Overview
To promote safe and healthy learning environments in K-12 schools, school administrators can work together with health departments to reduce the risk of coronavirus 2019 (COVID-2019). K-12 school administrators can play an important role in taking steps to slow the spread of disease to prevent outbreaks, and protect students, staff and teachers. Regardless of the level of community transmission, K-12 schools should be prepared for COVID-19 outbreaks in their communities that may introduce infection to the school setting, identification of cases among students, staff and teachers, and potential exposure(s) to COVID-19 that may occur at school facilities or events.
Operating schools during COVID-19: CDC’s Considerations provides guidance to assist K-12 school administrators in planning a comprehensive response. Case investigation and contact tracing are essential interventionspdf iconexternal icon in a successful, multipronged response to COVID-19, and should be implemented along with other mitigation strategies. As K-12 schools resume in-person learning, case investigation and contact tracing with staff, teachers and students should be anticipated as a crucial strategy to reduce further transmission once a case is identified. Centers for Disease Control and Prevention (CDC) encourages collaboration between K-12 schools and state, tribal, local, and territorial (STLT) health departments when investigating cases and exposures to infectious diseases, including SARS-CoV-2, the virus that causes COVID-19. Prompt and coordinated actions, including case investigation and contact tracing, may inform decision-making about strengthening, focusing, and relaxing mitigation strategies. This document aims to highlight potential collaboration between health officials and K-12 school administrators to facilitate effective case investigation and contact tracing.
Who this guidance is for: Administrators of public and private K-12 schools coordinating case investigations and contact tracing in schools, in order to inform policy development and program implementation. This document may also be informative for public health professionals coordinating K-12 school case investigations and contact tracing.
Background
COVID-19 is a nationally notifiable disease. When diagnosed or identified through laboratory or clinical criteria, COVID-19 cases are required to be reported, by healthcare providers and laboratories, to state, tribal, local, and territorial (STLT) health departments. When laboratories send positive test results for SARS-CoV-2 to health departments, many of these test results are received via electronic laboratory report. Testing locations, such as pharmacies and community testing sites, are also required to report positive test results to the health department for follow-up. Health care providers from a variety of clinical settings, including K-12 school-based clinics and community-based settings, also complete case reports on symptomatic patients diagnosed with COVID-19. Health departments have primary responsibility for case investigation and contact tracing. Case investigation and contact tracing are, core disease control measures employed by STLT health department personnel for decades, and an important part of the COVID-19 response.
Case investigation is the process of working with a person (patient) who has been diagnosed with COVID-19 to discuss their test result or diagnosis, assess their symptom history and health status, and provide instructions and support for self-isolation and symptom monitoring. This interaction is the first step to review the activity history of the person diagnosed with COVID-19, while infectious, and identify people (contacts) who may have been exposed to COVID-19.
Contact tracing is the process of notifying people (contacts) of their potential exposure to SARS-CoV-2, the virus that causes COVID-19, provide information about the virus, and discuss their symptom history and other relevant health information. In addition, instructions for self-quarantine and monitoring for symptoms, and support and referrals to testing, clinical services, and other essential support services are provided, as indicated.
The case investigation and contact tracing processes help to prevent further transmission of disease by separating people who have (or may have) an infectious disease from people who do not. Prompt identification, voluntary self-quarantine, and monitoring of those contacts exposed to SARS-CoV-2 can effectively break the chain of transmission and prevent further spread of the virus in a community.
Classification of an individual as a close contact is based on many factors and should be assessed on a case-by-case basis. In the context of COVID-19, the definition of a close contact is someone who was within 6 feet of a person diagnosed with COVID-19 for a total of 15 minutes or more. More information to inform the determination of exposure risk can be found, on CDC’s Public Health Guidance for Community-Related Exposure. This information further notes that: 1) data to inform the definition of close contact are limited. Factors to consider when defining close contact include proximity, the duration of exposure (e.g., longer exposure time likely increases exposure risk), and whether the exposure was from a person with symptoms (e.g., coughing likely increases exposure risk). Furthermore, while research indicates masks may help keep those who are infected from spreading the infection, there is less information regarding how much protection masks offer a contact exposed to a symptomatic or asymptomatic patient. Therefore, the determination of close contact should be made irrespective of whether the person with COVID-19 or the contact was wearing a mask. 2) Data are insufficient to precisely define the duration of time that constitutes a prolonged exposure. Recommendations vary on the length of time of exposure, but a total of 15 minutes or more close exposure can be used as an operational definition. Brief interactions are less likely to result in transmission; however, symptoms and the type of interaction (e.g., whether the infected person coughed directly into the face of the exposed individual) remain important. Assessment of exposure beyond close contact is a recommended strategy in some K-12 school and IHE settings to control transmission of SARS-CoV-2.
SARS-CoV-2, the virus that causes COVID-19, can cause symptomatic illness and asymptomatic infection among young and healthy populations. K-12 schools may be a potential source of COVID-19 outbreaks, due to the number of individuals intermingling in close proximity for extended periods of time. K-12 school settings contain a mixed population of students, staff, and teachers, ranging from young children to older adults, who can be highly interconnected in multiple, close-contact networks such as classrooms, libraries, theatres, gymnasiums, social meal events, sports teams, clubs, dormitories, and transportation. Some studies show that transmission from young children may be limited, [ 1 ] but more data are needed as some countries have observed widespread disease transmission in primary schools. [ 2 ] A priority consideration for when an outbreak of COVID-19 is identified in a K-12 school is the subsequent exposure/transmission to other members of a school community, such as “older and/or more vulnerable individuals (e.g., teachers, school workers, volunteers, grandparents, or immunocompromised children or adults) who are in proximity to school children.” [ 3 ] In some instances, students may live in multigenerational households or have parents, guardians or caretakers with underlying health conditions, which may increase their risk for severe illness from COVID-19. These close settings, as well as close contact activities such as certain sports, may cause the K-12 school population and more broadly at-risk family members and caretakers to be at increased risk of transmission of the virus.
Health departments are responsible for leading case investigations, contact tracing, and outbreak investigations. Case investigation and contact tracing in response to COVID-19 transcends standard practice. Throughout the country, health departments are scaling up case investigation and contact tracing programs by using different staffing models and technology supports. Given the large number of COVID-19 cases reported to health departments, coupled with how easily and quickly SARS-CoV-2 is spreading, health department resources can be overwhelmed. Multisector partnerships can be an asset to expand the reach and timeliness of case investigation and contact tracing, thus facilitating prompt isolation and quarantine of cases and contacts. Partnerships between health departments and K-12 schools are encouraged as they may help to limit the spread of COVID-19, in these settings and local communities.
