The Florida Department of Health provided a special presentation to the school board Monday regarding contact tracing of COVID-19 and how both entities can work together once school resumes.

Superintendent Dr. Greg Adkins said the Florida Department of Health has been wonderful through the entire school reopening, adding they have enjoyed the community partnership with the department and Lee Health.

“I can’t express enough how appreciative I am that they have stepped up and helped the school district with some of the most difficult decisions we have ever had to make,” Adkins said.

Florida Department of Health in Lee County Administrator Angela Smith said contact tracing started with four staff members. They now have 78. 

Florida Department of Health in Lee County Director of Communicable Diseases Jennifer Roth said they have two main goals of contact tracing: Identifying all persons with close contact to a confirmed, or probable COVID-19 positive case and ensuring all close contacts identified are notified and directed to self-quarantine and monitor all symptoms.

There are four steps of contact tracing:

* The Department of Health is notified of a positive case.

* A DOH investigator then interviews the case to determine the infectious period and who they have been in close contact with during that infectious period.

* The DOH investigator then notifies all contacts of their exposure and instructs them to quarantine for 14 days after their last date of exposure.

* The quarantined contacts are then monitored daily through phone, or text messages to determine if they develop symptoms.

“We have to get the individual information for each case and use that to determine when they are infectious to others and how many they exposed,” Roth said. “We do this monitoring because we want to know if someone develops symptoms. If that is the situation we encourage them to be tested as soon as possible. We also instruct them to isolate further.”

COVID cases are considered infectious to others starting 48 hours before symptom onset until at least 10 days have passed since symptom onset, and at least 24 hours have passed since resolution of fever without the use of fever-reducing medications and other symptoms have improved.

Roth said this infectious period has changed over time as more is known about the virus, adding the guidance was just updated last week by the Centers for Disease Control.

For example, if someone started feeling symptoms on July 27, they consider them to be possibly infectious to other people as of July 25, Roth said. That infectious period continues for 10 days as long as it has been 24 hours since the last fever and symptoms have improved.

“That is when we start considering someone infectious to other people,” she said. “We consider them to be infectious to other people for at least 10 days since their symptoms have started.”

An example provided is on day 10 an individual develops symptoms and receives positive results. They then begin isolation and start the 10- day quarantine. Due to this the individual can be out for another 10 days, up to 24 days depending on the symptoms involved.

Roth said they use the date of the test for those who have no symptoms at all. She said if the person never has any symptoms day 10 is considered the last day of the infectious period.

The goal is to get the person isolated for the remainder of the infectious period, so they do not expose the virus to anyone else.

Once the investigator knows when the case started, and worked out their infectious time frame, and who they have come into contact with, the contact tracing begins.

Roth said “contacts are considered exposed if they were less than 6 feet from a positive case for more than 15 minutes during the infectious period.” She said brief passing interactions are less likely to result in some kind of a transmission.

“We do evaluate each contact to determine whether or not there is a possible trace of transmission,” Roth said.

An example in this case would be airline travel with two people sitting two rows from a sick person, or within six feet. All of those people would be considered exposed.

Roth said when someone is exposed and they are interviewing people to find out about contact, it is a 14-day quarantine period because it could take up to 14 days from the time someone was exposed to have the symptoms and go into the infectious period.

“From the day you were exposed to the day you might show symptoms is up to 14 days,” Roth said. “We have definitely seen people become sick on day 14 after an exposure.”

As long as the individual goes 14 days without symptoms they can return to work and school.

Roth said they do not recommend someone running out and getting tested as soon as they find out they have been exposed.

“If you are exposed today, on Monday, and find out Wednesday that you have been exposed and you run out and go tested, well that’s only day two of the incubation period and it’s up to 14. Just because you tested negative on Wednesday does not mean you will not end up being positive on day 10,” she said. “It can take 14 days, so no matter what kind of test you have before 14 days you will not go back sooner.”

Roth went on to say if someone was with a friend for three days, they will take the last day as the day of exposure.

“We would start the quarantine after the last day of exposure and it would be for 14 full days regardless of their tests,” she said.

The goal of contact tracing, Roth said is to prevent that initial exposure.

“If all of those contacts, if they were to become cases, they are all home and isolated in quarantine anyway. Even if they become systematic there is no further spread. We have stopped the spread with that one round of transmission,” Roth said. “That is our ultimate goal of contact tracing.”

Board Member Chris Patricca asked who notifies the DOH when a student is sent home with COVID symptoms?

Smith said there is no requirement, but they would surely welcome that relationship with the school district and they can dedicate DOH staff that the school nurses are able to call should they have a child that is suspicious of having COVID. She said the official requirement for recording is only when they have laboratory confirmed cases.

She said of the 78 employees that were brought on board some are going to be dedicated to work with the school district, as well as other large employers. 

Smith said if you are systematic, that person should consult with a physician and be tested. She said they would not take a student or employee out of work without identifying and testing them.

Patricca said some of the students in the district might not have access to healthcare and the free COVID testing areas are only testing over 18 years of age. She asked if there is a community organization or health plan put together for kids, so they do not have to miss school because of a cold.

Smith said the Florida Department of Health has a pediatrics client at their Michigan Avenue location. She said they are also preparing to be a little more mobile in their testing efforts, so very shortly they will be able to bring those efforts into the community.

Board Member Debbie Jordan asked if there needs to be proof of a negative test before they can come back to school, or is it assumed to be gone at the end of the quarantine. 

Roth said when someone is released from isolation, if they are 24 hours symptom free, is when they can go back to school. She said that is the criteria from the CDC saying you are no longer infectious to other people.

Last week the CDC moved to using that strategy to determine that someone is no longer infectious. Roth said that is being used because it has been shown that people can intermediately shed the virus for weeks, or months at times.

She said what is happening is your body is shedding dead pieces of the virus and the test itself is only looking for the DNA of the virus.

Smith said the turnaround time for a test is 48 hours, which is much improved over the seven to 10 days prior with commercial labs.

Board Member Gwyn Gittens asked if the whole class needs to be quarantined because you do not know if that person has infected anyone else and they are within the 48 hours.

Roth said it is plausible if someone is tested and sick and waited two or three days that others could be exposed in the classroom. She said they will take into consideration who was walking around, group interactions and students involved in other situations outside of the classroom to provide best recommendation of how COVID was exposed and who should be quarantine.

Roth said unfortunately it may be the case that you have to quarantine the entire classroom for two weeks because they are unable to truly say these people meet the criteria. She said if there is ever any question, or concern if they are able to define if there was an exposure, they always err on the side of caution.

“We want to be as careful and caution, especially with our children,” Roth said.