Return to School: A guide to responding to COVID-19 cases in
K-12 school settings. 2021-2022

August 27, 2021
		
	Fresno County Department of Public Health.

Return to School: A guide to responding to COVID-19 cases in K-12 school settings

This document was designed to provide guidance for Fresno County K-12 schools in response to COVID-19 related scenarios. As students return to school and in-person instruction resumes without any physical distance requirements, we recognize the importance of protecting the health and safety of our students, school staff, and community. The goal of this document is to help school staff respond to different scenarios and cases of COVID-19. Fresno County Department of Public Health (FCDPH) also advises schools to prepare plans for remote instruction for students who may need to isolate or quarantine or in the event of class or school closures related to outbreaks. This document is applicable to all K-12 schools, public or private, throughout Fresno County.

The following guidance is included in this document:

•	COVID-19 Prevention and Best Practices •	COVID-19 School Scenario Guidance
•	Guidelines for COVID-19 Exposure Scenarios for Schools

We will continue to revise these documents as necessary and as guidance from the California Department of Public Health and CDC is updated, in particular:

Guidance for COVID-19 Prevention in K-12 Schools | CDC K-12 Guidance 2021-22 School Year (ca.gov)
Guidance for the Use of Face coverings (ca.gov)
COVID-19 Emergency Temporary Standards Frequently Asked Questions (ca.gov)

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COVID-19 Prevention & Best Practices for Schools

Fresno County Department of Public Health’s Best Practices

•	Post or perform screening for recent COVID-19 positive close contact or COVID-19 symptoms for all students upon entry into first classroom of the day, AND for all staff, volunteers, or others when entering school buildings.
•	Implement universal face coverings while indoors and on public transportation for all students, teachers, staff, volunteers, etc.
•	Although masks are optional while outdoors, masks are recommended when unable to maintain physical distancing
•	Availability of hand sanitizer at all entrances and commonly visited locations.

•	Practice physical distancing in all indoor and outdoor settings when possible, particularly when not wearing face coverings such as in cafeterias.
•	Assess and address adequacy of ventilation in all indoor school settings.

•	Maximize space between students and between students and the driver on school buses, and open windows and keep air circulation open to outside air to the greatest extent practicable.
•	For activities where physical distancing is difficult to maintain we recommend: o students stay with their class cohorts
o limit these activities to 15 minutes or less o stay outdoors as much as possible
•	Maintain capacity for isolation of symptomatic students in a room with a separate entrance when students are on campus, with staff with appropriate PPE immediately available.
•	Cleaning all high use surfaces at least daily.

•	Minimize opportunities for contact where students/staff may congregate, i.e., start/end of the school day, lining up for lunch, etc.

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Guidelines for COVID-19 Exposure Scenarios for Schools

This following is guidance for steps to take in response to confirmed and suspected positive cases on your school campus.

Scenario
	
Response and Isolation Steps
	
Communication and Contact Tracing Steps
	
1. Student has tested positive for COVID-19
	Student to remain at home for 10 days with at least 24 hours of no fever and resolution of symptoms. If asymptomatic, the 10 days begins on the date the student was tested. If symptomatic, the 10 days begins on the day the symptoms began.
If symptoms persist beyond 10 days, student to remain at home until at least 1 day after symptoms have resolved without the use of medication.

Identify locations where the index case spent more than 15 minutes over a 24-hour period in the two days prior to the day the positive test was collected OR to symptom onset: classroom, library, cafeteria, school bus, etc. If these locations have not been cleaned and disinfected since the student was present, close off areas used by the person who is sick and do not use those areas until after cleaning and disinfecting, wait as long as possible (at least several hours) before you clean and disinfect.
	School to identify close contacts in the two days prior to the day the positive test was collected OR to symptom onset, up to the time the student was last in class. School to send notification letter to all close contacts.

Advise ALL household and close contacts to quarantine for 10 days and continue to wear a mask while indoors through Day 14 and self-monitor for COVID-19 symptoms through Day 14. If symptoms occur during this period, immediately self-isolate and contact their local public health department or licensed healthcare provider and seek evaluation and testing.

When both parties (index and close contact) were wearing a mask in the indoor classroom setting, unvaccinated students who are close contacts (more than 15 minutes over a 24-hour period within 0-6 feet indoors) may undergo a modified 10-day quarantine as follows. They may continue to attend school for in-person instruction if they:
i.	Are asymptomatic;
ii.	Continue to appropriately mask, as required;
iii.	Undergo at least twice weekly testing during the 10-day quarantine.

