SC School Nurses ‘Overwhelmed,’ ‘Unsafe’ With COVID Surge In Schools

Elizabeth Clark has had days when she felt unsafe. Days when she hasn’t felt like she can help everyone who needs it. When she’s overwhelmed. When she’s dealt with frustrated people who “say things they wouldn’t in another situation.”

Clark is the only full-time school nurse at Gilbert High School, in the middle of a school district that has had some of the highest rates in the Midlands of COVID-19 spread and exposure since the new school year started just weeks ago.

Since classes resumed in mid-August, the normal maladies that come to a school nurse — from the minor but incessant to the potentially quite serious — have competed for attention with the near-constant focus on COVID-19. At one point, more than 6,000 students in Lexington 1 were excluded from class and multiple schools were teaching online-only classes.

“Two weeks before school, we get health cards on all our students,” Clark said. “I have 1,100 students, and I try to read through every single one by the first couple weeks of school. We just started on those this week. I try to orient myself to my students, but... COVID is so huge and in our face, it’s almost the only thing you can see.”

As of Thursday, Gilbert High had 153 students excluded with either positive COVID tests, symptoms or close contacts. Some 3,000 are out of school across the district, less than half from the new school year’s peak.

But this year’s COVID-19 cases continue to surpass what schools and their nurses had to deal with last year. Lexington 1 Superintendent Greg Little tweeted Friday that the district had recorded 1,940 positive coronavirus cases in the first 22 school days. Lexington 1 recorded 1,598 cases in all of the 2020-21 school year.

Amy Wood has been the director of nursing and health services in Lexington 1 throughout the pandemic. She says the rapid rise in numbers are indicative of fast in-school spread of the coronavirus among the students compared to last year, when the district had a slower and more cautious beginning to the school year. A year ago, students started the year on a “hybrid” teaching model that involved a limited number of in-person classes mixed with remote, online learning

“Only half of the students were in school, and we had more in our (full-time) virtual academy,” Wood said. “You could space out more, and make sure you have everyone wearing a mask at the time. We were able to do more, and last year it wasn’t really impacting the student population as much as it is now.”

Since then, the S.C. Legislature has mandated schools provide in-person instruction five days a week, rather than a hybrid plan where students alternate days on campus as little as twice a week. The state also capped the number of students receiving virtual instruction to no more than 5% of the student body, at the risk of the district losing a portion of its state funding. Finally, a proviso of the state budget prohibits state funds from being used by schools to enforce a mask mandate, although other school districts are trying to require masks anyway.

“We don’t have the space, the masks, and people can’t go to the online academy,” Wood said. “That places more people in our buildings, and the delta variant, which is still the most prominent variant in South Carolina, appears to be far more contagious.”

The only options left to schools, according to Wood, are to quarantine students who have been exposed to the virus — potentially keeping them out of class for up to two weeks — or to close whole schools until case levels drop, which Lexington 1 has done on a very selective basis.

At Gilbert High, Clark said she’s often questioned if she even can do enough to keep her students safe in the current environment, or provide them the kind of help they need. For a school photographer, she showed off the full body protective equipment she wears to treat her young patients. The State wasn’t able to visit Clark’s nursing station in person because of COVID-19 restrictions that keep unessential visitors off campus.

“I think we all cry more than we have other years,” Wood said of her fellow nurses. “I have.”

A nurse’s regular duties can encompass more than just a case of the sniffles. Students who come to school with chronic conditions can depend on health care services for them to learn safely and effectively. She handles insulin injections, or monitors a diabetic’s blood sugar. The nurse makes sure a busy student takes their medications on time.

All that before they move to the front lines of the COVID-19 pandemic.

“A student can start the day OK, and then when they start to feel bad, you have to decide if it’s a COVID-like illness, and if they need to be sent home,” Wood said. “You have classes were someone is positive and then you need to focus on contact tracing.”

Clark said staying on top of the spread of coronavirus has taken her away from her other duties.

“I’m out measuring people who are close contacts, when my phone rings for an emergent case with a student, when I’m out checking that, I’ll get a call on another student,” she said. “COVID is so important that I can’t do these other things.”

One effort to lighten nurses’ work load this year has been hiring an outside firm to conduct the school’s contact tracing, which means Clark and her colleagues won’t have to spend an inordinate amount of their time finding and contacting anyone who a positive student might have come into contact with on campus.

“Nurses by and large are always taught to finish your job before you leave,” Wood said. “If you work the floor at the hospital, you get your orders done before you turn it over to the person after you. On some days here, that’s not possible. They have a feeling of, not failure, but letting people down if they don’t get to everything. And this is when they’ve been working nine, 10, 11 hours, weekends. We hope contact investigators handle that.”

“It’s really quite complex to be a school nurse,” she said.

Although younger people generally have less severe reactions to the coronavirus than older people, students who come back from a COVID-19 diagnosis can still present lingering symptoms that can complicate their recovery — and the school nurse’s job.

“It’s been a really hard, busy year,” Clark said. “I say if you’re complaining, you’re not busy enough.”

On top of her school duties, Clark has had to deal with her own 7-year-old daughter spending most of the school year so far in her own quarantine, and her elementary school going remote. She said she was thankful her husband and mother were available to provide her daughter with more attention than she has been able to.

When Clark thinks of the stresses of her job, the 13-year nursing veteran thinks of her license renewal form, where it asks if she will be willing to help out in this or that scenario. She always answers yes.

“When I get really overwhelmed, I think about the nurses in hospitals who have to turn away patients who need care, because they’re not high enough on the triage list to get,” she said. “I’m in a better position than they are. Everyone is dealing with hard things. I think that’s how we all feel at times, but I don’t think anybody’s quit yet.”

Little, the superintendent, praised the hard work the district’s nurses have put into their jobs this year.

“Very often when we think about heroes, we think about comic book superheros — but, I think of our school nurses,” Little said. “They are working harder than ever before to keep our students healthy. We truly appreciate them and their dedication to our students, schools and community.”

Both nurses said they still need the public’s cooperation to get the spread of the virus under control.

“We need some combination of everyone who can getting vaccinated, and wearing masks,” Wood said. “If we can break transmission, we won’t have so many quarantines, because we won’t have so many positives.”

Clark, meanwhile, is giving her patients more straightforward medical advice. “I ask people to take care of themselves. Rest. Eat well,” she said. “We have to take care of our body so if we are infected, it can fight it off.”