Oct. 30--For the last week, as many as 10 students, some with fever, aches and runny noses -- telltale signs of the flu -- have been lining up at the nurse's office at Easton Area High School by 7:10 a.m.
"As soon as they're off the bus, they're in the nurse's office and they're already being sent home by 8 a.m.," said Deirdre Darragh, a district nurse.
The next morning some of the same sick students will show up again, in what is one of the daily battles school nurses, administrators and staff are facing as they find themselves on the front lines of the H1N1 flu pandemic.
"It is certainly stressing the school setting, trying to separate the ill from the well," Darragh said. "It takes cooperation on everyone's part."
The so-called swine flu is hitting schoolchildren the hardest. Despite flu prevention messages online, over the telephone and in letters sent home in backpacks, some parents are still not heeding the call to have children cover coughs, wash hands and stay home when sick.
Others are hearing the message and flooding schools with calls, seeking information about vaccines or demanding to know how many sick children are in their child's classroom.
Caught in the middle, districts are walking a fine line between giving parents accurate information and not causing unnecessary alarm.
One problem is that parents -- some with children who have other medical issues-- want exact numbers on H1N1 cases, information that is not available, Darragh said. Health care providers are no longer testing every patient to determine who has swine flu, and not all doctors are alerting schools when they encounter positive tests.
Also, there are confidentiality issues that prevent schools from reporting flu cases to parents, said Allentown School District nurse Barbara Malcolm.
"What we're trying to do to allay the fear is to make [parents] understand that although we are seeing an increase in flu incidence, we are not seeing a major epidemic," Malcolm said.
As a way of keeping parents informed, Nazareth Area School District had been posting a tally of students with "flu-like illness" on its Web site. Last week, when that kind of tally became increasingly difficult to do, it switched to posting attendance rates.
But a high absentee rate isn't a perfect measure of flu activity either.
In the Bangor Area School District last week, about 20 percent of students were absent, up markedly from previous weeks, said Superintendent John Reinhart. But knowing how much H1N1 has spread through the student body is anyone's guess, Reinhart said.
"Do we have cases of swine flu in Bangor? Absolutely we do," he said. "But we don't know how many cases."
Knowing the number of flu cases in any one school isn't really important anyway, said Dr. Stephen Ostroff, Pennsylvania's physician general.
"It's not clear to me what the added benefit would be of trying to keep a tally," he said. "At this point I'd just presume that in many, many schools in Pennsylvania there are children likely to be present with this virus."
Ostroff said rather than press schools for numbers, parents of children with medical conditions who have concerns should talk to their pediatricians about whether their children should be in school.
For most schools, absenteeism hasn't reached a level that might lead to school closures. Only a handful of schools in Pennsylvania, including the middle school at Moravian Academy in Bethlehem, have closed this flu season.
Still, it's something that is weighing on the minds of area administrators.
"When do we close school? When do we keep it open?" said Bangor's Reinhart. "It really requires you to search your soul to make sure you're comfortable with your decisions."
The federal Centers for Disease Control and Prevention recommends closing as a last option, only when large numbers of students and staff are out with the virus.
Both the Bethlehem Area and Allentown school districts have local health bureaus to help them make the call about whether to close and also to shoulder other burdens of H1N1, such as arranging vaccine clinics.
"We're very lucky," said the Bethlehem district's head nurse, Kathy Halkins.
She said one of the bigger issues for Bethlehem is persuading parents to keep sick children home. In some cases, employers refuse to let parents take a day off to care for a sick child. So Halkins has resorted to calling workplaces and interceding for parents.
"Parents in those jobs, in this economy, they're worried," she said. "It would be really helpful if employers could be more understanding."
In Easton and many suburban areas in Lehigh and Northampton counties, the responsibility of informing parents, holding clinics and administering vaccines is falling largely to school districts.
Schools do have some help from the state Department of Health, which has offered to staff H1N1 clinics for schools that want to host them. Some schools have decided to offer the vaccine. Others, such as Easton, have decided cost, staffing and other factors would keep them from doing so for the time being.
Reinhart said Bangor registered for the vaccine, but he doesn't know when it will arrive or how many doses are coming. Once the district gets a shipment, setting up the clinic will take a major deployment of school personnel, Reinhart said.
That deployment will cost taxpayers, who will pay for a refrigeration unit to preserve the vaccine and for staff overtime to guard the vaccine and run the clinic, he said.
For Reinhart, it's a clear example of why the area needs a regional health department. The joint Lehigh-Northampton county health department, formed earlier this year, is still not completely operational.
"This absolutely should not be the responsibility of school districts," Reinhart said. "I think that everyone who pays taxes in Lehigh and Northampton counties really has to look this over and see this as a rehearsal to perhaps a bigger health scare and problem that could be coming."
veronica.torrejon@mcall.com
610-820-6583
"As soon as they're off the bus, they're in the nurse's office and they're already being sent home by 8 a.m."
--Deirdre Darragh,
Easton Area School District nurse
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