What Happens When Students Or Teachers Test Positive? : Consider This from NPR Millions of students are getting ready to head back to school. Some already have. NPR's Anya Kamentez reports on what happens when positive cases crop up — as they inevitably will.

School nurses understand the challenges of returning to school safely better than just about anyone. But NPR's Clare Lombardo reports somenurses have no input in the process.

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The Virus Is Out Of Control, And Kids Are Headed Back To School Anyway

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The Virus Is Out Of Control, And Kids Are Headed Back To School Anyway

The Virus Is Out Of Control, And Kids Are Headed Back To School Anyway

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KELLY MCEVERS, HOST:

About 9,000 people live in Modoc County, Calif. It's way up in the northeast corner of the state. Cows outnumber people there 5-1. Modoc was the only county in California without a single known case of the coronavirus until last week. A waitress at a local bar, the Brass Rail, tested positive.

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DEBORAH BIRX: What we're seeing today is different from March and April. It is extraordinarily widespread. It's into the rural as equal urban areas. And to everybody who lives in a rural area, you are not immune or protected from this virus.

MCEVERS: Dr. Deborah Birx told CNN on Sunday this virus is basically everywhere. And now it's August. Many schools are getting ready to reopen, and some already have.

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MARC MULLINS: A Hancock County junior high school is already having a large group of students in quarantine. And today is just the second day of school.

MCEVERS: In Greenfield, Ind., last week, a student got a positive test result on the first day of class. That means two weeks of quarantine for anyone who made close contact. Before classes started, parents in that district had the option, if they could, to enroll their child in virtual learning. Eighty-five percent said no. And while the president is saying, open the schools, Birx is saying, not so fast.

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BIRX: If you have high case load and active community spread, just like we're asking people not to go to bars, not to have household parties, not to create large spreading events, we're asking people to distance-learn at this moment so we can get this epidemic under control.

MCEVERS: Coming up, deciding whether or not to work at a school, protecting schools for those who do go and what happens when the virus shows up. This is CONSIDER THIS FROM NPR. I'm Kelly McEvers. It is Monday, August 3.

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MCEVERS: Teresa Keeton has been driving a school bus since the '70s.

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TERESA KEETON: When I first started out, I had a five-speed transmission bus, and it had - it came with an ashtray and a lighter. And in between the routes, you would smoke cigarettes and...

MCEVERS: She lives in Indiana, a few hours south of that district we talked about with the positive case. And these days, she says, the buses are better. They have automatic transmission. But...

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KEETON: The kids are pretty much the same.

MCEVERS: This year, even if those kids are wearing masks, Keeton realized she just isn't going to feel safe doing her job.

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KEETON: It's like being in a big tin can, you know? And you've got all 40 kids and you and everybody breathing. Even with masks, that's a really enclosed spot.

MCEVERS: So she decided not to drive the bus this year.

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KEETON: It was one of the hardest decisions I've had to make in a long time.

MCEVERS: Yes, we all want things to go back to normal, especially for the kids.

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HEIDI HISRICH: And I think that part of what I have struggled with is that it's just not possible right now to have normal and to have safe.

MCEVERS: Heidi Hisrich has been a high school science teacher in Richmond, Ind., for 13 years. She also decided she would rather resign than go back to school this year even if there are safety measures in place. Worst-case scenario, she thought, she catches the virus at school and then infects a loved one who gets sick or even dies. And the best-case scenario, when she gamed it out, also sounded pretty horrible.

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HISRICH: Constantly trying to stay away from my students, keep my students away from each other, not having my students participate in things like labs, forcing them to sit in straight rows and wear masks. And I ended up calling it my spectrum of misery because nowhere in that spectrum did I see a way that I could be happy with what I do.

MCEVERS: A spectrum of misery that goes from bad to worse - that is what a lot of teachers are facing. And for parents, the decision is even more stark. Keep your kids at home and they miss out on all the benefits of being in school, or send them to school - which a lot of parents have no choice but to do - where there will be cases of the virus. And here's just a fraction of what some districts are trying to figure out.

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EILEEN GAVIN: Busing is a concern.

DAWN MCADAMS: Water fountains.

GAVIN: Contact tracing.

GLORIA BARRERA: Ventilation is also a big concern.

GAVIN: Maybe grab-and-go meals.

MCADAMS: It's very daunting and overwhelming.

MCEVERS: That was Gloria Barrera, Dawn McAdams and Eileen Gavin. They're all school nurses, which means they understand better than just about anyone how hard it's going to be to keep schools safe. But not all school nurses have a role in that process. NPR's Clare Lombardo takes it from here, and she starts with Eileen Gavin.

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CLARE LOMBARDO: Gavin leads a team of nurses in New Jersey. She says she's been a big part of her district's plans for the fall.

GAVIN: I feel as though it's a rabbit hole. Once I go down the hole, I think I solved something, there's another issue with that. So we go down that hole. It seems endless.

