With the start of school across Southern Illinois only a few weeks out, questions remain how education and health officials will coordinate contact tracing and notification when positive cases arise among students, faculty and staff.
Will parents receive word of an outbreak at their children’s schools? Will schools need to temporarily shut down classes, school buildings or close altogether if an outbreak is detected? Who decides what mitigation steps are necessary?
School district and health department officials told The Southern that they are still working through how the process will work — and it may vary by school district or county.
“It’s kind of like we’re changing the tire on the car while we’re driving as we go through this,” said Frankfort School District 168 Superintendent Matt Donkin.
As Donkin spoke to The Southern this past week about the daunting task of reopening schools, he was waiting in line at a drive-thru COVID-19 testing site in Marion. That day, he had to shut down his five-person administrative office because an employee tested positive, which required the rest of the staff to get tested and quarantine. Donkin tested negative, but the situation, he said, has shed light on the complications coming the way of school districts when students return for in-person classes.
Donkin said state and federal guidance do not mandate schools close down entire buildings if a case or cluster of cases is isolated to a classroom. “But I know that concern will be there among parents and staff” and some will want to know if they face an elevated risk, he said. At the same time, he said, school officials also have to be mindful of student and health privacy laws if they decide to notify the school community of an outbreak in some manner.
Complicating matters, health departments may not be notifying schools when their students test positive — at least not directly. Presumably, they will know if a child attending in-person classes is quarantined for 14 days and unable to show up. But the communication may be left to the child’s parent to decide whether the school is notified, and when.
Carrie Eldridge, director of health education and emergency preparedness with the Franklin-Williamson Bi-County Health Department, said the agency is consulting with its legal team to determine what information it can share with school districts without violating patient privacy laws. It’s a delicate balance, she said. While awaiting that guidance, she said, “we’re kind of at a stand-still” in planning with local school districts.
While broader notification to the school community would be up to district officials, contact tracing is the job of local health departments.
Contact tracing is the process by which health departments attempt to stop the spread of an infectious disease. It starts with an employee of the health department contacting the individual who has tested positive and directing them to isolate. They also interview the person about where they’ve been and who they’ve been around. The health department then reaches out to these “close contacts,” directs them to quarantine for 14 days, and advises them to get tested.
But “close contacts” are relatively narrowly defined.
According to the Centers for Disease Control and Prevention, a “close contact” is an individual who was within 6 feet of an infected person for at least 15 minutes, starting from two days before illness onset until the time the patient is isolated. For asymptomatic patients, the window is two days prior to a positive specimen collection to isolation. That means “close contacts” could include some students in a class, but not others, and typically would not extend building-wide, unless there was knowledge the child had been in multiple locations of the school.
Eldridge said contact tracing during the school year will work much like it does now — the health department will rely on the parent and student to provide information about close contacts, not necessarily the school district. But they are asking schools to provide classroom assignments and seating charts to aid the process.
“Of course, we don’t want a lot of movement in the schools,” Eldridge said. “That will help out as well, and help in the prevention of the spread of the virus. So there are a lot of key factors that are going to come into play in a school system.” That said, the health department may not contact the school for further details beyond the student/parent interview and the provided seating charts.
“There may be a parent who doesn’t want their child’s information passed along to school districts” and the health department, she said, must be mindful of restrictions for sharing personal health information detailed in the Health Insurance Portability and Accountability Act, commonly known as HIPAA. Clusters of cases among students in multiple classrooms may change the reporting dynamic, she said. At that point, the health department would work with the affected school to determine a mitigation strategy, which could include closing down all or portions of a building.
These difficult questions loom large at a time when cases across the region are escalating at alarming rates. On Friday, the Illinois Department of Public Health elevated several Illinois counties to a “warning level,” seven of them in Southern Illinois: Gallatin, Jackson, Johnson, Perry, Randolph, Saline and White.
Angie Hampton, CEO of Egyptian Health Department, which covers Gallatin, Saline and White counties, said health officials are nervous about the rise in cases and corresponding hospitalizations on the verge of the start to the school year.
If an outbreak of cases is identified within a school once classes resume, Hampton said the decision of whether to close down would be left to school officials, working in consultation with the health department. She said there’s not a brightline test that says a school should shut down if a certain percentage of students test positive. Hampton also said school and health officials are eager for more information about how they should respond. “We are very much looking for what is that specific metric, and that just isn’t out yet,” she said.
The Illinois Department of Public Health declined to comment for this story and referred The Southern to local health departments for any questions.
According to guidance given to schools by the Illinois State Board of Education, families and staff are encouraged to report cases to their local school district. Further, districts are asked to inform the school community of outbreaks per local and state health department guidelines while maintaining student and staff confidentiality rights.
But health departments don’t all come down in the same way on the delicate balance between individual health privacy and a community’s desire to know vital life-saving information about outbreaks.
For people living within the jurisdiction of the Southern Seven Health Department, only “close contacts” will be notified of a positive case. There will not be any kind of mass or public notification of a positive case — within a classroom, building or business due to “privacy” concerns, according to Shawnna Rhine, department spokeswoman.
When asked if there could be a change with the department’s notification policy if there were to be an outbreak impacting a certain location, Rhine said likely not, and notes the health department “generally (does) not release information like that without a court order.” She said the release of that kind of information has “tended to backfire” for many facilities and added they may “want to handle that internally and that’s up to them” no matter if they are a nursing home, school or any other facility.
