughout the K through 12 years. It was distressful to hear many parents report that their children did not have access to computers, tablets and/or the internet at home to continue their education virtually. To achieve meaningful societal change, social justice and educational parity, we encourage educators, parents, and all community members to analyze the local educational needs and to plan accordingly to meet the needs of all students.

As Erik Erickson said, “School is the work of children.”

 We value the education our children receive throughout the US each year preparing the children to develop into healthy, kind, valuable, innovative and productive members of society in whatever careers and professions they choose. The immediate closing of schools at the onset of the COVID-19 pandemic has further enlightened everyone on the value of educators and the school systems. All HCPs want children to return to school safely and free of the threats of contracting COVID-19 within the school environment. Thus, our recommendations are based on the best available evidence as of this date and time. Screening, non-invasive testing, masks for all children over 2-years old, eye protection, social distancing, cleaning, transportation, and bathroom use are critical to the health and well-being of the children, all school personnel, their parents, family members and the community in which they live and grow.

1. Lowe, B. New poll: Two-thirds of parents support keeping schools closed ‘until they are certain there is no health risk’. Published May 11, 2020. Accessed June 3, 2020. 

https://www.the74million.org/new-poll-two-thirds-of-parents-support-keeping-schools-closed-until-they-are-certain-there-is-no-health-risk/

2. Erikson, EH. Childhood and society (2nd ed.). 1963. W. W. Norton & Company.

3. The Editorial Board. How to reopen America’s schools. The New York Times. Published June 6, 2020. Accessed June 17, 2020. 

https://www.nytimes.com/2020/06/06/opinion/coronavirus-schools-reopen.html?referringSource=articleShare

4. Center for Disease Control and Prevention. Interim Guidance for Administrators of US K-12 Schools and Child Care Programs Plan, Prepare, and Respond to Coronavirus Disease 2019 (COVID-19). Published April 12, 2020. Accessed June, 3 2020 

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-schools.html

5. Center for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Coronavirus Disease 2019 (COVID-19). Considerations for Schools. Published May 19, 2020. Accessed June 3, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/community/schols-childcare/schools.html

6. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). K-12 Schools and child care program. Published June 3, 2020. Accessed June 17, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools-faq.html?deliveryName=USCDC_2067-DM29945

7. AAP Council on School Health. Role of the School Nurse in Providing School Health Services. Pediatrics. Published June 2016. Accessed July 12, 2020. Accessed from 

8. Center for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). Interim considerations for K-12 school administrators for SARS-CoV-2 testing. Published June 30, 2020. Accessed July 12, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-testing.html

9.Center for Disease Control and Prevention. For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Published May 20, 2020. Accessed June 10, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html

10. Hindson J. COVID-19: faecal-oral transmission?. 

. 2020:17(5):259. doi:10.1038/s41575-020-0295-7

11. WHO Water, Sanitation and Hygiene strategy 2018-2025. Geneva: World Health Organization; 2018 (WHO/CED/PHE/WSH/18.03). License: CC BY-NC-SA 3.0 IGO Published 2018. Accessed June 28, 2020. 

https://apps.who.int/iris/handle/10665/274273

As fall approaches, one of the biggest questions is: Can children return to school and be in classroom environments that assure health and well-being for all?

Author | Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN

Articles

Emerging dermatologic conditions in the presence of COVID-19 pandemic

Let’s proactively stop another public health nightmare!

Safe return to school: Part 2

Safe return to school: A call to action