In Minneapolis, students exposed to covid-19 at school are supposed to quarantine for 10 days. In the suburban Anoka-Hennepin school district, a single exposure does not trigger contact tracing or quarantining.

In Andover, Kansas, schools follow quarantine protocols set by county health departments. With students from different counties attending the same school, those sitting next to each other in classrooms could be quarantined based on two sets of rules.

In Anchorage and many schools in Texas, close contacts of classmates who test positive for covid are given the option to stay in class or to quarantine. In suburban Chicago, siblings of students with any symptom of covid are required to quarantine until their sibling tests negative.

The number and complexity of school quarantine policies — in Fort Mill, South Carolina, eight pages of guidance directs students when to quarantine — have left many parents with the impression there is little rhyme or reason in quarantining one kid and not a classmate. Sometimes rules seem to vary within families: Christina Kennedy, a teacher in Bend, Oregon, got a call when her son was exposed to a positive case in August, and he was required to quarantine. But when her daughter was a close contact to a positive case, no call ever came.

“Unfortunately, we have a natural experiment going on across the country when it comes to schools reopening, particularly regarding quarantining,” said Dr. Leana Wen, a public health professor at George Washington University. “Some of it is understandable, but there is a piecemeal approach for certain when it comes to various approaches.”

The Centers for Disease Control and Prevention’s calls for unvaccinated kids exposed to someone who tests positive for covid to quarantine for a length of time determined locally. But a state or county or school district’s decision to impose a quarantine requirement is haphazard. An informal coalition that advocates for in-person learning, Ed300, found that 31 states are not automatically quarantining students from close-contact exposures.

“What we have learned from this pandemic is that when there is not a directive, school districts will behave autonomously and you’ll get this kind of outcome — good, bad or otherwise,” said David Law, superintendent of Minnesota’s Anoka-Hennepin School District.

Schools in his state act independently, Law noted.

That’s true in many other areas too. “Principals and county health officials have a lot of leeway,” said Leslie Bienen, a parent involved with Ed300 and a faculty member at the Oregon Health & Science University-Portland State University School of Public Health.

“The quarantine could be seven or 14 days,” Bienen said, and local officials have a lot of say in determining who qualifies as a close contact — defined by the CDC as having been within over a 24-hour period. But the agency has also recommended that schools maintain at least between students.

Local control isn’t necessarily a bad thing — schools should be the ones setting their rules, Wen said — but that’s why things can look so different from one school to the next, no matter how close they are in proximity.

Kennedy, the Bend, Oregon, teacher, works at a private school while her husband teaches at a public school her kids attend.

“The private school is much more prone to shutting down entire classrooms than the public school,” Kennedy said. “I know of three entire classrooms shut down since September at my private school” while zero have been shuttered in the public system.

Districts in the same county, under the purview of the same public health officials, are handling it differently, she pointed out. “Nothing is consistent. They say it’s all based on science, but we’re not allowed to question or point out anything. Why is it this way here and this way there? It’s super frustrating as a parent and as a teacher,” Kennedy said.

Another frequent complaint: Policies differ depending on whether students are there for school or for after-school activities or whether it is a community or sporting event. “What really irritates our community is that you can show up for a community event at the school or spend four hours at a sporting event and no one gets quarantined, but you can sit next to someone for 40 minutes during the school day and be out of school for 10 days,” Law said.

The confusion has left many parents wondering whether policymakers have done their homework.

Jessica Butler Bell, vice president of communications for Webster Elementary’s PTA in California’s Santa Monica-Malibu Unified School District, said parents are asking, “Are we really following the science? Or are we being too careful? It has to be rooted in logic, and I think people are going, ‘Have you thought this through?’”

Bienen co-authored an opinion piece in The Wall Street Journal titled “,” citing research showing that only a small percentage of students quarantined ended up testing positive for covid as a result of the school-based contact. The group also says data from Portland Public Schools shows that students who attend Title I schools — those that receive special federal funding because they serve large numbers of low-income families — are more likely to be quarantined.

“Kids with means go on vacation or to their grandparents when they’re quarantined,” Kennedy noted. “That’s great for them, but what about kids who don’t have parents at home? They’re sitting at home with no learning, no food, no services. It exacerbates the inequities.”

But parents get equally upset when rules are lacking: Wen said she’s heard of parents doing their own informal contact tracing when they think their schools aren’t doing a thorough job.

The complicated policies have other repercussions. Some parents grow reluctant to test their kids, Kennedy said, for fear that a positive test will force them out of school or activities. And at some schools, she added, teachers delay giving out seating charts to school nurses or other public health officials for contact tracing, knowing that kids may have to quarantine after the information is shared.

