By Jacqueline Howard, CNN
Getting children back in classrooms has been a top priority for the United States — but if a coronavirus outbreak were to happen within a school, how should schools respond?
Drew Charter School in Atlanta kicked off the new school year last week and already has reported initially nine students and five staff testing positive for Covid-19, and more than 100 students at the school are in quarantine, Peter McKnight, the head of the school, said Friday. Only one of the five staff members who tested positive had been vaccinated, he said.
The school initially informed parents in a letter Thursday that two staff members and a student had tested positive.
The school said it was “working closely with local public health officials to ensure we follow the proper recommendations to quarantine.”
On Friday afternoon, McKnight revised the number of positive cases in a statement and said discussions about a staff vaccination mandate were underway.
Health departments may step in
Institutions must respond quickly — with contact tracing, testing, the quarantining of people who were exposed to the virus and the isolation of people with infections, Dr. William Schaffner, a professor at Vanderbilt University School of Medicine and medical director of the National Foundation for Infectious Diseases, told CNN.
“The first thing that would happen — or one of the very first things — is that you would notify the health department,” Schaffner, who is not associated with the Drew Charter School, said about a potential outbreak.
“They likely would do a fair amount of testing,” Schaffner said.
“The larger community would find out what was going on, and that there was a response to provide some reassurance in that regard,” he said. “And in this context, a local health department may actually get some help from the state health department — send in personnel and other health department folks who could help with the testing, or perform the testing.”
Overall, testing would play a big role in responding to an outbreak — as well as local health departments.
Some schools may turn to certain resources — such as the online tool whentotest.org, which is supported by the National Institutes of Health’s RADx Tech program — to help with implementing an effective Covid-19 testing program for their institution to either prevent or respond to an outbreak.
At Drew Charter School in Atlanta, five Covid-19 cases were detected before the start of the school year on Tuesday following the testing of about 1,900 students and staff, according to McKnight, the head of the school. All staff and employees are tested weekly, and students are highly encouraged to also participate in weekly testing through the school.
“The best way to contain outbreaks that do occur in schools is to detect them early so that you can stop the outbreak before it becomes widespread. The goal is to prevent disease with the least disruption to education,” Dr. Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah, wrote in an email to CNN.
If an outbreak is confined to a classroom or team, people who had “significant exposure” initially may quarantine but “that does not necessarily include everyone if masks are worn at all times and there is adequate distancing which limits exposure,” Pavia wrote.
Whether masks and other mitigation measures are required or enforced in schools varies across states and school districts. At Drew Charter in Atlanta, for instance, all staff and students are required to use their masks at all times, except when eating or drinking.
“We now have the knowledge and the tools to prevent most school outbreaks, and those schools that use them are likely to do well. Sadly though, the trend in many jurisdictions seems to be not to use these effective tools to allow safe in-person learning,” Pavia wrote in his email.
“The least desirable approach is to close the entire school for 10 days and use testing to allow return to learning,” he wrote. “But, if safety measures are not in place before the outbreak, it may spread rapidly and that may be your only tool.”
Those who were exposed to the virus and tested would have to quarantine until their results determine whether they have Covid-19, and if they do, they would need to isolate until they are no longer infectious.
For instance, “when we are aware that an individual has Covid, they are required to have a 10-day break from school to be able to return when they’re symptom-free, when they’ve had a negative test or 10 days after that positive test,” Mark Lane, superintendent of Decorah Community School District in Iowa, where state law blocks mask mandates in schools, told CNN’s Victor Blackwell last week.
However, again, rules can vary across districts.
Lane said if students are in quarantine the school will offer virtual supports. He said students and families are not required to disclose if someone in their household has Covid-19 — but they are encouraged to stay home from school if they experience symptoms.
Outbreak plans vary ‘state to state and school district to school district’
In Tennessee, Metro Nashville Public Schools will follow the same protocol that was followed last year for Covid-19 cases, Sean Braisted, a spokesperson for Metro Nashville Public Schools, told CNN in an email.
“Metro Nashville Public Schools partners with the Metro Public Health Department for our school nurse program. As they did last year, school nurses will conduct contact tracing in the event a student tests positive for COVID-19 and those students or staff who are unvaccinated and deemed to be a close contact will quarantine based on CDC guidelines,” Braisted wrote.
“Students who are required to quarantine or self-isolate will have the opportunity to do class work remotely and receive online assistance through our MNPS Virtual School in order to be counted present for the school day.”
In Colorado, the nursing and student health services team at Denver Public Schools is still developing plans and protocols with help from local health officials for the upcoming school year, Will Jones, a spokesperson for the school district, told CNN in an email last week.
Seattle Public Schools in Washington has Covid-19 site supervisors in place to help identify the close contacts of a Covid-19 case within a school, Tim Robinson, a spokesperson for the district, wrote in an email to CNN.
The school district’s protocol includes contacting people who may have been exposed, providing recommendations on testing and remaining in quarantine, and consulting with public health officials, among other steps.
Outbreak response plans can vary state by state and school district by school district, Kim Anderson, executive director of the National Education Association, told CNN.
“From what we understand, it does depend on what district you are in. The district should have very well thought-out outbreak plans that have included the voices of educators and parents and community members in the crafting of those plans, and they should have plans that follow the CDC recommendations,” Anderson said.
“Our recommendation to all students and school districts is to follow the medical experts and follow the CDC. Follow what the medical experts are telling us is the pathway to keeping our students and our educators and our community safe,” she said. “But in reality, it does vary from state to state and school district to school district.”
