Contract Tracing, Exclusion and Quarantine

Contract Tracing, Exclusion and Quarantine

How are close contacts determined in school?

Contact tracing is used by local health departments (LHDs) and schools to prevent the spread of infectious diseases. In general, contact tracing involves identifying people who have a confirmed or probable case of COVID-19 (cases) and people who they came in contact with (close contacts) and working with them to interrupt disease spread. This includes asking people with COVID-19 to isolate and their contacts to quarantine at home voluntarily. Persons who have completed COVID-19 primary vaccine series and are under 18, and persons 18 and over who have completed their primary series and recommended vaccine doses, including boosters and additional primary shots for some immunocompromised people, and remain asymptomatic, and those with documented COVID-19 infection within the past 90 days, are exempted from quarantine or exclusion. However, the updated CDC guidance recommends that fully vaccinated persons test at least five days after the known exposure and wear a mask in public indoor settings for 10 days after exposure.

CDC defines a close contact as an individual who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period. This does not include students in a classroom setting (indoors or outdoors) between 3 and 6 feet who are both consistently and correctly masked. If either the case or contact was not consistently masked, then close contacts include students in a classroom setting who were within 3-6 feet of an infected student for a cumulative total of 15 minutes or more over a 24-hour period. Students exposed at less than 3 feet are close contacts regardless of masking. For individuals on school transportation, IDPH and ISBE recommend that contacts exposed to an infected person within 3 to 6 feet do not require exclusion as long as both the case and the contact were consistently and correctly masked during the entire exposure period and windows were opened or HEPA filters were in use. These individuals may benefit from participating in Test to Stay. (For complete details on TTS, see Interim Guidance on Testing for COVID-19 in Community Settings and Schools.)

Students aged 5-17 who have not completed the primary series of the vaccine are close contacts who should quarantine or be excluded from school if exposed to a confirmed or probable case of COVID-19. Individuals (age 18 and older if eligible) who have received primary doses of a COVID-19 vaccine but have not received recommended booster doses are close contacts who should be excluded from school if exposed to a confirmed or probable case of COVID-19.

In general, individuals who are solely exposed to a confirmed case while outdoors should not be considered close contacts. Schools may coordinate with their LHD to determine the necessity of exclusion for higher-risk outdoor exposures.

The longer a person is exposed to an infected person, the higher the risk of exposure/transmission. The infectious period of close contact begins two calendar days before the onset of symptoms (for a symptomatic person) or two calendar days before the positive sample was obtained (for an asymptomatic person). If the case was symptomatic (e.g., coughing, sneezing), persons with briefer periods of exposure may also be considered contacts, as determined by LHDs. Persons who have had lab-confirmed COVID-19 within the past 90 days or those fully vaccinated, according to CDC guidelines, are not considered close contacts and do not need to be excluded from school unless they exhibit COVID-19-like symptoms.

Who will do contact tracing?

Schools are required to investigate the occurrence of cases and suspect cases in schools and identify close contacts for purposes of determining whether students or school personnel must be excluded pursuant to Executive Order 2022-03 and 77 Ill. Admin. Code 690.361.

Contact tracing will also be performed by the local health department (LHD), sometimes in partnership with IDPH or a community-based organization. Schools can assist the LHD by identifying all close contacts to a confirmed case. Both schools and any other third parties are required, pursuant to the state’s regulations, to cooperate in the LHD’s disease investigation and contact tracing initiatives. Cooperation with contact tracing and disease investigation by parents/guardians and other individuals can help ensure infection control measures are being maximized. Documentation of assigned seats and taking photos of assembled classes can be useful in helping schools determine who was within 6 feet of a given case.

Schools must be aware of confidentiality laws pertaining to school student records, including exceptions for release of information in the event of an emergency and requirements to notify parents and to create a record of emergency releases of information. (105 ILCS 10/6(a)(7); 23 Il. Admin. Code 375.60).

Is contact tracing only performed when a positive test is received?

Contact tracing is performed for a confirmed case (positive PCR test) or a probable case (positive antigen test OR person with clinically compatible COVID-19-like symptoms and epidemiologically linked via known exposure to a confirmed case.

If a confirmed or probable COVID-19 case is identified in a classroom, or on a school bus, who will be considered close contacts that need to be excluded and quarantined? Will this include the entire classroom or all the students on the bus?

