Managing Asthma at School During the COVID-19 Pandemic
What a difference a year makes. It would have been unimaginable this time last year. Most of us wouldn’t even have been capable of stretching our imaginations to believe that the school year 2020/21 would be overshadowed by a global pandemic. But that’s the reality we are facing. And because of this, returning to school will be different in many ways and we will have to deal with that. New rules, new recommendations, new procedures and protocols will dominate our kids’ lives. No doubt there will be anxiety and uncertainty, mistakes and missteps as we get used to the new ways. If, like me, you have a child with asthma or allergies there may be an additional layer of worry. Is there more risk for a child with asthma or allergies returning to school because of COVID-19? If so, what are these risks? What steps has my school taken to protect my child? How will my child navigate the new normal? What about protecting school staff that have asthma?
You are not alone if these issues are playing on your mind. The incidence of asthma in school kids is high and the chances are that there are 2 other children in your child’s class that also have asthma and those parents have the same questions. We have had our kids at home for months. At home, any change in asthma symptoms, any reaction or deterioration happens under parental supervision. Inhalers are at hand, help is asked for without shyness, treatment is administered using the correct technique. School environment has always been different. Supervision cannot always be one on one. Our worries range from forgotten inhalers or empty inhalers, to our child being lost in the crowd, an attack going unnoticed, to exposure to a new trigger or inadequate treatment.
September is typically a bad month for people with asthma. The return to school for students and staff exposes them to respiratory viruses and to asthma triggers in the school building. This is happening at the same time as high environmental ragweed pollen and mold spores. This ‘perfect storm’ culminates in Asthma Peak Week in the third week in September, when Emergency Rooms experience a spike in visits for asthma related illnesses. And now, COVID-19 has complicated this even more. How will schools cope with children with asthma this school year? There will have to be changes, not only in the classroom, but around school meals, and physical activity.
AAFA’s COVID-19 and Asthma Toolkit for Schools
This is where the COVID-19 and Asthma Toolkit for Schools comes in. The Asthma and Allergy Foundation of America (AAFA) has published this comprehensive document covering all things related to asthma, from asthma management and prevention to its relation to COVID-19. By using this toolkit, schools will not only be creating a more asthma friendly environment but also will be helping to reduce the spread of COVID-19. The resource is a supplement to the current district, state and federal reopening guidelines and isn’t intended to replace those guidelines.
Some of the aspects in the toolkit are:
Hand washing and sanitising protocol
We know that handwashing provides the greatest protection against the spread of COVID-19. Proper handwashing technique is crucial and therefore should be reviewed daily with students and staff. Posting signs in restrooms and handwashing stations will help remind and consolidate this information. Schools need to provide greater access to handwashing. AAFA recommends increasing the number of handwashing stations in classrooms and throughout the school to create more opportunities for students and staff to wash their hands.
AAFA also recommends schools set aside time throughout the day to allow supervised visits for students to use the restroom and/or handwashing stations in the classroom or elsewhere in the school. To ensure safety in restrooms, there should be parents or educators assigned to monitor the restrooms.
When soap and water are not available, it is recommended that hand sanitizer with at least 60% ethyl alcohol or 70% isopropyl alcohol is used. Like handwashing, the technique for proper usage must be learned by students and staff.
School Nurses
School nurses are frontline health care providers and are critical to safely reopening schools. AAFA stands with the National Association of School Nurses (NASN) in advocating for at least one dedicated school nurse in every school, especially during the coronavirus pandemic. School nurses play an important role in watching for and monitoring symptoms and administering medicines. They can support the psychosocial and mental health needs of students and can have a unique and special relationship with students. Uncertainty, anxiety and grief caused by COVID-19 can negatively impact a student’s mental and emotional health and may exacerbate asthma symptoms, especially in students with poorly controlled asthma.
Importantly, the school nurse works closely with public health colleagues to track data and follow best practices.
Symptom and temperature monitoring
The toolkit has a full list of all symptoms and signs of COVID-19 for easy reference. It recommends that students and staff should stay home at the first sign of symptoms or illness or who have recently had contact with a person with COVID-19, to stay home.
