It’s an important time to remain vigilant

Archived Opinion

It’s an important time to remain vigilant

By Mark Jaben • Guest Columnist | Two big things are happening in Haywood County this week.

First, a tremendous outpouring of help and support from people coming here in the aftermath of the devastating flood. Already, though, one member of a group has developed COVID and is hospitalized. The first rule of incident management is don’t become part of the incident; don’t contribute to the disaster. The fact is if someone gets COVID and has to isolate, or has a close contact exposure and should quarantine, they cannot do the good work they came here to do.

And it’s not just COVID. Messing around in the muck and debris raises the risk of other diseases, like tetanus and hepatitis. A tetanus shot is only protective if immunized before the wound. So by all means, come here and help, just come prepared and safe. Better yet, come with one of the organized groups who have experience with relief work.

While here, be careful to avoid being a close contact with anyone you work around. The challenge of COVID has been that a person is contagious days before getting symptoms. This community is already struggling with high prevalence and a very stretched hospital and EMS system. Please come and help; you are much appreciated, just don’t contribute to the disaster.

The second big thing happening is the school board decision to pivot to requiring masks in the face of rising cases here. There are many questions about quarantining and close contact, and frankly, much misunderstanding around just what the CDC recommendations actually say.

Throughout this pandemic, the Health Department has defined close contact as not wearing a face covering and being within 6 feet for more than 15 minutes of a person who is infected.

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Often some of these criteria are met and others not. When not, other considerations come into play, such as indoors versus outdoors, quality of ventilation, consistency of mask wearing, community situation and prevalence, and others.

Once a close contact exposure is identified, the CDC recommendation is quarantine for 14 days, as infection can show itself any time during this period. We have seen people in Haywood County become positive as late as day 12. The recommendation also is testing 5 to 7 days after the exposure. This result does not change the quarantine period, but if a quarantined person tests positive, there may then be close contacts that need to possibly quarantine.

This has not changed.

Last year, CDC did not change the 14-day length of the quarantine period, but added two options for how to manage this quarantine period. In doing so, CDC acknowledged that options 2 and 3 had more risk of a quarantined person becoming ill and contributing to community spread, even if that risk is low.

Those option are:

• 14 days separated from anyone and everyone.

• Test day 5 and if negative and no symptoms after day 7, the person does not need to spend the remainder separated from anyone and everyone.

• No test, and after day 10, if no symptoms, the person does not need to spend the remainder separated from anyone and everyone.

The second and third options also include following all protective public health measures through day 14: face covering at all times except when alone, keep a distance of greater than 6 feet from anyone, limit time around anyone else, good hand hygiene. Right now in schools, it is extremely difficult to follow all of these.

Please be aware, CDC gives guidance; it does not make rules or laws. They look to state and local agencies to apply those guidelines. In other words, they acknowledge the best decisions are based on local conditions.

Options 2 and 3 do not shorten the quarantine period. It bears saying again — they only give options for how to manage that period. Options 2 and 3 leave open the real risk of an infected person being in school. CDC acknowledges this in providing these options. Throughout the pandemic, the Health Department has not recommended options 2 and 3 because of that risk, even more so in the face of the widespread cases we are seeing especially in the younger child and adult age groups. There is a direct link between what’s happening in the community at home and at work and what happens at school; they cannot be separated. Adults infect kids, particularly at home; both infect others who really cannot afford to get COVID. You may do well; kids may do well. Others do not. We all are closely intertwined as a community in this risk.

In-person school is the goal

We all agree that the goal is to have students in person, learning in a safe environment. The goal all along been that not every case in a school can be prevented, but that one does not become 100. The framework throughout the pandemic has been to structure school in a way that everyone is not a close contact. Then if exposed, quarantine would not be advised. This preserves kids and staff at school. Last year, this approach worked. After two days of school this year, I am sorry the experiment to remove some of the measures that prevent close contact has not worked.

Certain families made choices about their children. And in some cases, the child did otherwise. This opened the door to the need for quarantine once exposed. The guidelines used by Health Department now are the same as applied throughout this entire pandemic. If some are just now coming to grips with the reality of COVID, it is on them and not the Health Department, which has and will continue playing its role so one case doesn’t become 100. The time to be careful and safe is before the exposure, not hoping to bend the guidelines and risk safety afterwards.

I hope every child and staff in quarantine clears their 14 days in good health; that would be fantastic. The school board made a difficult choice after much deliberation. They appropriately pivoted in the face of accelerating cases and established a framework to pivot again when each of us has done our part. The belief of some that they were bullied is an insult to the deep care and commitment of this board to a safe, in-person school experience for all. And now going forward there is a much better chance for this to happen. How about let’s all pitch in and make it be so.

I trust this answers many of the concerns voiced this week.

For everyone in Haywood County, be well, be kind, and be careful, especially right now.

(Dr. Mark Jaben is the medical director for the Haywood County Department of Health and Human Services.)

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