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Schools prepare for ‘twindemic,’ COVID and flu

Sophie Grosserode
N.Y. State Team

The majority of school buildings in New York are now open, but there’s no time for schools to take a masked breather before they meet their next big challenge: cold and flu season.

As the weather gets colder, children get sick. But the coughs and sniffles long regarded as mild signs of the changing season are now on the state Department of Health’s list of COVID-19 symptoms, meaning they could get students and staff sent home. 

“I have to send a child home for a runny nose, nasal congestion, cough because these are symptoms of COVID,” said Roberta Bourke, school nurse at Carl L. Dixson Primary School in Elmsford, Westchester County. 

“Is this making it difficult for parents?” she said. “Absolutely. Is it making it difficult for staff? Absolutely. Because the truth of the matter is, no one knows the answer until the test comes back.”

While trying to distinguish the common cold from the coronavirus, schools will also be facing what is normally their toughest winter foe: influenza. A bad flu season in the midst of a pandemic could heighten anxieties in schools and have serious implications for schools and beyond. 

Health experts suggest a “twindemic”—a flu outbreak combined with rising COVID-19 numbers—could endanger New York’s entire medical system again, putting a strain on everything from urgent care clinics and hospitals to pharmacies and laboratories.

“Influenza will be out there competing with COVID, and that will be presenting to clinicians a great conundrum because the symptoms are very, very similar,” said Dr. William Schaffner, an infectious disease professor at Vanderbilt University Medical Center in Tennessee.

And schools, in many ways, will be on the frontline of the battle against simultaneous outbreaks of flu and COVID-19.

A realistic scenario could be a steady march of children presenting to school nurses with fever, cough and other symptoms of respiratory illness, requiring testing for both flu and COVID-19.

“There will be a much greater interest in testing, and we may run into shortages in both kinds of tests if we have a prominent flu this season,” Schaffner said.

In other words, a flu outbreak could increase the demand for COVID-19 testing, which could leave fewer tests available for people who do have COVID-19 and threaten the state’s effort to avoid a repeat of last spring.

The push for immunization

Testing for both flu and COVID-19 is likely to be necessary because the symptoms are so similar, said Maggie Racioppo, nurse coordinator for the White Plains school district.

The flu usually doesn’t cause a loss of taste or smell, but its hallmark fever, chills and body aches are identical to the coronavirus.

Another key difference between them is that while children can spread the coronavirus, it doesn’t seem to be as likely to make them sick. Influenza usually does make kids sick, said Dr. Kristin Roye, pediatrician and school physician in Pleasantville. 

There is reason to hope that this flu season might not be severe, Roye said. Masks and social distancing could have a positive impact on the spread of flu, and if people get their shots, that protection could be even greater.

Drugmakers are producing a record 198 million doses of flu vaccine this season, up from the 175 million doses last season, federal data show. School districts especially are calling on parents and staff to get their immunizations.

“People who always said ‘I never get the flu vaccine’ are coming in and asking for it,” Roye said. “In fact, my office right now is low, and we’re waiting for another shipment because we’ve just gone through them so quickly.”

Further, New York health officials are considering following Massachusetts’ lead and requiring flu vaccines for students returning to classrooms. The New York chapter of the American Academy of Pediatrics supports the mandate. 

Chapter President Shetal Shah said the move could even be of diagnostic assistance. If a child who is very ill has been immunized against the flu, it could help doctors determine if something else has made them sick.

“To me, the issues are going to be related to prevention,” Shah said. “Not only do we need to keep on social distancing, not only do we need to keep on wearing masks, but when it comes to influenza, we all need to immunize.” 

Shah said if students and staff get immunized for the flu, it can help determine if they get sick, whether it might be coronavirus, the flu or something else.

“The fact that someone had a flu vaccine is only going to be of diagnostic assistance,” Shah said.

Parents and school nurses have to follow state guidelines for identifying possible symptoms of COVID-19. Even if a child’s illness seems mild, they may have to stay home or be sent home until they can be evaluated. 

“Let’s say you have a cough, or your kid has a cold and cough. Yes, your kids have to stay home,” Racioppo said.

“We’ve been stating it to all the parents,” she said. “It’s on our website. It’s everywhere. We mention it to all of the staff. Please make sure that if your kids are sick, send the kid immediately to the nurse.”

Children with possible COVID-19 symptoms can’t return to school until they have an alternate diagnosis from a healthcare provider or a negative COVID-19 test.

Many districts are not accepting the rapid COVID-19 test because of concerns about its accuracy, so a child who has a cough will likely be out of school for at least a few days until the results are back.

“In the past, kids who weren’t that sick...it’s very common to say ‘Take some Tylenol, you seem okay, go ahead to school’,” Roye said. “But now….we really have to be cautious and keep the kids home.”

The good news is that thanks to remote learning, children with mild symptoms won’t necessarily have to miss out on class time.

Staff is another story.

Though they can teach from home, there still has to be an adult in the classroom. 

So this could be the first year the common cold causes a staffing shortage.

In some cases, seasonal illness could even keep a student’s siblings home.

If one child’s symptoms are mild, other children in the household are likely OK to go to school, Roye said. But if a child has a fever or other serious symptoms, other children in the household may need to be homebound too.

“If I had a student with a fever of over 100, I may call my other nurses and let them know,” said Roberta Bourke in Elmsford.

“[I may] ask them to check the sibling for symptoms as well.”