Brief on Covid-19 in Schools - St. Louis County, Missouri
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Brief on Covid-19 in Schools
St. Louis County, Missouri
Saint Louis County Department of Public Health September 8, 2021
Executive Summary
This brief represents the St. Louis County Department of Public Health’s (DPH) first report of COVID-19
cases in St. Louis County schools for the 2021-2022 school year. DPH collects self-reported data from all
County districts and schools and combines that information with youth case and testing data, as well as
information learned from case investigation and contact tracing to represent to the public the trends we
are seeing in St. Louis County schools. This brief includes data from the first week of the 2021-2020
school year. Based on what was reported and what we know about testing among children right now,
we believe that the data in this report are almost certainly a significant underrepresentation of cases in
St. Louis County schools.
As the public health authority for the County, DPH is concerned about the high number of cases among
students and staff, as well as the many instances of in-school transmission in the first week of school.
While it is still very early, these data suggest that COVID-19 may affect the school environment very
differently this year compared to last year. Notably, the currently circulating Delta strain is more
transmissible compared with previous strains, we are seeing more cases in children, and it often causes
infections that are difficult to distinguish from other common upper respiratory infections and seasonal
allergies.
It is everyone’s goal to keep kids in school and to do everything possible to promote their wellness and
safety in the school environment. A layered mitigation approach, which includes vaccination, masking,
testing, distancing, contact tracing, use of isolation and quarantine, ventilation, hand hygiene, and
keeping sick kids home is the best way to keep everyone safe. DPH acknowledges and appreciates the
tremendous effort and commitment on the part of St. Louis County schools and families in promoting
safe school environments.
DPH continues to strongly encourage all residents, including kids, to get vaccinated if eligible, wear face
coverings in indoor public places, and stay home if you are sick. Based on early observations in schools,
DPH’s specific recommendations to parents, caregivers, and the public in school settings are as follows:
1. Because no one younger than 12 is currently eligible for vaccination, it is crucial that all who are
currently eligible get vaccinated as soon as possible for the protection of themselves and young
children.
2. Testing is a key part of the strategy to decreasing spread of COVID-19 in schools. DPH
recommends COVID-19 testing for any child with any upper respiratory symptoms or new
unexplained symptoms not clearly linked to another diagnosis. Even children with a history of
asthma or allergies should be tested. Talk with your pediatric care provider if you are unsure if
your child should be tested.
Brief on Covid-19 in Schools
3. Testing is also critically important after an exposure to COVID-19, even if your child does not
have symptoms. For anyone exposed to COVID-19, DPH recommends testing 3 to 5 days after
the exposure. This is recommended even if the school-aged child was not required to
quarantine. An asymptomatic child with COVID-19 attending school puts other children and
staff at risk and compromises the safety of the school environment.
4. Ask questions of your school to learn about mitigation practices in place and to make sure you
are comfortable with how those practices protect your child and your family.
Cases of COVID-19 in schools will increase spread of the disease in the community more broadly. Our
data show that the Delta strain of COVID-19 easily spreads among people living in the same household.
A mildly ill or asymptomatic child who comes home with COVID-19 puts the entire family at risk for
illness. Even vaccinated people can get COVID-19 from a household contact. DPH is worried about what
this may mean for the trajectory of cases across the community in the coming months, including the
effect on parents, grandparents, and other caregivers of children, particularly those who are
unvaccinated.
DPH offers free, non-invasive COVID-19 testing for anyone 2 years and older and free COVID-19
vaccination for anyone 12 years and older at all DPH clinic locations from 8 a.m. to 4:30 p.m. Monday
through Friday.
DPH will watch this situation closely and hopes to learn more about the significance of in-school
transmission and the impact of mitigation practices on the likelihood of in-school transmission as more
data are available. We will communicate new information and trends to schools, caregivers and the
public as they emerge so we can all work together to protect our children and our community.
Emily D. Doucette, MD MSPH FAAFP
Chief Medical Officer, DPH
Saint Louis County Department of Public Health September 8, 2021
Brief on Covid-19 in Schools
1. Aggregate School Reporting
These data cover the reporting period 08/22/2021 through 08/28/2021. This was the first self-reporting
period of the academic year from St. Louis County schools and not all schools successfully submitted
their reports to DPH. DPH received information from 17 of the 23 public school districts and 41 out of
approximately 150 private schools. Given the number of schools who did not submit their reports, these
data are an underestimate of the true number of cases.
Cases and close contacts
• Total number of student cases: 373
• Total number of staff cases: 56
• Total number in quarantine due to school-related exposures: 1,318
Number of schools with cases
• 16 schools with >5 cases per school
• 18 schools with 3-4 cases per school
• 212 schools with 1-2 cases per school
In-school transmission
• At least 15 instances of likely in-school transmission were reported to DPH.
• Some of these resulted in numerous additional positive cases.
• Although in-school transmission reports were not collected in the same manner throughout the
2020-2021 school year, these 15 known occurrences in the first week of reporting represent
approximately 25% of the total number of reports from the entire 2020-2021 school year.
Please see Section 4 for additional information on the data sources for this section.
Saint Louis County Department of Public Health September 8, 2021Brief on Covid-19 in Schools
2. Youth Cases in St. Louis County Residents
These data cover the reporting period 08/17/2021 through 08/30/2021.
Average rate of new diagnoses among youth are highest for children 10 through 14 years, but remain
high for all youth age groups.
