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Health

The state just issued new school quarantine guidance. It's...complicated.

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Sharon McCutcheon via Unsplash
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Just in case anyone, anywhere still thought this school year was going to be simple, the Michigan Department of Health and Human Services has issued new guidance about how schools should decide who does and doesn’t have to quarantine this year. But it conflicts with what several local health departments are already doing, or have told parents they plan to do. 
Under the new state guidelines, exposed students would be allowed to remain in school in-person, if they don’t have symptoms and:

  1. If they’re fully vaccinated. Those students, regardless of whether they were masked when they had a COVID exposure, should get tested on day 3, 4, or 5 following the exposure, and monitor their symptoms for 14 days. 
  2. If both students were wearing masks and were 3-6 feet away from each other. They should monitor their symptoms for 14 days.
  3. If both students were masked, but were fewer than 3 feet apart. They should either get a daily COVID test for 7 days following exposure, or stay home for 7 days and return after a negative COVID test on day 7.

However, if either person (the infected and the close contact) wasn’t wearing a mask, then the close contact should go home for 7 days and return with a negative test on day 7, or return after day 10.
“When layered prevention strategies such as masking, distancing, testing, isolation and quarantine are applied consistently, school-associated transmission of COVID-19 is significantly reduced – which keeps kids in the classroom so they can learn,” said Elizabeth Hertel, MDHHS director, in the press release Wednesday.  “However, if someone is exposed to COVID at schools, it’s important for them to follow quarantine guidance to prevent spread to other children."

But the exclusion of students if they and/or the infected person weren't masked is a critical difference between what the state is advising, and what some counties are already doing.  

And in communities where masking is deeply unpopular, some local officials say offering the option to remain in-school with serial testing (rather than quarantining at home) is one of the few things still motivating students and parents to cooperate with public health efforts.

"I think that [guidance] presents more difficulties for the school, if they want to keep school in session,” said Joel Strasz, Bay County's public health officer. 

That’s not exactly what schools, health officials were planning on

On Tuesday, Livingston County rolled out an option the local health department is calling an "alternative quarantine," allowing students to remain in school after an exposure, regardless of whether they or the infected student were masked. But there are several requirements: students can only participate if their exposure happened in a bus or classroom setting, they don't have any symptoms, they undergo daily at-home testing and symptom screening, wear a mask at school, and don't participate in extracurriculars. 

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Credit MDHHS
An infographic provided by the state.

“All of the Livingston County Public Schools have opted into the Alternate Quarantine Strategy, as well as many of the private schools,” said Livingston County Health Department epidemiologist Emma Harman in an email Wednesday. “Schools have expressed their excitement in being able to promote in-person education for their students for the 2021-2022 school year.” 

Districts like Pinckney Community Schools even sent out a detailed explainer email to parents. 

But Livingston County doesn’t have a school mask mandate. So changing its plans to exclude situations where there wasn’t universal masking, would presumably mean many students and staff wouldn’t be eligible for the in-person option, even if they got regular tests, wore masks, and monitored their symptoms.  

“We are still working to assess if any adjustments will need to be made to our Alternate Quarantine Strategy and are planning to consult with MDHHS as we work through this new information,” a Livingston County Health Department spokesperson said.

Bay County doesn't have a mask mandate either. But the county's been using a "Test to Stay" model since May of last year, and rolled out a similar policy this year. In it, "close contacts" can still come to school, even if they weren't wearing a mask at the time of exposure. They still must submit to regular testing, done by the school, each morning before coming in, said Strasz. And they have to wear a mask in school during the "quarantine" period. 

Changing that policy to disqualify students if they or the infected person weren't wearing masks at the time of exposure, just wouldn't be realistic, he said.

"You can only control for so much," Strasz said. "These masking policies are great. But once you pack everybody into the lunch room, they go out the window.... You can't eat with a mask on. So there are certain things that are going to limit these things."

Does “Test to Stay” actually keep kids safe?

Here’s what everyone agrees on: While quarantines have been a crucial tool in the pandemic, sending dozens or even hundreds of teachers, staff and students home for 10 days after a possible COVID exposure is deeply disruptive, and can bring the entire school to a temporary halt.

And much like the debate over masks, there’s been increasing pushback against quarantines. Strasz said starting last spring, they’ve been having trouble getting parents to be honest about their kids’ own COVID test results or close contacts, for fear of missing school or sports.

“Once again, we’re coming into situations where we get information that doesn’t quite add up,” he said. “We had someone who tested positive yesterday, [but] when we did the case investigation and contact tracing, they were magically symptomatic 10 days prior to [our call.]"

(That's how long the CDC says people in quarantine need to go without symptoms before they can be around others again.)  "And they sent their kid to school," Strasz said. 

The lack of compliance is already affecting other students.

“We have more kids to identify [as close contacts of an infected student.] And parents go, ‘How did my child become a close contact from a week ago? Shouldn’t we have known sooner?” And I say, yeah, we should have, if other parents were cooperating.”

