B73 COVID-19 ECE & K-12

Non-Residential Congregate Settings: Early Care and Education Settings, K-12 Schools, and Programs Serving School-Aged Children*

*Programs serving school-aged children include Day Care for School-Aged Children, Day Camps, Parks and Recreation Sites, and Youth Sports Programs

B73 COVID-19 Core/Background Information (home page)
Outbreak Definitions
Epidemiologic Data for Outbreaks
Control of case, contacts & carriers
Cases
Contacts
General Control Recommendations for Outbreaks
Outbreak Closure Criteria
Table 1: Physical Distancing Measures for Non-Residential Congregate Settings: Early Care and Education Providers and TK-12 Schools

Forms / Quick Links

ECE Education Sector Outbreak Notification Letter Template (intranet access required)
K-12 Education Sector Outbreak Notification Letter Template (intranet access required)
Education Sector Outbreak Clearance Letter Template Resources (intranet access required)
COVID-19 Education Sector Outbreak Form
COVID-19 Case and Contact Line List for the Education Sector
COVID-19 Case and Contact Line List Data Dictionary
Resources (intranet access required)

REPORTING PROCEDURES

Outbreak Definitions:

Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.

Non-Residential Congregate Settings in Early Care and Education Settings and TK-12 Schools, and Programs Serving School-Aged Children

At least 3 laboratory-confirmed cases with symptomatic or asymptomatic COVID-19 infection within a 14-day period in a group* with members who are epidemiologically linked, do not share a household, and are not a close contact of each other outside of the campus. Epidemiological links require cases to be present in the same setting during the same time period while infectious.

*Groups include persons that share a common membership, e.g., same classroom, school event, school-based extracurricular activity, academic cohort, athletic teams, clubs.

Epidemiologic Data for Outbreaks

Create a line list that could include:

Names of cases
Dates of illness onset
Age
Recent illness among contacts and their symptoms
Epi links to other cases (rooms, meetings, etc.)
Last date at educational site
Hospitalization status
Results of laboratory tests
Vaccination status
Vital status

Maintain surveillance for new cases until no new cases for at least 14 days.
Create an epi-curve, by date of onset (see CDC Quick Learn Lesson: Create an Epi Curve for guidance). Only put those that meet the case definition on the epi-curve. (Optional)

CONTROL OF CASE, CONTACTS & CARRIERS

Investigation can be conducted over the phone.

The frequency of follow-up with the facility for outbreak updates will be at least weekly, but more frequently as needed and determined by the Outbreak Investigation Branch (OMB).

Complete COVID-19 Education Sector Outbreak Form at the conclusion of the investigation (See Report Forms).

Additional Guidance/Resources:

LA County COVID-19 Testing Strategy
Test Results Guidance
LA County Screening and Exposure Decision Pathways for Symptomatic Persons and Contacts of Potentially Infected Persons at Educational Institutions
Responding to COVID-19 in the Workplace Guidance
LA County COVID-19 Guidance for Early Care and Education Providers
LA County Protocol for COVID-19 Exposure Management Plan in ECE Sites
California Department of Public Health COVID-19 Updated Guidance: Child Care Programs and Providers
California Department of Public Health COVID-19 Case and Contact Management Within Child Care Facilities
CDC Guidance for Operating Child Care Programs during COVID-19
LA County Reopening Protocols for TK-12 Schools
LA County Protocol for COVID-19 Exposure Management Plan in TK-12 Schools
LA County Exposure and Screening Decision Pathways for Children and Employees at Educational Institutions
LA County Protocol for Management of Outbreaks of COVID-19 K-12 Schools
California Department of Public Health COVID-19 Reopening In-Person Instruction Framework and Public Health Guidance for TK-12 Schools in California
California Department of Public Health COVID-19 Industry Guidance: Schools and School-based Programs
CDC Operational Strategy for K-12 Schools through Phased Prevention

Cases

Confirmed COVID-19: A patient with a positive SARS- CoV-2 viral (molecular or antigen) test.

Presumed COVID-19: A patient with clinically compatible symptoms of COVID-19 and no clear alternate diagnosis with/without exposure history. This presumptive clinical diagnosis is used when the provider has a high index of suspicion that a patient has COVID-19.

