VPM’s Megan Pauly spoke with Chtaura Jackson, a COVID-19 epidemiologist with the Richmond and Henrico Health Districts about its guidance for schools as districts begin reopening in-person. Jackson focuses specifically on K-12 public and private schools in the Richmond metro area, as well as daycare and preschool settings. Below is a transcript of their interview, which has been edited for clarity.
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What are you considering as a COVID-19 exposure/close contact, either in school, on school property or during a school-related activity?
Great question. So both the CDC and VDH guides for identifying close contact is 1) anyone who falls within six feet for 15 minutes or more consecutively over a 24-hour period. So that could be five minutes here, five minutes there, five minutes there; if it equals up to 15 minutes or more over a 24-hour period, we will consider that person as an exposure.
Now there is an exemption to the close contact definition; that has to deal with, specifically, K-12, public or private indoor classroom settings. And this only applies to student-to-student [contact]. If a student [the COVID-19 positive case or suspected case] is wearing a mask, and also those students who fall within that three to six feet distance around that person are also wearing a mask consistently and properly, they are not considered as a close contact. But again, that is for a very specific setting, specifically in indoor classroom settings.
That exemption only applies to student-to-student [contact], not teacher-to-student or staff-to- teacher. So if a teacher has students who are identified as close contacts, that exemption would not apply to the teacher.
We may see a change in guidance, guidance changes very quickly with COVID-19, as many people know. So that might be a change down the line. But at the current moment, the exemption specifically only applies to indoors. So in outdoor settings, anyone who falls within six feet for 15 minutes or more consumed consecutively over a 24-hour period would be considered as a close contact.
If there’s a COVID-19 exposure on school property, who will be notified and when?
So obviously, the schools are the ones who are on the ground. So the schools would be the first people to reach out. So if Bob [a student] tested positive in a classroom, then that school nurse would initially do the contact tracing to determine who those close close contacts were and then notify those close contacts that you need to begin quarantine based on the exposure. So it would start from the actual school because they have the on-the-ground information, so the school would be the ones to initially ask people to quarantine.
We don't want people waiting on the health department to call to tell them they need to quarantine, that's something that should be initially started by the actual school.
What is the timeline looking like for contact tracing?
So it completely depends on the school. Because contact tracing initially starts at the school, then once we hear about a case, then our people will also do a separate contact tracing as well. So we would reach out to the case, the person who was either suspected or confirmed as a positive, to do a more thorough investigation with them, and to provide guidance and to also elicit additional contacts. And then our contact tracers within our health department would reach out to those contacts, to be able to provide additional guidance. A lot of it's the same guidance that is provided from the school nurses, i.e., this is the date you should be getting quarantined, and based on this, this is when you can come out of quarantine.
What is your protocol for quarantining? Is there a different quarantine protocol if the close contact person is vaccinated?
For those who are not fully vaccinated, the health department's goal standard has always been 14 days. Because we know symptoms can develop between two to 14 days from the date of exposure.
Earlier this year, the CDC offered two additional options for quarantines because they were seeing how much it [a 14-day quarantine] was negatively affecting families. One option is you can quarantine for 10 days with no test, return on day 11. Or you can quarantine for seven days, get a test no earlier than day five, return on day eight. So the school determines what quarantine dates they choose. It’s balancing not just the function of the school but also the public health aspect and the resources that they have. So the quarantine date the choosing between those three falls completely within the school's discretion.
For a fully vaccinated person, that is someone who is 14 days past the receipt of two doses of either the Pfizer or Moderna, or 14 days past the receipt of a Johnson Johnson vaccine and they do not have symptoms, they do not need to quarantine. The only time they [fully vaccinated people] would need to quarantine is if 1) they develop symptoms or 2) they return a positive COVID-19 test. We do recommend getting tested three to five days from the date of exposure and wearing a mask for 14 days or until you return a negative test.
What variation in quarantine timelines have you seen locally?
I've seen a lot of people who are doing the 14 days, returning one day 15. And I've also seen, especially if we’re looking at public and private schools, I've seen a lot who have gone with the 10 day quarantine, and are returning on day 11. So it just varies. We provide the CDC recommendations, and ultimately it really does fall within the schools or the school district to decide what quarantine guidance that they choose for their students.
At what point would you recommend an entire classroom or an entire grade be quarantined?
So that's a great question. Closing an entire class is generally a last resort, we really do want people to stick to the close contact definition, when we're trying to elicit context.
But we do know there are certain situations where it's very hard to identify who was around who. So let's just say that kids were just mingling around and there weren’t seating charts, and the teacher couldn't really identify where Bob [COVID-19 positive kid] was, then that would be a situation where you might consider quarantining a class.
We always put it as a last resort. If you just do not know who was around Bob, who made that close contact definition, then that's when the school could err on the side of caution, and quarantine the class.
When we look at grades, it has a lot to do with spread. Is it contained to one class, or is it spreading to other classes? Are the classes mixing? Those are the kinds of things that we take into consideration when we're recommending the quarantine of just one class or quarantine multiple classes.
At what point would you recommend that an entire school close, at least for in person instruction? Would there have to be a certain percentage of positivity?
That's a hard one to determine. It's multifaceted, and it's case by case. It could depend on whether or not the outbreak is contained. If it is contained, and you know that there's no more spread inside the school, then you don't need to close. However, if you can't contain it, and you're finding out that this person’s been to other places you did not expect, whether it's affecting other groups, then those are things to take into consideration. But again, it's a case by case situation. And again, closure would be something that would fall within the school’s discretion. Obviously, we would make a recommendation based on X, Y and Z. But it is definitely not a one size fits all, it’s case by case.
If you have a bunch of teachers out, because they're quarantining, obviously, that's going to have a direct impact on the school's ability to function. That might be a reason why you would need to close down if you don't have enough teachers to actually fill those positions, or if you have multiple outbreaks in a school at the same time, or if you have uncontrolled spread within the school. Is absenteeism high due to staff having to quarantine? Is absenteeism high due to quarening large amounts of kids? These are some of the things that we would take into consideration when we're talking about whether we should recommend closure.
