School settings in Douglas, Arapahoe and Adams counties saw 15 confirmed coronavirus outbreaks starting in August, according to the local public health agency that serves those counties.

“What we feared could happen is beginning to happen,” said John Douglas, executive director of Tri-County Health Department, during an Aug. 26 telephone town hall event.

In mid-August, Tri-County Health Department issued an order that requires masks for all children ages 2 through 11 — and all the individuals working or interacting with those children — in all indoor school and childcare settings in the three counties.

Tri-County’s board of health approved the mask order on Aug. 17, and it took effect Aug. 23. Some school districts had implemented mask requirements before the order was approved. All of the listed outbreaks started in August.

The Douglas County School District began requiring all students in preschool through sixth grade to wear masks when inside school buildings in a rule that took effect on Aug. 23. The rule also applies to staff who work with that age group.

Across the counties, officials have also seen 23 suspected outbreaks, said Becky O'Guin, spokesperson for Tri-County Health.

Of the total — confirmed and suspected — most are at K-12 settings, and one is from a childcare setting, O'Guin said.

Tri-County's mask order met pushback from crowds at public meetings in August where local government bodies discussed mask policy. At press time, two of the counties in the health agency's jurisdiction — Douglas and Adams — had already opted out of the order.

“While I am disappointed by that, I am pleased that many school districts, bolstered by our board of health” have acted to require masks, said Douglas, the health chief.

The policy is intended “to keep kids in class,” Douglas added. “If you get sick, you have to stay home. If your class has an outbreak, it may need to be canceled.”

COVID-19 thus far has not made kids as sick as adults, but “we want to keep kids from transmitting COVID to their parents,” especially among high-risk family members, Douglas said.

For public and private schools, and childcare settings, Colorado's updated definition of a confirmed outbreak is as follows:

“Five or more cases of COVID-19, of which at least one case has had a positive molecular amplification test or antigen test, among students/teachers/staff from separate households with onset within 14 days in a single classroom/activity or other close contact in the school setting (including transportation to- from- school and affiliated events),” a state definitions sheet says.

The definitions sheet acknowledges the question of whether a case was exposed to COVID-19 elsewhere in the community rather than at the facility listed with an outbreak.

“It is possible that a person may have been exposed elsewhere (and we can rarely prove where any individual was exposed with a person-to-person pathogen), but when a person worked/lived/spent time in a facility with a known outbreak, we attribute their illness to the outbreak even if there is no definitive determination that the case acquired the illness at the facility,” the sheet says.

Asked whether the public should interpret outbreaks in schools as indicative of COVID-19 spread in the broader community or as more indicative of spread occurring within the schools themselves, O'Guin said it should be viewed as both.

“With high levels of community infection, like there is now, infection can get introduced into the school by students or staff — frequently. Full in-person classrooms, lots more physical interaction in classrooms (or) sports (or) extracurriculars can contribute to an infected student or staff then transmitting in (the) school setting,” O'Guin said.

“Given the length of time that students spend in school settings, often in close contact with others — many of whom are unvaccinated — schools remain a source of primary exposure concern. That's why masking is important and why vaccination of 12-17 years old is important,” she added.