Of the COVID-19 precautions taken by Clarke County School District, contact tracing is perhaps the most mystifying. Conducted by 21 school nurses and a district-wide team, it’s a necessary effort to keep CCSD healthy.
“We are at a level in our community where everybody is likely exposed to COVID every day at some point, if you leave your house. That’s where we are: widespread transmission,” Director of Nursing Services Amy Roark said. “Contact tracing is important because it determines who was exposed and could potentially end up testing positive.”
The process begins with notification of a positive test within the building, usually a phone call or email from a parent or teacher reporting that their child or they themselves are sick. Close contacts—individuals with whom the positive individual has been within 3 feet of for 15 minutes or more—are then alerted by phone call that they must go into precautionary quarantine for 10 days.
Elementary and Middle Schools
Spread is most localized at the elementary level. Subsequently, when a child tests positive, parents or guardians of their homeroom classmates are alerted. The Health Insurance Portability and Accountability Act (HIPAA) prevents divulging the positive student’s identity.
“That notification is like a general FYI to parents: ‘Hey, your child was not identified as a close contact, but we did have a positive case in this classroom. Please be diligent, please be aware of a possible expectation that they’re sick.’ We do that as a courtesy because we think that parents want to know,” Roark said.
Because of the increased movement of middle school students, a COVID-19 positive person’s entire grade level is sent the generic notification.
Close contact identification is largely done through seating charts in both elementary and middle schools. Howard B. Stroud Elementary seats students in the same group of four to a table in homeroom, as well as other classes like art and music and at lunch, according to school nurse Caroline Chambers.
“If there isn’t that organization and the kids are interacting with multiple students across the day, then that causes us to have higher numbers of quarantine and possibly spread of COVID in our schools,” Chambers said. “We really try to contain that by having structure.”
Nurse Barbara Bithell of Alps Road Elementary maintains a similar system of three to group. If one member of the table tests positive for COVID-19, the whole group is considered close contacts and quarantined.
“At least at the elementary level, our kids try to keep their mask on, but if I ask a teacher, I don’t know that they could solemnly swear that a kid kept their mask over their nose and their mouth the entire day,” Chambers explained. “For precaution, we really need to keep those groups together, and the parents to know that if somebody comes up positive in that group, that whole group is going to stay home.”
Though the nature of elementary school structure aids productive contact tracing, age poses difficulty. Bithell recently had to quarantine an entire pre-K class. They’re too young to understand social distancing, she said, and are all at risk.
CCSD students aren’t required to wear masks outdoors. Contact tracing does not extend to recess, but social distancing is often maintained.
“The teachers do a great job of encouraging kids to spread out on the playground and to alternate. They have their little timers and bells and whistles out there, and they’ll let group A on the swings for so long, and then they’ll swap out with group B, one on the slide and one on the swing,” Chambers said. “We do the best that we can. Nothing’s ever going to be 100%.”
Ages 12 and up are eligible to receive the Pfizer COVID-19 vaccine. Individuals who are fully vaccinated are exempt from quarantine, even if they are close contacts. Nurses can access a database that reports if students are fully vaccinated or not.
Tracing in the high school environment poses unique challenges that call for a different system. Rather than using seating charts, contact tracers pinpoint close contacts from the narrative of the positive individual.
“It’s really difficult to identify close contacts with the same accuracy as in the middle and elementary schools, so what we have been doing in the high schools is talking to the person who tested positive and asking them to identify any close contacts,” Roark said. “It may be a boyfriend or girlfriend. It may be somebody that they carpool with. It may be somebody that they have all of their classes with.”
At the beginning of the school year, contact tracers would email teachers and ask who they thought close contacts of a positive individual would be, which is allowed under HIPAA. The new system, Roark said, is more reliable and allows for privacy. Still, the sheer size of high schools, along with mobility of older students and frequent out of class interaction, makes for a complex task. Lunch, transportation, sports, extracurriculars and social life simply can’t be accounted for by seating charts.
“We are definitely contact tracing in our elementary and our middle schools. In the high school setting, we are doing the best we can,” Roark said.
The high school system is adopted for contact-tracing teachers of any grade. A general notification is sent to the teacher’s students, and then the teacher is responsible for sharing what students or staff they have been in close contact with.
Though school nurses manage the bulk of contact tracing for their individual schools by themselves, they have help. A district-wide contact tracing team, including retired school nurses and University of Georgia public health students, recently trained in contact tracing steps when necessary.
“I believe in contact tracing, and that’s why we’re doing it. We are working truly around the clock to conduct it,” Roark said. “But there is a point where the spread is exponential, that it feels like you’re trying to play catch up, and that’s why we had brought on additional staff members to support our contact tracing efforts.”
High schools completed virtual instruction the week of Sept. 7-10, in part to let nurses catch up on contact tracing, with plans to resume this week. CCSD has had more than 600 COVID-19 cases since classes started at the beginning of August. As of late last week, 1.9% of students and staff were in quarantine.
Roark said contact tracing is working so far—many of those put into precautionary quarantine are testing positive and, because of contact tracing, aren’t at school to spread it.
“Everybody needs to give their colleagues, their friends, their students and the parents some grace, and know that everybody is working really hard right now to keep our schools open. There are no perfect processes, but we believe that contact tracing is worth doing if it prevents some people from getting sick, and that’s exactly what we’re doing,” Roark said. “School nurses are working triple time right now. They are really committed individuals to their schools and to their students. I just hope that our community realizes what a value and what a resource our school nurses are.”
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