Health departments meet with local schools

Wednesday, August 5, 2020

Sharing information, plans a priority as school is set to begin

More than 30 people from school districts in Barry and Lawrence counties, including superintendents, administrators and school nurses, met with the administrators of the counties’ health departments Monday for a question and answer session regarding plans to return to school this month amid the COVID-19 (coronavirus) pandemic.

Roger Brock, Barry County Health Department administrator, Janella Spencer, Lawrence County Health Department administrator, and Tana Bradshaw, Lawrence County Health Department health educator, answered most questions, and Barry County Emergency Management Director David Compton was also present to answer questions.

Much of the conversation focused on things like athletics and extracurricular events, how the health departments would handle contact tracing, how school districts should handle students showing symptoms, masking and personal protection equipment, and other questions regarding handling pandemic fallout.

As of Thursday, Barry County reported 206 total cases of COVID-19 with 53 active cases in isolation, none of whom are hospitalized, and 170 recovered. A total of 132 close contacts were quarantined, and two people have died.

Lawrence County on Friday had a count of 183 total cases, including 38 active cases and 143 recovered. Lawrence County has also had two deaths.

In Barry County, 32 of the total cases (16 percent) are school-aged youth 18-and-under. Bradshaw said the Lawrence County Health Department does not have the staff available at this time to break cases down by age.

Brock said the goal of Monday’s meeting was to get everyone in the same room and talk about going back to school and get everyone on the same page.

“Quarantine and isolation will probably be the major questions, and we will face some challenges,” Brock said. “We absolutely have community spread. There is not a location in Barry County on the map that does not have a case.”

Brock said a Centers for Disease Control team was in southwest Missouri about three weeks ago and projected a peak in cases in the county at about the second week of August. According to the Missouri Department of Health and Senior Services, Barry County has a rate of 638.13 cases per 100,000 population, and Lawrence County has a rate of 490.11 per 100,000. Surrounding counties’ rates, from greatest to smallest, include: McDonald, 4,021.15; Jasper, 1,563.05; Newton, 1,567.88; Joplin city, 884.38; Greene, 420.66; Christian, 325.35; Stone, 274.02; and Dade, 198.18.

Brock said it is highly likely for cases to appear in schools, and the health departments will use their contact tracing methods to determine how students, staff and parents will be handled.

Positive cases are put in isolation, which is a 10-day window to recover from the virus after testing positive. A person in isolation is not allowed to come out of it until after 10 days and 24 hours symptom free, with no use of fever-reducing medications. Close contacts will be defined as any person who was within six feet of a positive case for more than 15 minutes over a short period of time. Those people will be placed in quarantine, which is a 14-day period that begins when the contact was last near the positive case. For those in the same household, the 14 days would begin after the isolation ends and a positive case is recovered.

If a student is sent home as a close contact, Brock said the quarantine does not extend to family members. They would only be quarantined if the child later tested positive, thus turning the family members into close contacts.

“No one wants to put anyone in isolation or quarantine, but this is a very contagious bug,” Brock said. “We have no natural immunity to this virus, and we can agree or disagree on that, but for most people, even with a strong immune system, it takes a few days to recognize a virus and catch up. With the flu, it’s something our body recognizes and we can catch up quickly because the body is adapted to it. With COVID, if you have a good immune system, you can fight it and be asymptomatic, but if you have a poor immune system, it will put you in a really bad way.

“We didn’t ask for any of this, and we are dealing with it as best we can, and sometimes we will have disagreements over the approach. We have to try to do the best we can to work together.”

The initial questions at the meeting surrounded sports and extracurricular activities. The health departments advised schools to instruct coaches and extracurricular clubs and activities, everything from football to band to science club, to keep athletes in groups of no more than 10 during practices and meetings, and create an informational sheet of who is in each group and their parents’ names and contact information.

“If we have a positive, we will need all that information [immediately] and not two days later,” Spencer said. “The more time it takes to contact and isolate and quarantine, the bigger the circle of contacts can get. That can make a big difference as to how many will be quarantined.”

