Tens of thousands of children and adults are scheduled to start filling school buses, hallways and classrooms here next month.
What will happen when some of them test positive for COVID-19? Or when one of their family members test positive?
Will the public be notified? Will all parents and staff members be notified? Only some? Any?
Who will be responsible for making those notifications?
Who will be responsible for identifying and notifying the “close contacts” of students and staffers who test positive?
Who will determine whether and when an infected classroom, hallway or entire school will be closed? And for how long?
That’s true even as many faculty and staff already are reporting to work in those buildings.
A review of reopening plans submitted by opens in a new windowShelby County, opens in a new windowArlington, opens in a new windowBartlett, opens in a new windowCollierville, opens in a new windowGermantown, opens in a new windowLakeland and opens in a new windowMillington school districts shows the answers to those and other vital questions are vague or yet to be determined.
The reality of reopening school buildings and college campuses is that any missteps could cost lives…
Those public health protocols, along with other coronavirus prevention procedures already announced, will be crucial in controlling the spread of the virus as schools reopen.
That’s especially true in a county where the public health system is struggling to test, trace and control the highly infectious coronavirus.
Where the number of COVID-19 cases and related deaths continue to rise.
Where a large majority of public schools serve students who live in homes and neighborhoods that are more vulnerable to COVID-19. African Americans and Latinos represent about 60% of Shelby County’s population, more than 80% of its COVID-19 cases, and more than 90% of SCS, ASD and charter school students.
“We are still drafting the internal flow chart of decisions and working closely with the health department to guide our practice,” Jerica Phillips, chief of communications for Shelby County Schools. ”The Health Department has indicated that they will be sharing additional COVID-19 guidance/protocols with all Shelby County districts ahead of the start of school in August.”
Where up to a third of all public school teachers and staff members are in high-risk categories for the disease.
“The reality of reopening school buildings and college campuses is that any missteps could cost lives, particularly among our most vulnerable students and in Black, brown and poor communities,” said Lily Eskelsen García, president of the National Education Association.
Masks, Screening and Closings
Shelby County Schools and six suburban school systems (with a combined enrollment of about 140,000 students) released their reopening plans last week.
The Achievement School District (about 9,000 students) and most local public charter schools (about 18,000 students) are still working on their reopening plans.
All school systems have until Friday to submit their final plans to the state Department of Education for review and approval.
The SCS and suburban plans include details on start and end dates, holiday schedules and in-school and at-home options.
They also include guidelines for screening, masking, sanitizing, cohorting and other coronavirus precautions.
All of those guidelines are subject to change.
“We want to note that this opening plan is subject to change based both on the health situation in Shelby County and changes in guidance or orders from the Shelby County Health Department; local, county, or state government; or state or federal law,” says the Lakeland plan.
All districts except Millington will require students to wear face coverings when they enter and exit buildings and wherever social distancing can’t be accomplished.
“Currently, all students (grades 3-12) and staff are required to wear a facial covering (for example, mask or shield) when 6-feet of social distancing protocols cannot be maintained,” says the Collierville plan.
All districts except Shelby County will rely on parents to screen their children for COVID-19 symptoms before sending them to school, some via an online check-in system.
“GMSD will partner with families to complete daily at-home symptom screening for all students. Schools will monitor that parents are completing symptom screenings via an online check-in system,” says the Germantown plan.
Shelby County Schools say they will check the temperatures of all students, staff and visitors who enter each school every day.
“We will not administer or require COVID-19 tests of employees or students. However, we will check temperatures and ensure that people inside our schools and office buildings are symptom-free. We will also strongly encourage all students and staff who are not feeling well to stay at home,” says the SCS plan.
All systems will rely on parents to have their children tested for COVID-19, if necessary, and to notify the school if their child might or does have the highly infectious disease.
All systems will rely on parents to keep their children home and isolated for 14 days, and not send them back to school until they have been symptom-free for three days.
All systems will rely on students, teachers and staff to stay home if they are sick.
“If an employee has a confirmed diagnosis of COVID-19, the employee must contact a principal or immediate supervisor. If a student has a confirmed diagnosis of COVID-19, the parent is strongly recommended to contact the school nurse so we can take appropriate action within our buildings,” says the Collierville plan.
Only three of the seven plans mention anything about protocols for closing schools or parts of schools when COVID-19 has been detected.
