Quarantine violation & preschool attendance

[noneYet]

THE SUMMARY: Thursday morning a 3 year old (I'll call him C) was brought to preschool by a family member (hereafter Re) who mentioned that she (Re) was supposed to be in quarantine, and was going to get tested for Covid later that day. My wife, caught off guard and uncertain what to do, called her supervisor who told her to admit C until & unless Re's test was positive.

I am certain that answer was very wrong, but that's just my lay opinion. I'm pretty sure C should be out until/unless Re's test is negative. By my logic and understanding of the practice of quarantining: •Re broke quarantine and extended her exposure to C. •Since C was admitted to school, that quarantine should now extend to everyone who was there Thursday, and now their households as well. I have checked CDC and our state DPH websites, but couldn't find anything specific and solid enough to arm my wife to second guess her boss.

WHAT I NEED: A pro to either explain to me that I'm wrong, or tell me what she should say to her boss.

MORE DETAILS: •Re's exposure is not in doubt. She has definitely had considerable contact with someone who has tested positive. (We know someone else who went into quarantine at the beginning of the week due to contact with the same person, so I wonder if Re should actually have been quarantined and tested sooner.) •Since Re broke quarantine to bring C to school, I don't imagine that she's properly distancing while at home. Re is in C's household, and I'm told he is typically "all over her," so I'd guess that C's level of exposure is probably about equal to Re's. •One of the school's requirements is that everyone takes lunch "family style." Although they are seating fewer children per table than they used to, they still have 6 kids and a staffer seated around each small kidney table. •While at school, C does a lot of (uncovered) sneezing and coughing. He spits a bit when he talks, and is grabby with things & people. •Working with C and managing his behavior is very hands-on and demands a lot of close contact. I want to stress that of that I am not criticizing C - he's 3. But the last two points do drastically elevate the level of exposure to other students, and to staff even more so.

I have not been able to let this matter go. (Can you blame me?) This weekend one staffer contacted the supe to reconfirm the earlier (bad) decision. She was told that "C can only be kept home if Re was tested, and you can prove that she had contact with C this weekend." Since we already know Re had significant exposure and was supposed to get tested, I fail to understand how it matters whether or not she actually went in and got tested. Furthermore, staff saw Re carrying and kissing C since the the time of her exposure (while she was supposed to be quarantined), so why should they need proof that they had more contact over the weekend? (I understand that the facts in this paragraph don't materially change the scenario. But it all seems so d****d foolish that I needed to vent it to an audience that would understand. This answer seems so illogical that I've lost confidence in the admin's ability to make good decisions.)

I am convinced the admin (who work in a building 40 miles away) are making a dire mistake, but I lack the references and credentials to tell them so. I give my dearest gratitude to anyone who can advise me here. Again, if you can tell me I'm worked up over nothing, great! Otherwise, I need to arm my wife with the right jargon to start the conversation, and with a list of best practices, specific guidelines, or whatever, that spell out the correct response so that this bad decision gets overturned without my wife having to argue or appear insubordinate.

I look forward to hearing your thoughts.

Thanks again.

[SchlNrsKrn]

C is a "contact of a contact" and per my county guidelines, no further action is required unless the contact (Re) develops symptoms or tests positive.  I believe most are doing it the same.   See below example from NYS (not where I am, but the quickest reference I could find.)

https://coronavirus.health.ny.gov/system/files/documents/2020/03/contacts_of_contacts_guidance.pdf

[k1p1ssk, BSN, RN]

Hi; There is a lot to unpack here... There are issues of privacy and whose right is it to know anything and the risks associated with oversharing.

First, there is a very distinct difference between quarantine and isolation. Close contacts who are asymptomatic will typically only be told to get tested and quarantine - I.e. stay home and only venture out if medically necessary. This won't necessarily extend to household members unless they were also a close contact of a positive individual. If they are a close contact and suspiciously symptomatic, they will be instructed to get tested and self isolate and THEN the family/household members/close contacts will quarantine, as they may be diagnosed as a suspected positive.

I'm going to assume that Re is asymptomatic first...

Re should not have brought C to school, because yes, this breaks quarantine, but until Re is identified as a positive case, there is no need to exclude C from school. I know this sounds wacky, but if we followed this rule, the whole country would need to totally shut down because at this point, just about everyone in the nation is a close contact of a close contact....

If Re was symptomatic, then of course she still should not have brought him to school, however whether or not C also stayed home would be up to your school/district/state's quarantine mandates to determine.

Our district is not making people who are close contacts of Persons Under Investigation who are asymptomatic stay home until the PUI is deemed positive or diagnosed as suspected by their doctor. 

I understand how difficult it is to come to terms with this. But we have to understand that people are gonna people and will ignore best practices. All we can do is govern what happens in our schools. We can ask people to follow the rules outside of school all we want, but we cannot mandate what they do.