What the CDC recommends
With an internal CDC document revealing on Thursday night just how easily the highly contagious Delta variant can spread among both vaccinated and unvaccinated people, there has been renewed focus on what plans schools have in place in case of a potential outbreak.
The document notes that the Delta variant can be as transmissible as chickenpox and one infected person could spread the variant to about five to nine other people on average — whereas, with the original strain of the coronavirus, one infected person could spread it to two to three people on average.
Given new evidence on the variant, CDC updated its guidance for fully vaccinated people last week, recommending that all teachers, staff, students, and visitors to K-12 schools wear masks indoors, regardless of their vaccination status.
“Children should return to full-time in-person learning in the fall with layered prevention strategies in place,” says the CDC’s guidance for K-12 schools. “Though Covid-19 outbreaks have occurred in school settings, multiple studies have shown that transmission rates within school settings, when multiple prevention strategies are in place, are typically lower than — or similar to — community transmission levels.”
The guidance adds that parents or other caregivers should report when a child is newly diagnosed with coronavirus infection.
If a Covid-19 case is confirmed, the CDC notes that schools can help public health officials determine which close contacts and others exposed to the infected person should be tested and quarantined.
The CDC also offers a Covid-19 diagnosis flowchart detailing what to do if a student becomes sick or reports a new Covid-19 diagnosis at school, and the agency notes that the ill student can return to school and end isolation once there has been 10 days since the start of their symptoms, they have been fever-free for a day without the use of fever-reducing medication and their symptoms have improved.
The steps needed to control a Covid-19 outbreak within a school would be similar to steps taken for any outbreak of a communicable disease in a school, such as measles, Schaffner said.
One significant difference is that across all 50 states, measles vaccinations are among the routine childhood vaccines generally required in public schools. However, most schools do not require coronavirus vaccinations — and some states even block schools from making such mandates.
A CNN analysis has found that, as of last week, at least nine states — Alabama, Arizona, Arkansas, Florida, Indiana, Montana, Ohio, Oklahoma and Utah — have enacted legislation this year that would restrict public schools and universities from requiring either coronavirus vaccination or documentation of vaccination status.
Once vaccinations were required for measles, “transmission in schools absolutely stopped, and then it went down to zero,” Schaffner said, adding that when it comes to coronavirus vaccines, “it’s so important for children older than 12 — they are the ones currently eligible for vaccine — to be vaccinated.”
A CNN analysis found last month that fewer than a third of 12- to 17-year-olds are on track to be fully vaccinated against Covid-19 in the next two weeks.
“We don’t have the number of individuals vaccinated that are needed in order to control Covid,” Dr. Tina Tan, a professor of pediatrics at Northwestern University’s Feinberg School of Medicine and a board member for the Infectious Diseases Society of America, told CNN on Monday. She added that’s why the same protocols to respond to outbreaks before vaccinations became available should be followed now, even after vaccinations have become available.
‘School outbreaks seem inevitable’
There is growing concern about the risk of Covid-19 outbreaks in schools this fall, as some outbreaks already have occurred in summer camps in recent months, all while the more transmissible Delta coronavirus variant continues to circulate across the United States.
A parent whose children attend Drew Charter School in Atlanta said he had anticipated positive cases given the recent rise in Covid-19 and the spread of the Delta variant. CNN agreed not to publish his family’s surname because of the sensitivity of the situation.
The timing of the positive tests was concerning, said Brandon, the parent.
“We’re just going back,” he said, “so it makes you on edge.”
The parent said he would have preferred if only vaccinated students and staff had been allowed to return to school.
Brandon said the school doesn’t require teachers be vaccinated.
“I figure they shouldn’t be in the school if they’re not vaccinated,” he said. “That’s why they should have held off until we got everything under control.”
Brandon said his daughter learned at school Friday that classmates had been asked to quarantine. It’s unclear if any of Brandon’s children at Drew were in close contact with those who tested positive, but he said his children would stay home as a precaution.
He said his daughter is eligible for the vaccine and expects to get the shot soon.
His daughter, who left school to return home on Friday, told CNN she had been excited about the start of in-person learning because online study was challenging.
‘We should be able to contain outbreaks to a minimum’
“With the incredible contagiousness of the Delta variant, limited mask use, and low vaccination rates in some jurisdictions, school outbreaks seem inevitable,” Pavia wrote in his email. “I am very concerned for the impact that will have on children’s education.”
Other public health experts have expressed some concern as well for the communities surrounding schools, if mitigation measures are not followed.
“We can anticipate — because of the extraordinarily contagious Delta virus and because such a large proportion of our population is still under-vaccinated — that there will be sustained transmission of Covid, and there could well be local outbreaks,” Schaffner said. “I think we will see those kinds of outbreaks occur.”
As long as mitigation measures are followed, schools can reduce the risk of an outbreak even if there is a Covid-19 case in the school because masking, physical distancing and other measures will help control any spread, said Dr. Nathaniel Beers, who serves on the American Academy of Pediatrics’ Council on School Health and is president of the HSC Health Care System in Washington, DC.
The American Academy of Pediatrics released new Covid-19 guidance for schools last month that supports in-person learning and recommends universal mask use in school by everyone over the age of 2, regardless of vaccination status.
“We will certainly see cases in schools, because there continues to be spread in the community, and so certainly, we expect that within the staff population as well as student population, there will be cases,” Beers said. “If schools implement the recommendations that the AAP and CDC have made … then we should be able to contain outbreaks to a minimum.”
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Natasha Chen, Kevin Conlon, Alta Spells and Erica Henry contributed to this report.