“On a case-by-case basis, situations may occur in which an entire class, cohort, or school building will transition to distance learning to allow for quarantine. These decisions will be made in partnership with the Shelby County Health Department,” says the Germantown plan.
The Shelby County plan says only that a COVID-19 case “may result in the temporary closure of school buildings or offices for two to five days. At a minimum, in the event of a confirmed case, the District may close off portions of an entire office or building for a period of 24 hours and allow for additional cleaning/disinfecting before reopening.”
The Arlington plan is the most direct about potential school closings.
“A decision will be made regarding a classroom or school building closure to allow for disinfection, based on the information provided by the reporting party as to time, exposure to others, etc. If the classroom or building must be closed, parents will be notified through the ACS phone/email notification system. If the entire building is closed, students will shift to remote instruction immediately.
“Everyone must be prepared for intermittent closures. Parents must have plans that can be activated immediately if there is a school closure or if their children are not able to attend school because of a quarantine situation. Parents are urged to be prepared to change plans within 24 hours if needed. If there’s a widespread outbreak of it schools are forced to close again, parents must ensure they have contingency plans for their households.”
Plans submitted by Bartlett, Germantown, Lakeland and Millington don’t mention the possibilities of closing at all.
Testing the public health system
The Shelby County Health Department will play a key — but as yet undetermined — role in keeping students, teachers and school staffers safe from harm.
All systems say they will rely on the health department to confirm positive COVID-19 cases and identify and trace “close contacts” of those who test positive.
“Schools are not expected to screen students or staff to identify cases of COVID-19. Contact tracing and exposure information will be gathered by the Shelby County Health Department and communicated to the appropriate individuals and administrators, as required,” says the Collierville plan.
“While we acknowledge that testing and contact tracing are essential tools in the epidemiological response to the pandemic, testing and contact tracing are solidly in the domain of health professionals, not the District,” says the SCS plan.
The health department plans to do that.
“If there were a case in a K-12 school, the Health Department’s COVID-19 Response Team would investigate,” said Joan Carr, the department’s public information officer.
Given the increasing number of local cases, that will be difficult and might be impossible, said Dr. Jeff Warren, a physician, City Council member and former school board member.
“Our testing and tracing system is overwhelmed right now with the increase in community transmission,” Warren said.
Local COVID-19 test results are being delayed up to a week or longer by backlogs and supply shortages at local labs, federal government decisions about where supplies are sent, and bureaucratic requirements that results be sent to the state health department first.
Those delays have kept dozens of local hospital beds filled with patients waiting for test results before they can be sent to nursing homes.
Those delays also have made it even more difficult for the Shelby County Health Department to identify, notify and monitor all positive cases and their “close contacts.”
So far, only about 60% of Shelby County’s more than 15,000 COVID-19 case investigations have been completed.
The longer COVID-19 cases go untested and unidentified, the more likely the virus will spread.
“We can’t wait a week or longer to find out if someone has tested positive, and then several more days to trace all of their contacts,” Warren said. “We need that information within 48 hours to be effective in controlling the spread.”
It’s not just a Memphis problem.
Two months ago, the federal government took opens in a new windowcontrol of distribution of COVID-19 testing supplies to states. That left private suppliers like opens in a new windowRoche, Cepheid and others with fewer supplies. Local labs like AEL, supplied by Roche, lost up to a third of their capacities.
As community transmission increased, so did the demand for testing. Shelby County has seen the average number of COVID-19 cases more than double in less than a month.
As testing increased and supplies declined, results were further delayed.
Local labs have received FDA permission to start “pooling” lab results. That could dramatically improve testing results times decrease costs.
But at the moment, testing positivity rates are too high for results to be pooled safely. Those rates are running 10-15 percent a day, and need to be under five percent.
“We’ve got to get the community transmission under control before school starts, and that means getting the masking, testing and tracing we need to do that,” Warren said. “The health department can’t do this alone.”
Who will be notified?
All of the reopening plans say that “close contacts” will be notified about positive COVID-19 cases as soon as possible.
But none of the plans explain in more than vague or general terms who else will be notified — if anyone — when a student or staff member tests positive for COVID-19.
Some say parents will be notified when a classroom or school will be closed due to the virus.
None of the plans say all parents or staff members will be notified of a COVID-19 case in the building.
Shelby County’s plan says, “We will closely monitor the conditions and keep everyone informed.”
