The end of K-12 contact tracing? Some schools say symptoms, not exposure, should drive testing


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This has long been an underlying logic of pandemic safety for schools: in order to contain the transmission of COVID, identify students and staff who have been exposed to the virus and ensure they are put in quarantine or tested negative before returning to class.

That wisdom, however, seems to be changing in the wake of the surge of Omicron, which experts say may have peaked in many US communities but continues to strain K-12 operations.

Three New England states – Massachusetts, Vermont and Connecticut – recently announced new guidelines recommending moving away from individualized contact tracing in schools and towards strategies such as symptom monitoring and home testing kits for those worried about getting sick.

“We recommend that school health personnel focus more on identifying symptomatic individuals, rather than monitoring close contacts at school,” Massachusetts Education Commissioner Jeffrey Riley, Massachusetts, wrote. in a note dated January 18.

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“Individuals identified as close contacts at school are highly unlikely to contract or spread COVID-19,” he continued. “Therefore, extensive contact tracing and associated test-and-stay procedures do not add significant value as a mitigation strategy despite the demand they place on school health personnel and school personnel in general. .”

New York announced in mid-January that it was ending its statewide contact tracing program, which was intended for the general population rather than K-12. And individual school systems, including Bekeley, California; Brevard County, Florida; York, Maine and Delaware Valley, Pennsylvania have also chosen to move away from the practice, often scaling up other mitigation strategies instead.

Contact tracing places a “now impossible workload” on school districts, Berkeley Unified School District Superintendent Brent Stephens wrote in a Jan. 15 message to parents. The school system is now offering twice-weekly testing to every K-12 student, regardless of exposure, and investing in highly protective KN95 masks for students and staff.

A pre-Omicron study of classroom transmission in California and Illinois published by the Centers for Disease Control and Prevention found that only about one in 100 close school contacts of positive cases, on average, eventually fell ill himself – throwing himself into doubt, for some experts, the added value of the labour-intensive practice of cross-checking lists to track exposure at school.

Then came the Omicron variant, spurring record levels of infection. In Yonkers, New York, a quarter of students have tested positive. In Providence, Rhode Island, some classrooms had more students absent or in quarantine than present in class. Last week, across the country, more than 1.1 million young people caught the virus, a pandemic record and more than four times more than at any time during previous outbreaks.

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The lightning-fast spread has made it nearly impossible for some districts to accurately track exposures, school leaders said.

“Omicron is spreading faster than contacts can be traced. Contact tracing for this variant is ineffective,” York School District Superintendent Lou Goscinski wrote in a Jan. 13 message to the community explaining that the practice would be discontinued.

Indeed, the time between exposure and transmission is faster with Omicron than with Delta or other strains of the virus, the scientists say. For districts that practice universal masking, that means “contact tracing doesn’t do much as a preventative measure,” said Danny Benjamin, co-chair of the ABC Science Collaborative at Duke University, which examines the spread of COVID-19 in schools.

“By the time you find out who was in the room, were they really close, were they vaccinated, the list goes on and on, it’s now a few days after the exposure and this child is now infectious,” Benjamin told 74. “So [contact tracing] is not as useful in containing disease as we saw with the ancestral variant or the Delta variant.

Linda Mendonca (National Association of School Nurses)

From a work perspective, too, Omicron has made contact tracing less tenable, said Linda Mendonca, president of the National Association of School Nurses. Tracking exposure was already a heavy burden on school staff, typically requiring nurses to scour floor plans for lunches, bus rides and classrooms each time a student tested positive. In many cases, this work continued over the weekend as schools needed to prevent sick or potentially exposed students from showing up on Mondays, she said. In some schools, nurses had to skip the typical annual sight and hearing screening of students because contact tracing programs took up so much of their time.

Then, after the winter break, soaring case numbers pushed many schools’ case-tracking programs beyond breaking point.

“I’ve heard many school nurses say, ‘This is not manageable. We can’t keep doing this at this…capacity,” Mendonca told 74.

School nurse Adrienne Maguire conducting contact tracing in Revere, Massachusetts in May 2020. (John Tlumacki/Getty Images)

Either way, the longtime school nurse chose not to say whether the time was right to drop contact tracing altogether.

“We’re waiting to see what the CDC comes out with,” she said, stressing the continued importance of mitigation strategies like masking, ventilation and vaccination.

The last update to the CDC’s guidance on contact tracing in schools came in mid-October, according to the agency’s website, which says the practice remains an effective strategy for reducing the spread of COVID in schools when used alongside other multi-level mitigation strategies.

Dr. Danny Benjamin (Duke University ABC Science Collaborative)

But Benjamin is ready to take a tougher stance. Even amid Omicron, COVID transmission in schools remains low when all students and staff wear masks, he said. His team has a forthcoming paper that answers a key question: How many close contacts in fully masked schools develop infections after being exposed to the highly infectious variant?

“If everyone is wearing masks, it’s still below 5%, but it’s no longer in the 1% range,” he said, referring to the secondary transmission rate at school. under the previous strains.

These numbers combined with Omicron’s transmission speed and the logistical headaches of exposure tracking lead him to believe that contact tracing may no longer be a necessary or useful measure for schools that universally hide. But for schools that don’t mandate face coverings, it takes on a different tone.

“In unmasked neighborhoods, you probably want to [continue contact tracing]said the Duke University doctor, explaining that the practice can help determine whether specific people who have been exposed should mask themselves in the future so as not to infect others and test, tactics known as mask name to stay and test to stay.

“It breaks the chain between a group of us getting infected,” Benjamin said.

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As cases begin to ease in some parts of the country, but not all, many schools are now scrapping mask rules. Virginia Gov. Glen Younkin’s executive order allowing parents to opt out of face-covering requirements at school went into effect on Monday (although it now faces legal challenges). And two Long Island districts recently voted to end their requirement to wear face coverings at school when New York State’s face covering mandate expires Feb. 1.

On Monday night, a New York state judge ruled the warrant was unconstitutional and unenforceable, but the state’s attorney general has already filed a notice saying he intends to appeal. A spokesperson for the state’s education department said “schools must continue to follow the mask rule” as legal battles continue to unfold.

Meanwhile, the students themselves are frightened. In early January, young people in New York City staged a strike to protest what participants said were unsafe conditions in schools. Thousands of students joined the protest, calling for more COVID safety mitigation measures and a temporary pivot to remote learning.

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In the following days, students from Round Rock, Texas; Oakland, California; Montgomery County, Maryland and Chicago have also staged walkouts making similar demands.

Chicago students protest what they say are unsafe COVID conditions in their classrooms, January 14. (Scott Olson/Getty Images)

Samantha Farrow, a New York City walkout organizer and high school student from the city, said her school did not inform her when her office colleague in French class left in the middle of the school day after testing positive. The high schooler only found out about the exhibit, she said, because that student texted her directly.

“Nobody says anything to the students and you feel like you’re being left behind,” Farrow told 74 in early January. “It’s not fair to us because it’s us who are affected by this.”

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