School districts across Montana have been in session for a few weeks now and there have already been confirmed cases of the novel coronavirus in schools. But county health departments and school districts are taking varied approaches in how they are disclosing those cases to students, parents, staff and the broader public. MTPR's Aaron Bolton talks with YPR's Nicky Ouellet about his reporting on this.
Nicky Ouellet: So as I understand it, some school districts are letting parents know when there is a case in a particular school, or are even announcing publicly that there is a case. But others say a parent may not even know if their child sat in a classroom with someone who tested positive for COVID-19?
Aaron Bolton: That’s right. County health departments are charged with investigating COVID cases in schools and contact tracing, but some county health departments say state law prohibits them from sharing information about cases with the school district. Lance Melton heads up the Montana School Boards Association. He says that without that information, district administrators and school board members are flying blind as they make important safety decisions as the school year winds on.
"We have circumstances where school districts are only receiving information that there may be a case and, that they may or may not learn more about it; that the county is urging the individual to share that information with the school district, but leaving it up to the individual to do so."
Ouellet: Where is this more restrictive approach happening and why are health officials saying they can’t share information?
Bolton: Yellowstone County is the most prominent example of where information is not being shared between public health officials and districts. Riverstone Health CEO John Felton is the county health officer. He says it’s the Montana Government Healthcare Information Act that’s preventing health officials from sharing information about cases in local school districts, not the Healthcare Insurance Portability and Accountability Act, or HIPAA as most people know it.
"I think where it gets a little confusing is when we look at where the rules come from, they never really contemplated a respiratory viral pandemic. What they're really intended to address is public health information that we typically think about, which tends to be a more stigmatizing disease like sexually transmitted infections or HIV or that kind of thing."
Bolton: Felton says Riverstone is ironing out an agreement that it hopes to present to local districts this week. That agreement will allow districts to assist in contact tracing and could provide school administrators with high-level information about cases in their classrooms.
Billings Public Schools Superintendent Greg Upham says those agreements could allow the district to share information with parents and potentially with the public. But he also hopes it will allow the district to share information with county health officials in a secure way that complies with federal restrictions the district is under. An example would be letting health officials know a potentially symptomatic student or staff was sent home, so they can follow up.
"That’s one of our concerns, especially from our nurses, that people who are displaying symptoms aren’t being tested. That doesn’t mean we still can’t say, ‘you are not going to be back in school until you’re symptom free.’ That’s standard procedure, but we can’t control who tests and who doesn't test. So that’s a part of the equation also."
Ouellet: So, there's some concern that state law is blocking communication between health departments and schools. Is this making contact tracing a challenge for county health officials?
Bolton: Yes. As you may recall, many districts are keeping kids in small groups and are keeping track of seating arrangements in classes in order to keep a close eye on who students are in close contact with. But that information is only beneficial if public health authorities have access to it. Under the current circumstances, if the parents of a student don’t alert the school they have tested positive, Yellowstone County health officials are completely reliant on that student to identify close contacts. That can be hard if you’re working with a young child. That’s in part what Riverstone Health and school officials hope these forthcoming agreements will resolve.
Ouellet: For counties that are sharing information with districts and vice versa, how are they accomplishing all of this while still abiding by federal and state law?
Bolton: Big Horn County is a good example of this. The county is viewing school nurses almost as an extension of the county health department. They are the ones getting case-specific information from the county health department and in-turn are able to share information with school officials who are charged with making decisions to keep students, staff and in the case of a respiratory-based pandemic, the broader public safe from increased transmission in the community. So, some county health departments have a different interpretation of the state law that Riverstone Health says is so restrictive.
Ouellet: I’m curious, how is information on COVID-19 cases and outbreaks within schools being shared with state health officials? Because it was Gov. Steve Bullock who closed schools this spring and while that power has been given back to local districts, is it important for the state to stay abreast of what’s happening in school buildings?
Bolton: According to a statement I received from the Montana Department of Public Health and Human Services, there are 70 communicable diseases and conditions, which includes COVID-19, that require health providers to report them to local public health authorities. So if a student or staff in a school tests positive, local health officials will know about that and that information will in-turn be reported to the state.
But whether the state health department will provide any more information about how schools are playing a role in transmitting the novel coronavirus, say in its bi-weekly reports, that remains to be seen.
Ouellet: According to the state health department, the number of Montanans ages zero to 19 infected with COVID-19 nearly doubled from early August to September, but that demographic’s slice of total cases only grew from 12 to 14 percent. We know there have been cases in students in Hardin, Butte and Flathead County to name a few, but we’re less than a month into the school year. Are other states where schools started much earlier this year giving us an idea whether school reopenings are increasing transmission in their communities?
Bolton: It’s a complicated answer. There have been high-profile outbreaks in states like Georgia where schools had to shut down again, but like Montana, school and public health officials are bumping up against privacy laws intended to protect minors' identities that restrict how data is used and shared. Here’s Josh Michaud with the Kaiser Family Foundation. He’s a trained epidemiologist and Kaiser’s associate director of global health policy.
"The bottom line is that we do know that children can become infected and they can transmit this virus to others. Where we wish we had more information is how readily that occurs."
Michaud says early studies suggest older kids, particularly teens, are more likely to contract the virus that causes COVID-19 and transmit it to others. He points to outbreaks in high schools elsewhere in the country as potential evidence of that, but stresses there’s much more research to be done on this. And he notes outbreaks in schools are much more likely in places where there’s already widespread community transmission.
Ouellet: Aaron, thanks so much for your reporting.
Bolton: Thanks for having me.