Notes from the Nurse 

By Angela Montalvo, RN

Viruses Everywhere!


Since March of 2020, there has been one virus that has overshadowed all others- the SARS-CoV, better known as COVID. Of course, there are other illnesses that affect us, and many of them are viral. Prior to COVID, we often didn’t have a diagnosis of what virus it was and were told “it’s something viral”. Currently, many walk-in or urgent care providers are routinely testing ill patients for a variety of viruses (COVID, influenza A & B, and RSV). I point that out because some illnesses we called “a bad cold” in 2018 may now have a diagnosis of RSV or influenza. Before COVID, older children and adults were rarely tested for RSV. Now, with the need to have diagnoses prior to returning to normal life activities like work and school, testing has become much more common. 

Below is some basic information taken directly from the Mayo Clinic Patient Care and Health Information website on illnesses we are seeing in our schools. Guidance on returning to school after diagnosis is from the Wisconsin Department of Health Services.

Respiratory Syncytial Virus: 

Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults. In adults and older, healthy children, RSV symptoms are mild and typically mimic the common cold. Self-care measures are usually all that's needed to relieve any discomfort. 

RSV can cause severe infection in some people, including babies 12 months and younger (infants), especially premature infants, older adults, people with heart and lung disease, or anyone with a weak immune system (immunocompromised). 

Symptoms in adults and older children include: 

● Congested or runny nose 

● Dry cough 

● Low-grade fever 

● Sore throat 

● Sneezing 

● Headache 

In severe cases, especially in infants and young children: 

● Fever 

● Severe cough 

● Wheezing — a high-pitched noise that's usually heard on breathing out (exhaling) 

● Rapid breathing or difficulty breathing — the person may prefer to sit up rather than lie down Infants are most severely affected by RSV. Signs and symptoms of severe RSV infection in infants include: 

● Short, shallow and rapid breathing

● Struggling to breathe — chest muscles and skin pull inward with each breath 

● Cough 

● Poor feeding 

● Unusual tiredness (lethargy) 

● Irritability 

● Bluish color of the skin due to lack of oxygen (cyanosis) 

School rule: Students should stay home until they have been fever-free for 24 hrs without the use of fever-reducing medicine or they have a doctor’s note clearing them to attend school.. The lingering cough can be quite intense. If a student has a very bad cough, they may need to stay home until the cough improves. A bad cough makes it difficult to come to school well-rested and attend to school work. 

Hand-Foot-and-Mouth Disease: 

Hand-foot-and-mouth disease — a mild, contagious viral infection common in young children — is characterized by sores in the mouth and a rash on the hands and feet. Hand-foot-and-mouth disease is most commonly caused by coxsackievirus. 

There's no specific treatment for hand-foot-and-mouth disease. Frequent hand-washing and avoiding close contact with people who are infected with hand-foot-and-mouth disease may help reduce your child's risk of infection. 

Symptoms include: 

● Sore throat 

● Feeling unwell 

● Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks 

● A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks

● Irritability in infants and toddlers 

● Loss of appetite 

● Fever 

The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to six days. A fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and feeling unwell. 

One or two days after the fever begins, painful sores may develop in the front of the mouth or throat. A rash on the hands and feet and possibly on the buttocks can follow within one or two days. 

School rule: Students need to be fever-free for 24 hours without the use of medications before returning to school. If there are draining blisters, they need to stay home until the blisters dry up. Young children who are not efficient hand-washers should remain home until they are considerably better. Young children who drool or put their hands in their mouths should also be kept home until significantly improved. 


Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea and vomiting. 

At first, the flu may seem like a common cold with a runny nose, sneezing and sore throat. But colds usually develop slowly, whereas the flu tends to come on suddenly. And although a cold can be a bother, you usually feel much worse with the flu. Though the annual influenza vaccine isn't 100% effective, it's still your best defense against the flu. 

Common signs and symptoms include: 

● Fever 

● Aching muscles 

● Chills and sweats

● Headache 

● Dry, persistent cough 

● Shortness of breath 

● Tiredness and weakness 

● Runny or stuffy nose 

● Sore throat 

● Eye pain 

● Vomiting and diarrhea, but this is more common in children than adults 

School rule: Students should stay home from school until fever-free for 24 hrs without the use of fever-reducing medicine, no diarrhea or vomiting for 24 hours without the use of medications, and all other symptoms (like a cough) are improving significantly. 

Strep throat: 

Strep throat is a bacterial infection that can make your throat feel sore and scratchy. Strep throat accounts for only a small portion of sore throats. 

If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage. 

Strep throat is most common in children, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt testing and treatment.

Signs and symptoms of strep throat can include: 

● Throat pain that usually comes on quickly 

● Painful swallowing 

● Red and swollen tonsils, sometimes with white patches or streaks of pus 

● Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) ● Swollen, tender lymph nodes in your neck 

● Fever 

● Headache 

● Rash 

● Nausea or vomiting, especially in younger children 

● Body aches 

School rule: May return to school 24 hours after initiation of appropriate antibiotics and feeling much better. 

Angela Montalvo, RN school nurse: 

Kara Diers, health aide: 

Information copied from 

Disease exclusion from