COVID case at Potomac School shows communication shortfalls
November 5, 2020
POTOMAC – When Potomac School Principal John Rouse got the call from the Missoula City-County Health Department in mid-September that one of the students had tested positive for COVID-19, months of planning and policies were put to the test. Following the quarantine period, none of the 10 students or one teacher identified as close contacts exhibited symptoms or tested positive.
“We dodged a bullet,” said Rouse. “While I think we have a good plan, I don’t know it was our plan that did it. I think it was because we are small and remote.”
Rouse said Potomac School followed the guidance provided by the state, county and local school board that helped minimize risk as much as possible. However, there are policies surrounding the release of timely information about close contacts that he and other administrators would like changed at the state level.
“The issue is with restricting access to critical and timely information from those individuals at the school level who are faced with making hourly decisions that impact the safety of students and staff members in our schools,” said Rouse.
* * * * *
During the month of June, the Potomac School administration, staff and school board developed policies and procedures that provided the framework and guidance for reopening. Potomac School opened Aug. 26 with classroom instruction in place and an option for remote learning.
Per direction from the Potomac School Board including parameters from the Governor’s office and the public health department, Potomac staff and students practiced social distancing as much as possible by changing classrooms to accommodate the largest classes in the largest rooms and adjusting hallway traffic to avoid congestion. They also strictly enforced wearing face coverings inside and outside the building per the Governor’s Directive; checked students’, staffs’ and visitors’ temperatures before entering the building; provided opportunities for frequent handwashing and hand sanitizer use; restricted access to some playground equipment that does not allow for social distancing or frequent cleaning; added cleaning staff to daily disinfect classrooms and frequently touched surfaces; reduced or eliminated sharing of classroom supplies; and established classes as cohort groups that stay together and do not mix with other classes when they eat lunch, go to recess and have physical education classes.
“If you limit the interaction with those groups, you eliminate that propagation of the virus,” said Rouse. “When we have a class of six or eight it is much easier to do that [versus classes of 20-30 in larger schools].”
At the end of the third full week of school, Rouse was notified by the Health Department that a student tested positive for COVID-19. The student’s name was released to the school.
According to the Outbreak Response Protocols: K-12 released by Governor Steve Bullock’s Office in September, disclosure of information about a person who tests positive for COVID-19 is governed by the Government Healthcare Information Act (GHIA). This allows, in part, the disclosure of information to another state or local public health agency, to prevent or interrupt the transmission of a communicable disease.
School nurses are considered a public health agency who can receive such information. Schools that do not have a school nurse should designate a public health representative who may receive this information from the Health Department. Montana law allows a school nurse or public health representative to disclose information to the school’s principal in order for the principal to take the steps necessary to prevent or interrupt the transmission of COVID-19 in the school setting. However, schools must follow all federal and state protecting confidentiality of students’ records when communicating the presence of COVID among staff and students.
Missoula City-County Health Department COVID-19 Incident Commander Cindy Farr wrote in an email that the only time a student’s name is released to the school that they attend is if the student was attending the school while infectious and the contact tracer needs the names of students who may be a close contact. She added the county’s contact tracers can usually identify close contacts by just asking for seating charts without identifying the student.
After being notified about the positive case, Rouse and staff in contact with the student met with the Missoula County Health Department contact tracer who asked questions to build a close contact list. A close contact is defined as someone within six feet of an infected person, with or without a face covering, for a cumulative 15 minutes starting from two days before illness onset or two days prior to the positive test for asymptomatic individuals.
Rouse provided contact information for families that the contact tracer requested and then the county took over the contact tracing.
Farr said the contact tracing for students is just like anyone else. The contact tracer speaks to the parents, determines the symptom onset date, identifies the date the student became contagious and discusses where they were and who they were near during the infectious period. If the student was in school, they ask for seating charts and discuss what a typical daily routine looks like and identify close contacts.
On Monday, Rouse said they noticed students that they had named as being in close proximity with the positive case show up for school.
