Back-to-School in a Pandemic? Questions, Concerns, and Discussion with School Nurse, Robin Cogan

Robin is a brilliant, passionate, and vocal school nurse with almost two decades of experience as a New Jersey school nurse in the Camden City School District. She is the Legislative Co-Chair for the New Jersey State School Nurses Association and she joined us last week for A Better Normal community discussion about back-to-school (or not) plans families are facing this school year. Robin serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing and has been a Johnson & Johnson School Health Leadership Fellow and past Program Mentor due to her work with communities using the Community Café model.

If Robin looks familiar it’s because she has appeared recently on CNN as well as local Fox, NBC, and CBS channels speaking about student and staff safety and the important work of school nurses. I met Robin on social media via ACEs Connection and Twitter where she posts often about adverse childhood experiences and adverse community environments. Robin’s family has been traumatized by gun violence. Her father lost both his parents and his grandmother, as well as several neighbors when he was just 12-years old and at home when a mass murderer broke into their home and shot his family members as he hid in a closet. 70 years later Robin’s niece was a student at Parkland High School during the 2018 shooting. Robin’s niece survived but that experience transformed Robin. She started her Relentless School Nurse blog and has been speaking up about student, staff, family, and community safety as public health issues ever since.

Excerpts from our conversation are below as is the recorded conversation.
 Schools, Communities, and Families “Making Plans in the Sand”
As a school nurse, Cogan is “really concerned,” about returning to school in person this fall. “I don’t believe that we have a structure in place to keep our students and our staff safe,” she said.

“We have to center every single thing we do with safety first,” she said, which requires, “Testing, Tracing, Isolation, Quarantining, and Communicating.” However, Cogan pointed out, the United States has not had a national response to the virus, and instead, “it has been for each state, each county, each city, each school district to figure it out for themselves. There’s been a lot of lost time in trying to manage this horrific virus,” she said.

“I feel like we are making plans in the sand and that everything is constantly shifting,” she said.“The truth is if you haven’t heard details from your schools, it’s because they are still trying to figure it out themselves,” she said. And many schools are figuring things out without public health experts or use of scientific data to drive decision making and plans.

“25% of schools across this country don’t even have a school nurse at all,” Cogan said. “35% of schools across this county have a part-time school nurse. There are 57 million kids that are going to school and 60% of those schools have no school nurse or only a part-time nurse. One of my questions would be, who is taking care of these kids?”

COVID testing is taking too long both to get, and once it’s done, for results to come back. “We can’t contain things if we don’t have timely information. We just can’t. …. Right now, only the elite in this society are given access to rapid testing,” she said, and “even the parameters in place for these elite athletes could not prevalent virus from spreading. It’s going to be really easy to break protocol at school. And we don’t know who is positive at school, because we’re not testing. We’re guessing.”

Without community spread contained she feels we are doing “the biggest social experiment” with school children and staff. As she said to the New York Times in which she was quoted a few weeks ago, “I’m just going to say it: It feels like we’re playing Russian roulette with our kids and our staff.”

She said, about the fear of parents as well as staff, that “no school nurse wants to get this wrong because these are issues of life and death.”

While the situation is serious, she said, “I’m not saying this is impossible. I’m just saying we’re not there yet.”

Concerns Shared During the Discussion:

Under-resourced districts without enough supplies for students and staff (computers and protective)
Districts with brown and black students and families have been the most impacted by COVID
Our students with extensive IEP and learning challenges who requires close contact which will mean either violating the distance and the mask requirement or professionals needing medical equipment such as disposable gowns, masks, gloves, goggles,” which if the school even has them in stock might make for a “very sterile environment,” and some fear the sensory overload for kids or the trauma/ re-traumatization of a medical setting at school.
Stretched parents who are often juggling multiple personal and professional responsibilities, especially for women, since “teaching, like nursing, falls mostly on the shoulders of women,” said Cogan.
How we support parents that have kids that need significant behavioral and academic supports or have co-morbidities.
“Put people first,” and “make our own decisions about keeping our kids safe.
Kids who require in-person support.
Sterile and medicalized setting schools will have an impact that will have on students, staff, and families.
The grief, loss, and trauma faced by families (students and staff) who have had had COVID-19 are experiencing long-term symptoms, have lost jobs, income, health, or even lives. “We also have to understand that you know the impact that this has had. Almost everyone knows someone who has tested positive and maybe knows someone who has died, the grief component is something we have to be cognizant about. Grief, like trauma, comes to school with kids,” said Cogan.
Lara Kain said,” “Polyvagal Theory, safety cues are not the same as the absence of threat. AND what we think of as safety cues like police or metal detectors actual signal our defenses”
How will isolation rooms be staffed and monitored?
What about schools with little or no windows?
Fear of students, teachers, or staff getting sick or dying.
Lack of school nurses in schools.
Limited internet service for students to do remote learning.
Lack of options for essential workers who can’t be home.
Juggling basic and sometimes competing human needs for safety, health, housing, food, money, education, and social connections.
Lack of financial support and resources for families most impacted by COVID-19 and remote, hybrid, and in-person policies and potential schedule changes.
Access to information about COVID cases in specific schools

Questions Cogan Suggests Parents & Caregivers Ask:

Q)Do you have in place everything that we need to keep our students safe
Q)What is your testing and tracing and quarantining and isolating policy?
Q)What happens when someone is sick at school?
Q)How many have to be sick or positive before school closes? Q)What is going to happen if our school closes again?
Q)What do I need to do as a parent from home?
Q)Do we have the supplies that we need to keep our students and staff safe?
Q)Do we have a school nurse? If so, how often is he/she present?
Q)Is it the school nurse assessing health or supervising the isolation areas?

“There are things we can do”
When pressed what she would choose to do if she had school-age kids at home right now, she said: “In this moment, with what we do not have in place, with what I see as widespread community spread, without proper tracing, testing, isolating, quarantining, without the community buy in…. when we don’t have a healthy community, we are not going to have a healthy school because the school is the community - it’s not bubble wrapped by itself…. If I was making this decision today, my kids would be remote learning until I knew that it was safe and I don’t say that lightly. I want to go back to school. I do believe we are not there yet.”

However, Cogan stressed, that “there are things we can do as parents and as community members,” actions such as:

Organize events to get the attention of lawmakers.
Call school district leaders.
Call superintendent. Call governor.
Get as much information as possible.
Stay on top of what the latest scientific information and literature is and to get help from “your school nurse if you are lucky enough to have one,” about the school plans.
Get voice heard she said, because, “I don’t think the voice of the parent the voice of the community has been heard.”

“We are powerful when we use our voice. We really are,” Cogan said.

“I think it could be a time of transformations. Some of the best transformation in this country came out of the worst times we’ve lived through,” Cogan remarked. Plus, she said, we have models and data about national responses to this virus that do work. “If we spend 8 weeks like New Zealand did and nobody moved and everyone stayed put,... we’ve made it more complicated than it has to be,” she said.

And while we haven’t had an effective national response, to date, she said, “it’s not too late,” noting we can make decisions based on science and public health information. “There are scientists out there speaking out saying, ‘wait a minute, we can take care of this. We have to follow the data. We have to do the research. We can’t guess,” she said.

In the meantime, as families, staff, and school systems make back-to-school plans, Cogan shared the back-to-school decision making tree from the Centers for Disease Control and Prevention (CDC), a flyer about ten things parents can do to get kids ready for school, (attached below), and her own list (below) of what she calls the 6 W’s, which, she said, “is all we have in our toolbox right now.”