Physical distancing
Schools should ensure appropriate physical distancing in classrooms, common areas, administrative offices, and on transportation to and from school. Spacing of chairs and desks so students can sit 6 feet apart should be carried out in all classrooms. Desks should all face one direction, or all students should sit on one side of a table to make sure they are not facing each other directly. Staggering kids’ attendance is an alternative option if there is not enough space in classrooms to safely distance students and staff. On school buses, it should be one child per row and skip rows. If a student takes public transportation to school, parents should remind them to follow similar distancing practices and to avoid touching their face, mouth and eyes before they can properly wash their hands.
Face coverings
The wearing of masks is now considered one of the best ways of preventing someone with the virus spreading it to someone else and it is recommended that where it is not possible to keep 6 feet apart then a face covering should be worn. AAFA recommends that people with asthma try to find a face covering that is comfortable and breathable. Face masks or coverings made from 100% cotton fabric maybe more comfortable than other materials. Wearing some kind of breathable face covering is better than nothing. AAFA includes guidelines in their toolkit for those students or staff who cannot wear masks due to severe asthma or breathing difficulties.
AAFA’s blog “What People With Asthma Need to Know About Face Masks and Coverings During the COVID-19 Pandemic” provides updated guidance on wearing face coverings and masks.
Guidance on administering and stocking quick relief medication
All students have the right to carry and administer their own prescribed asthma medications so with this in mind, parents should talk to their kids’ doctors about their children doing this. Being able to self-administer without help from a nurse or guardian could be critical in preventing an emergency situation. Parents and schools should ensure that all necessary authorisation forms are completed and submitted. It is a good idea to ensure every child with asthma has a spare inhaler, kept at school, in case one is left at home by accident. AAFA has sample letters available for schools regarding these issues. Some states allow schools stock their own supply of spare asthma meds. Again, AAFA has a list of these states for reference. It’s important to note that the use of nebulisers is discouraged as they may contribute to the spread of coronavirus by releasing the virus into the air.
“Is it COVID-19, the Flu, a Cold or Allergies?,” a symptoms chart for quick reference (in English and Spanish) that shows the difference between seasonal allergy, cold, flu and COVID-19 symptoms
Symptoms of asthma and COVID-19 may overlap. Cough and shortness of breath for example are symptoms of both. AAFA have a clear symtoms reference chart for comparison of symptoms to help differentiate between the two. It is recommended that this chart is distributed to staff, students and parents so they can have it at hand if needed. If there is any doubt as to the diagnosis, the student or staff member should stay home and seek medical advice.
This is just some of the exhaustive and comprehensive advice and resources included in the publication. A wide range of subjects are covered, from basic asthma management to indoor air quality resources. Easy-to-use checklists to ensure protocols are in place to manage asthma and minimize the spread of the new coronavirus are available to download and print. These are an extremely useful tool for parents, teachers and nurses. This year schools face a logistical challenge never faced before and it is important to prepare and prepare early.
“More than half of U.S. children with asthma have one or more attacks each year. Even students with mild symptoms can have life-threatening episodes. School is where most of our children spend their time. Improving the school environment often serves as a first line of defense when it comes to helping to identify, manage, and control the risks of asthma,” said Melanie Carver, AAFA’s Chief Mission Officer. “AAFA has always been a leading advocate for the best public policies supporting people with asthma inside of our schools. We give recommendations through our State Honor Roll of Asthma and Allergy Policies for Schools report to help states and schools make significant improvements to protect our kids’ health. Coronavirus could change the landscape of how schools function for years to come. Hopefully our schools toolkit will not only help school districts face the immediate crisis of the pandemic but adapt some of these strategies long term.”
Medical & Lifestyle Author Dr Anna O’Donovan
About Dr. Anna O’Donovan – Medical & Lifestyle Author
Anna is a mum of three children, one with allergies, and she suffers from allergies and asthma herself. She is a qualified doctor and worked as a General Practitioner and as a dentist for a number of years. She is also an award-winning author.
Key Words
asthma, allergies, awareness, indoor air quality, return to school, asthma triggers, asthma education, hand washing, Covid19, sanitising, flu, cold, asthma medication, inhaler
References and further reading
Coronavirus (COVID-19): What People With Asthma Need to Know Read here
Covid19 and Asthma Toolkit for Schools Read here
What people with asthma need to know about face masks and coverings during the covid19 pandemic Read here
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