Brock said splitting into smaller groups may also keep from having a whole team quarantined should a positive case arise.

“The trigger [for shutting down a whole team] will be up to the school and how many [participants] are left after the contact tracing is done,” Brock said. “We are not looking to shut down anyone’s season or activity. We want kids to participate and to be in school.”

Brock and Spencer also said masks are good tools in general for preventing spread, but they do not play a factor in the quarantine or isolation decisions.

“We have no mechanism within our CDC guidelines to account for masking when determining isolation and quarantine cases,” Brock said.

“It’s a good idea to wear masks [for safety], but they are not used for isolation or quarantine purposes,” Spencer said.

Brock said the health department recommends masking for everyone to lessen community spread, but there is no state order to mask, so schools will have to make those protocols individually.

Brock and Spencer did suggest districts require masking while changing classes, as that could potentially slow any transmission should a contagious person sneeze or cough into a mask in the hallway versus into the open air.

Spencer said in the case of the Aurora football team player who tested positive, she and the coach discussed nearly every detail of two days of practice, including at some points what play was run and how long the play lasted. The health department and coach agreed if a second case were to be found, the team would shut down. Spencer said that was an on-the-fly rule in that situation.

“We have to take the coach’s word the kids were not within six feet for 15 minutes, and the idea to shut down the team upon a second case was an on-the-fly policy,” she said. “Our main goal was to notify all the parents and have them watch for symptoms and limit social contact.”

During games in the fall, should they occur, Brock and Spencer said there is a possibility for athletics to be affected. They said in the case of football, if an athlete played in a game while contagious, anyone who tackled that player would likely have to be quarantined. Such situations would affect both schools once things like huddles and tackling are taken into account.

“We can go through all the semantics and the ‘what ifs,’ but more than likely if there’s a positive case [contagious during a game], the 15 minutes within six feet rule will ultimately be met,” Brock said.

It was noted the athletic directors of all schools in the Big 8 Conference are set to meet Monday to discuss how they should handle sports.

Moving away from sports, another question was asked about if a positive case tested negative before the end of the isolation or quarantine, would the person be allowed to return to school. The answer from Spencer and Brock was a definitive no.

“Per CDC guidelines, a negative tests does not constitute release from the 14-day window of being infectious,” Brock said.

Bradshaw said the 2-14 day incubation period has proven a strong timeline in Lawrence County, as some positive cases did not show symptoms until day 13 of the window.

“The flu is a 1-4 day [incubation] period and COVID is a 2-14 day [incubation] period,” Bradshaw said.

As far as when to send a student home for showing symptoms of COVID-19, the health departments said those decisions will be at the individual school districts’ discretion. Health departments will only become involved in the case of a positive diagnosis and will perform contact tracing.

One school nurse at the meeting said in the course of a day, she may see 50 children with a headache and upset stomach, both of which are symptoms. Brock said in those cases, whether or not to send a student home will be based on guidance from a district or school board, and there are no mandates from the health department. Spencer said she expects at some point, there will be more guidance for those scenarios. They did recommend students with a fever of 100.4 or above be sent home.

“We have to err on the side of caution, and there are so many gray areas,” Bradshaw said. “It will be a rocky road.”

Spencer said it would be a good idea for districts to ask those showing symptoms if they were recently tested or anyone in the immediate family was recently tested. Ultimately, she and Brock said nurses should use their best discretion when deciding how to treat any students with symptoms.

Some at the meeting asked about PPE, as well, and the health departments suggested masks with face shields and eye protection. Some districts discussed buying face shields for teachers instead of masks, but Spencer said face shields should only be used on top of masks, not in place of them.

Some districts had purchased a mask-shield combination set with a clear mask so students could see the teachers’ mouths during lessons. Another person at the meeting said a child who had seen one used in a classroom said the masks were prone to showing spit and fogging up, which students found to be off-putting.

The meeting between districts and the health departments was held at the Monett High School Performing Arts Center, allowing for everyone to social distance. Almost everyone at the event was also wearing a mask, and those who were not were socially distanced and had one available if needed.

Most schools are set to open for classes on Aug. 25.

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