To discontinue quarantine before 14 days following last known exposure, asymptomatic close contacts must:
i.	Continue daily self-monitoring for symptoms through Day 14 from last known exposure; AND
ii.	Follow all recommended non-pharmaceutical interventions (e.g., wearing a mask when around others, hand washing, avoiding crowds) through Day 14 from last known exposure.
iii.	If any symptoms develop during this 14-day period, the exposed person must immediately isolate, get tested and contact their healthcare provider with any questions regarding their care

Alternatively, modified quarantine or quarantine can end for close contacts and

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		household members after Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative if they:
i.	Are asymptomatic;
ii.	Continue to appropriately mask, as required.

If close contact is fully vaccinated, see #2 below.

If other school-aged children are in the household, notify their respective school sites.

Notify FCDPH liaison.

Notify school community including staff and parents of a new positive case. Notification to indicate the date the school was informed of the positive case and the number of new positive cases that day without releasing information that would identify whether the positive case was a student or staff member or what grade or class was involved.
	
2. Student or teacher or staff person or volunteer (employee) is fully vaccinated but is a close contact
		OK to stay in school without additional restrictions if remain asymptomatic. Recommend testing for COVID-19 3-5 days after exposure, even if no symptoms. Fully vaccinated close contact should wear a mask indoors in public for 14 days following exposure or until test result is negative and isolate as described in #1 for 10 days if test result is positive.*

If vaccinated close contact becomes symptomatic, follow guidance for symptomatic students or employees in this document.

This guidance applies to close contacts who are household members as well.

*When You’ve Been Fully Vaccinated | CDC
	
3. Student is a close contact while wearing a mask when index case not wearing a mask
		Recommend quarantine for close contacts as described in #1 above.
	
4. Student is a close contact while not wearing a mask when index case was wearing a mask
		Recommend quarantine for close contacts as described in #1 above.

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5. Teacher or staff person or volunteer (school employee) is an unvaccinated close contact
		Follow CalOSHA ETS guidance for close contact:
The school must exclude from the workplace unvaccinated employees who had a close contact until the applicable return to work criteria are met. (An exception applies if the employee had COVID-19 in the preceding 90 days and has remained symptom free.) If the unvaccinated employee had no symptoms, they may return to work when 10 days have passed since the last known close contact. If the employee developed any symptoms, the person can be returned if they either meet the criteria required to return a COVID-19 case, or the person (1) tested negative using a PCR test after the onset of symptoms, and (2) waited 10 days following the last known close contact and (3) has been symptom-free for at least 24 hours without fever reducing medications.
	
6. Student becomes ill off school campus and is waiting for test results
	Student to remain at home for 10/1 or if symptoms persist beyond 10 days, for at least one day after symptoms resolve without the use of medication. OK to return to school if test negative for COVID (PCR) AND symptoms have resolved for at least one day, or if test negative for COVID with either PCR or rapid antigen and evaluated by a licensed health care provider AND symptoms have resolved for at least one day, OR if a licensed health care provider determines that symptoms are not new or worsening based on a chronic medical condition OR if a licensed health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza.
	Recommend student follow up with physician for evaluation and testing.

Notify student’s family that other school-aged household contacts should not return to school for 10 days from last contact with index case. Household contacts may end quarantine if student who is index case may return to school based on criteria described here AND household contacts have been asymptomatic for at least one day.

Notify classroom teacher and advise teacher to monitor other students for symptoms.

If second confirmed or suspected case in classroom, school to identify close contacts in classroom and other school settings in the two days prior to illness up to the time the student was last in class, including key contributing factors. Identify close contacts with symptoms and advise them to follow guidance in #6, or if asymptomatic, begin modified quarantine or quarantine as described in #1 and notify FCDPH liaison.

If student or close contact test positive for COVID, identify and notify close contacts, as well as school community, and FCDPH liaison as described in #1.

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7. Student develops COVID symptoms while at school
	Place student in isolation room with separate entrance until transported home or to higher level of care. More than one student may be placed in isolation room if all masked and physically distanced as much as possible. If unable to maintain six feet distance from index case, staff person with full PPE (N95 or higher mask, goggles/eye protector, gown, and gloves) must be immediately available to evaluate or assist student if necessary or arrange for prompt transfer to appropriate level of care.

