School nurses helped develop each district’s COVID-19 health and safety plan this summer based on guidance from the Arizona Department of Health Services, county public health, U.S. Centers for Disease Control, the Arizona Dept. of Education’s Roadmap for Reopening Schools and the  Arizona School Risk Retention Trust.

Now, they are on the frontlines implementing those plans as students return for in-person learning and answering families’ questions when they are notified a person on campus has tested positive for COVID-19.

“As school nurses, we have been monitoring Maricopa County Department of Public Health COVID-19 back-to-school guidelines to inform our quarantine and isolation guidelines as well as our safety requirements at school like wearing face coverings and handwashing schedules,” said Jacqueline Hoeffler, lead nurse for Dysart Unified School District, where students in all grades were back for in-person learning on Sept. 21.  

“We are also providing education on the subjects of handwashing, symptom management and monitoring, and emotional support as we settle into in-person learning,” Hoeffler said.

Training students on the importance of washing hands to prevent the spread of illness and the most effective ways to do it has always been a priority, said Norma Esquivel, school nurse at The Traditional Academy at Bellair. Now, training students on the safest way to wear masks is just another way to continue protecting Deer Valley Unified School District students and staff.

“This year our Kindergarten teachers asked if I would visit their class and go over hand washing,” Esquivel said.  “I was very honored that the teachers had the confidence and trust in me to invite me to share with their classes. With that, I decided to offer the same training with the other grades as they returned to school, with great results.”

“This pandemic has been a change for everyone,” Esquivel said. “Staying calm, being informed, and working together is very important. Using our common knowledge and common sense will go a long way.”

Mesa Public Schools health services team developed a first aid flow chart listing minor complaints and injuries to be handled in the classroom and those that require a student to be sent to the health office, “reducing traffic through the health office and allowing the health staff to focus on assessment and isolation if required of those students experiencing possible COVID symptoms,” said Christine Mahoney, MSN-Ed, RN, the district’s resource and education nurse.

“Our health offices and isolation areas have been designed to triage, separate according to physical distancing guidelines and exclusion protocols and we have had plexiglass and dividers added to most health offices,” Mahoney said.

School nurses and health assistants also work with administrators to determine if students have tested positive for COVID-19, have had direct contact with a positive case of COVID-19, or have had indirect contact with a positive case of COVID-19, Hoeffler said.

“Each of our nurses and health assistants took a contact tracing course to make sure we were on the same page with understanding the contagious period of this virus, the symptomatology, the isolation vs. quarantine guidelines, the tracing and the reporting guidelines,” Mahoney said.

That responsibility is increasing as COVID-19 cases have been reported at schools around the state, including in Benson, Snowflake, Mesa, Chandler, and Cave Creek.

How staff and students’ families are notified when a person tests positive for COVID-19 is up to each district.

Chandler Unified School District has a dashboard on its webpage that explains their protocols and the number of current, active, confirmed COVID-19 cases by school. Preschool through sixth-grade students were attending in-person instruction by Sept. 21, but some middle school and all secondary students will begin in person instruction on Oct. 13.

“There is ongoing communication with our parents and staff as to mitigation measures and any COVID related contacts or cases through Maricopa County Guidelines and communication letters being sent home to families,” said Mahoney with Mesa Public Schools.

In Cave Creek Unified School District, “We have decided to not only inform exposed students in a class, but also the families of all students in that class that a student has tested positive,” said Superintendent Dr. Debbi Burdick.

In addition, the district has participated weekly with the Maricopa County Department of Public Health webinars that provide timely information “and immediately started contact tracing so we could inform any exposed students,” Dr. Burdick said.

Schools’ different policies on communicating about COVID-19 cases led Superintendent of Public Instruction Kathy Hoffman to send out this statement.

“With the genuine fear about COVID-19 present in our communities, transparency is key to maintaining trust with our educators, students, and families,” Supt. Hoffman said. “I have heard from many individuals that they are alarmed to hear about positive cases in their schools through the grapevine. And while we can’t control every rumor that goes through a school, we – as school leaders – should prioritize consistent and transparent communication.”

“Having detailed communications protocols in place – and making them publicly available – can help provide some level of certainty in these very uncertain times,” Supt, Hoffman said. “I encourage all school leaders to utilize the Roadmap for Reopening Schools, particularly the sections on communication procedures and emergency preparedness, to ensure that the communities we serve feel confident in our ability to be focused on transparency and safety.” 

