With the first known cases of COVID-19 being reported in a Kamloops school and long-term care home this week, Interior Health is explaining the steps taken when cases occur in these settings.
A student or staff member at NorKam senior secondary and a care-aide at The Hamlets long-term care home and assisted-living facility in Westsyde each tested positive for COVID-19, with IH noting the school exposure occurred on Nov. 6. The care-aide has been off since Nov. 9.
The health authority implemented additional infection control and preventive measures at The Hamlets, while at NorKam, close contacts of the infected person are being told to self-isolate.
IH has been conducting contact tracing in both instances, which is where its protocols for addressing each type of institution begins.
Kamloops-based medical health officer Carol Fenton said laboratories will flag positive cases that arise in students or people who work at care homes and schools, leading to phone calls to the infected from public health.
“We ask them a series of questions around when their symptoms started, what their symptoms were and, using that information, we determine the period [of time] they are infectious,” Fenton said.
That period is defined as two days before to 10 days after symptoms began.
Once that timeline is established, public health will determine every place that person has been and every individual he or she was in contact with during those 12 days.
“That’s the basic contact tracing process. That happens with all of our cases,” Fenton said.
While there have been some delays in the process due to volume, test results and contact tracing investigations for health-care workers, students and school staff are given priority.
When it comes to determining where a person contracted the virus, Fenton said due to the 14-day incubation period of COVID-19, it can be difficult to pinpoint.
If a student or staff member was at school during their infectious period, IH contacts the district, which can supply class layouts, timetables and class lists to determine who was possibly exposed.
Once those close contacts are identified, public health informs those individuals to self-isolate for 14 days because they could be incubating the virus.
According to Interior Health, COVID-19 is more likely to be transmitted in close settings, where people are together for at least 15 minutes and layers of protection, such as masks and physical distancing, are not in place.
“Everyone else is at lower risk because they are not a close contact. They are asked to self-monitor for symptoms, as we all should be,” Fenton said.
Some of the most common COVID-19 symptoms are fever, difficulty breathing, chest pain, dry cough and fatigue.
School exposures are listed publicly online, with the date and type of notification: outbreak, cluster or exposure.
Fenton said an exposure means an infected person was in a school, so there is potential for transmission, while a cluster means more than one case grouped together in space or time has been found.
An outbreak is declared when there is uncontrolled transmission occurring — multiple cases that are connected, but it’s not clear how the virus is passing between them.
An outbreak triggers the need for added measures, including daily outbreak control meetings between IH and a school and enhanced cleaning practices to stop the spread, Fenton said.
Only one school outbreak has been declared to date in IH — at the Ecole de L'Anse-au-sable in Kelowna which ended on Nov. 5.
“Even in an outbreak, we would try to choose strategies that would minimize the need to close a school,” Fenton said, noting a grade or cohort may be asked to isolate, rather than have the entire school closed.
She said no outbreak has been declared at NorKam to this point because there is no evidence of transmission occurring there.
While it would take a lot to trigger an outbreak in schools or businesses, it takes just one case do so in a care home.
Fenton said this is the provincial standard for care homes and the reason for the different approach is to protect the long-term care population, which is the most vulnerable to severe cases of COVID-19.
Added measures implemented for a care home outbreak involve additional deep cleaning of the site, twice-daily symptom monitoring and regular outbreak-control meetings. Social activities are temporarily suspended, as are visitations, which are already fairly restrictive.
Non-essential medical appointments are cancelled or delayed and staff are also limited to specific units.
“If there’s an outbreak unit, all the staff who work on the outbreak unit don’t go and work elsewhere in the facility,” Fenton said.
The Hamlets COVID-19 outbreak is in units C1 and C2.
Asked why these outbreak measures aren’t utilized regularly, Fenton said care homes all have COVID-19 safety plans in place, which are proving effective as there have not been any cases of the virus in facility residents to date.
“Which is amazing,” she said, noting the added measures are also quite severe. “It wouldn’t be possible or fair to do this to them all the time.”
An outbreak is declared once public health has done contact tracing to determine if the employee worked while infectious and with whom he or she was in contact. Care home employees cannot work while symptomatic, awaiting test results or until they’ve finished self isolating,
Staff members are subject to symptom screenings and must change their clothes when they arrive for work, regardless of an outbreak being in place. Most, if not all, facilities perform temperature checks.
Asked why an entire group wouldn’t be tested at a school or care home, Fenton said COVID-19 testing is only recommended for those who exhibit symptoms of the virus, not for those who are asymptomatic. Fenton said this is because of the likelihood of false positives and false negatives.
Given the two-week incubation period of the virus, someone could produce a negative result while still carrying the virus, making it more important to self-isolate for 14 days.
“We need those 14 days to elapse to be sure there’s no COVID,” Fenton said. “There’s no way we could test at day three or day five and say, ‘Yup, it’s not here.’”