“The canary in the coal mine”

As HIN1 looms, the work of the school nurse expands

By CAROLYN CLICK - cclick@thestate.com

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School nurses have long served on the front lines in tracking communicable diseases.

Now, with the looming swine flu world pandemic, Midlands public school health professionals find themselves in hand-to-hand combat with a formidable and elusive foe.

The additional task of monitoring for the H1N1 virus has inevitably placed greater stress on the school nurse corps, officials said.

What you need to know

A primer on the swine flu virus, or H1N1, compiled from the Centers for Disease Control, the Department of Health and Environmental Control, and other sources.
Find links to helpful resources at thestate.com/health.
PREVENTION IDEAS
Wash hands well and often, cough into a tissue or the crook of your elbow, stay home when you’re sick.
Get plenty of sleep, eat well, stay away from people with coughs and runny noses.
Health officials recommend face masks only if you know you will be or have been in tight quarters with someone exhibiting flu symptoms, or if you have symptoms yourself.
IF YOU GET THE FLU
Know the symptoms: Similar to regular seasonal flu, including fever, body aches, cough, sore throat, runny nose and lethargy. For otherwise healthy victims, swine flu symptoms often have been less severe than seasonal flu. Some have kicked the disease in three or four days, rather than the seven to nine days often required to beat seasonal flu. But the virus is serious enough to have killed 1,462 people worldwide through Aug. 6, according to the World Health Organization. (Seasonal flu is a factor in about 36,000 deaths in the U.S. each year.) Most people who have died from swine flu had other chronic health problems before contracting the flu.
How to treat it: Consult your physician. If you have the symptoms, your doctor won’t be able to determine immediately if you have swine flu or some other virus. At this point, the vast majority of cases are swine flu, and many doctors aren’t even testing for the exact flu strain. If the virus has been detected early enough, you will be prescribed an anti-viral drug such as Tamiflu or Relenza, which can lessen the severity of the symptoms. Otherwise, rest and fluids will be prescribed.
Shots: A swine flu vaccine could be available as early as late October, and details on any inoculation program won’t be finalized for several weeks. The CDC expects the vaccine will require two shots, three weeks apart. Because this virus has spread more quickly among young people, the vaccine will go first to pregnant women, health care workers, those with chronic health problems and people ages 6 months to 24 years. Senior citizens are last on the list of vaccine priorities because they have contracted the disease at a rate of only 1.3 cases per 100,000 people. The rate for ages 5-24 has been 26.7 per 100,000 people. State officials expect to offer the inoculations for students at schools.
A special note about schools: In letters DHEC has sent to students in several Midlands districts, officials suggest keeping your child home if he or she has a fever of 100 degrees or higher and a cough or sore throat for which there is no known cause. And officials suggest contacting your child’s school and telling them your child’s symptoms. In most cases, DHEC notes, your child can return to school after he or she has been fever-free for at least 24 hours without taking fever-reducing medications.
Parents should make sure schools know how to reach them during the day, since students who exhibit flu-like symptoms at school must be sent home.

“My nurses are very stressed, very taxed,” said Dawn MacAdams, lead nurse for Richland 2.

In Kershaw County, the virus has struck in the midst of budget reductions. Among the losses: two nurses and 10 health room assistants.

“We are learning to live with frustration,” acknowledged lead nurse Sharon Baytes, who said there are now 13 nurses for 20 schools. “We are learning we can only do so much.”

Baytes, like other school nurses, is focused on disease prevention and education as she cares for children at her school, Pine Tree Hill Elementary.

But it is hard when she has to deploy secretaries, bus drivers and other non-medical personnel to cover the health room so that nurses can complete their medical tasks.

In addition to the usual nursing duties — health screenings, development of individual plans for students with chronic disease, and treatment of garden-variety playground injuries and other minor problems — nurses are now required to prepare a daily ILI report.

That report — which catalogs “influenza-like illness” among students and school personnel — is critical for state health officials preparing for the outbreak.

“We’re the canary in the coal mine,” said Jessica Porter, lead nurse for Lexington 1.

“DHEC has said they are really depending on this information,” Porter said. “If they see an increase in daily absences — and the normal average is about 3 percent — if they see it creeping up to 4 or 5 percent, that could be the indication that there are more cases of the H1N1.”

The nurse in each school compiles a daily report, which is pooled and analyzed by the lead nurse of the district, said MacAdams. The reports do not differentiate between swine flu and seasonal flu, which typically occurs in winter.

Swine flu symptoms, like symptoms of seasonal flu, can include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting.

When reporting began in May, local districts sent the reports daily to the state Department of Health and Environmental Control.

Now, DHEC is not requiring the information unless the lead nurse observes a significant percentage spike in flu-like cases, said DHEC spokesman Bob Beasley.

DHEC is working on establishing a central site for the school information that should be up and running in October.

“We do have to do this extra report, but mainly nurses feel this is exactly what we are supposed to be doing,” Porter said. “This is what we are trained to do.”

Donna Coyle, one of 13 DHEC disease surveillance response coordinators in the state, said the school nurses are “critical” to handling the outbreak.

“We rely on our school nurses, and they are wonderful out there,” said Coyle, who covers Richland, Lexington, Newberry and Fairfield counties.

School districts, including Richland 1, are sending letters home and posting information on their web sites to make sure parents are well-informed about the flu risk, said Richland 1 spokeswoman Karen York.

“It’s a lot of information and changing information,” York said. “We are just trying to make sure that schools know how to react and respond.”

One unknown is when the commercial vaccine for the H1N1 strain will be available to the public. The CDC and DHEC have predicted mid-to-late October.

DHEC and the state education department are in conversation about flu clinics, but no guidelines have been set, nurses said.

“The schools will decide whether they want to be sites for vaccination clinics,” Coyle said.

The vaccine, which would be given in two doses between 21 and 28 days apart, is voluntary, Beasley said.

Meanwhile, nurses are trying to get the word out that sick children should be treated and then remain at home until their symptoms are alleviated. Students must be fever-free for 24 hours before returning to school.

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