Per the DPH Screening and Exposure Decision Pathways for Early Care and Education Centers and TK-12 Schools, symptoms consistent with possible COVID-19 in children include: fever ≥100.4F; new cough (different from baseline); diarrhea or vomiting. Symptoms that may be associated with COVID-19 in adults include fever ≥100.4F or feeling feverish (chills, sweating); new cough (different from baseline); shortness of breath; muscle or body aches; diarrhea or vomiting; new loss of taste or smell.

Cases (Staff/Employees)

Instruct presumed and confirmed cases of COVID-19 to self-isolate at home. They should not return to the setting for at least 10 days after symptom onset and 24 hours after fever has resolved without the use of fever reducing medicines and symptoms have improved. For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset. See Home Isolation Instructions.
If the employee came to work while ill, they should be separated from others with door closed, masked, and directed to go home right away.
Determine when the employee was first symptomatic and when they were tested.
Refer presumed cases to their primary care provider to discuss testing options.
Determine which days and shifts the employee was at the site.
If employee has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
Remind employer that hospitalized and fatal cases of work-related COVID-19 must be immediately reported to Cal OSHA (see www.dir.ca.gov/dosh/Serious-injury-FAQ.html and www.osha.gov/SLTC/covid-19/standards.html).
Consider alternative work options like teleworking if employee is well enough to do so.
Instruct employee to notify all other employers of their illness. Document confirmed cases and contacts of these cases in the COVID-19 Case and Contact Line List for the Education Sector (see Forms section)
Close off areas used by cases and do not use these areas until after cleaning and disinfecting (see DPH Cleaning Matrix). Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting). Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting use an EPA-registered disinfectant approved for emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
Facility administrators should work with Public Health to determine if short-term closure of the affected area(s) is needed to prevent the spread of COVID-19.
Notify all employees of COVID-19 exposure at site, while maintaining patient privacy, and reinforce prevention measures across the facility/site.
Post a notification letter of outbreak at the entrance of the facility/site and community area.
Issue a public notification regarding on-site exposures if unidentifiable employees, attendees, clients or customers may have been close contacts. Examples of a public notification include, but are not limited to, issuing a press release, using social media, and/or including information in communications released to the public and/or customer list.
Do not require a healthcare provider’s note for employees who are sick with symptoms of COVID-19 to validate their illness or to return to work.

Even if COVID-19 testing is negative, utilize the symptom-based clearance strategy in bullet 1 for return to work.
Utilize return to work protocols for healthcare professionals (HCP) if the employee provides direct clinical care to patients. Refer to DPH Guidance for Monitoring Healthcare Personnel and CDC's Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance).

Restrict contact with vulnerable* persons until 14 days after symptom onset.

* Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS. Cases (Child/Student)

Instruct parents/caregivers of children with presumed or confirmed COVID-19 to isolate the sick child at home. They should not return to the facility for at least 10 days after symptom onset and 24 hours after fever has resolved without the use of fever reducing medicines and symptoms have improved. For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset. See Home Isolation Instructions.
If the child showed symptoms after drop-off at the facility, they should be separated from others, ideally in an outdoor isolation area, masked, and be picked up immediately. Children under the age of 2 (including infants) should not be masked. Those between the ages of 2 and 8 can be masked but under adult supervision to ensure that the child can breathe safely and avoid choking or suffocation. Children with breathing problems should not be masked.
Determine when the child was first symptomatic and when they were tested.
Refer presumed cases to their primary care provider to discuss testing options.
Determine which days the child was in attendance at the facility while infectious.
If child has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
Document presumed and confirmed cases and contacts of these cases in the COVID-19 Case and Contact Line List for the Education Sector (see Forms section).
Close off areas used by cases and do not use these areas until after cleaning and disinfecting (see DPH Cleaning Matrix) Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting). Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting, use an EPA-registered disinfectant approved for emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
Facility administrators should work with Public Health to determine if short-term closure of the affected area(s) is needed to prevent the spread of COVID-19.
Notify all staff and parents/caregivers of COVID-19 exposure at site while maintaining patient privacy, and reinforce prevention measures across the facility.
Do not require a healthcare provider’s note for children to validate their illness or to return to the facility. Refer to bullet 1 of this section regarding home isolation.
Restrict contact with vulnerable* persons until 14 days after symptom onset. *Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic ling disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.