Last year, some health departments even went so far as telling schools they wouldn’t be enforcing quarantines at all. That in turn led to increasing pressure in some places where health officials were still requiring quarantines. But rather than abandon quarantines altogether, Strasz wanted to offer families an option that would keep their kid in school, while also aiming to protect the community.

So in May, the county started using a “Test to Stay” model, where students and staff who had a “close contact” COVID exposure could stay in school, so long as they didn't have symptoms, and received a rapid COVID test at school every day for five days after exposure, and then again on days seven and nine. 

There’s some early evidence that it works, too. In Bay County, 98% of those who participated in the program tested negative and were able to keep going to school (and prom, and graduation) during the nine day period. The daily testing also allowed health officials to swiftly identify the 2% of students who were positive, and send them home. And students and parents seemed happy with the program, he said: In-person school was enough motivation for people to get tested regularly. 
 
The state of Utah also tried something similar last year: Schools that reached an outbreak threshold were offered the option of going remote, or testing everyone in school. Those who tested negative were allowed to stay, while those who tested positive, and close contacts, were quarantined. That policy, combined with a “Test to Play” strategy for extracurriculars, saved more than 100,000 days of in-person instruction, researchers found.

What happens in schools that don’t have mask mandates?

But this year is different, thanks to the lack of a statewide school mask mandate and the more contagious delta variant. Numerous county health departments have issued local mandates, and more than half the students in the state now attend schools where those mandates apply. But those orders have been controversial, to say the least, and already there are reports of noncompliance.

“I could easily put a mask order in place, but number one, how serious are schools going to follow that?” said Strasz. “Number two, if there’s a threat of violence or disruption in schools because of masks, how well are they going to implement that?”

Local health officials and school administrators often don’t have the resources to fight these battles and win, he said. And the lack of a universal mask mandate makes it harder.

“This far into the pandemic, with so much fatigue and conflicting guidance the last five or six months, the average person doesn’t know what to do,” Strasz said. “They’re looking for a black and white answer, hopefully from the state ... so it would be much more beneficial if there was a consistent statewide policy on this.”

In communities where masks aren't being worn widely (regardless of whether there’s a local mandate), getting people to cooperate with quarantines is even more important. And if, as Strasz believes, the way to gain that cooperation is to offer the option of staying in school to everyone – regardless of whether they were masked at the time of exposure – then that’s what they’re going to do.

"I’m happy in one way that, that I think this is an acknowledgement from the state that our testing program works, and can keep kids in school and keep kids safe," he said of the newly issued guidance. "There are things I don’t like about it and disagree with, but overall, if a district wants to adopt it, [that's great]."

Do we have enough tests to do this?

Yet even in counties that do have universal mask mandates, like Washtenaw County, the new quarantine guidance from MDHHS raises some concerns.

For one thing, health officials there just told schools to do something slightly different. On Thursday, September 2, Washtenaw County issued school quarantine orders that allowed close contacts to stay in school, so long as they don’t have symptoms and get tested “at minimum, 3 days per week during the quarantine period.”

But the state’s guidance requires seven days of testing in that situation. “We’re a tad concerned about the capacity and ability, the resources and testing kits to be able to do that daily testing,” said Susan Ringler-Cerniglia, a  spokesperson for the Washtenaw County Health Department. And it means they’ll likely need to revise their own guidance to match the state’s, and help schools understand and implement it. “So it’s a little bit rough to have this guidance coming out after school has started.”

The state health department said in its statement Wednesday that schools should be able to get the needed tests through their Intermediate School District. Those tests will be provided by the state, for free.

But Ringler-Cernigilia said they’ve heard similar promises before.

“Right before school, we’d had lots of assurances early on that there would be no challenges in terms of test kits and resources,” she said. “We were surprised to hear that that had gotten bogged down.... Some of our schools were getting beat up and accused [by parents] of not having testing in place, when we were assured that wasn’t going to be an issue, as were they. In some situations, it was another reason for people to attack their local schools. Which is unfortunate.”

The Washtenaw Intermediate School District is hopeful, however. "WISD received 25,600 antigen tests from MDHHS last week and we have an additional order in for another 25,600 that we should receive this week," said spokesperson Ashley Kryscynski. "We believe that as long as MDHHS continues to have tests stocked and is able to maintain timely deliveries, our schools can be responsive and prepared with tests." 

Still, the logistical challenges are real. 

"I do want to recognize that schools must not only have the antigen tests on-hand, but they also must have the capacity to manage the testing on-site at all of their schools, which includes registering with MDHHS and tracking each individual test from MDHHS in a dashboard the state has not shared widely with all schools," Kryscynski said.

"This has caused confusion for a number of public school districts, public school academies, and private schools, and we are doing everything we can to assist them because we know this is an important mitigation strategy to keep students and staff safe, healthy, and in school."

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