• 0–4 year-olds: 20.7 cases per 100,000 per day
• 5–9 year olds: 30.4 cases per 100,000 per day
• 10–14 year-olds 31.0 cases per 100,000 per day
• 15–19 year-olds: 21.6 cases per 100,000 per day
Age-stratified PCR positivity rates either decreased or remained stable among all youth age groups,
compared with the previous two-week reporting period. PCR positivity rates are highest among 10–14
year-olds (16.2 percent positive), followed by 5–9 year-olds (13.7 percent), 15–19 year-olds (11.3
percent), and 0–4 year-olds (6.6 percent).
Saint Louis County Department of Public Health September 8, 2021Brief on Covid-19 in Schools
Rates of PCR testing among youth range from 153 tests per 100,000 per day among 10–14 year-olds to
254 among 0–4 year-olds. High positivity rates among youth, particularly the alarmingly high 16.2
percent positivity among 10–14 year-olds, indicate that much more testing is urgently needed to identify
additional cases among youth and bring transmission under control through isolation and quarantine.
Please see Section 4 for additional information on the data sources for this section.
Saint Louis County Department of Public Health September 8, 2021Brief on Covid-19 in Schools
3. Stories from the Field
A student was exposed at school and was placed in modified quarantine, which allowed the student to
continue to come to class. This particular student had a history of food intolerance and last year had
vomited a couple of times at school. The student vomited one time after lunch and was sent home. The
parents brought the child for testing and the child tested positive. The family notified the school and
the school updated the other families as necessary following this secondary transmission.
• Even in a child with a history of similar symptoms, testing was critical in identifying a positive
case after a school exposure.
An elementary school student tested positive and the class was notified. Based on the details of the
exposure (masking, distance, etc.), no one was required to quarantine. Following DPH’s
recommendations, a family had their asymptomatic daughter tested at DPH four days after exposure
and the child tested positive. The family immediately notified the school. Subsequently, several
additional classmates tested positive and the class was placed in full, at-home quarantine.
• Again, testing was essential in identifying additional cases. Also, by adjusting the quarantine as
new cases were identified, students were allowed to remain in school until new information
made it clear that in-person learning was no longer safe.
A family has multiple children ranging from elementary through high school. Unbeknownst to the
school, both parents had COVID-19 and several of the kids were exhibiting symptoms. All children were
sent to school. The school identified these children as symptomatic and called the parents to pick them
up, at which point the school learned that the parents were positive. All children were tested and
received positive test results. Having several symptomatic kids in multiple schools resulted in a
substantial number of students and staff being placed in quarantine.
• Never send a child to school sick, and don’t send a child to school if there is someone with a
current COVID-19 infection in your household. This puts a whole lot of other people at risk of
becoming infected and also results in many staff and students being required to quarantine.
A middle school student tested positive. The school conducted the investigation and determined that
no one was required to quarantine. The school notified all families about the exposure and said that
children should be tested 3 to 5 days after exposure or upon onset of any symptoms. A few days later,
one of the classmates developed cold-like symptoms. The family said that their child had a history of
allergies and refused to have their child tested.
• The family refusing testing put the school in a very difficult position. Per the school’s policy,
without a negative test, the symptomatic student and any siblings would be excluded. However,
the quarantine for the rest of the class would depend on whether the symptomatic student had
COVID-19 from in-school transmission. Without a test, the school would be forced to make a
decision with less-than-complete information, potentially either quarantining additional
students unnecessarily or allowing people to come to school when it was not safe to do so.
Please see Section 4 for additional information on the data sources for this section.
Saint Louis County Department of Public Health September 8, 2021Brief on Covid-19 in Schools
4. Notes on the Data
Aggregate School Reporting
Each week, K-12 public and private schools self-report the following information to DPH for the previous
week:
• total number of student COVID cases, regardless of whether the student became infected after
exposure at home, at school, etc.;
• total number of staff COVID cases, regardless of whether the staff member became infected
after exposure at home, at school, etc.; and
• total number of students/staff in quarantine due to school-related exposures.
The information is de-identified (i.e., it does not include information that identifies the individual) and
aggregated (e.g., only the totals for each school are submitted). Whether an exposure is considered
school-related is determined by the school’s investigation of a particular person’s likely source of
exposure. School related exposures include: in-classroom; other academic; before/after care; school
sports and extracurricular activities; school events or trips; etc. Anyone in quarantine due to non-school
exposures (club sports, household exposures, other non-school activities) is not included in the
quarantine number reported to DPH. Schools also submit a report to DPH when their investigations
determine that there has been likely in-school transmission (i.e., someone who was exposed in school
subsequently became a case due to that exposure). Someone who was exposed in school and
subsequently became a case due to that exposure is considered a secondary school case.
Although the majority of students and staff at St. Louis County schools are also residents of the County,
these aggregate numbers also include student/staff cases from other jurisdictions who attend or work at
St. Louis County schools, as well as students/staff from other jurisdictions who are in quarantine due to
an in-school exposure at a St. Louis County school. Students or staff who attend or work at schools
outside of St. Louis County would not be included in the aggregate reports submitted to DPH.
Youth Cases in St. Louis County Residents
Data are collected daily and include all new cases among St. Louis County residents ages 19 years and
younger (in accordance with age groups defined by the U.S. Census Bureau). These data include all
youth cases, regardless of whether they attend a school in Saint Louis County. Additional information
can be found in the Youth Supplement section of DPH’s Bi-Weekly COVID-19 Trends Report.
Stories from the Field
This information is primarily gathered from conversations between the DPH Schools Team (the group of
investigators who handle school questions and exposures) and school nurses or administrators,
including follow-up conversations after a school has submitted an In-School Transmission Report. The
stories do not contain any identifiable information in order to protect the privacy of the people involved,
but the details have not otherwise been altered.
Saint Louis County Department of Public Health September 8, 2021You can also read
