This webinar first aired on Wednesday, July 29, 2020
The speakers offer direction to families and health professionals on how to help children with asthma prepare for a very unusual school year. The speakers also presented an overview of available resources to assist schools and families from Allergy & Asthma Network.
- Tonya Winders, AAN President & CEO
- Dr. Mary Cataletto
- Dr. Purvi Parikh
No CNE or CME is available for this webinar.
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Question and Answers from the Webinar
Q: What are some basic principles to consider when planning for children to return to school during COVID-19?
A: Students, staff and teachers who are sick should NOT come to school when sick.
School staff should enforce regular handwashing with soap and water or an alcohol-based hand sanitizer. The school should be cleaned and disinfected daily.
To manage social distancing:
- Limit larger gatherings (cafeteria, recess, gym classes)
- Consider staggering school start/stop times
- Consider cancelling assemblies or sports games – anything where large groups gather
- Create space for students’ desks to be 6 feet apart
- Wear a face mask during the school day
Q: What kind of policies should schools have in place?
A: Develop a plan for isolating students and staff who become ill at school and coordinate with local public health officials if necessary.
Develop easy ways to share information with students, staff and families. Implement policies that call for flexible attendance and sick leave.
For those students and teachers who are ill and not able to come to school, develop a plan to help ensure continuity of education.
Q: Are there special considerations for the September Asthma Peak?
A: September is a perfect storm of allergens and viruses, which is even more concerning in the era of COVID-19. The key is to make sure asthma is under control by being proactive – take your medications as prescribed and avoid triggers. Use the 10 steps to avoid the September Asthma Peak.
Q: How can parents plan for school for children with asthma?
A: Keep up to date on the latest facts about COVID-19. Recognize signs and symptoms of COVID-19, keep children home when they are feeling sick (whether it’s COVID-19 or another virus) and reinforce handwashing. Deal with your own stress and help your child to deal with their stress.
Here are some quick tips for parents:
- Get the flu shot early.
- Update your child’s Asthma Action Plan.
- Make sure quick-relief and daily controller medications are readily available; get a refill if the expiration date is coming soon.
Q: Are there special considerations when considering the potential impact of COVID-19 on people with asthma?
A: COVID-19 is a virus that binds to the cells in the nose, begins to replicate, then travels down into the smaller airways. It is primarily contracted through close contact, thus the need for masks and social distancing. (It can also be transferred to hard surfaces through coughing or sneezing.)
People with asthma may be more at risk from severe outcomes – including pneumonia – if they are diagnosed with COVID-19. The severity of asthma exacerbations from viruses is normally increased in those that have poor asthma control.
Q: What are things to think about when considering returning to school?
A: Schools not only provide educational instruction, but they also support social and emotional development. Schools are able to address nutritional needs and facilitate physical activity.
Children with certain underlying health conditions may be more at risk from COVID-19
It is important for parents to educate themselves on what their school is doing to protect students
Q: What are some reasons why some hospitals and clinics saw a reduction in asthma flares during the COVID-19 pandemic?
A: Many schoolchildren with asthma experienced reduced exposure to respiratory tract infections as well as outdoor allergens (pollen and mold) and pollutants (idling buses outside schools). In addition, social distancing policies reduced other infection exposure and parents may have supervised their children’s daily medication use more effectively during the pandemic.
Q: What factors may negatively impact children’s health when they are staying home from school?
A: Some factors may include:
- Lack of access to nutritious, school-provided lunches
- Mental health issues such as anxiety, depression and substance use
- Domestic violence, child abuse, or community violence
- Lack of support services in the community
- Parent loses health insurance as a result of losing a job
Q: What are special considerations for school nurses and teachers during this time?
A: School nurses and teachers will need to know which students are at risk for an asthma emergency; teachers will also need to be responsible for recognizing asthma symptoms.
School nurses may need to provide asthma education for students, teachers and coaches.
When at school, students should have easy access to quick-relief medication – usually an albuterol inhaler – in the event of an asthma flare. By law, students are allowed to self-carry their albuterol inhaler at school. Some states also allow schools to stock emergency supplies of albuterol inhalers and administer them if properly trained.
If a student has severe asthma, the school nurse may need to develop an emergency plan for this student.
Q: What is the impact of poor asthma control on learning?
A; Asthma accounts for 13.8 million missed school days per year, whether it’s due to doctor’s office visits, emergency department visits or hospitalizations. Students also miss class time due to visits to the school nurse.
Many students with asthma report fatigue and difficulty focusing at school. If they are experiencing symptoms such as coughing and wheezing at night, it could be the result of not getting quality sleep.
