Pima County is seeing an increase in school outbreaks as students return to the classroom, with health officials warning the spread of COVID in schools could have a significant impact on the community at large.

Pima County Health Department Director Dr. Theresa Cullen told the press this morning that as of today, there have been eight outbreaks in schools and 56 school cases reported in the last seven days since July 19, but there were no outbreaks in the summer. She said they have closed one school classroom in the last five days and expects another 10 cases will be reported today.

The cases are primarily from a school district that is already back in session and some of the outbreaks are in schools and others are from school-related activities, like football, cheerleading or freshman orientations, Cullen said.

“We are now seeing this increase as students go back to school,” said Cullen. “We anticipate that approximately 5% to 10% of the cases we are seeing right now will be due to school as opposed to a maximum of 4% last year.”

Although several studies conducted early during the COVID-19 pandemic suggested children have lower incidence rates than adults, this may be partly due to children having fewer opportunities for exposure and a lower probability of being tested, CDC officials warned in an updated July 9 brief. They noted that studies that systematically tested children and adolescents, irrespective of symptoms, for COVID-19 infection or prior infection found “their rates of infection can be comparable, and in some settings higher, than in adults.”

Cullen said pediatricians, primarily working in hospitals, “are seeing increased admissions and increased severity of illness, including ICU admission.”

Currently, younger children are not eligible to receive the COVID-19 vaccine (only those 12 to 17 can receive the Pfizer vaccine), which are highly effective against hospitalization and death for all COVID-19 variants. In a briefing last week ADHS Director Dr. Cara Christ reported that nearly 32% of 12 to 17-year-olds have been vaccinated with at least one dose of vaccine.

The expected rise in school-related cases comes as the U.S. faces another wave of COVID-19 and the increased prevalence of the Delta variant.

As of today, the CDC reports Arizona has a high rate of transmission with 132.6 cases in the last seven days per 100,000 individuals. In Arizona, the Delta variant accounts for about 75% of all cases, said Dr. Joe Gerald, epidemiologist at the University of Arizona, in his July 23 COVID-19 report.

Emerging data suggests lower effectiveness of the vaccine against confirmed infection and symptomatic disease caused by the Delta variant, according to the CDC’s brief on vaccinations updated on Tuesday.

The CDC reports the Delta variant is “more than two times as transmissible as the original strains circulating at the start of the pandemic and is causing large, rapid increases in infections.”

Pima County remains at a substantial rate of transmission at about 65 cases in the last seven days per 100,000 individuals, about half the state's transmission rate. Cullen notes that until July 19, when the county received increased reports of school COVID-19 cases and outbreaks, the county was in moderate transmission.

“If we continue to see the increases that we have seen in the last week in our caseload. It is very possible that we will get to high transmission,” said Cullen. “The reason why we don't separate out kids cases from adult cases, from elderly cases, and it's all one, is because the belief is that that reflects what's going on in the community at large. So, there is potential for a very significant impact on the community at large because of the school base cases.”

Cullen said the health department is increasing their school team, because they believe “there will be an increasing number of outbreaks unless we have further mitigation.”

However, new state law prohibits schools from mandating masks and requiring students and teachers get vaccinated. Schools in Arizona also faced backlash from Governor Doug Ducey’s office for using language from the CDC, which states vaccinated individuals do not have to quarantine.

The Pima County Health Department is responsible for assessing vaccination status and determining the recommendation for isolation and quarantine, while school districts report positive cases, said Cullen.

“From the school district perspective, our goal is to say this is a Pima County Health Department prerogative, responsibility to keep the county safe and it falls within the purview of our authority to follow up on this,” said Cullen. “We are cognizant of what the Governor has stated. We believe that our approach to this takes the onus off the school, and basically says the follow-up is due to us.”

Cullen emphasized that the county is “doing everything [they] can to keep kids in school.”

The Pima County Health Department will be updating their Public Health Advisory to match the new CDC guidelines released on Tuesday. The CDC updated their guidance, recommending fully vaccinated individuals in areas with high or substantial rates of transmission should also wear a mask in public indoor settings because of the new evidence on the Delta variant.

Matching CDC language, they will be “strongly recommending all teachers, staff and students, visitors to K-12 schools wear masks indoors, regardless of vaccination status.” Cullen hopes school superintendents will elect to push out the same recommendation and language.

Catalina Foothills School District and Tucson Unified School have opted to post signage around schools to encourage masking and the Catalina Foothills School District has updated their mitigation plan to match the new CDC guidelines.

The Arizona Department of Health Services will also be updating their public health recommendations to the CDC recommendations, according to Communications Director Steve Elliot. While it will take a few days to update, Elliot said the headlines would include:

“Everyone, those who are vaccinated in addition to those who aren't vaccinated, should wear masks and distance in indoor settings where they are around people they don't live with. In schools, everyone should wear masks regardless of whether they are vaccinated. This includes students, teachers, staff and visitors. Previous CDC guidance recommended masks only for those who weren't vaccinated.” It also notes that state law prohibits mask mandates.

In the updated July 9 brief on transmission in schools, the CDC notes that when a combination of effective mitigation strategies, like masking and social distancing, are implemented and “strictly adhered to in the K-12 in-person learning environment, the risk of transmission in the school setting appears to be lower than or equivalent to the transmission risk in other community settings.”

“Schools have done an amazing job, they have all worked with us for the past months, over the last year to ensure that they have layered mitigation,” said Cullen. “However, they have limited ability to do certain things and that's why we believe it is our responsibility to do the recommendation, the strong recommendation about masking.”