Informed about what? It doesn’t say.
“When a school experiences exposure to the virus, the District will consult with public health officials to determine if the school needs to close completely or if a portion of the school needs to be blocked off for deep cleaning,” the SCS plan says.
“It is imperative to community health that the District be made aware of any student or staff member that has tested positive for COVID-19. Positive or suspected cases will be confirmed with the local Department of Public Health who will assist with developing recommended next steps based on the level of potential exposure.
“According to the most recent guidance from the SCHD, those who may have come in close contact with a confirmed case will be directed to self-isolate and self-monitor for potential symptoms. Depending on the extent of positive cases within a school, a school may need to close for up to two weeks and then stagger student attendance upon restarting.”
Germantown’s plan says only direct contacts will be notified. “Standard health procedural letters will be sent to notify parents if students or staff have come in direct contact with individuals who tested positive for COVID-19,” the plan states.
Collierville’s plan briefly mentions notifying “the appropriate individuals and administrators” of exposure. “Contact tracing and exposure information will be gathered by the Shelby County Health Department and communicated to the appropriate individuals and administrators, as required. District Central Office staff and schools will work with the local health department to report suspected and/or confirmed cases of COVID-19 and assist with contact tracing upon request.”
Arlington’s plan says parents will be notified by phone or email, “If the classroom or building must be closed” due to the virus, but not about any particular COVID-19 cases.
Reopening plans from Bartlett and Lakeland promise more details to come.
“BCS will follow the ‘BCS Reopening Health Guideline Plan’ to be released.”
“Lakeland School System will follow the ‘Lakeland School System Safer at School Health Guidelines’ which can be found at the end of this document. So far, that’s just a “symptom screening checklist.”
Millington’s plan doesn’t mention anything at all about those who test positive and those who will be notified.
“Those protocols need to be in place before school opens,” Dr. Tina Tan, professor of pediatrics at the Feinberg School of Medicine at Northwestern University, said Thursday in a webinar hosted by the Infectious Diseases Society of America.
“You don’t want to find yourself in a situation where you don’t know what to do when someone is diagnosed with COVID. It’s not just about masks, cohorts and social distancing.”
Federal, state guidelines
Clues about how local schools might handle COVID-19 cases on campus can be found in recent directives from federal and state health agencies.
The lengthy guidance includes only one brief section on notifying the public of any case of COVID-19.
“In accordance with state and local laws and regulations, school administrators should notify local health officials, staff, and families immediately of any case of COVID-19 while maintaining confidentiality in accordance with the Americans with Disabilities Act (ADA).
“Inform those who have had close contact with a person diagnosed with COVID-19 to stay home and self-monitor for symptoms, and follow CDC guidance if symptoms develop.”
The CDC is expected to issue additional guidance next week. The information will contain resources and information for schools and families on working toward “safely opening schools this fall.”
Dr. Deborah Birx, who serves on the White House Coronavirus Task Force, told reporters last week that every school district should have a detailed plan in place for what to do when a student or staff member tests positive for COVID-19.
“They need to know what they’re going to do when they find one case, when they find five cases,” opens in a new windowBirx said.
Last week, the Tennessee Department of Health released a “ opens in a new windowHealth Matrix” to help guide local schools in how to respond to COVID-19 cases.
The matrix is divided into three categories, based on whether the local community’s spread of the virus is low, moderate or high. It doesn’t define those terms.
Within each of those categories are guidelines to follow (1) if there are no COVID-19 cases in the building, (2) for every identified case, (3) for two or more unlinked cases — no common classes, friends or teammates, (4) linked cases within 14 days, and (5) increasing numbers of cases within 14 days.
Next, officials must determine whether infected persons have been in the school for at least two days before the onset of symptoms, where they’ve been in the building, and who they’ve had “close contact” with.
The state health department defines a close contact as someone who has been “within 6 feet of the infected individual for 10 minutes or more at any time within 48 hours before the individual’s onset of symptoms until the individual has left school property.”
As the number of cases rise, so does the severity of the response.
The least severe response: “Notify local public health. Close CLASSROOM for 24 hours for cleaning and until the school has identified close contacts. Exclude contacts from the building for 14 days. Reinforce prevention measures. Reopen CLASSROOM.
The most severe response: “Minimum 14-day BUILDING closure unless circumstances dictate otherwise. Consult local health department for guidance.”