Some schools are piloting a possible solution: replacing quarantines with a “test-to-stay” policy. Under such a policy, any student deemed a close contact would be able to take a rapid test and show a negative result to stay in school and avoid quarantine.

CDC Director Rochelle Walensky “we are working with states to evaluate a test-to-stay policy as a promising potential new strategy for schools. And we anticipate that there will be guidance forthcoming.”

Wen said she is optimistic the policy could help. “It’s a way to prevent kids from being out of school.”

In Santa Monica-Malibu, one frustration Butler Bell hears from parents is that there’s no plan for ending quarantines and other layers of protection.

Parents often feel their concerns are not being considered, Kennedy said. “If [decision-makers] spent one hour inside an actual classroom, they would make different decisions,” she said.

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“No soy muy mayor, pero no soy tan fuerte como otras personas”, dijo. “Por eso, necesito ser realista sobre mi situación. ¿Quiero participar en algo que podría ponerme en riesgo? ”

La Administración de Drogas y Alimentos (FDA) ya otorgó la autorización de uso de emergencia para una vacuna y está considerando la aprobación de una segunda.

Mientras tanto, funcionarios de salud pública de todo el país se preparan para lo que podría ser tan desafiante como la distribución de la vacuna: persuadir a comunidades que han sido duramente afectadas por el virus, familias de bajos ingresos, personas de raza negra y latinos (de cualquier raza) de que se vacunen.

Sin embargo, funcionarios creen que algunas zonas tienen ventaja. Rochester, en Minnesota, sede de la Clínica Mayo, es uno de ellas. La Rochester Healthy Community Partnership ha estado trabajando para reducir las disparidades de salud en las comunidades de inmigrantes del área, residentes somalíes, hispanos, camboyanos, sursudaneses y etíopes, durante 15 años.

La asociación está compuesta por investigadores y proveedores de salud de Mayo, funcionarios de salud pública del condado y voluntarios comunitarios como Torres-Herbeck, quien emigró desde México hace 27 años.

“Cuando la pandemia impactó en marzo, nos dimos cuenta que con estas alianzas de larga data estábamos en una posición única por la confianza construida a lo largo de los años entre los expertos de Mayo y sus socios comunitarios”, dijo el doctor Mark Wieland, quien apoya al grupo y estudia el .

Aunque hasta ahora solo se ha recopilado evidencia preliminar, hay indicios de que desde que comenzaron estos esfuerzos, Rochester ha aumentado las pruebas para COVID-19, ha mejorado el rastreo de contactos y ha impulsado comportamientos preventivos como el uso de máscaras y el distanciamiento físico en estas comunidades vulnerables, agregó Wieland.

El grupo espera que esos primeros éxitos sean un buen augurio para la aceptación de la vacuna.

Aprendiendo del sarampión

La asociación de Rochester apuesta por un enfoque de sentido común que se centra en valores compartidos, transparencia y comunicación clara.

Es una estrategia que ha tenido éxito en el pasado.

Cuando una epidemia de sarampión golpeó a la población somalí en Minneapolis-St. Paul, en 2017, la Clínica Mayo se acercó a los líderes comunitarios de los 25,000 inmigrantes somalíes que viven en el área de Rochester.

Muchos tenían miedo de vacunarse por la falsa presunción de que la vacuna podría causar autismo, y las tasas de vacunación eran bajas en la comunidad. Médicos realizaron reuniones públicas en mezquitas y centros comunitarios, respondiendo preguntas sobre la seguridad de las vacunas y asegurando a los residentes que no había evidencia científica de un vínculo con el autismo.

Actores somalíes crearon videos de YouTube para ayudar a abordar preocupaciones comunes. Al final, no se registraron casos de sarampión en el condado de Olmsted, hogar de Rochester.

Hace aproximadamente un año, y a pedido de un rabino, el doctor Robert Jacobson, director médico del Programa de Ciencias de la Salud de la Población en la Clínica Mayo, visitó una comunidad judía ortodoxa en Nueva York en la que el rechazo a la vacuna estaba generando otro brote de sarampión. Ayudó a líderes de la atención médica a disipar preocupaciones.

“Los judíos ortodoxos de esa comunidad rechazaban esa vacuna por la misma razón por la que la recomendamos”, dijo Jacobson. “Estaban tratando de proteger a sus hijos”.

Los esfuerzos de líderes judíos, expertos en salud pública como Jacobson y legisladores que endurecieron las leyes sobre exenciones de vacunas, .

Desde marzo, la asociación de Rochester ha transmitido sobre COVID-19. El miedo o los malentendidos fueron un problema al comienzo de la pandemia. Los miembros de las comunidades de inmigrantes colgaban cuando los llamaban del departamento de salud.

