Parents and children getting ready for school, now they have to be ready for another innovation – the morning medical the filter. The new regulation requires examination of children on entrance to school and kindergarten, and if you suspect a cold-related illness will not be allowed to classes and be sent home. Parents were divided into two camps – someone warmly welcomes the initiative, someone is outraged. But experts point to obvious problems.
Photo: RIA Novosti / Vitaly ANEC
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“Why should we collect other people’s snot”
In June, the chief state sanitary doctor Anna Popova issued a decree, which concerns the prevention of viral diseases. According to the document, from September 1, schools and kindergartens will appear procedure “the morning filter”. During the rise of virus activity of influenza and SARS every morning before class the health care provider or educator will need to examine each child. If you suspect a disease of the children will be sent home with the adult who brought him in.
“According to the Constitution everyone has the right to a healthy environment and health. The responsibility of an educational organization is to provide conditions for maintaining the health of any person. During the rise of influenza we recommend you to use the remote form of education”, – commented on the TV channel “Russia-1” in the program “Morning of Russia” the decree Elena Ezhlova, head of Department of epidemiological supervision of Rospotrebnadzora.
Discussion “the morning filter” caused controversial opinions among parents. Some people like this law:
“A very effective measure! At the moment, there was a gap in the legislation, could only rely on the conscience of the parents. If a normative act, the result will not wait!”
“In our kindergarten, and so was sent home sick. And rightly so: one result with the temperature and the nozzle such that there is a strong feeling that his not spare their own parents. If people watch their children and invested in their health, why do they have to collect other people’s snot and again to invest in treatment? I think if the work is not a child neither the means nor the time, such work is not needed at all. Another thing is that medics were gone.”
“Finally. The main thing that it really worked. And tortured the child health ruin due to the inadequate parents who carry children in kindergartens and schools with snot, temperature, and all related!”
Many noted weaknesses in the regulations:
“I wonder how they distinguish between allergies and colds? The only difference is that with allergies and no fever. My child is allergic runny nose, watery eyes, sneezing, coughing, and that’s a big part of the school year. And our medicine is not treated”.
“The government has decided a medical examination to impose on teachers to save money on health professionals. And by what right teachers will do this? This is an illegal medical activity”.
“Then we have the teachers with the nurses not to allow patients to work, and teachers in schools. And indeed all whose work is somehow connected with the children.”
“And let’s get to work to prevent with snot and coughing? That’s me sneezing employees are infected, let the house sit? And customers with a cough and snot are not to serve in let treated, there is nothing the infection to spread. No to protect himself or the children. Necessary to temper”.
“What’s the point? In the incubation period in the absence of external manifestations of the disease the child is still in close communication, or random sneeze pereskazhet the half-group”.
“First, how much time to explore all children. In our class of 31 people – even if each minute is more than an hour. Then imagine the prosecution of a teacher by other parents that he “didn’t notice the sick child” (a teacher not a doctor, he is not able to see everything, and the doctor is not always can). Reverse the situation: you take the child, go to the doctor in the clinic, and in fact it turns out that the child is not sick – who will pay for the missed day of work?”
Children’s health is now the task of the teacher
The execution of the decision will fall on the shoulders of doctors and teachers. The head of Department of epidemiological supervision of Elena Ezhlova explained, what is the problem:
Elena Ezhlova
– Of course, ideally we would like and it would be correct that all educational institutions were medical personnel. Knowing the children, the teacher can pay attention to any signs unusual for the child’s behaviour, lethargy, complaints of headache. The task of the teacher, if there is no healthcare worker – to bring the child to the medical room educational institutions, and not to leave it unattended to call parents. If a serious condition is the ambulance already arrived and the health care provider determines the further tactics: to hospitalize him or send along with your parents home.”
