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Mid-Missouri's county governments are working with school districts to find resources and personnel to trace contacts for COVID-19-positive cases in schools.

Last week, Cole County commissioners said they'd hire additional contact tracers to assist public schools using federal funds. They are considering hiring 12 part-time staff members to do so.

The support each school district needs varies, and it can be made more challenging by whom is being notified of positive cases first, the school district or the county, according to Cole County Health Director Kristi Campbell. The Missouri of Health and Senior Services will notify the county of positive cases. But, oftentimes, parents of a child who tests positive notifies the school district before the county knows, she said.

"We are working collaboratively with the schools," Campbell said. "Whoever receives the information first reaches out to the other entity to begin the contact investigation."

The health department relies on staff at schools to identify close contacts because they know the seating layouts, seating charts, schedules and other factors that affect contact information, she said.

"We work together in identifying and contacting the close contacts," she said.

Similar policies apply to the colleges and universities in the county, she continued.

Contact tracing is a collaborative process, Campbell said, using "lots of phone calls" between county health department staff and schools.

County staff enter any information gathered in the state information database, she said.

Chad Sooter, director of health services for the Jefferson City School District, currently does contact tracing within the district.

"When notice is received that a student or staff member has tested positive for COVID-19, I work as quickly as possible to determine whether the individual was symptomatic while they were on school property (or within 48 hours before becoming symptomatic)," he said. "This is accomplished by reaching out to the parents of the positive student or the positive staff member and collecting additional information related to the case."

Helped by school nurses, Sooter also has to trace where the student or teacher has been while at the school, including on buses.

"Once I have compiled all of this information, I put together my recommendation and share it with the appropriate local health department for their review and confirmation of my recommendation," Sooter said.

Osage County Health Department Administrator Susan Long said outbreaks had been light at State Technical College of Missouri, where only two students had tested positive for COVID-19.

Long said her county also uses a sort of "joint effort" to contact trace. She has toured facilities to determine whether children are able to social distance or not.

And, she recently hired two nurses, who can help.

"I'm going to be assigning a nurse to work with the schools directly," Long said. "It's easier if they just have one contact."

Osage County R-3 Superintendent Chuck Woody said while Fatima school principals and nurses will help with some contact tracing, it is primarily done by the county health department. The schools help by providing seating charts, lunchroom assignments, bus seating and other information, he said.

"I provide updates through social media when and if a positive case occurs," Woody said.

Osage County has seen cases "spill over" from the Truman Building in Jefferson City, a nursing home in Hermann and from Jefferson City Manor, Long said.

Receiving notification about people testing positive for COVID-19 sometimes takes time. Getting information sooner could help with contact tracing, she said.

Miller County Health Center is responsible for all contact tracing in the county, including at schools, according to Administrator Mike Herbert.

"We ask the schools to determine who are the close contacts of certain staff or students," Herbert said. "We aren't there, and younger children are not a good source of information, so we must utilize school administrators, teachers, coaches and other staff."

Schools in the county use seating charts, staff interviews and even video recordings to determine close contacts, Herbert said. The health center lets the schools know how long each of the close contacts should be quarantined.

"The school notifies the parents of the quarantine dates and provides a letter and infographic from us. Parents are encouraged to call us with questions about what quarantine means, benefits of testing, etc.," Herbert said.

If parents want to argue about whether their child was or wasn't a close contact, the center isn't much help, he continued. Because staff at the center weren't at the school when the contact happened.

There were some bumps in the road to creating a cooperative investigation with the schools, he said. On the very first COVID-19 case, the center and a school district realized they were both reaching out to all the parents. So, they are now taking steps to not duplicate efforts.

"We also know that parents are more likely to answer calls from their child's school," Herbert said.

Darrell Hendrickson, an environmentalist with the Moniteau County Health Department, said the health department does all the contact tracing. That's been a challenge for a county that has a school district where more than 110 students have been asked to quarantine at home because of close contact. (That's in a high school, middle school and elementary school.)

Fortunately, notification came over a weekend, so the county was able to identify close contacts and tell their parents before they returned to school Monday.

Dwight Sanders, California Schools superintendent, said it's often difficult to determine if students have been within 6 feet of each other for more than 15 minutes. The close contacts may occur on buses, in holding areas, or various areas of the building where students report in the morning.

It's best if the health department contacts families, Sanders said, because there will sometimes be questions about the process.

Sanders said most of the COVID-19-positive cases (and close contacts) in the school district happened at the middle school. So, about 30 percent of the school's 330 students are out for about two weeks.

"It's absolutely a concern. It puts an extra burden on the teachers," Sanders said. "We still have two-thirds of our students in seats. Teachers have face-to-face instruction but also other instruction for students who are under quarantine."

Another concern, he said, is uncertainty about students who are in quarantine and whether they are receiving nutritious meals.

A little less than 50 percent of students in the district qualify for the free or reduced-price lunch program. However, under COVID-19 rules, all students in the district qualify for free meals through Dec. 31, Sanders said.

Other students qualify for behavioral health services, which they receive at school.

There have been a few more positive cases and close contacts identified in Moniteau County more recently, Hendrickson said.

"We've had everybody working on this particular issue," Hendrickson said. "We've hired another individual to work contact tracing."

What the county is faced with is "quite challenging," Hendrickson said. "We started our flu program. We had nurses giving shots at 7 o'clock in the morning (Tuesday)."

All those things mingling with the center's normal routine, responding to dog bites and other things, are putting a strain on the health department, he said.

"Fatigue is showing. We are tired," Hendrickson said. "We aren't, maybe, sometimes as patient as we should be. But, they're doing the best they can in really difficult situations."

If things continue, the center may have to ask the state for additional resources, he said.

The center encourages people to be smart — wear masks, wash hands, practice social distancing.

One of the things the center did to speed things up is begin contact investigations as soon as it is notified of a positive, whether that's from the state or from a parent.

"That may save us a day or two," Hendrickson said. "I've always been working this virus from behind. We're trying to get ahead of it. We don't wait. We go ahead and do it."

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