There’s concern that some schools around Indiana planning to reopen this fall will be without a full-time nurse.

The lack of nurses predates the COVID-19 pandemic, but the presence of the virus has made the lack of nurses an obvious concern. Indiana Chalkbeat reports that the state only requires each district have at least one nurse, even if that means they cover multiple buildings.

Some advocates say many districts in the state don’t meet the nationally recommended ratio of one nurse for every 750 students. More than 1,100 nurses were reportedly working in 400 districts and charter schools in the state last year.