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H1N1 Fears Show Soft Belly of School Health Underinvestment

September 17, 2009 By John Fitzgerald, Education Policy Fellow

The Novel H1N1 flu, or Swine Flu, is like other flu viruses in that it is communicable via sneezing, coughing and touching - all common occurrences in schools.

That puts the battle to contain possible H1N1 outbreaks right into the school nurse's court. Whether the nurses are up to the task is not a decision made today. Rather, lawmakers made that decision in the past decade when drastic state budget cuts forced school administrators to cut the corps of school nurses.

Today, Minnesota stands 30th in the nation with a school nurse-to-student ratio of 1,400-to-1, about half the 750-to-1 ratio recommended by the National Association of School Nurses.

The H1N1 cat is already out of the bag, said Ann Hoxie, St. Paul Public School's Assistant Director of Student Health and Wellness. When H1N1 appeared last spring, officials tried to contain the virus by closing and cleaning school buildings after a case was reported. This fall, officials will simply tell parents to keep their children home until 24 hours after the flu's fever has subsided.

This doesn't take any pressure off the nurse corps. In addition to sending information home to parents about how to handle the flu (cover your coughs and sneezes, stay home when you're sick, wash your hands often), they are also preparing to handle multiple contagious children at one time.

"When we have sick kids, it could become all-consuming," Hoxie said. "If we get 20 or 40 or 60 students with fevers and a cough, we'd like to get them home because they're contagious. This means contacting parents or grandparents or neighbors, which is time consuming. And in the meantime, we have to find a place to put these contagious students so they don't infect other students who come to the nurse's office for their asthma medication and so on. We'd have to set up a separate room for contagious children and a lot of schools, especially rural schools, don't have that kind of space."

Nor do they have the foot soldiers. Minnesota law requires that a school district with more than 1,000 students must have at least one school nurse in the district. That means small districts may have no nurse, and many medium-sized districts may have one nurse to cover five or six schools, aided by nursing assistants or secretaries.

This situation came about because of chronic education underfunding. State support to schools has dropped an inflation adjusted 13 percent since 2003. While local property taxpayers have tried to make up the difference, schools can't rely on property taxes alone, putting school leaders in the difficult place of laying off school nurses along with social workers, counselors and paraprofessionals.

In case of H1N1 outbreaks in multiple buildings, Minnesota's school nurse corps will be stretched thin and students will reap what our lawmakers have sown.

"Public health is not something we have invested in general over the last few decades. This year school districts with an adequate nursing staff will be glad they have them," Hoxie said.

This underinvestment will cost the education and business communities as well.

There are students who will find it very difficult to catch up to other students if they miss a week of school because of the flu.  Certainly their standardized test scores may suffer, leaving Minnesota even more vulnerable under the misguided No Child Left Behind strictures. In addition, Minnesota requires 9th, 10, and 11th grade students to pass the GRAD tests to show academic achievement before they can be awarded a diploma. Missing time from school could drastically affect their ability to graduate.

In addition, sick children mean adults who stay at home to care for them. Health officials have advised businesses to cross train worked three-deep in preparation for absenteeism related to H1N1.

All the nurses in the world won't stop H1N1, but foresight and investment from our lawmakers in this past decade would have created a robust corps of nurses that keep the virus from spreading.

Perhaps H1N1 - whatever its' eventual outcome -- will serve as a lesson about the importance of adequate health care in our schools. Minnesotans deserve better than a government that provides health care on the metrics

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