Also, think of it this way: Re was under no obligation to share that information with the school in the first place. It sounds like Re is not necessarily a parent, and may not live with C? If the public health officials in your town thought it was of consequence to the school, then they would have notified you (if they were aware of the connection). So, had Re not said anything, you all would have been none the wiser and nothing would change anyway, right? 

[ruby_jane, BSN, RN]

Per our policy: An exposed parent who tells you this should quarantine their student for 14 days. 

You say "family member" - is this person living with your student? Were masks used by both on the drive if not? Those are things that mitigate exposure but...I'd be doing detective work with the family.

[JenTheSchoolRN, BSN, RN]

Above posters saying this is a "contact of a close contact" are correct. Technically, no you do NOT need to quarantine this child. I navigated this very thing recently with staff members whose child tested positive with my local board of health. 

However, this is also why part of my pre-screener I have students complete asks "Are you OR anyone in your household currently awaiting the results of a COVID test?" It was give them a "do not come to school" response if they say yes.

And it will flag me to call the family and investigate so even if I can clear a contact of a contact, I can reminder the quarantining family member that they must maintain quarantine and cannot be the person to pick up or drop off their child and should actually be doing their best to maintain social distancing in the home with their child. 

[LikeTheDeadSea, MSN, RN]

"Exposure to an Exposure" has no isolation/quarantine indicators where I am.  It's very nice and wonderful and certainly feels morally/ethically good when an adult calls and says they are an "Exposure to a Positive" and will be keeping their kids home in good diligence, but in reality the only person on an actual quarantine is the person who was directly exposed to the positive case, and their children are welcome to come to school despite anyone who knows about it getting the heebie-jeebies

 

 

[NutmeggeRN, BSN]

Is anyone else here concerned about the OP's spouse sharing all that information? FERPA?

[NutmeggeRN, BSN]

3 hours ago, k1p1ssk said:

Hi; There is a lot to unpack here... There are issues of privacy and whose right is it to know anything and the risks associated with oversharing.

First, there is a very distinct difference between quarantine and isolation. Close contacts who are asymptomatic will typically only be told to get tested and quarantine - I.e. stay home and only venture out if medically necessary. This won't necessarily extend to household members unless they were also a close contact of a positive individual. If they are a close contact and suspiciously symptomatic, they will be instructed to get tested and self isolate and THEN the family/household members/close contacts will quarantine, as they may be diagnosed as a suspected positive.

I'm going to assume that Re is asymptomatic first...

Re should not have brought C to school, because yes, this breaks quarantine, but until Re is identified as a positive case, there is no need to exclude C from school. I know this sounds wacky, but if we followed this rule, the whole country would need to totally shut down because at this point, just about everyone in the nation is a close contact of a close contact....

If Re was symptomatic, then of course she still should not have brought him to school, however whether or not C also stayed home would be up to your school/district/state's quarantine mandates to determine.

Our district is not making people who are close contacts of Persons Under Investigation who are asymptomatic stay home until the PUI is deemed positive or diagnosed as suspected by their doctor. 

I understand how difficult it is to come to terms with this. But we have to understand that people are gonna people and will ignore best practices. All we can do is govern what happens in our schools. We can ask people to follow the rules outside of school all we want, but we cannot mandate what they do.

Also, think of it this way: Re was under no obligation to share that information with the school in the first place. It sounds like Re is not necessarily a parent, and may not live with C? If the public health officials in your town thought it was of consequence to the school, then they would have notified you (if they were aware of the connection). So, had Re not said anything, you all would have been none the wiser and nothing would change anyway, right? 

 Do you work there as well?

[BrisketRN, BSN, RN]

Why are admin making these decisions?  The local or state department of health should have guidelines to follow.  If those guidelines are unclear then admin (or health staff) should contact the DOH for clarification.

[k1p1ssk, BSN, RN]

5 minutes ago, NutmeggeRN said:

 Do you work there as well?

Nope! Just trying to navigate these muddy waters like everyone else!

[NutmeggeRN, BSN]

2 minutes ago, k1p1ssk said:

Nope! Just trying to navigate these muddy waters like everyone else!

Ooops that ? was meant for the OP, sorry about that! Muddy water for sure!

[LikeTheDeadSea, MSN, RN]

Also, there is a chance that your Health Dept may be issuing '"Modified Heightened quarantine" for "Exposure to positives." which  more or less means "Exercise greater caution in general hygiene practices, avoid close contact with others, always wear a face covering at all times, maintain social distance.  Eat/face covering breaks separate from others, etc." but is not a true quarantine at all.  It's not a green light to attend social activities, but allows for basic a day to day functions to occur with almost no change if  a person is already maintaining good practices. . My region is general is using these.