‘Very anxious:’ As Connecticut prepares to reopen schools, health districts in small cities, towns say their resources are already stretched thin

With the new school year rapidly approaching, health districts in Connecticut’s smaller cities and towns say their resources are stretched thin even before they face the challenge of thousands of students returning to the classroom and increase demands for contact tracing.

The Farmington Valley Health District covers 10 towns, including Farmington, Simsbury, Avon and Granby. Director Jennifer Kertanis and three other staff members are tracing COVID-19 cases full time, with help from the district’s 11 other employees.

Kertanis would like two more full-time staff members to handle the current load and the work that will come in the months ahead, like distributing a future vaccine. But the money isn’t there. The district has only received $40,000 in federal funding, and used that to buy laptops for staff to work from home, pay overtime and pay employees who’ve been pulled off their grant-funded work.

Her team has been responsible for tracing more than 300 cases so far, with each of those producing another two or three contacts. When schools reopen, that number could spike.

“I am very anxious about what that will look like,” Kertanis said.

Charles Brown, director of the Central Connecticut Health District, also expects school reopenings to strain his staff.

His office has four full-time contact tracers, and has already supplemented them with seven or eight volunteers, mostly retired nurses who help with annual flu vaccine clinics in his towns, which include Berlin, Newington, Rocky Hill and Wethersfield.

“Really, I think all of our schools are not really designed to be operated in a pandemic,” Brown said. “It’s just not what we build them [for]. Kids sometimes are packed in 29, 30 to a small classroom.”

Getting people to cooperate with contact tracing is another issue.

Health officials in Connecticut have made contact with at least 90% of people newly infected with COVID-19 within 48 hours, the state’s chief operating officer, Josh Geballe, said at a recent press briefing. But he estimated only half to two-thirds of those individuals participated with interviews and provided names of the people they had contact with for tracers to follow up with.

While Manchester has reached out to nearly 100% of its confirmed cases through emails, phone calls, and texts, health director Jeffrey Catlett said only about 20% of those individuals fully participated in the process.

Many people pick up the initial phone call, but in order to fully participate, individuals must be willing to share their recent contacts, as well as monitor their symptoms on an ongoing basis.

These responsibilities lead to a drop-off in participation, Catlett said. In-person learning will only increase the scope and the stakes of the process.

“If you have a classroom of let’s say 20 students, and a student tests positive, now you’re not only doing contact tracing for the other 19 students, you’re doing contact tracing for those 20 students’ families,” Catlett said.

Despite a social media campaign and efforts to establish trust with residents, “People get very intimidated when somebody calls them and starts asking for personal information,” he said.

Digital thermometers, monitoring symptoms

The state recently issued guidelines for how local health officials and schools should use COVID-19 infection rates to determine how much learning can take place in person, and when whole classes, grades and school buildings may need to be closed back down. It has also supplied communities with thousands of digital thermometers that can be linked to smartphones so temperature readings can be shared with health departments.

Hartford plans to distribute 5,000 thermometers to families before the start of the year so parents and guardians can take their kids’ temperatures before school and monitor symptoms if someone gets sick.

Earlier in the pandemic, health and education experts had wondered whether students should get their temperatures taken at school each day. That would be a “logistical nightmare,” said Hartford health director Liany Arroyo.

Instead, schools will rely on parents to watch for COVID-19 symptoms and keep their kids home when sick. Connecting the smart thermometers to a phone will be optional, but Arroyo said it will help by giving the health department real-time information about clusters of fevers in areas of the city.

When cases pop up, Hartford has 54 contact tracers ready to act — some are city employees, others students from the UConn School of Medicine and staff from the CDC Foundation.

Public health departments are responsible for tracing all COVID-19 cases outside of congregate living facilities, like nursing homes and jails. Between mid-May and Aug. 1, Hartford managed to reach people in 92% of its cases, Arroyo recently reported.

While Hartford has seen good participation, it also faces a broader challenge around engaging parents and guardians. Like other big districts in the state, a large portion of Hartford students and their families are dealing with longstanding and pandemic-related strains, like unemployment and housing insecurity, language barriers and illiteracy and trauma and loss.

When the school system asked families whether they planned to continue with remote learning, only 40% percent responded in the first week from neighborhood and non-magnet schools. Nearly 70% of families responded from magnet schools, where more students come from the suburbs and issues related to poverty are less concentrated.

Hartford saw a similar disparity in the spring with participation in distance learning, and spent countless hours tracking down the hundreds of students who weren’t logging in to their classrooms at all.

When one school suddenly lost track of four siblings in one of its most engaged families, despite providing them with technology to access the internet, it turned out they had fallen into homelessness, Superintendent of Schools Leslie Torres-Rodriguez recalled. Those kinds of challenges take continuous work, and may impact efforts to trace cases of COVID-19.

Difficulties tracing young people

Contact tracing also gets more complicated when cases are linked to young people socializing outside of school. Greenwich officials recently faced that situation after a series of high school parties in July resulted in a flare-up of infections. Barbara Heins, an aide to First Selectman Fred Camillo, said many of the young people and their families did not cooperate with contact tracers who reached out to them.

“That scenario could be very challenging,” Catlett said.

New Haven shares those concerns. Public health director Maritza Bond said the community is working to dispel the misconception among young adults that the virus only significantly impacts the elderly.

Early in the pandemic, the city developed a contact tracing app, which has helped Bond track key data by demographics. Now she’s working with other stakeholders to prepare youth-focused campaigns.

“We need to step up our messaging to youth,” Bond said recently. “Our messaging had been so focused on older adults. …. They’re young and they think they’re invincible. I have a 22 year-old and a 17-year-old myself.”

While New Haven County is categorized as “low risk” for reopening schools based on state metrics, the city’s school board voted recently to petition the state to reopen completely online, in contrast to strong preferences from Gov. Ned Lamont, Education Commissioner Miguel Cardona and New Haven Mayor Justin Elicker for at least some in-person learning.

If New Haven schools are to open, they will need more nurses to staff every building, Bond said. Previously, nurses “floated” from one school to another, but that isn’t adequate under these conditions, she said.

The summer has brought some reasons to be optimistic about communities’ abilities to prevent the spread of the virus among youth.

In central Connecticut, camps and day care centers have contributed few new COVID-19 cases, according to Brown.

According to Lamont’s recommendations, schools should favor in-person learning as long as counties are seeing fewer than 10 cases per 100,000 people per week, and a hybrid model as long as there are fewer than 25 cases. Anything over that and the state would recommend shifting to complete remote learning.

School districts can choose to start the year with a hybrid model even if community spread is still low, and parents can choose to keep their children at home, the state has said.

However, if a low-risk school district wants to reopen completely online — like New Haven is proposing — it will need to make a strong case “as to why those kids would be denied an in-classroom opportunity,” Lamont has said.

“Can I force that school to open? Can I force those teachers in there? Probably not,” he said recently. “But I feel very strongly that if there’s an opportunity for in-school option. It’s the best option for these kids.”

Dr. John Schreiber, interim chief of pediatric infectious diseases at Connecticut Children’s Medical Center, said there is no definitive “right answer” on how to reopen schools.

“The risk we worry about the most is coming back to the household where there is a vulnerable person, who has diabetes, or a grandparent lives there, or an immunosuppressed sibling,” he said. “Each family is going to need to deal with their risks a little bit differently.”

Health directors across the state say it will be well worth the effort to work through the challenges and give kids the option to sit in a classroom again.

“We have a window to get kids in school and I think we should take advantage of that window because we don’t know what the future holds with a potential second wave,” Arroyo said.

Amanda Blanco can be reached at ablanco@courant.com.