LOMBARDO: Things like hallways in a high school with thousands of teenagers.

GAVIN: I know to avoid those hallways (laughter). On a normal school year, you could just get picked up by the crowd.

LOMBARDO: But she says masking protocols and one-way hallways could help decrease transmission.

GAVIN: Honestly, I feel like, would you want your child to return to a school where a school nurse was not part of the plan?

LOMBARDO: Gavin says that she feels lucky to have a voice in her district's reopening because there are lots of other school nurses that aren't involved in decision-making like Colleen. She leads a team of school nurses in Texas, and she says she asked her district leaders if she could give her input.

COLLEEN: Overwhelmingly, the response has been, well, let us get some decisions made. And then once the big decisions are made, you and your nurses can implement plans around that.

LOMBARDO: We're using her middle name so she can speak freely about her employer.

COLLEEN: They're our kids. We care for them. That's what we do. It's why we're in this job.

LOMBARDO: But Colleen isn't the only one who feels left out of the decision-making. In April, back when lots of schools were closing their doors, the National Association of School Nurses took a poll. They found that 40% of school nurses were not involved in the discussions in their school districts around COVID-19.

COLLEEN: A lot of school districts don't even realize the resource that they have on their staff as a specialty public health nurse who knows their campus community and culture.

LOMBARDO: But sometimes there isn't even a nurse on staff. Just half of all schools have a full-time nurse, and this fall, some who already work in schools can't because they're high-risk for COVID-19. So the need for more nurses will be even greater.

MCADAMS: But you need funding for that, you need money for that and you need personnel. But right now the need is very high in the hospitals for nurses.

LOMBARDO: That's Dawn McAdams, who oversees health programs in her district outside Columbia, S.C. She says it's not just staff that schools need money to pay for this fall.

MCADAMS: We also need funding for the PPE. I mean, the amount of masks, face shields, gowns, gloves that are going to be needed by districts, hand sanitizer, cleaning supplies - it's very overwhelming when you think of the cost.

LOMBARDO: And here's the thing. Even if schools got all the funding they need, there are still lots of unknowns.

MCADAMS: Heaven help us when the regular flu season hits and you have a blur between influenza or influenza-like illness and COVID-19 symptoms.

LOMBARDO: So for now, school nurses are just doing the best they can to prepare.

GAVIN: I do feel the weight of the world and the weight of my community as we return to school that we're doing everything right; that, you know, there was nothing else that we could have done if there is an outbreak.

LOMBARDO: But Eileen Gavin says that feeling would be much worse if she didn't have a say in her district's plans.

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MCEVERS: NPR's Clare Lombardo.

So yeah, we know no matter how much schools prepare and how many safety measures they put in place, when school districts do reopen, there are going to be cases of the virus. So what happens then?

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ANYA KAMENETZ: So districts have started to release details on what is supposed to happen.

MCEVERS: NPR's Anya Kamenetz talked about that with my colleague Rachel Martin.

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KAMENETZ: And first of all, I should say these plans rely entirely on testing actually being available with a reasonable turnaround time within a few days and a robust local public health department that can do contact tracing. And if you have those two things, the basic principle is if you find one case, you can possibly just test and quarantine the folks who came into close contact with that one person. Ideally, if the school's practicing distancing and breaking kids into small cohorts, it could just be a few people that have to quarantine or maybe just one classroom pod.

On the other hand, if you find more than one case across different cohorts, then you might be shutting the whole school down. And so families are wrapping their head around the idea. Oh, my gosh. It's not just that I only have school on Mondays, Wednesdays, Fridays. It is also that on any given day, I have to brace for school being closed by the health department.

RACHEL MARTIN: Meanwhile, I mean, we have - if you look across the ocean and you look at Europe, I mean, there are schools there that have reopened safely for the most part. And why are we not able to point to them and say, hey; Europe made it happen. Why can't we?

KAMENETZ: Yeah. I mean, there's a variety of experiences in Europe in Asia, a little bit of a mixed bag in Israel. I think the problem is, Rachel, it's almost not useful to get into the details of what they did because what public health experts are saying is that you just can't open schools safely unless a pandemic is well under control in the local area. And that's just a couple of places in the U.S. right now.

MARTIN: Anya, what does the science say - the most up-to-date science - on how children are affected by the virus?

KAMENETZ: There have been a few new papers and case studies out in the past few days that do underline that children and teens - at times they can get this virus. And they can potentially spread it pretty efficiently. At the same time, the overarching evidence has still been that children and even teens don't get sick as often or severely with coronavirus as adults. But, you know, that's cold comfort to the adults who are heading into school buildings to work closely with lots of children in a few weeks.

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MCEVERS: Anya Kamenetz with NPR's Ed team. Additional reporting in this episode from our colleagues at All Things Considered and Morning Edition. For more news, you can download the NPR One app or listen to your local public radio station. Supporting that station makes this podcast possible.

I'm Kelly McEvers. We'll be back with more tomorrow.

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