Student may be accompanied while moving from classroom or other school site to isolation room by staff person with face covering AND observing physical distancing protocols. If closer contact required, staff person with full PPE must accompany child to isolation room.

Isolation room to be cleaned and sanitized after symptomatic student leaves. Room cannot be re-used until cleaning and disinfecting completed.
Student to remain at home for 10/1 or if symptoms persist beyond 10 days, for at least one day after symptoms resolve without the use of medication. OK to return or remain in school if test negative for COVID (PCR) AND symptoms have resolved for at least one day, or if test negative for COVID with either PCR or rapid antigen and evaluated by a licensed health care provider AND symptoms have resolved for at least one day without the use of medication OR if a licensed health care provider determines that symptoms are not new, or worsening based on a chronic medical condition OR if a licensed health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza.
	Recommend student follow up with physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician for evaluation and testing.

Notify student’s family that all household contacts should follow quarantine recommendations as described in #1. Household contacts may end quarantine if index case tests negative for COVID AND household contacts have been asymptomatic for at least one day without the use of medication OR if a licensed health care provider determines that symptoms are not new, or worsening based on a chronic medical condition OR if a licensed health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza.

Notify classroom teacher and advise teacher to monitor other students for symptoms.

If second confirmed or suspected case in classroom, school to identify close contacts in classroom and other school settings in the two days prior to illness up to the time the student was last in class, including key contributing factors. Identify close contacts with symptoms and advise them to follow modified quarantine or quarantine guidance as described in #1 and notify FCDPH liaison.

If student tests positive for COVID, identify and notify close contacts, school community, and FCDPH liaison.
	
8. Member of student’s household tests positive
	Student, and ALL household contacts, including other school-aged household contacts, need to quarantine and not return to work or school for 10 days from date of last contact with index case during index case isolation period.

Alternatively, quarantine can end after Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative as described in #1.
	If student in same household becomes symptomatic, refer to scenario #6 or #7 above. If student tests positive for COVID, refer to scenario #1 above.

Notify school community including staff and parents of a new positive case. Notification to indicate the date the school was informed of the positive case and the number of new positive cases that day without releasing information that would identify whether the positive case was a student or staff member or what grade or class was involved.

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9. Teacher or staff or volunteer (school employee) tests positive
	Follow CalOSHA ETS. School employee to remain at home for 10/1. If asymptomatic, the 10 days begins on the date the teacher was tested. If symptomatic, the 10 days begins on the day the symptoms began.
If symptoms persist beyond 10 days, teacher to remain at home until at least1 day after symptoms have resolved without the use of medication.

If not cleaned and disinfected since teacher was last in class or in any other school setting for 15 minutes or more over a 24-hour period since the two days prior to testing positive or becoming symptomatic, close off areas used by the person who is sick and do not use those areas until after cleaning and disinfecting, wait as long as possible (at least several hours) before you clean and disinfect.
	School to identify close contacts in the two days prior to the day the positive test was collected OR to symptom onset, up to the time the teacher was last in class. School to send notification letter to all close contacts.

Advise ALL household and close contacts to follow quarantine or modified quarantine as described in #1. If symptoms occur, immediately self-isolate and contact their local public health department or physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician and seek evaluation and testing.
If there are school-aged children are in the household, notify their respective school sites. Notify FCDPH liaison.

Notify school community including staff and parents of a new positive case. Notification to indicate the date the school was informed of the positive case and the number of new positive cases that day without releasing information that would identify whether the positive case was a student or staff member or what grade or class was involved.
	
10. Teacher or staff or volunteer (school employee) has symptoms.
	Follow CalOSHA ETS and #9 for school employees who either test positive for COVID-19 or are awaiting evaluation for COVID-19 symptoms. COVID-19 symptoms means fever of 100.4 degrees Fahrenheit or higher, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea, unless a licensed health care professional determines the person’s symptoms were caused by a known condition other than COVID-19.
		
11. Student feels ill with COVID symptoms, but parent/guardian will NOT be testing child.
	Student to remain at home for 10/1. The 10 days begins on the day the symptoms began.
If symptoms persist beyond 10 days, student to remain at home until at least 1 day after symptoms have resolved without the use of medication OR if a licensed health care provider determines that symptoms are not new, or worsening based on a chronic medical condition OR if a licensed health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza.
	Recommend evaluation and testing with physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician for index case, and household members to quarantine as described in #1.
Notify teacher of symptomatic student and to monitor class to determine if others become ill.

