When Matthew Eccles got word that his daughter had been exposed to the coronavirus at school, he did a double take.
The message was sent Sept. 8 — a full week after the exposure occurred Sept. 1.
Right after that, another alarming message arrived from Syracuse Jr. High: A text from Eccles’ daughter, with photos she had taken at a school assembly that very day. Kids were crowded into a gym with hardly a mask in sight.
“There are no real protocols in place,” Eccles said. After receiving the notification, he said, “We were supposed to get tested and provide proof to the school before being allowed back in school, but nobody requested proof. So it’s almost as if they didn’t care.”
With recent testing difficulties and delays in contact tracing, parents around Utah are saying they aren’t getting notified of their kids’ classroom exposures until it’s almost too late to do anything about it. Quarantine periods generally are backdated to begin 10 days after the exposure or a student began having symptoms, but families may not know to start quarantine until days later.
“I received the email the day before she was scheduled to be off quarantine,” said Reggie Hennessy, whose daughter attends North Davis Preparatory Academy in Layton. “Either the health department dropped the ball on letting the school know about the COVID case or the school dropped the ball on letting me know.”
And cases are sometimes taking days to verify before they appear in school infection rates and case counts — the very metrics that trigger containment measures like Test to Stay operations, which provide students testing to allow them to stay in classes.
“We have 180 cases in the queue right now,” awaiting verification that the diagnosed patient is a district student and was in school when contagious, said Granite District spokesman Ben Horsley.
“There was a time a few weeks ago where they cut off cases that were eight days old or more,” he said, “because after the contact tracing would have been done with those cases, it would have been past the time of exposure or contagion.”
What’s taking so long?
Alerting families of an in-school exposure to COVID-19 always has been a slow process, said Sarah Willardson, epidemiology director of the Davis County Health Department.
“If a student who attends school starts feeling ill on Tuesday, their mom takes them to get tested on Wednesday, it takes a couple of days to get that result back — Friday or Saturday — the health department gets it Friday or Saturday, and it’s Monday before school contact tracing,” Willardson said. “We had this problem last year as well.”
Those delays may have been worsened in recent weeks, with parents reporting difficulty getting their children tested and lab test results taking longer on average than at any point in the pandemic.
Cathy Foster wasn’t notified until Sept. 8 that her son, also a Syracuse Junior High student, was exposed on Aug. 31.
“I assumed the delay in letting us know was that the person may have waited longer to be tested,” she said.
The Davis School District has hired aides to help with contact tracing and notifications, but with cases rising precipitously, they might be getting overwhelmed, said parent Mariah Bailey. Her son is in third grade at Syracuse Elementary School, the first school in the state to reach “outbreak” case levels. She was notified last week, about four days after the exposure occurred.
“I was hoping that this year it would be better controlled, but with no masks in school — about 15% of kids are wearing them — the spread is worse than last year and the COVID aides are not going to be able to keep up,” Bailey said.
And there’s a lot to keep up with, said Nicholas Rupp, spokesman for the Salt Lake County Health Department.
“When a school has 30 kids in each class, they need to look at a seating chart potentially for each child, list out the number of students within six feet, and do that for all the kids who were positive that day throughout the school,” he said. “When you get 20 at each school, it’s going to get backed up. None of this is automated when you have to check for proximity and time to the positive patient.
“Some schools are very far behind.”
Within Salt Lake County, health and school officials have divvied up responsibility for case verification and contact tracing differently from district to district.
In Canyons School District, for instance, a team of school nurses receives lists of possible school cases from the county health department, verifies whether the children attended school in the district while they were contagious, and conducts contact tracing, Rupp said.
On the other hand, in the Jordan School District, administrative staff verify school attendance, district officials said, while county teams conduct contact tracing.
Meanwhile at Granite, county teams were conducting all contact tracing early in the year, but about two weeks ago the district redeployed the team of nurses that did school contact tracing last school year, Horsley said. The backlog of notifications had gotten too large.
“Two to three days after exposure is pretty normal lag time. Four to five days is rough. Anything after that is untenable,” Horsley said. “We have to be able to notify families as soon as possible.”
Rupp confirmed that districts that do their own contact tracing have generally been notifying parents of exposed kids faster than districts that rely on the county, since the county’s contact tracers also are busy with a growing number of non-school cases.
Meanwhile, contact tracing has gotten more difficult this year because the definition of who counts as a “close” or “high risk” contact is more complicated, Horsely noted. Last year, everyone was masked and no one was vaccinated. Contact tracers only had to find out the proximity and duration of a contact.
This year, with masks optional in all but the Salt Lake City School District, contact tracers have to find out whether infected students or nearby students were masked, or whether nearby students were vaccinated, and distribute different instructions depending on each kid’s risk level. If everyone involved was masked, parents may be told to simply watch out for symptoms. If the infected student was masked but the exposed student was not, the exposed student may be advised to quarantine.
“That has taken a regular contact tracing case of about two to five hours to eight to 16 hours, just to do one case — because of all those additional variables you have to identify,” Horsley said.
Are the case counts accurate?
But contact tracing itself doesn’t seem to be the only chokepoint; it’s also taking a while to verify that children who test positive are enrolled in a given district and attended classes while they were contagious — a step that needs to happen before contact tracing and notifications can begin, and before a case is added to a school’s count.
That can take up to 72 hours, county health officials wrote in a tweet last week.
That means a lot of cases are not included in school case counts until days after diagnosis or symptom begin — and it appears some districts have more delayed counts than others.
Canyons District, for example, had recorded 141 new cases in the past 14 days as of Monday, with 119 cases that are older than 14 days. But 14 days ago, the district was reporting 85 total cases. That means its case count at that time captured about 70% of the cases now confirmed for that time frame.
Meanwhile, Granite District recorded 193 new cases as of Monday, with 214 cases older than 14 days. But two weeks ago, the district was reporting just 84 total cases — meaning its case count captured only about 40% of the cases now confirmed for that time frame.
That also was about the time the district was reactivating its contact-tracing nurses, Horsley said, and the district has combined its attendance verification with its contact-tracing steps in order to speed up exposure notifications to other students — although it may take longer to get through the list of new patients that need to be verified as having attended school.
The downside of delayed verification is that case counts may remain artificially low, putting off mitigation measures like closure or Test To Stay — a requirement that students test negative to attend school if a school records more than 30 positive cases, or a 2% infection rate in schools with more than 1,500 students.
Because cases are backdated to when symptoms began or a positive test was taken, counting delays mean it likely will take longer to reach 2% — and that threshold is already too high, Rupp said.
“Two percent Test to Stay was never a public health recommendation. We suggested 1% as a compromise,” Rupp said. But legislators banned districts from requiring tests unless they reached the higher thresholds, as well as banning districts from making masking compulsory. County health officials can propose school mask mandates, but county officials can overturn them, and the trend so far this year is that they do so.
“We encourage testing much earlier, and we offer testing much earlier to any school that wants it — but very few of them do,” Rupp said. “They’re all waiting to be required by state law.”
County health officials hope school case counts will become more current next week with a new digital verification system for test results, Rupp said. “I think [that’s] going to alleviate all of this,” he said.