Parents send kids to school sick, citing as reasons their need to work, concerns about missing class and pandemic weariness

At least 58 districts have closed or used non-traditional instruction days in November due to illness, affecting more than 186,500 students. (Ky. School Boards Assn. map, adapted by Ky. Health News)

Schools in Kentucky and across the nation have been hit hard by a slew of respiratory viruses, and some parents are sending their children to school sick or sending them back to school while still infected.

They cite an inability to take more time off work, concern about their children missing in-class instruction and a weariness from dealing with the pandemic, Alex Janin reports for the Wall Street Journal.

In a typical year, Jackie Follansbee, a nurse in the Yakima School District in Yakima County, Washington, would send two to three children a week back home for returning to school sick, she told Janin. Now, it’s two to three “repeat offenders” a day, she says.

Respiratory illness has been so bad in Kentucky that so far in November, 58 Kentucky school districts have closed or used non-traditional instruction days due to illness, affecting more than 186,500 students, according to the Kentucky School Boards Association.

The Pike County Board of Education has amended its attendance policy to increase the number of parent notes that can be used for excused absences from school from five to 10, Kristi Strouth reports for the Appalachian News-Express. Students will continue to be allowed an unlimited doctor's notes to excuse their absences. 

Janin reports that schools across the country are sending notes to parents urging them to not send their children back to school until their child is fever-free for 24 hours without medication and symptoms are improving. And in some cases, nurses are calling families to remind them that symptoms of viral illnesses can last for a week or more.

In addition to an influx of respiratory syncytial virus, or RSV, Covid-19, and the common cold, Kentucky's latest influenza report shows that most of the 6,061 confirmed flu cases this year have been in children under the age of 10, followed by people between the ages of 11 and 20. 

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults. 

As of Nov. 19, about 16% of PCR tests for RSV in the U.S. were positive, more than double the 7.5% at the same time last year, according to voluntary lab reports to the Centers for Disease Control and Prevention.

As of the first week of November this year, the Wall Street Journal reports, U.S. children under the age of 18 were hospitalized for flu at the highest rate since 2009, according to CDC data.

Increased infection and the need for school-aged children to stay home until they are well is also affecting workplaces.

"A new round of viral infections — flu, RSV, covid-19 and the common cold — is colliding with staffing shortages at schools and day-care centers to create unprecedented challenges for parents and teachers," Abha Bhattarai reports for The Washington Post. "More than 100,000 Americans missed work last month because of child-care problems, an all-time high that’s surprisingly even greater than during the height of the pandemic, according to new data from the Bureau of Labor Statistics." 

Tried and true public-health measures help to decrease the spread of all of these viruses, including avoiding close contact with others when you are sick, covering your nose and mouth when you cough or sneeze, keeping your hands washed and staying  home when you are sick and don't have fever for 24 hours without medication.

Respiratory viruses are increasing among children, and are occurring earlier than usual; one can cause a debilitating condition

CDC graph shows share of outpatient visits for respiratory illnesses, by week of the year.

By Melissa Patrick

Kentucky Health News

With common respiratory viruses on the rise among children, doctors are concerned that the viruses are showing up earlier in this year, says Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children's Hospital.

In addition to increases of rhinovirus and enterovirus, which cause the common cold, Ragsdale said the hospital is seeing upticks in Respiratory Syncytial Virus, or RSV, which normally shows up between November and February.

"This is very unusual, compared to [a] decade's worth of epidemiologic data," Ragsdale said. "We normally see a winter surge in kids, and now we're seeing it starting in July this year."

Norton Children's Hospital in Louisville is reporting similar unseasonable spikes in RSV, Aprile Rickert reports for WFPL, saying that the hospital has admitted 66 patients with the respiratory virus, more than double the 32 at this time last year.

These increases in respiratory viruses in children are happing all over the country, prompting the Centers for Disease Control and Prevention to issue a health advisory alerting clinicians that there has been a surge in pediatric patients with severe respiratory illness requiring hospitalization. The CDC notes a rise in three respiratory viruses: rhinovirus and enterovirus and a more severe version of enterovirus called D68 or EV-D68, which can cause a rare polio-like paralysis in children.

The vast majority of children fully recover from EV-D68, but it can result in a rare complication called acute flaccid myelitis, or AFM. "Children with AFM may have weakness in one or more limbs, difficulty walking, and pain in the neck or back. Most require hospitalization, and about half are admitted to intensive care," write epidemiologists Katelyn Jetelina and Caitlin Rivers in Jetelina's newsletter, Your Local Epidemiologist. 

The CDC notes that outbreaks of AFM appear every two years, but it skipped 2020, likely due to efforts to prevent spread of Covid-19. But with the increase in the EV-D68 strain this year, the agency encourages clinicians to consider it as a possible cause of acute respiratory illness and to assess children for AFM.

The newsletter also included a CDC graph showing a rise in outpatient visits for respiratory illness, which includes symptoms of fever plus cough or sore throat, especially among those under age 4. "It’s normal to see an increase in cold and flu illness each year, but this is occurring ahead of the normal winter schedule," they write.

Lindsay Ragsdale, M.D.

Ragsdale said the increase in respiratory illness in children is likely because they haven't been getting normal immune system exposures because we have been social distancing and masking during the pandemic, so now exposures are happening in a different way.

Jetelina and Rivers agreed: "The drawback is that the population immunity normally maintained through regular cold and flu seasons eroded, leaving more people (especially kids) without recent immunity."

That said, Ragsdale stressed that most kids are pretty resilient and that the ones who need hospitalization often have an underlying lung disorder or have other health conditions that make them more fragile.

"So even though they've gotten these infections, the vast majority of them can stay home and just do symptomatic care," she said.

Another concern, she said, is that this early influx of respiratory illness will overlap with the incoming flu season and a possible Covid-19 surge this winter.

"That will cause some capacity challenges . . . for our Children's Hospital admissions," she said. "But we are working really hard to expand to new units and to make sure that we have room for every child that needs care. . . . I am worried that we're already seeing a high number of infections, but we're making plans."

Ragsdale encouraged families to seek medical care for their children with a respiratory illness if their child is dehydrated, is having trouble breathing or has prolonged fevers. Otherwise, she encouraged families to keep their child at home if they are sick, especially if they have a fever, to keep their hands washed and for the whole family to get their flu and Covid-19 vaccine.

"We do anticipate having a pretty significant flu season," she said. "We're glad to see the Covid numbers coming down, but again, we don't know what's going to happen this winter and vaccines are effective to prevent those infections."