Health officials are trying to get in touch with everyone who came into contact with a physician over four days before the doctor had symptoms of the new coronavirus.


A different approach is being taken regarding an employee at Russell Boulevard Elementary School who was diagnosed.


On Monday, the Columbia-Boone County Department of Public Health and Human Services reported 19 confirmed infections in Boone County, with three cases tied to community transmission.


The doctor was in the Columbia and Kirksville locations of Missouri Cancer Associates. Adair County reported its second COVID-19 case on Monday.


“The Missouri Department of Public Health notified Missouri Cancer Associates that a health care provider was diagnosed with COVID-19 on March 21, 2020,” reads a statement from the medical practice. “During the short period of time from March 16-19, this provider had no symptoms and had brief interactions with a limited number of patients and staff at the Columbia and Kirksville locations.”


The doctor didn’t return to work after developing symptoms. The patients and staff who interacted with the doctor were identified and notified and are being managed in accordance with guidelines of the federal Centers for Disease Control and Prevention.


In a news release, the Adair County Health Department said it is obtaining a complete list of patients the doctor had contact with on Thursday.


“Staff from the health department will contact all patients to obtain information necessary to monitor them and to conduct contact tracing to identify others who could be at risk for exposure,” the statement reads.


The Adair County Health Department is advising the patients to self-quarantine for 14 days.


“One of our primary responsibilities during an infectious disease event is contact tracing,” Jim LeBaron, Adair County Health Department administrator, said in the news release.


Missouri Cancer Associates did not return calls seeking comment.


While health officials are examining a four-day period of the doctor’s contacts, the Columbia-Boone County Department of Public Health and Human Services is only tracing the last 24 hours before a Columbia Public Schools employee started showing symptoms.


Late Sunday, Columbia Public Schools released a letter to parents and staff at Russell Boulevard Elementary School seeking to reassure them about the possibility of being infected by an employee who later tested positive. Columbia schools suspended classes on Wednesday.


The health department is tracing everyone who had contact with the employee in the 24 hours before the symptoms appeared, the message stated.


“Based on the risk assessment and contact investigation, the Health Department is not initiating further contact with Russell Boulevard staff, students or families because the employee has not had contact with those at the school within the previous 24 hours of showing COVID-19 symptoms,” the statement read.


The health department is following guidance from the Centers for Disease Control that the most likely time of spread is when symptoms, including fever, difficulty breathing, coughing, and/or sneezing, are present because the virus is spread in respiratory droplets in the air and on surfaces.


“With regard to the school district employee who tested positive, if you have not been contacted by the health department, you were not identified as a close contact of the individual and your risk of infection is considered to be no greater than the general population,” the health department told Russell staff and family in the district’s message.


Jeanne Legge, grandmother of a Russell Boulevard student, said the information didn’t reassure her.


“I think we’re not getting the information we need,” Legge said.


She said contrary to the school district’s information, she had seen television news reports that people with the virus can transmit it to others five days before developing symptoms.


A CNN report stated that transmitting the disease when one doesn’t have symptoms is more common than previously thought.


“You can have it and be asymptomatic, totally,” Legge said.


The school district and the health department may have good reasons for not contacting students, parents and staff members, but she said she hasn’t heard it.


“They didn’t explain why they didn’t pursue it,” Legge said.


If the employee had contact with eight teachers who had contact with eight classrooms full of students, who then brought the virus home, the spread could be great, Legge said.


Ashley Millham, medical director for the Columbia/Boone County Department of Public Health and Human Services, didn’t respond to any questions about communication between her department and the school district, saying it would violate patient confidentiality.


Based on CDC guidance, she said people are thought to be most contagious when they are most symptomatic, or the sickest.


“Some spread might be possible before people show symptoms,” she said. “There have been reports of this occurring with the new coronavirus, but this is not thought to be the main way the virus spreads.”


Columbia Public Schools spokeswoman Michelle Baumstark didn’t respond to phone calls and emails before deadline on Monday. Superintendent Peter Stiepleman didn’t respond to a phone call and text message.


School board member Paul Cushing said it’s his understanding that the health department made the decision of who to contact, or not, in the Russell Boulevard matter.


“I think the health department is the best source to use,” Cushing said. “If that’s what they say, it’s alright with me.”


All of the Tribune's coronavirus coverage is being provided free to our readers. Please consider supporting local journalism by subscribing to the Tribune at columbiatribune.com/subscribenow.