Contact tracing in Vermont schools has taken a wild journey in the nearly three weeks since classes started.
Schools reopened in the midst of a major surge in Covid-19 cases, driven by the spread of the Delta variant. They reported cases and closures within days, yet found themselves mostly alone when it came to identifying and quarantining potential close contacts.
Weeks ago, school officials across the state complained that the health department’s response time lagged when they had questions or needed help making decisions.
This week, the state reached a record high of Covid-19 cases in schools, with 174 reported by the state Department of Health in just a single week. That’s likely an underestimate, since the department reports only cases believed to have been transmitted within the school building.
On Tuesday, Education Secretary Dan French said the Agency of Education had adopted a new policy to help schools handle the rush: Stop contact tracing in schools with high vaccination rates.
“The current content tracing process is not sustainable, so we have to make adjustments,” French said at a press conference. He cited anecdotes of high school staff members spending hours reaching out to contacts, only to identify a handful of people who needed to quarantine.
The agency now plans to issue guidance to schools instructing them to skip contact tracing if their vaccination rate is over 80%, and the entire student body is eligible for vaccination, French said. That’s more likely to apply to high schools, where most students are eligible for vaccination.
“We think we can leverage relatively high vaccination rates among eligible students to shift (districts’) limited contact tracing resources towards the elementary, where most students are not yet eligible for vaccination,” French said.
Under the plan, schools would still send parents a notification letter informing them that there was a case in their student’s class and giving them general advice.
French also said that forthcoming weekly surveillance testing in students is a “competing strategy” and balancing it with contact tracing could create a more “sustainable approach” for using school resources.
Experts and school officials interviewed by VTDigger expressed concern over the efficacy and practicality of dialing back contact tracing.
The agency’s assertion that high-vaccination schools don’t need contact tracing is “not an evidence-based strategy,” said Anne Sosin, a policy fellow and public health researcher at Dartmouth College.
That approach “is inconsistent with both the evidence that we have and guidance from the [U.S. Centers for Disease Control and Prevention] on contact tracing,” she said. “Contact tracing remains a critical public health strategy that needs to be used in conjunction with testing, quarantine and isolation, as well as broader community and school-based mitigation strategies.”
The CDC does not require vaccinated people to quarantine if they’re a close contact to a Covid case, Sosin said, but it does require notifying them so they can monitor symptoms and decide whether to get tested.
Contact tracing and testing are “linked” approaches, she said, not competing ones. Surveillance testing identifies one case; contact tracing gives schools information about that case to help prevent it from becoming a schoolwide outbreak.
Asked how the Agency of Education created the new guidance, spokesperson Ted Fisher said via email that a range of staff at the agency and the Department of Health contributed, along with “outside feedback from other partners” with health expertise.
“I should also note that this update is the result of direct feedback from Vermont schools,” he said.
Fisher said one district devoted over 20 hours to contact tracing a case with a “very large number” of close contacts, but wound up identifying only two unvaccinated individuals.
The state currently does not release data on how many contacts end up testing positive for Covid. It also doesn’t currently collect data on school closures and remote learning as a result of Covid, although French has suggested it may do so in the future via a monthly survey.
According to state guidance, students and staff who are exposed to Covid don’t need to quarantine if they’re vaccinated and asymptomatic. But Sosin pointed out that those vaccinated people may come from households with unvaccinated people, including younger children, and households with high-risk or immunocompromised people.
“We need a whole community approach still, not an approach that just considers the vaccination status of individuals,” she said.
Kelly Landwehr, head nurse of Middlebury Union High School, also said she’s concerned about the households of students and staff and thought families would be “unsettled” by the decision.
“I wouldn’t be pleased if I was a parent of a medically fragile student and my student was a close contact and I didn’t know that, because we no longer contact-trace,” she said.
Landwehr is president-elect of the Vermont State School Nurses Association. She said she’s “torn” over the agency’s decision, because she knows contact tracing can be very time-consuming for school nurses, on top of everything else they’re doing to manage Covid and student health.
But, she said, it’s one of the most important things they do to minimize the spread of Covid in their school buildings.
“It just doesn’t sit well with me,” she said. “I’m in high school, and you know I feel like, unless that’s some kind of mandate … I really feel like it would be a disservice to our school and our school community to not contact-trace in those cases.”
Soph Hall, past president of the state nurses association and a nurse at Miller’s Run School in Sheffield, said she can spend “hours” tracking down contacts even for a single, mild Covid case. Sometimes she gets notified of test results on nights and weekends. “It’s sort of the nature of the beast,” she said.
The process has some benefits, though. It helps build relationships between families and the school and serves as another mechanism of communication, she said.
Hall said she’s encouraged by a strategy that other states have used to limit the spread of Covid in schools. The “test to stay” model, sometimes called the “test and stay” model, has students’ close contacts stay in school and get tested every day for seven days, rather than quarantine and potentially miss school.
Massachusetts is the only New England state that has adopted that model, although many others have adopted surveillance testing strategies. Sosin said recent research has found the method fairly effective at preventing an infection from spreading within classrooms.
But with schools already making hard choices about how to use their limited resources, such an intensive testing model seems far away. Hall said her school hadn’t even adopted surveillance testing yet because it lacks the staff needed to support it.
David Younce, superintendent of Mill River Unified Union School District, said staffing concerns had also prevented his district from adopting surveillance testing. He said he’d heard that other schools have asked the Agency of Education or the Department of Health if they could help staff that process.
Younce said he was concerned that less contact tracing would leave him with fewer data points to make decisions about when and how to close schools. Many schools have sent classrooms of students home in order to ensure the virus won’t spread further while they do contact tracing.
“I trend toward a more conservative approach,” he said. “If I can close the classroom down for a day, and I know that I can limit any school-based spread by doing so, and allow my team to get the contract tracing cranked out and get to the bottom of things, that’s a safe move.”
Younce, who is also president of the Vermont Superintendents Association, said he would appreciate clear expectations, guidance and decisions from the state to make the right decisions.
“When things feel muddy or are changing frequently, it makes it hard to find that clarity,” he said.
Landwehr, the Middlebury school nurse, said the lack of guidance from the state was a “challenge.” Officials from her district met with others in the Champlain Valley to create their own guidance, and she said it was a thoughtful decision-making process, despite the “spotty” guidance shared with them.
But last year’s state approach was “a much more thoughtful rollout of the guidance, much more comprehensive, and just gave us a much better roadmap that felt so much better,” she said. “And it had us all on the same page, doing the same thing.”
Sosin, the Dartmouth researcher, said Vermont should do whatever it needs to do to follow CDC guidance, rather than base decisions on what resources are available.
“We need to fix [this] broken system, or we need to invest resources into contact tracing, rather than start cutting corners as cases grow in schools,” she said.
Sosin said resource constraints at the state and school level are “not justification for compromising the health and education of kids in schools.”