“We were puzzled,” said Rouse.
Rouse contacted the health department and asked since the staff identified these students.
“We were told they were working on it but they hadn’t gotten to everybody,” said Rouse.
While the school never released the name of the positive case, it didn’t take long for word to spread in the small community. Parents called Rouse asking him why they hadn’t been called by the County. Rouse told them that the County was doing the contact tracing and the school is not involved.
“It should not be incumbent on the school district people to become contact tracers,” said Rouse. “That is not our role,”
Rouse called the Health Department to check. He had his list and wanted to see if his list of close contacts was the same as the County’s.
“I was told they were not allowed to reveal the list of close contacts to the school,” said Rouse.
Farr confirmed that the County will not provide schools with a list of close contacts because it is private HIPAA covered information.
Instead, Rouse provided the name of the student in question to the County for comparison.
“The person looked at a list and said ‘Oh, well, we missed that one.’ That is not acceptable,” said Rouse. “I know they have a tough job and everyone out there is trying to do his or her best in their job. However, if they need more people to do it effectively then get the resources you need.”
Farr said that the County’s case investigation and contact tracing teams are staffed seven days a week.
“Our capacity to conduct [contact tracing] was great [in mid-September] as we were getting far fewer cases then,” wrote Farr in an email. “Our capacity is much more limited now as we are experiencing a spike in cases.”
Within the next couple of days, the County identified 10 students and one teacher as close contacts and instructed them to quarantine for 14 days. While the state said case investigations can take several days, Rouse did not feel students they identified in close proximity to the positive case were notified fast enough.
“It was frustrating,” Rouse said. “We are trying to do what we are suppose to do in terms of identifying kids like they asked us to do with the expectation that they would do their job and contact the families and those kids would be quarantined and not show up to our school. My responsibility is to try and keep the whole school open and not have other incidents and close contacts. There is a problem with the system.”
Potomac School remained open and the close contacts worked remotely from home. The students watched a live stream of their classroom and the teacher taught the lessons via computer while another staff member came into the room and worked in person with the students.
“We already had it in place and everyone knew the mechanism,” said Rouse who added those students who didn’t have a computer at home were provided one by the school.
Rouse said it worked well for most of the students who were older, more responsible and used to the online tools. However remote learning was more challenging for those in the younger grades or those without supervision at home to keep them focused and ensure they completed their work.
While he didn’t think it happened at Potomac School, Rouse agreed that it is possible that someone who was identified as a close contact continued to come to school because the County would not release the close contact list.
Farr said if someone believes that an individual should be quarantined and they are not following the direction from the County Health Department, they can report it by calling 258-INFO. One of the staff will follow up.
The Governor’s officer said that quarantine and isolation measures can be enforced through Montana Code Annotated Power and Duties of Local Boards of Health 50-2-116 and Power and Duties of Local Health Officer 50-2-118.
While some schools require documentation for a positive case or close contact to return to school, Rouse said the only documentation he saw was the date the positive case could be released back to school. To his knowledge all the close contacts and the positive case followed the direction of the County Health Department and none of the close contacts exhibited symptoms. While no one else tested positive, there was no requirement for close contacts to get tested at the time.
Rouse thinks that the combination of all the safety measures in place as well as limiting interactions to cohort groups helped limit the spread. He added that mask enforcement within the school has not been an issue.
However, Rouse would like to see more consistent communication and coordination between the federal level, state level and the local level. He said prior to the start of school he would sit in on several meetings a week. Then each level of government would send out their set of guidelines and there were differences.
“People in my role in the schools across the state are put in a situation where we are having to interpret it on our own because we are getting multiple interpretations,” said Rouse. “With regard to the [close] contact list, some of us are concerned about that not being [released to the school].”
To read the entire Outbreak Response Protocols: K-12 visit https://www.seeleylake.com/home/customer_files/article_documents/outbreak_response_protocols_k-12.pdf