CDC Has Changed the "Close Contact" Definition

[k1p1ssk]

I saw this WaPo Article this AM (I hope you can all read it and that it isn't behind a paywall): CDC expands definition of who is a ‘close contact’ of an individual with covid-19

And yep, sure enough, the CDC has expanded who is considered a close contact (from https://www.CDC.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact?

"Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated."

Huge implications for our classrooms. We were hoping that a max of like, 4 kids would have to go out and quarantine if we had a positive case... now it looks like entire classrooms will have to shutter if we have a positive case as our teachers can't guarantee that the students weren't within 6ft of each other for less than 15minutes over the course of the school day.... especially with different eyes on them at recess/lunch, etc.... Though our district closed the entire HS/MS building for 1 positive case and wasn't planning on closing an elementary school because of the distinct cohorting happening in those pk-6 buildings... I think they'll have a hard time explaining why if they don't close the entire school. We shall see, I'm sure!

 

[Jedrnurse, BSN, RN]

23 hours ago, Mavnurse17 said:

My district is and has been going by 15 CONSECUTIVE minutes, not cumulative.  They decided that because it would be impossible to keep any school open if we were going by cumulative.  I heard in our weekly update meeting yesterday that we're continuing to go against this new CDC information until further notice ?

Denial is a river in Egypt...

[JenTheSchoolRN, BSN, RN]

On 10/22/2020 at 9:22 AM, SchoolNurseK said:

This has been our criteria for determining a contact for quite some time.  The question I keep getting is, what about masks?  Parents want to know why we are wearing the masks at all if this is how we are determining contacts.  I am not sure what to say, honestly.  The chances of their child being positive are significantly lower with the mask, but they argue that we should either not quarantine if the mask was being properly worn OR don't wear the masks.  Anyone else having this conversation?  What are you saying?

Masks do not matter in terms of close contact determination in my state. It has been that way since the beginning. Families and staff were told this. 

Only time it is taken in consideration is if it was a health care worker close contact, then they look at the level of PPE worn and use the CDC guidance there (basically school nurses can work if asymptomatic, even while waiting for testing if they were wearing the proper PPE during exposure). 

[turtlesRcool]

On 10/22/2020 at 10:13 AM, Queen of Icepacks said:

Our lead nurse keeps reminding us that masks reduce the chance of transmission they do not eliminate it.   I use this often with our parents.   

We don't have infection control measures that completely block transmission (except arguably properly fit-tased N95s and full PPE, which is not an option in a school setting). So we use multiple means of harm reduction.  

For something like this, the Swiss Cheese image can be helpful.  A slice of Swiss Cheese has holes of varying sizes, representing areas of weakness where the virus could get through.   But when you line up several slices, you usually get a whole surface because one slice will cover up the hole of the slice in front of it.  So, too, with public health, we want to have several layers of protection in our infection control plan because no layer by itself is completely effective.

Masks are the first line of defense, in hopes that the infected person's secretions will be contained.  Distancing is the second line of defense, in hopes that any secretions that get out will fail to reach another person. If droplets or aerosols get to someone else, masks on the healthy are another line of defense to reduce the virus particles that get through to the face.  Along the way, we stress proper handling techniques for the mask donning/doffing/storage, and hand hygiene and surface cleaning to decrease fomite-based transmission.  Finally, we use quarantine as a firewall.  Better to send multiple people home to quarantine at the same time than to have to keep doing it over and over because the virus got through and infected just one or two each time.

As for the argument that kids shouldn't have to mask if there will be a quarantine anyway, unmasked kids are going to cause a LOT more people to have to quarantine.  6ft is the "safe zone" for the respiratory droplets from breathing and ordinary talking.  But just ONE sneeze from an unmasked kid has the potential to travel 28ft and remain in an aerosolized cloud, according to research from MIT.  That basically puts the entire class into the infection zone. 

 

[cgw5364, ADN]

I think the wording "cumulative" is the focus. I read an article this weekend about a prison guard who testing positive after having brief contacts with 9 new inmates who were all asymptomatic. The guard wore a microfiber mask. The inmates were masked and unmasked. Here is the article:

https://www.CDC.gov/mmwr/volumes/69/wr/mm6943e1.htm

 

[JenTheSchoolRN, BSN, RN]

13 hours ago, cgw5364 said:

I think the wording "cumulative" is the focus. I read an article this weekend about a prison guard who testing positive after having brief contacts with 9 new inmates who were all asymptomatic. The guard wore a microfiber mask. The inmates were masked and unmasked. Here is the article:

https://www.CDC.gov/mmwr/volumes/69/wr/mm6943e1.htm

 

Very interesting!

I wonder why they had this guard wear a gown and googles (and gloves), but not at least a surgical mask? Not saying it may have mattered here, but a surgical mask is higher level protection over the microfiber cloth mask the guard was wearing and he was wearing in a quarantine unit for inmates with symptoms consistent with COVID.  That makes little sense to me.