As schools grapple with a resurgence of swine flu, many districts have few or no nurses to prevent or respond to outbreaks, leaving students more vulnerable to a virus that spreads easily in classrooms and takes a heavier toll on children and young adults.
The shortage of school nurses could lead to more students falling ill from the H1N1 virus, which can be particularly dangerous for children with weakened immune systems or respiratory conditions such as asthma, experts say.
"It's really irresponsible of the school district to not really provide medical oversight while kids are in school," said Jamie Hintzke, who has two kids in Northern California's Pleasanton Unified School District, including a son with severe food allergies. The district has one nurse for 15 schools and almost 15,000 students. "I'm playing Russian roulette every single day he goes to school."
Many schools around the country don't have a medical professional who can quickly diagnose students and detect outbreaks.
A 2008 survey by the National Association of School Nurses found that only 45 percent of public schools have their own full-time nurse, another 30 percent have a part-time nurse, and a quarter don't have any nurses at all.
Lodi Unified School District has 21 nurses — 16 school nurses and five licensed vocational nurses — for its estimated 30,000 students, according to Ivie Gonsalves, coordinator of special services, who oversees the nurses. That equates to about one nurse for every 1,400 students.
The Galt elementary school district has one nurse among its seven campuses, although there are health assistants at every school, Superintendent Karen Schauer said. There are about 3,500 students in the district.
The ratio exceeds statewide figures, which report there was one nurse for every 2,240 students last year. Further, roughly half of the state's 1,000 school districts do not have any nurses at all.
The average nurse-to-student ratio nationwide was one nurse for every 1,151 students, but in 14 states there was only one nurse for more than 2,000 students, according to the nurses association. States with the highest ratios include Oregon, with one nurse for every 3,142 students; Michigan, with one for every 4,204; and Utah, with one for every 4,893.
Only 12 states, mostly in the Northeast, met the 1-to-750 ratio recommended by the Centers for Disease Control and Prevention, the association found.
With swine flu cases rising with the new school year, districts are depending on teachers, principals and secretaries with little medical training to identify, isolate and send home sick children, as well as monitor absences and illnesses for signs of a wider outbreak. Some teachers complain they haven't received guidance or training on how to deal with swine flu.
In Lodi Unified schools, however, nurses have taken a proactive approach to deal with passing germs.
At the beginning of the school year, they began conducting the same hand-washing campaign undertaken this time every year. There is a contingent that teaches the district's pre-schoolers how to wash their hands correctly and how to cover their mouths when they cough or sneeze.
Even before the swine flu scare, local school nurses put reminders on large campus bulletin boards on how to prevent the seasonal virus, and many teachers have made waterless antibacterial gel available.
Since it was first identified in April, the swine flu has infected more than 1 million Americans and killed nearly 600, the CDC estimates. So far swine flu does not appear to be more dangerous than seasonal flu, which kills an estimated 36,000 Americans each year, but it appears to be more contagious and health officials are concerned that it could mutate and become deadlier.
Federal health officials are urging parents to have their kids vaccinated, but the H1N1 vaccine will not be ready until later this month.
Meanwhile, the California Department of Education released its pandemic response plan on Thursday.
The Pandemic Influenza Planning Manual for California Public Schools, created by the Department of Education, is a state-specific supplement to the guidance provided for schools by the Centers for Disease Control and the U.S. Department of Education.
The manual covers a number of topics, including recommendations and resources available for preparedness and prevention; notification and reporting procedures for student dismissals; and fiscal impacts of extended school, district, or statewide student dismissals if ordered by a public health officer due to pandemic influenza.
The draft of the manual is available online at CDE's Web site, www.cde.ca.gov, where students, parents, teachers, school staff and administrators, as well as the general public, are encouraged to review the draft and submit comments.
News-Sentinel reporter Jennifer Bonnett contributed to this report.