The teacher of one of Moscow schools Sophia P. considers a good idea, but the implementation is vague:
– In the 90s and 2000s due to low funding of the school has dramatically reduced the number of health workers, and still in many institutions all remained unchanged. For example, in our rating of the Moscow school nurse works on two buildings, for a half-day each. So, who will be subject to this duty? For headteachers, the overloaded list of responsibilities and a complex system of relationships with students and their parents.
Of course, there are cases when a child comes to school obviously sick people; because “the mother ran on the lessons.” Even when the mayor this year due to the weather conditions allowed to remain students at home, it’s a lesson 13 fifth-grade, and it’s almost polklassa. Come less often sick because of the tests or important lessons. Such situations should not be treated favorably, but I think they are universal.
I winter-spring are in a permanent state of cold, because I always in the class who a child is sick. If this was done by the health workers who would be unbiased to the children and the situation, and that would be enough for all children in the school…
Suspect parents – the worst strategy
Pediatrician Sergey Butre the decision raised many questions:
Sergey Butry
– Another hasty and ill-considered, but high-profile initiative, which will complicate the lives of all involved, and will not help to reduce the incidence.
I’ve only seen news articles and the resolution of the Chief state sanitary doctor of the Russian Federation from 25.06.2018 No. 38 “On measures for the prevention of influenza and acute respiratory viral infections during the epidemic season 2018-2019 years”, but information about the new “morning filters” there is very little, and yet a lot more questions than answers.
1. The most obvious question: how is it technically done? Impossible for any to successfully conduct a morning inspection of each child in the garden one kindergarten doctor or nurse, they will create congestion at the entrance. The average waiting time parent “approval” workers of the filter to be visited by a kindergarten child will be about half an hour, and so every morning is absolutely unacceptable for parents in their morning rush. If to trust the teachers – who can guarantee the quality of the inspection?
2. As a pediatrician, I history taking is based on the fundamental fact: the parent I have no reason to lie, he is interested in the correct diagnosis, we are allies. But “the morning filter” from the beginning, it is assumed that a parent or a fool, or a liar. This is a very bad start, it’s hard to build anything constructive. If we subtract from pediatric honest and mutually respectful dialogue with the parent – does not leave me with symptoms for which we can confidently identify SARS or another infectious disease. Child was coughing all night, but how could I know? Red throat, copious runny nose by themselves are not the criterion that the child is highly contagious.
3. How do we know that the child was not contagious? Many children with the common cold a runny nose and coughing lasts one or two weeks, and they can only be in the morning (just when the child goes to the workers, “filter”). The child is maximally contagious only in the first days of the disease, and then the level of isolation of the virus is either zero or comparable to mild cold. Bring it on all these three weeks while the cold will not pass finally? But the parent of a child has only a residual catarrhal phenomena, the doctor will not give sick leave – how then is it to be?
More questions are just some. In my humble opinion, to force caregivers to suspect every parent of a liar and a pest to her child and cause him good by force is the worst possible strategy.
If we look at international experience, for example, in the UK there are clear algorithms for any diagnosis for what period of time should be taken of the child from the team, and SARS it is simply not stated (perhaps not the planned output of such a child at all). And we have such documents is simply not designed – and what then to rely on the workers of the filter in case of conflicts with your parents? On their own ideas?
In Australia, too, has such a document, and there is said to be the child with SARS “is not necessary”, except that until then, until he himself does not become better. Because infection during the epidemic everywhere, it is isolated not only patients with obvious symptoms and isolation only a few of them that changes.
And in the US for parents, childcare workers and medical experts write an excellent memo, in which much greater attention is paid to vaccination against influenza, rules, hand washing, etiquette sneezing/coughing, etc. – the isolation of patients. About the isolation of said only two words: it is desirable to be at home during the fever and another 24 hours after normalization of temperature.
That’s how we approach this complicated and multifaceted issue in developed countries: education, hygiene, vaccination, fair sotsgaranty parents of affected children; gradually, systematically, intelligently, with an eye for the long term. And our country is again trying to solve the sudden prohibitions, categorical ill-conceived orders and penalties. It’s a ridiculous farce, not competent prevention.