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

B73 COVID-19 - Procedural Guidance for DPH Staff


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

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 either or all were infectious.** Epidemiologically-linked cases include persons with identifiable connections to each other such as sharing a physical space (e.g., in a classroom, school event, sports team, other extracurricular activities, school transportation, office site), indicating a higher likelihood of linked spread of disease in that setting rather than sporadic transmission from the broader community.

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

**A case is considered infectious from 2 days before symptoms first appeared until isolation ends or if no symptoms, two days before their test was taken until isolation ends.

Epidemiologic Data for Outbreaks

  1. Complete a COVID-19 Case and Contact Line List for the Education Sector that includes information for all cases (outbreak associated and non-outbreak associated). (See Reporting section for definitions for outbreak-associated and non-outbreak-associated cases.)
    1. Names of cases
    2. Dates of illness onset
    3. Date of birth/Age
    4. Address and phone number
    5. Epi links to other cases (rooms, meetings, etc.)
    6. Occupation/job title or role at education site
    7. Last date at educational site
    8. Hospitalization status
    9. Symptom status
    10. Results of COVID-19 tests
    11. Vaccination status
    12. Linked to outbreak (yes/no)
  2. Maintain surveillance for new cases until no new outbreak-associated cases for at least 10 days.
  3. Create an epi-curve by date of illness onset, either date of symptom if symptoms are present or date of first positive specimen collection date, whichever date is earlier, for outbreak-associated cases. (See CDC Quick Learn Lesson: Create an Epi Curve for guidance.) Only put those that meet the case definition on the epi-curve. (Optional)
  4. Complete COVID-19 Education Sector Outbreak Form at the conclusion of the investigation (See Report Forms).

REPORTING

  1. The start of an active outbreak is defined as the earliest date any case among the first epi-linked cluster was present at the facility while infectious. Sporadic case/cases occurring prior to the identified epi-linked cluster can be considered part of the outbreak if there is an identifiable epi-link between the sporadic case to a case in the cluster or a subsequent outbreak-associated case and the epi-linked cases are within 14 days of each other.
  2. All cases associated with the outbreak occurring with a symptom onset or positive test after the first 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 10 days after the last date that any outbreak-associated case was on-site or at a site-related event while infectious.
  3. An outbreak-associated case is a person at the outbreak site or at a site-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 site with confirmed COVID-19 that has been determined by the Public Health to not be epi-linked to an outbreak-associated case.
  4. The Public Health Outbreak Investigator must be notified by the site of a hospitalization and/or death associated with the outbreak site during the surveillance period.

GENERAL CONTROL RECOMMENDATIONS FOR OUTBREAKS

  1. Reinforce good hand hygiene among all (including clients, vendors, and visitors).
  2. Emphasize respiratory etiquette (cover cough and sneezes, dispose of tissues properly).
  3. 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.
  4. Consider screening all persons, including clients, vendors, and visitors, for symptoms either at home or in-person. Consider checking for fever by measuring body temperature.
  5. Urge employees, children, students, and parents/caregivers to test more frequently in addition to following the required close contact instructions if someone in their house is sick.
  6. Emphasize importance of early detection of cases and removing them from contact with others.
  7. 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.
  8. Minimize, where possible, close contact and the sharing of objects such as cups, food, and drink.
  9. Evaluate if and where physical distancing measures need to be implemented, when feasible, to enable staff, students, and children to maintain 6 feet of physical distance from others, including when eating or drinking. Conduct increased environmental cleaning and disinfection of all frequently touched surfaces and objects. Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If disinfecting, use cleaning chemicals with EPA-registered disinfectant labels with claims against emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
  10. Site administrators should work with Public Health to determine if closure is needed to prevent the spread of COVID-19.
  11. Notify all employees and parents/caregivers of COVID-19 outbreak at site while maintaining patient privacy and reinforce prevention measures across the facility/site.
  12. 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.
  13. Increase routine cleaning and disinfection of all frequently touched surfaces and objects.
  14. 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.
  15. Instruct facility to maintain daily visitor log, if feasible, with date and time of visit.
  16. Assess need for referrals to vaccination sites or mobile vaccine unit.

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). 

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.

Refer to the Early Care and Education COVID-19 Exposure Management Plan, the ECE Actions for Isolation and Close Contacts flowchart, the TK-12 Schools COVID-19 Exposure Management Plan, and the TK-12 Actions for Isolation and Close Contacts flowchart for actions to take once a case has been identified. See also Screening and Exposure Decision Pathways for Early Care and Education Centers and TK-12 Schools.