Individuals who are 5 to 17 and have completed COVID-19 primary vaccine series, and persons 18 and older who have completed their primary series and recommended vaccine doses, including boosters and additional primary shots for some immunocompromised people, do not need to be excluded but should get tested at least five days after coming into close contact with someone with COVID-19 and wear a mask around others for 10 days. If symptoms develop, they should isolate and get tested immediately. For others not meeting the above criteria on school transportation, contacts exposed to an infected person within 3 to 6 feet do not require exclusion as long as both the case and the contact were consistently and correctly masked for the entire exposure period and windows were opened allowing for good ventilation (front, middle, back, or overhead) or HEPA filters were in use.

Do vaccinated students and staff have to be excluded after an exposure to a case?

A student aged 5-17 years who completed the primary series of a COVID-19 vaccine or students and staff aged 18 years and older who have received all recommended COVID-19 vaccine doses, including boosters and additional primary doses for some immunocompromised people do not need to be excluded after an exposure but should be tested on day 5 and, after returning to school, should wear a well-fitting mask around others for five more days. The individual should be excluded if symptoms develop. 

Does an individual with positive SARS-CoV-2 antibody testing need to be excluded if identified as a close contact?

Yes. Antibody testing should not be promoted as a way to avoid exclusion. The robustness and durability of immunity following natural infection remain unknown.

Serologic testing does not replace virologic testing and should not be used to establish the presence or absence of acute SARS-CoV-2 infection, nor should it be used to determine immunity after vaccination or to determine if vaccination is needed in an unvaccinated person. 

If a student or staff member is identified as a close contact to a person with COVID-19 and is excluded from school, are their household members and close contacts also required to be excluded?

No. Contacts of a person who is a close contact to a COVID-19 case (i.e., contacts to contacts) do not need to be excluded or self-quarantine unless they develop symptoms or if the person identified as the close contact develops COVID-19. They should, however, monitor themselves closely for symptoms of COVID-19 and if they become symptomatic, self-isolate and seek medical evaluation/testing.

What are best practices for exclusion and quarantine?

Local health departments are the final authority with regard to quarantine recommendations. They are best positioned to make these recommendations for setting quarantine timeframes for exposures outside of the school. Local health departments are ultimately responsible for protecting the health of their communities and understand best the practices and compliance efforts within their communities.

For close contacts identified within the school setting during the school day, Test to Stay (TTS) is the preferred method because it keeps children in school and includes testing  that will identify new positives quickly. (For complete details on TTS, see Interim Guidance on Testing for COVID-19 in Community Settings and Schools.) For close contacts not consenting to TTS or for exposures occurring during extracurricular activities, a five-day exclusion is required, followed by five additional days of masking at all times around others As recommended by CDC in updated guidance for quarantine and isolation, IDPH and ISBE do not recommend exclusion periods longer than five days for school exposures unless clinically recommended by their medical provider due to certain underlying medical conditions such as immunosuppression (i.e., a weakened immune system).

For household exposures, the local health department will assess the extent of ongoing exposure. If quarantine and isolation can occur safely removing ongoing exposures, a five-day exclusion is acceptable. If ongoing exposures cannot be avoided, exclusion for the close contact would not start until the end of the positive case’s isolation period (5 days if fever free without fever reducing medication, 24 hours with diarrhea/vomiting ceasing, and other symptoms have improved). After this, a five-day exclusion is recommended followed by masking around others for an additional five days. Students under age 18 with no symptoms of COVID-19 who received their primary series and those 18 and older who have received their primary dose and all recommended COVID-19 vaccine doses, including boosters, and additional primary doses for some immunocompromised people, are exempt from exclusion but should wear a mask around others for 10 days. CDC also recommends all exposed individuals test at least five days after exposure.

What restrictions on activities do students and staff have after completing exclusion or Test to Stay, especially those returning after 5 days?

Students returning from exclusion may resume all activities as long as they remain asymptomatic and mask at all times when around others for 10 days from their last exposure. This includes dining periods, extracurricular activities and riding the bus. Students participating in Test to Stay should avoid competitions and performances until the end of the testing period.

Schools should ensure that there is a plan for students or staff returning after 5 days to stay masked at all times until day 10. During times in the school day when students or staff members may typically remove masks indoors (such as during lunches, snacks, band practice, etc.), schools should have a plan for them to adequately distance from others and ensure they wear their masks when not actively participating in these activities (such as when they are not actively eating).