Contacts

A contact is a person with exposure to a confirmed case of COVID-19 during the period from 48 hours before symptom onset until the case meets criteria for discontinuing home isolation (See Home Isolation Instructions). For asymptomatic cases, the date of collection of the specimen that was positive for SARS-CoV-2 can be used in place of symptom onset.

Exposures are defined as follows:

Being within approximately 6 feet of a person with confirmed COVID-19 for a prolonged period of time (15 minutes or more within a 24-hour period);
Having unprotected direct contact with infectious secretions or excretions of a person with confirmed COVID-19 (e.g., being coughed or sneezed on, sharing utensils or saliva, or providing care without using appropriate protective equipment).
All exposures will be reviewed by Public Health to assess which persons need to quarantine, including the possibility of quarantining individuals beyond named close contacts if exposures cannot be ruled out. Refer to the protocols for COVID-19 Exposure Management Plans in ECE Sites and TK-12 Schools for updates on quarantine requirements.

Note: Asymptomatic persons who are fully vaccinated OR have recovered from laboratory confirmed COVID-19 within the last 90 days AND who are a close contacts to a confirmed case are not required to quarantine or test for COVID-19. However, they should monitor for symptoms of COVID-19 for 14 days following an exposure.

A person is considered fully vaccinated >2 weeks following the receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna) OR one dose of a single-dose vaccine (Johnson and Johnson/Janssen). This guidance can also be applied to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization (e.g. AstraZeneca/Oxford). See WHO's website for more information about WHO-authorized COVID-19 vaccines.

Quarantine Instructions for Contacts

Contacts who are asymptomatic should be instructed to self-quarantine and monitor symptoms for 10 days after last exposure, even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14. Exposures include contact that occurs during the period from 48 hours before symptom onset until the case meets criteria for discontinuing home isolation. See Home Quarantine Guidance.
If quarantined contacts develop symptoms of COVID-19 then they should begin self-isolation. See Home Isolation Instructions.
Do not require a healthcare provider’s note for contacts under quarantine to validate their illness or to return to the facility.

Targeted Testing for Contacts

Public Health is encouraging targeted testing to prevent spread of COVID-19 in ECE sites, K-12 Schools, and Programs Serving School-Aged Children. This strategy is aimed to supplement infection control, universal source control, and physical distancing measures. With the targeted testing strategy, when there is a known COVID-19 case, all presumed cases and contacts of confirmed cases are tested whether they have symptoms or not.
Instruct contacts to get tested as soon as possible. Refer contacts to their primary care provider to discuss testing options, and other testing resources, if needed.

Clients, Vendors, and Visitors: Contact any clients, vendors, and visitors who may have been exposed to a suspected or confirmed case, especially those who are at higher risk for severe infection. Instruct them to self-quarantine and monitor symptoms for 10 days after last exposure, even if they receive a negative test result during their quarantine period (see above Quarantine Instructions for Contacts). If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14. Clients, vendors, and visitors should call their primary care provider to discuss testing options.

Contacts (Staff/Employees)

Identify all employee contacts to confirmed cases of COVID-19.
Instruct employee contacts to self-quarantine and monitor symptoms for 10 days after last exposure even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14 (see above Quarantine Instructions for Contacts).
Document contacts on the COVID-19 Case and Contact Line List for the Education Sector (see Forms section) and submit it to DPH as soon as possible.
Instruct contacts to get tested as soon as possible, whether they have symptoms or not. Refer contacts to their primary care provider to discuss testing options, and other testing resources, if needed.
Do not require a healthcare provider’s note for employees to return to work.