The matrix doesn’t mention reporting COVID-19 cases to anyone other than the local health department and “close contacts.”
Privacy rights and public health
Late last month, the state health and education departments distributed an eight-page list of “ opens in a new windowrecommendations for the management of COVID-19 in schools.”
“Staff and families should be aware of the school’s plan of action when an individual in the school is showing signs or symptoms or has been diagnosed with COVID-19,” it says.
Important elements of such a plan should include:
• Notify the emergency contact of the ill individual. If the individual is deemed stable, ask that they be picked up from school. If the individual requires emergency medical attention, call 911 and inform them of the situation.
• Contact your county health department to notify them of a suspected or confirmed case of COVID-19.
• Identify those who have been within 6 feet of the individual for 10 minutes or more at any time within 48 hours before the individual’s onset of symptoms until the individual has left school property. Those individuals will be required to self-quarantine for 14 days from their last exposure to that individual.
The directive doesn’t say who is responsible for doing that.
• Clean and disinfect areas where the ill individual has been while in the building.
The CDC and other agencies recommend that those areas be closed for at least 24 hours before the cleaning begins.
• Consider assigned seating and cohort classes to minimize crossover among children and adults. Consider cohorting middle and high school students with students enrolled in a similar academic track. (e.g., students taking Advanced Placement classes also take other classes together).
All districts are considering some form of that.
“When applicable, students will stay in their assigned classrooms while teachers will move from classroom to classroom to deliver instruction rather than having students move from class to class (this model will be different for high school students),” says the Bartlett plan.
“When reasonable and appropriate, schools will make every effort to limit the movement of students on elementary and middle school campuses. This means a group of students, a cohort, will be assigned to a classroom for the majority of the school day. Instead of the student traveling from classroom to classroom for special activities or other classes, the teachers rotate from one classroom to another.
Cohorting practices may vary from school to school,” says the SCS plan.
Only one of the state’s 94 recommendations mention notifying all parents and staff, and that only vaguely.
• Draft call messages and letter templates to use to communicate with parents and staff after a case has been confirmed in the school. Ensure communications conform to HIPAA and FERPA regulations.
Several school reopening plans mention one or both of those federal laws that protect the security and privacy of certain health information.
But according to the federal government, HIPAA rules (Health Insurance Portability and Accountability Act) don’t apply to students.
”Because student health information in education records is protected by FERPA, the HIPAA Privacy Rule excludes such information from its coverage,” the U.S. Department of Education explained in a opens in a new windowletter in March.
FERPA is the Family Educational Rights and Privacy Act.
“Nothing in FERPA prevents schools from telling parents and students that a specific teacher or other school official has COVID-19 because FERPA applies to students’ education records, not records on school officials. However, there may be State laws that apply in these situations,” the letter states.
“For example, school officials may determine that it is appropriate to disclose identifiable information about of a student with COVID-19 to parents of other students if parents need to know this information to take appropriate action to protect the health or safety of their children.”
When it comes to public health, HIPAA rules don’t seem to apply to school employees either.
“The HIPAA Privacy Rule recognizes the legitimate need for public health authorities and others responsible for ensuring public health and safety to have access to protected health information that is necessary to carry out their public health mission,” according to the opens in a new windowHIPAA Journal.
“If the educational agency or institution determines that there is an articulable and significant threat to the health or safety of the student or another individual and that certain parties need the PII from education records, to protect the health or safety of the student or another individual, it may disclose that information to such parties without consent.”
So far, no national, state or local parents or teachers organizations have taken a stand on who should be informed when someone in a school tests positive for COVID-19.
“We urge all schools and institutions of higher education to follow the CDC guidance advising that individuals be informed if they have been exposed. That includes educators, students and their families,” said Donna Harris-Aikens, senior director for education, policy and practice for the National Education Association.
Danette Stokes was the only teacher on the 15-member committee that developed Shelby County’s reopening plan.
“I was encouraged to see a shared commitment and dedication to developing a reopening plan that works in the best interest of students, educators and SCS families,” said Stokes, a second-grade teacher at Robert R. Church Elementary and president of the United Education Association of Shelby County
“As far as if schools should inform teachers of anyone testing posting for COVID-19, if the law does not prohibit the information being disclosed, then, yes, they should inform the teachers, families, and staff.”
This story first appeared at dailymemphian.com under exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.