Below is a memo to all public and private schools in Orange County from Dr. Irina Gelman, Orange County Commissioner of Health, dated Dec. 7, 2020.
Given the alarming rise in cases in Orange County, I remain convinced that it is in the best interest of the public health to have a minimum of two periods of “holiday pause” for a return to remote instruction for two weeks after Thanksgiving and two weeks after New Year’s Day. Alternatively, a period of remote instruction covering the entire holiday period could also be considered.
As you all know, the local impact of this global pandemic has been significant. In my November 19, 2020 memo to all schools in Orange County, I reported that there had been 15,594 cases of COVID-19 to date. As of December 7, 2020, a mere two weeks later, the cases have surged to 18,354 and 545 deaths.
Orange County is seeing daily case numbers which recall our late April numbers. On December 4, 2020, Orange County had 262 new COVID-19 cases. Even more alarming is that in the last three weeks, the Mid-Hudson region has seen a 148% hospitalization rate increase. This is concerning because this means that hospital beds may not be available for non-COVID injuries and illnesses and people will suffer as hospitals are overwhelmed with COVID-19 cases. While children account for 8.3% of the total cases, this virus is completely new and although some symptoms are common among those suffering from the illness, the complete list of symptoms, as well as long term complications remain unknown. In fact, some children seem to be at risk for developing more severe complications from COVID-19, such as
multi-system inflammatory syndrome in children (MIS-C), which is of great concern, especially for children who are medically fragile. For more information about MIS-C, please visit the following website: https://www.cdc.gov/coronavirus/2019-ncov/daily -life-coping/children/mis-
In September, when school resumed, the 10-day rolling average of cases was 9.8 cases per day. The current 10-day rolling average is 182 cases per day. This recent increased case load as noted above is not reflective of the increase in cases which are the result of Thanksgiving gatherings; that spike is anticipated shortly. It is estimated that 65% of all currently active cases in New York are related to small social gatherings. Due to the persistent broad community acquired rate of transmission in Orange County I continue to urge you to take a “holiday pause” for a minimum of 14 days after each holiday. There were several plans I outlined in my previous memo. The purpose of the suggested “holiday pause” is to prevent the widespread community
transmission from coming into the school setting. This is because once broad community acquired transmission is achieved, such as is the case now, the presentation of a COVID-19 positive person into the congregate setting of a school should be expected. School exposure will disrupt the continuity of school operations as this will lead to the isolation of the positive person
and the quarantine of those exposed. In the past few months, each time a positive person presented to a school setting, an average of 30-50 additional people were exposed and then quarantined which resulted in a return to remote instruction for some, if not all students and faculty as was evident in the aftermath of Halloween gatherings. This return to remote instruction may have been because of a lack of sufficient staff or faculty, the need for deep
cleaning, the need to do contact tracing, in addition to the necessary isolation and quarantine of the individuals involved.
To understand the impact of COVID-19 on schools thus far, as a matter of fact from mid-September of this school year until November 14, each of our 18 public school districts have had at least one positive case reported. To date, the 539 positive cases that presented to schools in Orange County resulted in approximately 21,560 individuals being quarantined during the same time period. Fourteen out of eighteen school districts have had one or more schools close due to COVID-19 related exposure issues.
Many have asked why schools should close since the in-school transmission rate is low. It is important to remember that schools are located in communities. The students, faculty, and staff who are coming to school reside with others in households located in communities. There is a high degree of community acquired transmission at this time, which will be exacerbated when
the impact of gatherings taking place at this time of year affects the Orange County COVID-19 disease propagation. Just because the transmission of COVID-19 does not happen as much in school, doesn’t mean that transmission that continues outside of school won’t impact the continuity of school operations, as outlined above. The isolation and quarantine of students,
faculty, and staff also affect their families. This is why community-acquired transmission rate is more relevant than the school transmission rate in predicting the impact of COVID-19 on a school community. This is especially true as households are comprised of student of varying ages, attending different schools. This is true also of the households of the faculty and staff.
Despite in-school transmission being low, almost all of the public schools in Orange County have had to take action when a person who ended up testing positive for COVID-19 presented to school. These actions included isolating the positive individual and then quarantining all of that person’s contacts. In fact, in the time there has been in-person learning in Orange County, 539
persons have presented to public school while positive. This has required the mandatory quarantine of 21,560 persons to date. Last week, the last public school that attempted to resume in-person instruction (reported 12/1) in a NYS designated yellow micro cluster area of Orange County, has had 40% of the group of individuals tested for COVID-19 test positive and due to this fact, continues to operate on a remote basis. This data is provided to demonstrate the scope and magnitude of COVID-19 positive individuals presenting to in-person congregate setting. The facts bear out that community transmission of COVID-19 has an impact on the school community irrespective of the fact that in-school transmission is low. These statistics highlight the need for the “holiday pause” as previously recommended, especially given the current rate of disease propagation in our area.
The Mandatory Quarantine Period for those exposed to a person who has tested positive for COVID-19 remains 14 days.
Recently, the CDC proposed a change to the quarantine period for those who have been exposed to a person who has tested positive for COVID-19. This change was made by the CDC based on economic and social behavioral issues with the idea that a shortened time period might increase national compliance. However, the incubation period for COVID-19 has not changed and is still 2-14 days. In fact, the CDC still supports the longer period of 14 days as the safest option. Therefore, the OCDOH quarantine parameters will not change, unless new scientific evidence or mandatory guidelines emerge to suggest otherwise. The NYSDOH has also not changed the quarantine parameters.
I reiterate the OCDOH requirement for a clearance note from a medical provider prior to returning to in-person instruction for all those who have been isolated or quarantined due to testing positive for COVID-19 or being a close contact to someone who has tested positive or due to other COVID-19 related absences as outlined in the OCDOH School COVID-19 FAQ.
The OCDOH will continue to require the doctor’s clearance note to return to in-person instruction, as originally specified in the OCDOH School COVID-19 FAQ (8.12.2020/10.21.2020) and previously discussed with school districts in Orange County. However, in the case of a school exposure which required quarantine and the school then begins remote instruction with a return to in-person learning occurring three or more weeks later, a clearance note will NOT be required. Please note that this only applies to school related exposures prior to the “pause” to in-person learning. When the time period for remote learning is less than three weeks, the requirement of a note to return to in-person learning post school-related exposure will be made on a case-by-case basis.
Let me be clear, we share a common goal of keeping schools open for in-person instruction as long as it is possible to do so safely. The OCDOH takes the health and safety of our children very seriously, even more so during the worst public health crisis in a century. While infection rates are increasing daily and given the fact that there is a high degree of community transmission of COVID-19, we need to proceed with caution and take every step possible in resuming in-person instruction safely and responsibly.
Dr. Irina Gelman