Contacts (Child in ECE Site/TK-12 School)

Identify all children with contact to confirmed cases of COVID-19.
Instruct parents/caregivers of children who have had contact with a confirmed case of COVID-19 to home-quarantine and monitor symptoms for 10 days after last exposure even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14 (see above Quarantine Instructions for Contacts).
Initiate daily temperature and symptom checks on all children and staff still at the facility.
Document the contacts on the COVID-19 Case and Contact Line List for the Education Sector (see Forms section).
Instruct contacts to get tested as soon as possible, whether they have symptoms or not.
Refer parents/caregivers of contacts to their child’s primary care provider to discuss testing options.
Do not require a healthcare provider’s note for children to return to the facility.

GENERAL CONTROL RECOMMENDATIONS FOR OUTBREAKS

Reinforce good hand hygiene among all (including clients, vendors, and visitors).
Emphasize respiratory etiquette (cover cough and sneezes, dispose of tissues properly).
Sick persons (including clients, vendors, and visitors) with symptoms of COVID-19, even with mild symptoms, should be restricted from entering the campus and urged to stay home and self-isolate.
Consider screening all persons, including clients, vendors, and visitors, for fever by measuring body temperature.
Urge employees, children, students, and parents/caregivers to quarantine at home if someone in their house is sick.
Emphasize importance of early detection of cases and removing them from contact with others.
Ensure adequate and easily accessible supplies for good hygiene, including:

Tissues and trash receptacles
No touch hand sanitizer dispenser near customer entrances if feasible.
Handwashing stations
Soap
Paper towels
Alcohol‐based hand sanitizer.

Minimize, where possible, close contact and the sharing of objects such as cups, food, and drink (See Table 1: Physical Distancing Measures for Non-Residential Congregate Settings).
Discontinue in-person group events and consider virtual group events; otherwise ensure physical distancing requirements between people if an in-person event is essential.
Close off areas used by cases and do not use these areas until after cleaning and disinfecting. Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting).Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting, use an EPA-registered disinfectant approved for emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
Facility administrators should work with Public Health to determine if closure is needed to prevent the spread of COVID-19.
Notify all employees and parents/caregivers of COVID-19 outbreak at site while maintaining patient privacy, and reinforce prevention measures across the facility/site.
Provide employees, clients, vendors, and visitors, if possible, with accurate and updated Public Health information and materials about novel coronavirus. Signage should be posted at the worksite to reinforce frequent hand washing, cover your cough and maintain social distancing.
Increase routine cleaning and disinfection of all frequently touched surfaces and objects.
Implement strategies to protect employees who are at higher risk for adverse health complications. This may include strategies such as telecommuting, staggering shifts, and cross training staff.
Instruct facility to maintain daily visitor log, if feasible, with date and time of visit.

REPORTING

All cases associated with the outbreak facility, occurring with a symptom onset or positive test after the first outbreak-associated case, regardless of whether they are epi-linked, should be reported on the outbreak line list until the end of the surveillance period. The surveillance period ends 14 days from the latest date any outbreak-associated case was on-site or at a facility-related event while infectious.
An outbreak-associated case is a person at the outbreak facility or at a facility-related event who is either (1) the index case in the outbreak or (2) a person with confirmed COVID-19 who is epi-linked to another outbreak-associated COVID-19 case during the surveillance period. A non-outbreak-associated case is a person associated with the outbreak facility with confirmed COVID-19 that has been determined by Public Health to not be epi-linked to an outbreak-associated case.
The Public Health Outbreak Investigator will forward outbreak line lists to ACDC-Education@ph.lacounty.gov when new cases are added.
The Public Health Outbreak Investigator must be notified of a hospitalization and/or death associated with the outbreak facility during the surveillance period.