Entonces, la asociación desarrolló mensajes en varios idiomas para explicar la importancia de esas llamadas telefónicas. Resolvieron problemas de comunicación. Por ejemplo, en somalí se usa la misma palabra para “resfriado” y “gripe”.

Ahora, menos gente cuelga.

Los miembros de esta alianza “son expertos en las sutilezas de sus comunidades”, observó Wieland.

Cuando el grupo se enteró de que muchos inmigrantes se sentían intimidados por las pruebas de COVID-19 y no estaban seguros de la logística, recomendó simplificar el proceso: ahora, videos con líderes comunitarios en las redes sociales dirigen a las personas a los sitios de prueba. Una vez allí, cualquiera que no hable inglés puede realizar la prueba sin necesidad de identificación ni tarjeta de seguro médico.

Faltaba el “por qué”

Solo el 40% de los adultos mayores de raza negra y el 51% de los hispanos mayores dijeron que probablemente se vacunarían contra COVID-19, en comparación con el 63% de los blancos no hispanos mayores, reveló .

Sus preocupaciones reflejan las de Torres-Herbeck: qué tan bien funciona la vacuna o qué tan segura es.

Una aún más reciente de personas de todas las edades para COVID Collaborative, un grupo de defensa de salud, mostró que la confianza en la seguridad de las vacunas es tan baja como el 14% para los afroamericanos y el 34% para los latinos.

Los adultos mayores dijeron que les gustaría recibir recomendaciones de personas en las que confían, según la encuesta de Michigan. Y los afroamericanos tienen el doble de probabilidades de confiar en , reveló la otra encuesta.

La ventaja de grupos como la asociación de Rochester es que sus miembros son mensajeros de confianza.

Torres-Herbeck contó que había estado hablando con un jardinero que no usaba máscara. Ella le explicó que COVID-19 es un virus y cómo se propaga. El jardinero se sorprendió y se puso un cubrebocas.

A menudo, los funcionarios de salud pública ofrecen instrucciones sobre cómo actuar y qué hacer, como usar una máscara y lavarse las manos, pero no explican por qué, dijo Torres-Herbeck.

Sin embargo, no se trata solo de difundir hechos. Centrarse en los valores compartidos es clave para generar confianza. Cuando Adeline Abbenyi, gerente del programa de Mayo Clinic para el Centro de Investigación sobre Equidad Saludable y Participación Comunitaria, dijo que su madre, que nunca había temido a las vacunas, dudaba en recibir una vacuna COVID-19, Jacobson entendió.

“Muchos de nosotros sentimos lo mismo”, dijo Jacobson en una reunión por Zoom. “Participo del optimismo de que tendremos una vacuna que sea segura y efectiva, pero no la usaré hasta que vea esa evidencia”.

Es normal que la gente dude, no son anti-vacunas. Los médicos y enfermeras que están recibiendo las primeras dosis probablemente ayudarán a muchas personas a superar esa vacilación, agregó.

De hecho, Torres-Herbeck dijo que lo que la persuadiría a ella de vacunarse es ver a Jacobson recibir la vacuna.

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“I’m not super old, but I’m not as strong as other people,” she said. “So, I need to be realistic on my own situation. Do I want to participate in something that might be a big risk for me?”

This month, the Food and Drug Administration gave emergency use authorization for one vaccine and is weighing approval of another. So, public health officials around the country are gearing up for what might be as challenging as figuring out how to store a vaccine at 70 degrees below zero Celsius. They need to persuade people who are part of communities that have been hit hard by the virus — those in low-income families and some minority populations, especially Black and Latino residents — to take a vaccine developed in less than a year and approved under emergency use authorization.

Yet there are a few places where officials think they have a head start. Rochester, Minnesota, home of the Mayo Clinic, is one of them. The Rochester Healthy Community Partnership has been working to reduce health disparities in the area’s immigrant communities, including Somali, Hispanic, Cambodian, South Sudanese and Ethiopian residents, for 15 years.

The partnership is composed of Mayo health providers and researchers, county public health officials and community volunteers like Torres-Herbeck, who immigrated to the U.S. 27 years ago from Mexico. One of the first of its kind, other similar efforts have sprung up around the country, but no one officially tracks such partnerships.

“What we realized when the pandemic hit in spades in March was that with long-established partnerships we were uniquely positioned to leverage” trust built up over the years between Mayo experts and their community partners, said Dr. Mark Wieland, who helps direct the group and . “We realized we were obligated to jump in with two feet.”

Although only preliminary evidence has been gathered so far, there are indications that since the efforts began, Rochester has increased COVID-19 testing, improved contact tracing and boosted preventive behaviors such as mask-wearing, hand-washing and physical distancing in these vulnerable communities, he said. The group is hoping those early successes portend well for vaccine acceptance.

