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Already at a breaking point, school nurses grapple with another pandemic puzzle


As we enter the third year of the coronavirus pandemic, cases are surging once again. The Centers for Disease Control says the U.S. is averaging more than 118,000 cases per day. Hospitalizations are rising at a concerning rate, and the country is averaging more than 1,000 deaths per day. The new omicron variant and the busy holiday travel season have health officials worried about what's ahead. In light of this, we want to check in with a group that's long been at the frontlines of the pandemic, school nurses, so we've called Robin Cogan. She's a school nurse in the Camden, N.J., school district. She also teaches in the school nurse program at Rutgers University, Camden. Robin Cogan, welcome, and thank you for joining me.

ROBIN COGAN: Thanks for having me and giving voice to school nurses. We have been grappling with this issue now for 20 months.

FLORIDO: Well, your state, New Jersey, is experiencing a rise in COVID-19 cases and hospitalizations. The delta variant is still the dominant variant in your state, but omicron has been detected in New Jersey. What are you and your colleagues across the state seeing in schools as cases rise there?

COGAN: Cases are definitely rising in schools, and every Thursday, we have something that's called the CALI score, the COVID activity level report, and they report it based on the prior week. And it's a color-coded map of the state of New Jersey. Most of the school year, my region of the state has been mostly yellow, which is a moderate level of transmission. But last week, we turned orange, and when I checked yesterday, the entire state was orange. And that impacts our students' quarantine time. They have to quarantine for 14 days. There is no testing out of quarantine when we are in CALI score orange. And that really does change the dynamic of how we can continue to manage all of the mitigation strategies around COVID testing when we have to quarantine students for 14 days.

FLORIDO: There are new fears now with this omicron variant and the surge about what the future of the pandemic looks like. There's also dread among families that it could lead to a new round of school closings. Are nurses in your network trying to prevent that from happening, or is that kind of out of your hands?

COGAN: It's very discouraging because I remember back in July, we were looking forward to having a more typical school reopening, and then the delta variant came. And we've managed. It's been really difficult with the delta variant, but we - I think we all felt that we were maybe able to take a breath or a pause. And now the omicron variant is here. So there just - it is just an endless parade of very unfortunate events. And as much as we try - and we try to implement all of the mitigation strategies, in spite of pushback from families, from - you know, the political pushback around universal masking - we do our best. And just having no specific end date and this ever-increasing number now of COVID cases, it's really hard to find, you know, the fuel to keep going.

FLORIDO: One of the ways that you support school nurses across your state and across the country is by holding, you know, virtual support sessions for school nurses. What is the mood of nurses who log onto these virtual sessions?

COGAN: Yes, I've been holding virtual sessions since October of 2020. I've had more than 100 hours. And in our weekly sessions, we are having some really brave conversations because there are difficult decisions that school nurses are beginning to really think about - about resignation, early retirement. Some school nurses have gone out on medical leaves, and you know what? It is understandable because, you know, we don't have the support the infrastructure, the - just the bodies on the ground that we need to fulfill the incredible task at hand. I mean, we are the de facto health department.

FLORIDO: What are your students telling you?

COGAN: Our students are really happy to be back in school. They are really glad to have the relationships back, to start building as much of a typical school day as they can. I would like to talk about the mental health issues in school with kids. Prior to COVID, school nurses were spending up to 34% of our time on mental health issues. And unfortunately, that number has certainly escalated since we've returned from - especially after a lockdown. You know, kids have been isolated for so long. So we are seeing some very concerning behaviors in school. We're seeing some school resistance. We're seeing kids who haven't really socialized in the last almost 20 months having a really difficult time getting back into the flow of the school day and the structure and the requirements and the expectation.

FLORIDO: It is hard to believe that we're entering the third year of this pandemic. It feels like it started only yesterday, and it also feels like it's been going on forever. It's been a really tough slog for you and your colleagues as much as for many people on the frontlines of this pandemic. Is there anything that is keeping you hopeful or optimistic or that makes you look forward to going to work in schools every day?

COGAN: Boy, I wish I could answer that with a joyful, happy answer, but I can't. And, you know, I've been a school nurse for 21 years. I have never felt like this. What's keeping me moving forward is that I know that this is going to be in our rearview mirror if we can just get through this. But what we need is to be treated respectfully. What we really need is for parents to understand that we're on the same team with them. We need people to care about other people's children as much as they care about their own because our children are watching us. They're watching, and that is what keeps driving me forward. You know, we are the chief well-being officers in those schools. Even if we don't have that title, that's our function.

FLORIDO: Robin Cogan is a school nurse in the Camden, N.J., school system. She's also a faculty member at the school nurse specialty program at Rutgers University, and she's the author of a blog called The Relentless School Nurse. We reached her via Skype. Robin, thanks for joining me.

COGAN: Thank you so much for having me.