Q: What are the key components of effective guided asthma self-management?
A: It starts with a written Asthma Action Plan and regular review of asthma control and treatment with a healthcare professional.
The key is to educate students and their parents so they can participate in their care and self-monitor their symptoms.
With patient-directed self-management, patients can make changes based upon their Asthma Action Plan developed with their doctor. This is more common in older children
With doctor-directed self-management, patients still have a written Asthma Action Plan, but treatment decisions are made by their doctor. This is more common in younger children.
Q: What are some specific COVID-19 considerations for schools when planning to return to school?
A: It is important to keep up with the latest scientific guidance from the U.S. Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics.
Some strategies may include:
- Alternating schedules or half days
- Implementing cohorts – smaller groups of children
- Selective return of grade levels, students or teachers
- One course at a time
- One-room schoolhouses
- Individual learning plans
These should be considered in conjunction with recommended prevention strategies of wearing masks and maintaining social distancing.
Q: What are the risk levels for returning to school?
A: There are three levels of risks that schools should consider for back to school:
- Lowest risk: students and teachers participate in virtual only classes, activities and events
- Moderate risk: small, in-person classes, activities and events – this is a hybrid of in-person and virtual learning. Groups would stay together with the same teacher throughout the day and not mix. When together students would stay 6 feet apart and not be allowed to share objects.
- High risk: full-sized in-person classes, activities and events. Students would not be spaced apart, mix between classes and activities and share classroom supplies.
Q: What should parents, teachers and even students watch for with regards to mental health during this time?
A: There are several factors to keep an eye on in gauging how schoolchildren are handling the COVID-19 pandemic from a mental health perspective.
These include irritability or acting out, unhealthy eating or sleeping habits, unexplained headache, difficulty paying attention or concentrating, excessive worry or sadness and avoiding previously enjoyable activities.
Poor school performance or avoiding school altogether are also signs of anxiety or depression.
Some students may need to be monitored for substance abuse and internet addiction, especially in these times when schools are relying on online learning.
Younger children may start showing previously outgrown activities (such as bedwetting).
Q: How can parents and school staff support children during the pandemic?
A: Talk with them about COVID-19. Answer questions and share age-appropriate facts about COVID-19. Reassure them that they are safe, and that it is okay to feel upset.
Try to keep regular routines and schedules. Limit news and social media exposure.
Share coping and stress reduction strategies. Parents and staff should be role models – practice self-care (adequate sleep, exercise, eating healthy, take breaks, connect with family and friends). Spend time doing meaningful activities
Q: Are nebulizers appropriate for use in schools at this time?
A: Nebulizers should not be used during this time. If a child’s asthma is out of control and requires them to use a nebulizer, then they should not be in school. Metered-dose inhalers (MDI) are safer to use.
Nebulizers should be used on a case by case basis – it may be needed by a child who did not respond to an MDI. When administering a nebulizer, the school nurse must wear appropriate personal protective equipment (face mask, gown, gloves).
Q: Are masks with a vented hole safe to use in the school setting?
A: The goal of the mask is to reduce the transmission of COVID-19. The valved mask is a type of N95 mask that allows exhaled air to be released – but this would release air that is potentially infected with COVID-19 respiratory droplets.
N95 masks should only be used in healthcare settings while cloth masks are for the general public.
Q: How should healthcare professionals respond to requests from parents for notes excusing a child with a disability or asthma from wearing a mask?
A: There is no data showing that a person with asthma cannot safely wear a mask. High-risk groups, such as people with lung conditions, need the masks more than most. There may be unique situations where people cannot where masks, but those are the exception and should be evaluated on a case by case basis.
Q: School reopening plans have acknowledged that the use of wind instruments should be avoided. What is the recommendation regarding the participation in activities like band or choir?
A: Music or choir classes should not take place due to potential transmission. The American Academy of Pediatrics does say that if there is an opportunity to do these activities outdoors, then they may be considered.
Q: If a student is sent home from school with viral symptoms, what should be required before they return to school?
A: This depends on what condition the student has. If a child develops a fever during the school day, they will need to be isolated. The school nurse will need to wear PPE and administer treatments in an isolated room.
As far as returning to school, it will be an individualized decision that will require working closely with the child’s pediatrician. The school may need to communicate with the pediatrician as well.
Q: If students and staff become sick, should the entire school be notified?
A: Contact tracing will play a big role – the person who is sick will need to be isolated and anyone with contact with that person in the previous 10 days may need to be tested. If the person is isolated and the disease is contained, the school may be able to remain open, but if the virus starts spreading, the school may need to shut down.