Helping with contact tracing after a positive COVID-19 test. Watching for coughs and other signs the virus could be taking hold in a student. Keeping up with shifting recommendations and rules about when students should or shouldn't be in school. Answering a slew of calls from parents, teachers, administrators and others about isolation periods, testing and other issues.

These are among the many duties school nurses are performing amid the pandemic, raising the importance and profile of their often-unsung roles in keeping kids healthy.

"Even the smallest sore throat we have to worry about this year," said Kellie Bamford, who as lead nurse in the Andover district supervises 21 staff in the schools.

Her district is relatively fortunate, she said, in that COVID-19 rates aren't as high as the Wichita area as a whole. Elementary students have stayed in school since opening in the fall, while middle and high schoolers are currently in hybrid mode, in the buildings some days, learning remotely on others.

"The nurses are spending all their time watching for symptoms and answering questions," said Bamford.

As a parent, pediatrician and educator, Kari Harris' appreciation of school nurses' role in school and community health care has grown, especially during the pandemic.

"They really are unsung heroes in our schools and in health care," said Harris, an M.D. and associate professor at KU School of Medicine-Wichita. "They fill such a huge gap for these kids. They give them crackers when they miss breakfast and make sure they brush their teeth after lunch. They give medications that could be given at home. They wash clothes when kids spill ketchup on themselves in the cafeteria. They have this huge role that is underrecognized."

Last spring, Harris decided to do something to support the nurses by providing resources and T-shirts that encourage a vital task during the pandemic: hand-washing. She sought and received a $5,000 grant from the Kansas Pediatric Foundation, the philanthropic arm of the Kansas Chapter, American Academy of Pediatrics. With money and design help from the foundation, KU Wichita Pediatrics bought and is distributing the T-shirts, along with hand-washing resources and other supplies, including soap, at the KU Wichita Pediatrics clinics.

The blue tees proclaim that "In 20 seconds, you can be a hero!" and include instructions to water, soap and scrub. Because the initial focus group - Harris' kids - insisted the shirt must have a superhero, there's a muscular cape-wearer along with logos from KU Wichita Pediatrics and the Kansas Chapter of the pediatrics academy. Since school began, more than 300 shirts have been distributed, with two-thirds going to school nurses.

Not only do the T-shirts carry a reinforcing message about hygiene, they're also nice and soft. School nurses and KU Wichita Pediatrics doctors and staff make a point of wearing them each Monday.

"It kind of felt like someone is noticing us. Nurses often get overlooked," Bamford said. "We're working hard, and they're seeing it."

Harris said "the T-shirts were kind of a jump-start to getting involved with schools in a broader capacity." She also serves on the Kansas COVID Workgroup for Kids, a KU Wichita Pediatrics-initiated effort to share information and resources regarding how the pandemic is affecting kids. School nurses, psychologists and others are part of the group. Beth Schutte, district nurse in Haysville, is a member.

Schutte has a staff of 17 spread across the 5,300-student district. Like Sedgwick County and many parts of Kansas, the district has seen an "explosion of COVID." With the recent influx, middle and high school students are learning remotely.

Through fifth grade, Haysville students remain in the classrooms.

"Our goal is to keep the elementary kids in person. Little kids aren't the spreaders," Schutte said.

For her staff, "contact tracing is really enormous as far as the time involved." The amount of work grows once students reach the age where they move from class to class. One infected high schooler "could take out 25 to 30 others."

School nursing can be a solitary job, one less visible amid teachers, administrators and staff. Even in healthier times, but especially so during the pandemic, their role then can resemble that of a social worker or public health nurse, helping students who are homeless or need medications or food. In districts from Haysville, a higher poverty one, to Andover, which is less socioeconomically disadvantaged, parents have been laid off or children are fending more for themselves as they learn remotely. With fewer family resources, nurses help man the safety net.

"A lot of families are struggling financially," Schutte said.

"We are trying to watch kids whose parents have lost income and services because of COVID. That's a piece you can't forget," Bamford said.

Schutte said hand-washing was something they've pushed for the last few years, making it fun with scented hand sanitizers - peppermint and fruits among them.

"The T-shirts are a visual reminder to wash your hands. They were definitely well received," Schutte said. Wearing them on Mondays, "it is a unifying thing, that we're a group and we're presenting that unified message - wash your hands - to the district."