Caution and consultation are key to preventing outbreaks in schools

By Erin Murphy and Ben Stocking

The high school athlete had a history of migraines, so he decided to go to school even though he had a bad headache. It never occurred to him that he might have COVID-19. 

He attended practice that Monday but did not work out. He helped the coach pass out uniforms instead. By Wednesday, he felt great and decided to practice with his teammates at his East Side high school.  

The very next day, he learned that his girlfriend, who attends school in a different district, had tested positive. He then tested positive, too, and soon discovered that he had potentially exposed 15 teammates and coaches to COVID-19.  

His case presented a challenge that many schools will confront now that classes have resumed across King County. Until the pandemic is brought under control, more cases are sure to arise in schools – even those that take all the right precautions as COVID-19 comes into schools from the broader community. 

After a positive test, what’s next  

For school administrators, several questions arise whenever a case occurs: 

  • How many people were exposed? 
  • When and where did those exposures occur? 
  • How many people need to isolate or quarantine? 
  • Do classes, practices or other school activities need to be canceled? 

Public Health – Seattle & King County investigates outbreaks and advises districts on how to prevent or contain them. The King County school response toolkit is an important resource for schools that provides immediate guidance on how to respond quickly and effectively when COVID-19 cases arise, including notification templates to support school outreach to families and students.  

The final decision on school closings lies with the districts themselves.  

Communication between districts and Public Health helps ensure that a single case doesn’t quickly spread through an entire school. The goal is to make prudent decisions about safety without taking steps that are unnecessarily restrictive. 

At the East Side high school where the athlete’s case arose, Karla is the lead nurse and COVID-19 safety coordinator. She immediately contacted Stacey, a nurse who serves on the King County team that investigates outbreaks in schools and childcare centers. 

“Every time I talk to Public Health, I learn something new,” Karla said. “Everyone in our district – both teachers and administrators – agreed from the start that we would follow public health guidance.” 

How the sports team investigation unfolded  

Karla and district administrators had consulted regularly with Public Health from the outset of the pandemic. School and district leadership already had a relationship with the Public Health Schools and Child Care Taskforce, consistently receiving technical assistance and supportive answers to questions regarding COVID-19 safety strategies in the school. A Public Health representative from the Taskforce had even participated in a community information meeting, hosted by the district back in December when preparing to bring back K-1 students.  

When the athlete’s case arose, they were prepared. 

“The district has been very meticulous about taking steps to prevent the spread of the virus,” Stacey said. 

The two nurses quickly agreed on a containment strategy appropriate for the athlete’s case, which they approached like detectives piecing together clues.  

Stacey called the coach to find out everything she could about the practice, in a sport where athletes do not wear masks. 

How close together were the teammates, and for how long? Did everyone at the practice mingle with everyone else, or were the students separated from one another? 

The coach had instituted clear procedures to make sure that athletes remained six feet apart whenever possible. But on the day in question, she missed the practice and the assistant coaches let those rules slide. 

“The coach contacted me and said, ‘Hey, it doesn’t look like we ran practice the way we usually do,’” Karla recalled. 

Karla’s response? “I’m like, OK, of course they didn’t! Welcome to Covid!” 

She asked the student who tested positive for details. Then she interviewed anyone who had been close to him. She retrieved a videotape that caught most of the practice on camera.  

For the most part, the athletes had minimal contact with one another. But her concerns rose when she learned that the entire group, as well as two coaches, had stood close together for several minutes while athletes were catching their breath after a sprint. 

Entering quarantine 

She told the team to immediately suspend practice, and then focused on deciding which teammates needed to quarantine. 

All of them did, for 14 days. 

“We don’t want kids to miss opportunities that they’ve been missing,” Karla said. “But we do want to quarantine people because it’s safe and necessary and we want to knock transmission down.” 

The athletes have all been tested, and none of them had the virus. Fortunately, the practices in question occurred during spring break, greatly reducing the chances of transmission.  

Karla informed the team that they would need to quarantine on a Friday. For some, Monday would have been their first day back to school in a year. 

One sent Karla an email, begging her to let him skip quarantine. “I know I didn’t have close contact! I didn’t get anywhere near the kid!” 

Request declined. 

“We want to keep athletics open,” Karla said. “But before athletics comes school.” 

Karla feels lucky that the case did not turn into an outbreak, which is defined as two or more cases epidemiologically linked to a school occurring within 14 days. An epidemiological link means that the cases share common characteristics, like close contact to a confirmed case, shared environment or common exposure. 

“From the perspective of outbreaks, we’re pretty boring. And that’s good.” 

We can all help reduce COVID-19 in the community around school 

While it is fortunate that this school did not experience an outbreak, that is not always the case, particularly during times of high community transmission. COVID-19 comes into schools from the community.  So what we do as a community has a direct impact on possible school transmission.  

Your personal, daily choices can help mitigate COVID-19 in schools, buses, etc, because what you do at home and in other spaces has a direct impact on whether COVID-19 is more likely to be introduced into school settings.  

With counties loosening restrictions and reopening more, we all need to continue to follow the recommended safety behaviors to keep transmission low. Let’s all commit together to do our part to keep our kids safely in school! 

Originally posted April 27, 2021