HomeSpecial ReportsScreening Student Health Prior to Boarding School Bus Rife with Complexities

Screening Student Health Prior to Boarding School Bus Rife with Complexities

Among the biggest questions facing the industry as it proceeds into the new school year are how to determine if students have COVID-19 symptoms before they board the school bus and if they do, what then?

Several state guidance documents, including in California and Oregon, stated that school districts should have a plan in place to health-check students prior to boarding the bus. The California Department of Education specifically recommends that school districts should consider placing one aide on each bus to perform the temperature checks and ensure the students remain physically distanced during the ride.

Many California transportation directors shared that they are still uncertain about whether their bus drivers will be expected to preform health screenings. For instance, Anthony Briscoe, director of transportation for Oxnard School District, said his department is not currently planning on temperature checking students prior to them boarding the school bus.

Briscoe shared that Oxnard, located about 60 miles northwest of Los Angeles, health screen was a large discussion piece of a task force formed to plan fall startup. But before making temperature checking mandatory, the district is awaiting a state requirement or a recommendation made by the Centers for Disease Control and Prevention.

Saundra McKinney is the transportation supervisor for Winters Joint Unified School District, located west of California’s state capitol in Sacramento. She said that if the district implements a hybrid style of learning, her department will temperature check each student prior to them boarding the school bus, as social distancing requirements would reduce passenger capacity by 50 percent. However, if the district decides that all students are permitted to return to in-person learning, McKinney explained that it would be “an impossibility to check 50 kids temperatures without being late.”

She added that final decisions remain on hold as the district awaits Yellow County’s guidance on reopening schools, which is scheduled to be released this week. When asked who would perform the temperature checks, she said that is also unknown at this writing.

Elsewhere, David Uecker, director of transportation at Hutto Independent School District, north of Austin, Texas, commented that temperature checking is the “elephant in the room.”

“I think everybody has asked that question, but nobody wants to answer,” Uecker explained. “Do you really endanger a whole school by having a kid at a stop that has a fever? So, then what do you do? Do you let them on the bus? … But the old adage is you can’t leave a kid on the side of the road.”

He said if his district decides to temperature check, it is considering running a “quarantine bus” that he or one of the office staff would drive. Additional buses would also remain on call at the transportation garage, to be dispatched to pick up a student who shows symptoms and take them home.

“But that means, that I am the one now at risk,” Uecker said. “So, it’s not a perfect science, but at least it cuts the risk down to me and that child, versus an entire campus.”

Drew Damien, transportation director for Palmer Public Schools and the president of the Massachusetts Association of Pupil Transportation, said that most transportation professionals would agree that health checks are important. But who conducts them is a different story.

“They are certainly not something that we can ask our bus drivers to do,” Damien explained. In the instance a child does show signs of COVID-19, he questioned if bus drivers would be required to have extra personal protective equipment on board to provide the child and then continue transporting them to school.

That is the perspective of the Oregon Department of Education and the Oregon Health Authority, as stated in its back to school guidance that was released on June 10. The “Ready Schools, Safe Learners, Guidance For School year 2020-2021,” outlines requirements for school districts, one of them being a visual screening of students exhibiting symptoms. If a student does show signs, the driver must transport the child anyway. However, the student should be provided with a face covering and must stay six feet away from others.

“So, how do you isolate the child, and what happens when the child gets to school?” Damien asked. “Is transportation then out of the picture? Or are we going to be told, ‘Well, we have four kids that have fevers that have to go home and there are people home, but we can’t get them there.’ How is that going to look?”

However, his concerns don’t stop there. He said he hopes parents would keep their sick children home, but he said expecting that in every circumstance is unrealistic. For example, when adults are sick with a cold, or a cough, most go to work regardless.

“Are we going to be able to think that parents are going to change that stance, for their children?” Damien said. “Because if they keep the child home, in many cases they have to stay home. So, we may be facing that we know that children who are sick are going to be coming to school and on buses, not that we haven’t in the past, but now we are looking at a different animal. That’s what I think is the most concerning to those of us in schools across the board right now. There are so many more questions than there are answers.”

Parent Responsibility?

While some transportation directors are making accommodations to check students prior to boarding the bus, others believe it should solely be the responsibility of parents.

“I really don’t want to put that burden on the driver,” said Tom Burr, director of transportation for Saint Paul Public Schools in Minnesota. “Personally, I don’t want the driver to be the gatekeeper of who comes to school and who doesn’t come to school. I guess you have to have a little faith in families. If their child is sick, they need to stay home, and these days it’s more important than ever. But I don’t think that should be the responsibility of the driver.”

