Quarantining students for close contact to a COVID-19-infected classmate, even if they don’t become sick, is causing children to miss a substantial amount of in-person class. In a nine-week grading period, a 14-day quarantine, which health officials recommended for most of the school year, would result in a student missing nearly one-fourth of in-person class time.
The Ohio Schools COVID-19 Evaluation (OSCE) created a study in the fall of 2020 to answer the question: If a child in a supervised setting was in close contact to another child with COVID-19 and both children were wearing masks properly, did the close-contact child need to stay at home to quarantine?
The OSCE used The Centers for Disease Control and Prevention (CDC) definition of close contact for their study purposes. The CDC defines close contact as being within 6 feet of an infected person, for a total of 15 minutes or more over a 24-hour period. That applies to the two days before a person is symptomatic or tests positive.
Catherine MT Sherwin, Ph.D., FCP, Wright State University Boonshoft School of Medicine (BSOM) vice chair for pediatric research, professor of pediatrics and pharmacology and toxicology, and director of pediatric clinical pharmacology with Dayton Children’s Hospital, along with several BSOM students, participated in the six-week study that took place in November and December of 2020.
Sherwin’s role was field supervisor and training lead for the southwest Ohio study site. She was involved in all visits to schools and in training the BSOM students who volunteered to be part of the study field team. Students were trained on procedures required to be research assistants, and how to administer the COVID-19 test. Staff from Dayton Children’s Hospital assisted with their training for COVID-19 testing. Trainings were recorded and shared with the other study sites statewide.
The field team for the study site consisted of Sherwin and BSOM students who traveled weekly to designated schools within southwest Ohio to perform COVID-19 testing. “The students were great and contributed a lot of hours and dedication to this project; I couldn’t have done it without them,” said Sherwin. BSOM students participating in the project included Hilary Kleppel, Amber Prater, Cameron McGlone, Charu Gupta, Mirjana Grocic, Abigail Schmidt and Kyle Henneke.
The study also received support from school administrators. To encourage participation and build confidence in the safety of the process, the superintendent of Mason City Schools, near Cincinnati, was videoed being COVID-19 tested. The video was shared throughout the district for parents and students. “We also relied on good communication between the school superintendents and principals, and our team,” said Sherwin. Every Monday, the field team received reports from the districts on the numbers of positive COVID-19 cases, along with confirmation on which students were allowed to be tested. This information dictated which schools the team visited that week.
COVID-19 rapid-tests were given to students, twice weekly for children who had been in close contact with an infected classmate, and once weekly for the comparison group of students of the same age and grade who had not been in close contact with an infected student. “I was surprised by how many students volunteered to be part of the comparison groups,” Sherwin added.
To be included in the project, close-contact children had to have been exposed to a COVID-19 case in school, been within 6 feet for more than 15 minutes, and both COVID-19 infected and close contact students were wearing masks appropriately. Students exposed to COVID-19 outside of school, for example, during extracurricular activities, were not eligible to participate.
Schools could choose whether to have close contact children quarantine at home or remain in school with regular testing. Close-contact children were identified by the schools, who worked with their local health departments. All children with a positive test were isolated, and the local health department was informed.
Surveys were also administered as part of the project. Children were asked about interactions with friends and exposure to people beyond school. Parent surveys focused on information regarding prevention practices at home, and stressors related to the pandemic. Teachers were asked about school structure, class activities and mask usage, and district superintendents answered questions related to pandemic communications, equity challenges and paths forward.
OSCE included over 700 children in the study, with nine Ohio school districts participating in the survey portion, and seven of the nine participating in both the survey and COVID-19 testing. The participating schools and districts included Marysville Exempted Village and Whitehall City Schools, in the Columbus area; Lakota Local Schools, Mason City Schools and Princeton City Schools near Cincinnati; Ashland City Schools and Champion Local Schools near Cleveland; Athens City Schools; and Troy City Schools, near Dayton.
The schools were chosen intentionally by the state. Effort was made to ensure the schools had a reasonable representative sample with regard to characteristics that included number of recent COVID-19 cases, school size, location, instruction model (hybrid or in-person) and proportion of impoverished students and students enrolled in Medicaid.
Sherwin worked closely with other program participants, The Ohio State University and the Ohio Colleges of Medicine Government Resource Center (GRC). The GRC partners faculty at Ohio’s colleges of medicine with state health policymakers for the purpose of improving the state’s health systems. Timothy R. Sahr, director of research with GRC, was principal investigator with the project. The GRC kept the teams amply stocked with testing kits and personal protective equipment (PPE). Sherwin chuckled as she recalled her dining room filled with boxes of test kits and PPE.
Jonathan Thackeray, M.D., served as the project’s medical advisor. Thackeray is vice-chair and professor of pediatrics with BSOM, and chief medical officer of population health with Dayton Children’s Hospital. Sherwin shared how much she appreciated his support during the project, including filling in for her on field testing when she was out.
OSCE was managed by several entities in the state of Ohio, including The Office of the Governor, the Ohio Department of Health, the Ohio Department of Medicaid, the Ohio Department of Insurance and the Ohio Pandemic Leadership Team. Funding was provided by two grants through Wright State and came via the Medicaid Technical Assistance and Policy Program (MEDTAPP), a federal program that provides funding solely to universities from the department of health, Medicare and Medicaid, for research purposes.
Overall, results from the study showed that children who were appropriately masked and in close contact to an infected student in school had rates of COVID-19 similar to children who had not been exposed to COVID-19. As long as students in the classroom wore masks and complied with social distancing, they had no increased risk of catching COVID-19 from a nearby student, as compared with students further away in the same classroom or in the same grade outside that classroom.
Survey findings showed over 70 percent of students believe masking stops the spread of COVID-19, and that student mask usage in school is high. Teachers also believe masks prevent the spread and reported high mask usage by students. Administrators responded that masking was near 97 percent in the schools, and that nearly all schools had a mask policy. They also found that exposure outside of school was substantial, with participation in out-of-school activities high and mask usage low. During exposure to other children outside of school in informal settings, mask usage was low.
Sherwin’s big take-away from the study is that schools are doing it right; the protocols in place are working. Most COVID-19 transmission was happening in the community and away from the school setting. “I was surprised and pleased by how good the students were at following safety protocols, mask wearing and social distancing, especially in the high schools,” said Sherwin.
“I loved engaging with the communities. Going into a school, I enjoyed seeing students following safety guidelines, but going to school ‘like normal,” said first-year BSOM student Hilary Kleppel. “Participating in this study re-emphasized the importance of teamwork,” said fourth-year BSOM student Cameron McGlone. “I’ve never seen science move as fast as the OSCE study,” McGlone added.
“This was the fastest study I’ve ever seen; it went at lightning speed! I credit Wright State University and Dayton Children’s Hospital for pulling this off. They provided great volunteers and support throughout the project,” said Sherwin. She also specifically thanked John Duby, M.D., chair and professor of pediatrics with BSOM. “This project was a little out of my scope, but it’s because of Dr. Duby’s support I became involved.”
OSCE was a pilot evaluation and not intended to answer mask and quarantine questions definitively. The schools saw value in the data collected, and the results from this project are helping Ohio’s health officials modify school quarantining protocols to get more kids back in the classroom.
Educators agree it is important to have the kids in the classroom. Their social, emotional and academic well-being is more important now than ever.
—Lisa Coffey