She said the department has prioritized privacy and personal interests when dealing with COVID-19 cases because, Rhine said, people may be “concerned they’re going to be outcasts” or have a certain “stigma” pinned on them. “That’s not what we want out there for people,” she said. “We want people to take their experience and use it to help other people, but again, ultimately, that’s their decision.”
But others are taking a more communal approach, saying broader notification, without identifying information, is essential to building community trust. As a prime example of this, the Marion High School Athletics Department sent an alert out on social media Wednesday notifying the community of a positive case within the football program.
Ryan Goodisky, Marion High School Athletic Director, said after speaking to the school’s principal and district superintendent, they decided transparency would be key to maintaining strong relationships during the COVID-19 pandemic. “You know, we don’t want to hide anything,” he said. “Obviously, when you’re talking about the safety and the health of student athletes and coaches and teachers, transparency is definitely important.”
Goodisky said when a COVID-19 situation arises, his first phone call is to the Franklin-Williamson Bi-County Health Department and then the department will take care of contact tracing. He said while the pandemic necessitates he take things “day by day,” the school is “trying to work together and do it safely and make sure our kids are still engaged and having a safe, but fun, high school experience considering everything that we’re going through.”
Bart Hagston, Jackson County Health Department administrator, said his office has been working with schools for several weeks now to plan for the return of in-person classes. Many school districts in the county are offering a hybrid model where students will have the option of attending some time at school, and will also spend some time learning remotely.
Carbondale Elementary District 95, Unity Point and Carbondale Community High School, however, all plan to begin the school year remote-only. Carbondale High School had planned to offer a hybrid model, but changed its mind at a school board meeting Thursday, citing the alarming rise of cases in the region in recent days.
While some health departments are taking a more conservative approach to sharing information with schools, Hagston said he anticipates working closely with them to identify close contacts and make other decisions as necessitated by potential outbreaks.
Hagston said it has to be a hand-in-hand partnership — the health department, he said, is stretched relatively thin as it is, and schools are facing new and daunting challenges. He said working together is the best way to protect as many people as possible and make it through to the other side, while adding that it is his vision the health department will work with schools to do robust contact tracing if a child tests positive, in addition to calls to parents and students.
Ultimately, he said, it will be up to schools to decide whether they need to shift to remote-only learning because of an outbreak, but all parties will be in close communication in making the call.
Hagston said he doesn’t envy the position schools are in. “There’s a giant mountain of issues they have to overcome,” he said. “The work we’re doing at public health seems insurmountable at times, but at the same time I don’t envy what the school administrators are having to do one bit.”
Donkin, the Frankfort schools superintendent, said administrators are feeling the pressure, and it is only going to intensify when classes resume. He said officials are spending hours going over countless scenarios, but they also have to stay nimble and be willing to make decisions on the fly. Donkin said that the struggle in achieving balance between privacy and sharing helpful information is one of the more difficult decisions facing schools. Schools could be held legally liable no matter which side they err on, he said.
Ultimately, Donkin said there is no administrator who wants to make the wrong decision and put any children or staff at risk. Several of his teachers are in high-risk categories for coronavirus complications. The entire southern Delta region of Illinois has high percentages of people living in deep poverty and with health co-morbidities. Generally, children suffer less severe symptoms, but much is still unknown about long-term implications of the disease, Donkin noted. And community spread among young people will eventually lead to more high-risk people becoming infected.
Even with some plans in place, some have remained nervous about the future of schools and COVID-19, including one area teacher who walked away from her job because of risks the virus poses to her family.
Sharon Craig decided to leave her position teaching fifth grade at Lick Creek School in Buncombe after debating her options for several months. She said her decision wasn’t easy, but she is extremely concerned about how her job could affect her husband, who is immunocompromised, if she returned to a classroom for in-person learning.
“My husband takes medication for multiple sclerosis that weakens his immune system,” Craig said. “I just wasn't comfortable with the potential of me bringing COVID-19 back to my husband.”
She said there’s a saying within the school community that “you have to build up your immune system because children are always getting sick,” and she recalls multiple experiences of getting sneezed on and then coming down with something. “I just can’t take the chance,” she said.
Craig said she will also not be sending her 8-year-old son to school in the fall because as a child, he “cannot be as vigilant with keeping the germs away,” and that is something they can’t afford. “I wouldn't want him to potentially bring it home,” she said.
As Craig and her husband look to the future, they are trying to figure out how to navigate life amid a pandemic. She said her husband has also had to leave his job at a local nursing home in fear of catching COVID-19 and the couple is “heavily considering homeschooling.”
As some question the ability to do in-person learning safely, two prominent teachers unions called on leaders to start the 2020-21 school year fully remote.
The Illinois Education Association and Illinois Federation of Teachers, unions that represent nearly 240,000 school, college and university employees, released a joint statement Wednesday stating they will hold schools accountable in providing instruction safely, even if it means going to the courts or going on strike.
“We are working to ensure that any district providing in-person instruction in Illinois is prepared and able to abide by the safety measures outlined by the state, the federal government, and medical professionals,” the organization’s presidents wrote in the statement. “If those measures are not met, we will do everything we can to protect our students and those who care for them — teachers and professors, bus drivers, classroom aides, secretaries, building janitors and everyone in between.”
The organization's leaders noted teachers had to rebuild the public education system in a week when schools suddenly switched to remote learning, hand-delivered food and schoolwork, and dove headfirst into remote learning, and all they want is to be able to see and work with their students safely.
On Twitter: @brianmmunoz
On Twitter: @MollyParkerSI
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