As thousands of students prepare to step back into the classroom during a global pandemic, local health experts are trying to remind families that COVID-19 won’t be the only illness schools are navigating this year.
With flu season right around the corner, officials are urging the public to remember that the relationship between both is a complex issue.
There are still too many unknowns. There are even points where medical experts disagree. But how schools navigate one could could affect how they manage the other.
The one area they do agree, is that COVID-19 does not affect children as severely as adults, but it continues to have a higher mortality rate overall compared to seasonal influenza, especially as people age and develop medical issues.
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And getting a flu shot this year will play a critical role for schools navigating both illnesses as they start running parallel to each other this fall, local medical experts said.
Parents will have to be on guard to watch for symptoms of both.
“We have both issues and both concerns we want to be cognizant of,” said Molly Satter, the Sioux Falls School District’s top health services coordinator. “Certainly, there can be complications with both COVID and influenza. We want to be paying attention, aware and watchful of both.”
Sioux Falls school officials recently released their plans for how to handle the possibility of a positive COVID-19 case within a campus or across the district.
But what they didn’t say is that in some instances, students and staff with the flu or some other respiratory illness may also be treated in similar ways.
“That’s really the main piece, to not be so focused on COVID that we don’t pay attention to or we misidentify influenza or something like that,” Satter said. “It’s really a matter of looking and making sure we’re aware that both are going to be present and circulating in our community and in our schools.”
Students and staff are expected to be screened daily before they enter the buildings.
If they’re showing COVID or flu symptoms, they’ll need to reach out to their healthcare provider, who may be testing them for other things besides COVID, she said.
But if it can’t be determined whether a person has the flu or COVID-19 after testing, they’ll be sent home for 10 days and will need to be fever free for 24 hours to let whatever the infection may be run its course before returning, Satter said.
“That would cover COVID and influenza in the absence of having another diagnosis through their healthcare providers,” Satter said.
If someone falls ill at school, however, they will be assigned to a pre-designated, but visibly monitored isolation space.
Partitions or curtains may be added to separate anyone infected if socially distancing by 6 feet isn’t manageable.
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The school nurse and other staff will use PPE while caring for the sick, and symptomatic students and staff must wear PPE when in the isolation area.
Custodians will clean the isolation area as needed, while the district’s health service department works with the state health department on contact tracing and notifying any close contacts or other student and staff groups.
“Continually, the message is if you’re not feeling well – whether it’s school, whether it’s going to community activities, going to work – if you’re not feeling well, it’s best to stay home right now,” Satter said.
Yet, federal and state leaders have touted in recent weeks the flu is worse than COVID as far as how the symptoms affect children, and the focus should be on remaining positive.
Even as recently as Friday, Gov. Kristi Noem stated kids are less likely to contract the virus and far less likely to get seriously ill.
“There is a risk associated with everything that we do in life,” Noem stated in her column. “More South Dakotans have died from accidental injuries than from COVID-19 in the past 5 months. We mitigate risks by taking proper precautions when we get in our cars, when we operate farm equipment and when we make choices about what we eat and how much we exercise. The same should be true about life as we get back to normal.”
She mentioned similar things in a press conference about opening schools, citing several medical studies and focusing on the need to protect South Dakota’s most vulnerable children who rely on school as a respite from home life.
More: COVID-19 outbreak leads to closure of Camp Judson youth facility near Keystone
The South Dakota Department of Education shared similar thoughts a couple weeks ago, citing a study from May by the Journal of the American Medical Association Pediatrics and advocating that it’s best to have students in schools this fall. The study stated, “It is to emphasize that the overall burden of COVID-19 infection in children remains relatively low compared with seasonal influenza.”
“What we know about this virus is that it doesn’t affect children as severely as adults, in general,” stated Jeremy Cauwels, the senior vice president medical officer for Sanford Health. “As with many types of emerging evidence in medicine, the evidence will continue to evolve and change.”
That JAMA article reports on children admitted to intensive care units. And to extrapolate that data to all children is not the intent of the article, he said. So far, in a given flu season, more children are admitted to intensive care units with infuenza complications than have been admitted to an ICU with COVID complications.
But that doesn’t mean children can’t be infected or spread the virus at all, and recent evidence suggests otherwise.
As of last weekend, a new study in that same journal suggested that while the symptoms of infection may not be as severe in young children as adults, they could still spread COVID-19 significantly.
And news articles have shown how schools could become hot spots, after looking at how the illness has been transmitted in summer campus and youth programs.
More: Kids less likely to die from coronavirus, but schools could become hot spots for spread
Locally, South Dakota closed Camp Judson, a youth facility near Keystone, after an outbreak. As of late July, there were fewer than 10 confirmed cases. As of Aug. 4, there were 96.
“We don’t know what the normal cold and flu season is with COVID yet,” said Chad Thury, a family medicine doctor with Avera Health. “I think we’re going to learn a lot here just over the next four to six months, and how we live with COVID and influenza.
The same goes for the flu, Satter said.
While the district hasn’t had to close a campus because of low attendance numbers tied to the flu since Satter started in 2011, it has happened locally and in other districts across the U.S.
And influenza season in Sioux Falls starts as fall turns to winter and lasts three or more months, Sanford and Avera health experts said.
A vaccine.
“Most years, we do well with matching the right flu strain in the vaccine to what’s circulating in the United States,” Thury said. “If we can really increase those flu vaccine rates, that’s going to decrease the spread of influenza. And that’s a good thing.”
The last major influenza outbreak was around 2009, Thury said. And it’s difficult to predict what is going to happen this year.
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The South Dakota Department of Health and the education department will be working with schools to navigate both illnesses throughout the year, officials have said.
But the Sioux Falls School District is currently not offering on-site testing or rapid testing opportunities for students and staff.
If a positive case is detected through that program, a health department official will notify the superintendent and start contact tracing.
The school district may then consider sending a notification letter out to the public drafted by the health department.
In fact, health department and local medical officials don’t recommend universal testing or on-site, rapid testing for schools, they said.
That kind of testing hasn’t been proven to be as reliable as certified lab based testing supervised by a physician and healthcare team, Cauwels said.
“Influenza versus COVID, it’s not an easy black and white thing for sure,” Satter said. “It will be complicated to work through that, but we will use the guidance we have in front of us and work mainly with parents and health care providers. And we’ll keep working at it.”