TESTING CONSIDERATIONS

Public Health recommends diagnostic testing to identify persons actively infected with COVID-19 based on symptoms or exposure to prevent spread of COVID-19. This strategy is aimed to supplement infection control, universal source control, and physical distancing measures. With diagnostic testing, when there is a known COVID-19 case, all presumed cases and contacts of confirmed cases are tested whether they have symptoms or not.
The ECE or School Program should instruct symptomatic persons and persons with an exposure to get tested as soon as possible. Refer individuals to any of the following to discuss testing options and other testing resources, if needed.
1. primary care provider,
2. Employer occupational health
3. 2-1-1 for county or city testing sites (https://covid19.lacounty.gov/testing/)
Employers may request that staff/employees report their test results (see cdflaborlaw.com/_images/content/DFEH-Employment-Information-on-COVID-19-FAQ_ENG.pdf and www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws). Employers must maintain confidentiality in compliance with privacy laws.
Asymptomatic contacts who are fully vaccinated or have previously tested positive for SARS-CoV-2 within the past 90 days, do not need to test if identified as a close contact.
Retesting of contacts is not recommended if they remain asymptomatic from date of exposure to end of quarantine period. Retesting is recommended if any of the contacts become symptomatic.
Expanded testing at the site beyond diagnostic testing of close contacts may be considered on a case-by-case basis (e.g. if outbreak is extensive or close contacts are not identifiable due to nature of exposures).

OUTBREAK CLOSURE CRITERIA

The last day of surveillance is the 14^th day after the last date that any outbreak-associated case was on site or at a facility-related event while infectious.
Outbreak can be closed if all conditions below are met:
1. No outbreak-associated cases have occurred within the 14-day surveillance period; and
2. The facility has implemented all necessary COVID-19 control and preventive measures and observed violations have been abated.
Public Health Outbreak Investigator uploads all documents into IRIS and documents in IRIS per protocol.
Public Health Outbreak Investigator or Supervisor can close COVID-19 outbreak in IRIS after approval by AMD or AMD-delegated physician. Closure letter will be signed by AMD or AMD-delegated physician.

Table 1: Physical Distancing Measures for Non-Residential Congregate Settings: Early Care and Education Providers, TK-12 Schools, and Programs Serving School-Aged Children

Common Workspaces	Stagger mealtimes to reduce crowding in shared eating facilities Stagger the schedule for use of common/shared kitchens Create a schedule for using common space Consider closing break rooms Reduce activities that congregate any children/students or staff at once Re-configure workspaces to create space between children/students and staff, if possible Add physical barriers in shared settings where it is difficult for individuals to adhere to physical distancing requirements. Use flexible work and learning sites (telework, virtual learning) and flexible work or learning hours (staggered shifts or classes) Pursue virtual group events, gatherings, or meetings; otherwise practice social distancing per required distance of space between people if events are held. Consider staggering shifts so that students and staff have contact with the same cohort each day to limit the opportunity for the virus to spread Limit nonessential visitors, volunteers and activities involving external groups or organizations.
Employee Communication	Consider using alternative methods of communication: Bulletin boards, signs, posters, phone, sliding information under doorway, email, website, social media platforms Utilize technology to minimize face-to-face meetings Reduce unnecessary assembly of children/students and staff (e.g., large meetings where information can be communicated otherwise)
Staff Interaction	Re-configure workspaces to create required distance of space between employees and clients/vendors Provide physical guides, such as tape on floors or sidewalks and signs on walls to ensure that individuals remain apart in lines per physical distancing requirements. Reduce unnecessary assembly of children/students and staff (e.g., large meetings where information can be communicated otherwise)
Students	Limit the number of the children/students in a single classroom to no more than permitted per reopening protocols. Re-engineer classrooms to create physical distance of space required between children/student activity stations, tables, desks and chairs Provide physical guides, such as tape on floors or sidewalks and signs on walls to ensure that individuals adhere to the required physical distancing of space between each other. Eliminate group activities that require congregation (circle time, assemblies, team sports) Use a backpack or large Ziplock bag for each student/children's individual materials Encourage individualized activities that children/students can do independently Stagger activities such as outdoor time or other breaks so no two groups are in the same place at the same time Discontinue buffet style food options and offer pre-packaged foods when possible. If possible, serve individual plated meals (versus buffet or any self-serve station). Have lunch and/or meals outdoors and ensure children/students sit per physical distancing requirements, using marked intervals. Modify daily operations to minimize exposures (e.g., avoid use of touch screens for sign in/out). Restrict nonessential visitors, volunteers and activities involving external groups or organizations.

ECE, K-12 Education, & Programs Serving School-Aged Children

B73 COVID-19 - Procedural Guidance for DPH Staff

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