Last week, the National COVID-19 School Response Dashboard, which is the first nationwide database that systematically maps schools’ responses to the pandemic across the United States, was unveiled by AASA, The School Superintendents Association, the National Association of Secondary School Principals,the National Association of Elementary School Principals, Brown University Professor of Economics Emily Oster; and Qualtrics, the experience management company.

The dashboard lets school leaders, policymakers and the community members examine current conditions in their own communities — and compare them with other areas — to adapt and make data-driven decisions during the 2020-21 school year.

Developing COVID health and safety plans

School districts reached out to the Arizona School Risk Retention Trust when developing their plans to discuss many things, including sanitizing and disinfecting best practices, daily health screenings, enhanced social distancing, face coverings, personal protective equipment, training of staff, communication with staff, parents/guardians, and visitors; transportation considerations, and more, said Ryan Cole, director of operations for the Trust.

In response, the Trust released its “COVID-19 Protocols for Re-Opening Schools” to members in early June that covered various options districts should consider when re-opening that they could adapt to best fit their needs, referenced CDC, ADE, and local public health guidelines for addressing COVID-19 contact and response and facilitated a panel of education attorneys who’ve drafted over 25 whitepaper documents since April on frequently asked questions regarding the many aspects of COVID-19 response whose work can be found on the protocols for reopening schools webpage under the heading “Legal Research and Findings.”

When Mesa Public Schools developed their plan, the health services team wrote protocols and guidelines to match safety measures implemented, made classroom recommendations, gave input on placement of signage and hand sanitizer stations, and worked with each school and special education department to identify and order personal protective equipment for students and staff, Mahoney said.

The district also videos to emphasize the importance of face coverings, physical distancing, and washing hands and sanitizing that will be shown during morning announcements and throughout the day, Mahoney said.

Putting plans in action

Dysart’s Community Education programs have been running since March 17th which let the district implement new processes step-by-step in a smaller environment, said Karen Winterstein, director of student services for the school district.

“We learned early on that keeping small groups of students with staff helped limit those who had direct contacts with others,” Winterstein said. “Quick communication allowed us to limit exposure, quarantine when necessary, and get them back into the school setting.”

“We have seen first-hand that reinforcing handwashing, social distancing, masks and face coverings, along with following new procedures for movement among sites is crucial to limiting the spread of germs and in decreasing direct contact with others,” Winterstein said. “These have been instrumental in decreasing exposure without additional positive cases.”

The district also refined processes to collect information and communicate more effectively within schools and with the community, Winterstein said. 

“As we have gradually phased students back to in-person learning, we have made revisions along the way based on input from those who are working with the documents, students, and families,” Winterstein said. “We continually train and retrain to remain consistent district-wide.”

As staff and students have returned to in-person instruction in phases, it became clear it was essential to strengthen relationships and build up physical and emotional safety, Winterstein said.

“We knew that addressing anxiety and fear of the unknown while reuniting after months of separation was necessary and that we had to find a balance between reconnecting with each other and following safe practices,” Winterstein said. 

Those include new safety processes and procedures for arrival and dismissal, temperature checks, an online symptom referral process, health office entry and exit points, movement around campus, and much more, Hoeffler said. 

“Parents are appreciative of the extra precautions that are being taken,” Hoeffler said.

“We are inspired by how our community has responded to public health requests to wear face coverings and engage in frequent hand washing and ask that they continue to engage in these safety practices as flu season begins,” Hoeffler said.  

Each day, Mesa Public Schools staff and students’ parents complete a health attestation “to keep everyone safe and mitigate the spread with the ultimate goal of supporting a transition back to face-to-face learning and remaining that way,” Mahoney said.

“We are getting a great deal of positive feedback from the school community related to the comfort level of starting back, as well as an appreciation for our district giving the options of remaining remote for those families who feel as though that is the best plan for them,” Mahoney said.

“We have also had a few families who are not pleased that we have to be so conservative in our identification and exclusion of kids based on symptoms that cannot be attributed to a known underlying condition,” Mahoney said. “We are following Maricopa County guidelines to be very conservative in our assessments as we play an important role in that mitigation process.”

“By following all safety protocols, we protect our entire school community and have the best chance of keeping our schools open,” said Cave Creek Supt. Dr. Burdick. “We are extremely proud of our students and how they are following our safety protocols to keep our school community safe.”