Cases (Staff/Employees, Students/Children)

  1. Instruct presumed and confirmed cases of COVID-19 to self-isolate at home, regardless of vaccination status, previous infection, or symptom status.
    1. Cases must follow the Home Isolation Instructions. Day 0 of the isolation period is the first day symptoms developed. For asymptomatic cases, the specimen collection date is Day 0.
    2. A negative COVID-19 test may be required for a case to return to site/work. See Home Isolation Instructions.
  2. The school/facility or employer/site coordinator, should advise all symptomatic children or employees to get tested as soon as possible, even if they have been boosted, fully vaccinated (at least 2 weeks have passed since the final dose of their vaccine series), or previously tested positive. They can be referred to their primary care provider or 2-1-1 to access county or city testing resources.
    1. Symptomatic cases and close contacts that test negative or indeterminate/inconclusive for SARS-CoV-2, regardless of vaccination status, should not return to work until they have met return-to-work criteria, outlined in the Screening and Exposure Decision Pathways for Early Care and Education Centers and TK-12 Schools.
    2. It is strongly recommended that those with indeterminate or inconclusive SARS-CoV-2 test results have repeat testing.
  3. If the individual came to the school/facility while ill, they should be separated from others with door closed, or ideally in an outdoor isolation area, masked, and directed to go home or be picked up right away. Instruct them to not return until they have met the return criteria, outlined in the Screening and Exposure Decision Pathways for Early Care and Education Centers and TK-12 Schools.
  4. Determine when the child/student or staff was first symptomatic and when they were tested.
  5. Refer presumed cases to their primary care provider to discuss testing options.
  6. Determine which days the child/student or staff was at the site while infectious.
  7. If the child or employee has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
  8. For staff, consider alternative work options like teleworking if staff case is well enough to do so.
  9. Instruct staff case to notify all other employers of their illness to initiate contact investigations or other necessary infection control measures.
  10. Document confirmed cases and contacts of these cases in the COVID-19 Case and Contact Line List for the Education Sector.
  11. Provide thorough cleaning and disinfection of equipment and the environment of the case(s) along with frequently touched or shared surfaces and objects such as doorknobs/push bars, desks, restroom doors, etc. Use cleaning chemicals with EPA-registered disinfectant labels with claims against emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2). In most cases, temporary closure is not essential if environmental cleaning and other standard infection control measures can be appropriately conducted.
  12. Notify all staff and parents/caregivers of COVID-19 exposure at site, while maintaining patient privacy, and reinforce prevention measures across the site.
  13. Instruct the site to notify the public health outbreak manager assigned to the outbreak immediately if any additional children/students/staff or contacts, if known, test positive for COVID-19.
  14. Do not require a healthcare provider’s note for children/students or staff who are sick with symptoms of COVID-19 to validate their illness or to return to the site. Refer to bullet 1 of this section regarding home isolation.

Contacts

A close contact is a person with exposure to a confirmed case of COVID-19 during the period from 48 hours before the case’s symptom onset until the case meets criteria for discontinuing home isolation. (See Instructions for Close Contacts.) 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.

In ECE and TK-12 settings, the preferred method to determine which persons are considered to have been exposed, or are close contacts, is if they shared the same indoor airspace at the site with the infected person for 15 minutes or more over a 24-hour period. In certain circumstances, such as in large indoor airspaces and classrooms, those considered exposed may be limited to those who were within 6 feet of the infected person for 15 minutes or more over a 24-hour period.

Refer to the Early Care and Education COVID-19 Exposure Management Plan and the ECE Actions for Isolation and Close Contacts flowchart for guidance on how to identify who meets criteria to be considered a close contact in ECE settings. For TK-12, refer to the TK-12 Schools COVID-19 Exposure Management Plan and the TK-12 Actions for Isolation and Close Contacts flowchart for guidance. See also Instructions for Close Contacts.

Actions for Close Contacts

  1. Identify all children/students and staff at the setting with an exposure to the confirmed positive case during their infectious period.
    1. A case is considered infectious from 2 days before their symptoms first appeared until their isolation ends or the date of their first positive COVID-19 test if no symptoms, whichever is earlier.
  2. Notify all close contacts regarding the exposure.
    1. Notification can be done using an individual notification or a group notification method. Refer to the ECE COVID-19 Toolkit and TK-12 COVID-19 Toolkit for sample notification letters.
  3. Provide close contacts with the actions to take in the notification of exposure.
    1. 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.
    2. If close contacts have or develop symptoms of COVID-19, then they should remain at home and test immediately. Refer to the ECE Actions for Isolation and Close Contacts flowchart or TK-12 Actions for Isolation and Close Contacts flowchart.
  4. Do not require a healthcare provider’s note for contacts to return to the facility.

TESTING CONSIDERATIONS

  1. DPH requirements and recommendations for testing should be communicated to the site. Refer to the Early Care and Education COVID-19 Exposure Management Plan and the TK-12 Schools COVID-19 Exposure Management Plan, and the Screening and Exposure Decision Pathways for Early Care and Education Centers and TK-12 Schools. See also Instructions for Close Contacts.
  2. 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.
  3. Expanded testing at the site beyond 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

  1. The last day of surveillance is the 10th day after the last date that any outbreak-associated case was on site or at a site-related event while infectious.
    1. New cases occurring during the 10-day surveillance period should be evaluated as described in the Reporting section above.
  2. Outbreak can be closed if all conditions below are met:
    1. No outbreak-associated cases have occurred within the 10-day surveillance period; and
    2. The site has implemented all necessary COVID-19 control and preventive measures and observed violations have been abated.
  3. Public Health Outbreak Investigator uploads all documents into IRIS and documents in IRIS per protocol.
  4. 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.

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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