Laurie Combe, president of the National Association of School Nurses (NASN) agreed, adding that she is concerned about the health ramifications of temperature checks school bus drivers and attendants.

“If you put an attendant on [a school bus], … then how does an attendant safely take the temperature of students?” Combe explained. “Face to face puts them at risk, and how do you clean the thermometer in between?”

She noted that while infrared thermometers are frequently discussed, she said they are not accurate in every circumstance.

“I agree with the transportation director who said it should be the parents doing the screening,” Combe advised. “NASN guidance really supports frequent, evidence-based, and clear messaging to parents and the broader school community about policies and procedures. And that communication can include a system checklist that parents would review with their child each morning and each evening.”

She added that she advocates for school districts discussing with parents their shared responsibility for the health of the school’s community.

“And most parents would adhere to those procedures and generally do. Even when we are not in the COVID-19 related situation,” she noted.

Like Damien, Combe cautioned, however, that not all parents will adhere to that messaging. She speculated that the main reason could be inequities within communities. For example, some families are dependent on an hourly job with no family leave.

“So, if I don’t go to my job, I lose my job. But I know, if I send my child to school, that somebody there will take care of them,” Combe commented. “Those are hard decisions that parents have to make about sustaining their families and nutrition and health care.”

Dr. Joseph O’Neil, who specializes in development and behavioral pediatrics at the Riley Children’s Health at Indiana University Health, noted that transportation directors are “between a rock and a hard place” when looking to obtain an accurate temperature reading at a distance that also doesn’t put the temperature taker at risk.

“They are a lot of variables that go into taking a skin surface temperature,” he advised. “The skin has to be dry. The child has to be cooperative. The thermometer needs to be calibrated, to make sure it is accurate and frequently tested [and] to make sure that it maintains accuracy.”

He said taking temperatures under the tongue or under the armpit puts the temperature taker at risk. Taking temperatures from the forehead using infrared device reduces the chances of disease or virus transmission but also have their obstacles.

“You can hopefully get in the ballpark, and if it’s well-calibrated, hopefully, you will do fine,” he pointed out. “There is no easy answer to that one. And the good news is, technology is getting better all the time.”

Dr. Nathaniel Beers, president of the HSC Health Care System in the Washington, D.C, metropolitan area and a member of the American Academy of Pediatrics (AAP) Council on Children and Disasters, said an ideal solution would be an app that parents can use to enter the temperature and symptoms of their child and confirm that “all is well and good.”

While companies are in the process of creating such apps by utilizing artificial intelligence, Beers advised that other challenges will persist. For example, he questioned the likelihood that certain staff members who don’t have healthcare experience will suddenly be able to test students and determine who gets on the bus and who doesn’t.

He said including health screenings in the overall transportation discussion is a huge reality that school districts need to consider.

“And certainty there is more and more technology, even in the healthcare space. We know that many hospitals have moved to remote monitoring and having people enter in affirmatively that they don’t have symptoms or they don’t have a fever, which could be used in school situations as well,” he advised.

But how early in the morning does that information have to be entered so transportation staff can affirmatively produce a roster for the day of who can and who cannot ride the bus?

“Today, you are going to pick up these five kids. This one kid who would normally be on the route has symptoms and so they are not allowed to get on the bus, so don’t stop for them,” he suggested. “And yet, there are a lot of steps that have to happen to make that possible. And I don’t want to minimize that for transportation directors, the complexity of those routes and challenges for being responsible for picking up and dropping off children safely every single day.”

He continued, “And what happens when that list is wrong and Johnny is standing at the curb waiting, and no bus ever comes? Or the bus comes and doesn’t allow him on because he has been deemed as ineligible today? So, all of that is an extra layer of complexity that we are putting on school transportation systems, in an era which was already complex and reliant on very complex data management systems, to make it even function on a daily basis.”

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O’Neil also expressed concerns with an app, as parents would be entering their own children’s symptoms.

“With self-reported symptoms, you have to assume that, first off, people are accurately entering in what is going on. The second thing is you have to make sure that the algorithm that decides whether you get a thumbs up or thumbs down is reliable and valid,” he advised. “So, apps are nice. But you have to make sure it has been tested, validated, and is reliable.”

Editor’s Note: Temperature checking and the role of artificial intelligence to aid in health screenings for the school bus ride is further discussed in the July magazine issue of School Transportation News.

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