Learning From a Measles Outbreak

The Rochester partnership is banking on a commonsense approach that focuses on shared values, transparency and clear communication.

It’s a strategy that has succeeded in the past.

When a measles epidemic hit the large Somali population in Minneapolis-St. Paul in 2017, the Mayo Clinic reached out to community leaders among the 25,000 Somali immigrants in the Rochester area. Many had been frightened of the measles vaccine by baseless claims that it could cause autism, and vaccination rates were low in the community. Medical experts held town hall meetings in mosques and community centers, answering questions about vaccine safety and reassuring people that there was no scientific evidence of a link to autism. Somali actors created YouTube videos to help address common concerns. In the end, there were no recorded cases of measles in Olmsted County, home to Rochester.

About a year ago, Dr. Robert Jacobson, medical director for the Population Health Science Program at Mayo Clinic, at the request of a rabbi visited an Orthodox Jewish community in New York in which vaccine refusal was fueling another measles outbreak. He helped health care leaders there allay concerns.

“The Orthodox Jews in that community were refusing that vaccine for the same reason we were recommending it,” Jacobson said. “They were trying to protect their children.”

Efforts by Jewish leaders, public health experts such as Jacobson and lawmakers who tightened up laws on vaccine exemptions .

Since March, to diverse audiences. Fear or misunderstanding was an issue at the beginning of the pandemic. Health leaders found that members of the immigrant communities were hanging up when the public health department called. So, the partnership developed messaging in several languages to explain the importance of the phone calls. They worked around problems, including that other languages don’t always have terms that mesh with English words for illnesses. For example, the word for “cold” and “flu” is the same in Somali.

Now fewer people hang up.

At the same time, these public health teams report back to the medical experts on what the community needs. “They’re the experts on the subtleties of their communities,” Wieland said.

So when the group learned that many immigrants were intimidated by COVID-19 testing and unsure of the logistics, the group recommended simplifying the process: Now, videos featuring community leaders on social media direct people to testing sites. Once there, anyone who doesn’t speak English automatically gets tested — no identification or insurance card necessary.

“We think that’s part of the reason that, as a county, we have overtested minority populations in relation to white populations,” Wieland said.

The ‘Why’ Was Missing

Only 40% of older Black adults and 51% of older Hispanics said they are somewhat or very likely to get the COVID-19 vaccination — compared with 63% of older white people, . Their concerns mirror Torres-Herbeck’s: how well will the vaccine work or how safe it will be.

An even more recent , an advocacy group of national and state health and economic leaders, the NAACP and other groups shows trust in vaccine safety is as low as 14% in Black Americans and 34% in Latinos.

Older adults said they would like recommendations from doctors, health officials, or family and friends — people they trust, according to the Michigan poll. And Black Americans are twice as likely to trust Black messengers versus white messengers, the other survey .

“Even if people don’t trust doctors in general, they trust their own doctor,” said Dr. Preeti Malani, one of the authors of the Michigan survey and chief health officer of the university.

The advantage of groups like the Rochester partnership is that its members are also trusted messengers.

Several weeks ago, Torres-Herbeck said, she talked to a landscaper who didn’t wear a mask while working with his business partner. She told him that COVID-19 is a virus and explained how it spreads. He was surprised, and Torres-Herbeck understood. “When I came here 27 years ago, we were not as educated on that,” she said. “When I grew up, it was believed that if you walk barefoot you will catch a cold.”

Often, she said, public health officials provide directions on how to act and what to do, such as use a mask and clean your hands, but don’t explain why.

“That ‘why’ was missing for him,” she said.

Now when she talks to him, he puts a mask on.

In mid-November, Jacobson visited with members of the Rochester partnership via Zoom, part of the group’s initial effort to disseminate vaccine information.

Approving a vaccine under emergency use authorization is no less stringent than the normal procedure, he explained. The process has been dramatically sped up and condensed, he said, by the amount of money poured in and newer technology — and by increased FDA resources.

It’s not all about disseminating facts, however. Focusing on shared values is key to building trust. So when Adeline Abbenyi, the Mayo Clinic program manager for the Center for Healthy Equity and Community Engagement Research, said her mother, who had never feared vaccines, was hesitant to get a COVID-19 vaccine, Jacobson understood.

“A lot of us are feeling the same way,” Jacobson said in that Zoom meeting. “I go into this optimistic that we will have a vaccine that’s safe and effective, but I won’t use it until I see that evidence” of safety and efficacy the FDA is reviewing.

It’s normal for people to hesitate, he said, but that is far different from — and more widespread than — the anti-vaccine movement. Doctors and nurses getting the first doses will likely help many people overcome that hesitancy, he said.

Indeed, one thing that would persuade Torres-Herbeck to be inoculated? Seeing Jacobson get the vaccine, she said.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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