If second confirmed or suspected case in classroom, school to identify close contacts in classroom and other school settings in the two days prior to illness up to the time the student was last in class, including key contributing factors. Identify close contacts with symptoms and advise them to follow modified quarantine or quarantine guidance as described in #1

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		above, and if symptoms occur, immediately self-isolate and contact their local public health department or physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician and seek evaluation and testing to guide further isolation recommendations.

If student tests positive for COVID, identify and notify close contacts, school community, and FCDPH liaison.
	
12. Student tests negative but has COVID symptoms (possible false negative)
	Student to remain at home while symptoms persist consistent with screening protocols at school. Ok to return to school after negative PCR COVID test AND all symptoms have resolved without the use of medications OR if a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician determines that symptoms are not new, or worsening based on a chronic medical condition OR if a licensed health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza.
	Recommend evaluation and testing with physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician for index case.

Notify teacher of symptomatic student and to monitor class to determine if others become ill.

If second confirmed or suspected case in classroom, school to identify close contacts in classroom and other school settings in the two days prior to illness up to the time the student was last in class, including key contributing factors. Close contacts to follow modified quarantine or quarantine guidance as described in #1 above, and if symptoms occur, immediately self-isolate and contact their local public health department or physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician and seek evaluation and testing to guide further isolation recommendations.
	
13. AM Kindergarten student or teacher tests positive
	PM Kindergarten sharing classroom with AM class with positive case shall move class to another location on the day of notification unless classroom cleaned since index case tested positive.

See scenario #1 and/or #8 regarding student tests positive for additional guidance, or #5 if teacher tests positive.
	See scenario #1, #5, and/or #8 above.
	
14. Outbreak of cases on campus
	Report all positive cases identified by the school to FCDPH immediately per CCR Title 17. Evaluate all situations when two or more positive cases in a classroom are identified, or 3 or more positive cases within a 2-week period on a school campus to determine source of spread consistent with CDPH guidance. Consult with FCDPH, as needed.
	FCDPH recommends classroom closure for those schools where 2 or more students in a classroom with no alternative source of transmission is identified, particularly in middle and high schools where students are moving from classroom to classroom. Consider classroom or school shutdown on a
case-by-case basis in coordination with FCDPH and consistent with CDPH guidance.
	
15. What should a school do if a student
	Recommend request documentation of a medical, mental health, or disability

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is not wearing a face covering?
	exemption from a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician based on a diagnosis that is documented in their medical record to not wear a face covering. Students with a medical exemption from a licensed health care provider based on a diagnosis that is documented in their medical record to not wear a face covering are expected to wear a face shield with a drape.
		
16. What should a school do if a student has a medical exemption from a licensed health care provider to not wear a face covering and is not wearing a face shield and drape?
	Verify that a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician has determined that the student is medically exempt from wearing both a mask as well as face shield and drape. If there is a medical exemption for both a mask as well as a face shield and drape from a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician that is based on a diagnosis documented in their medical record, consider assigning students to sit in seats that are physically distanced from others in the classroom.
		
17. What should a school do for students in TK to second grade if the student is not wearing a face covering or a face shield and drape?
	See scenario #16 and #17 above
		
18. What should a school do if a student engages in high-risk behaviors such as speaking loudly, yelling, or singing without a mask or face shield with drape, or not following directions to maintain physical distancing?
	Consider alternative educational models other than in-person classroom instruction.
		
19. What if a student or staff member has a chronic condition causing one of the COVID-19 symptoms?
	FCDPH Health Officer Order of 6-28-2021 requires individuals with new or worsening COVID-19 symptoms to isolate as described in #2. Students and staff members with a chronic condition that in the opinion of a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician is causing one of the COVID-19 symptoms can return to school if they have a note from a physician, nurse practitioner, or other

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	licensed medical professional practicing under the license of a physician indicating that their symptoms are related to a chronic condition and are not new or worsening. The physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician should document in their medical record the chronic condition that is the basis for the symptom(s) in question. If a student or staff member has recurrence of similar symptoms related to the same chronic condition on a later date, schools should consider both symptoms and prior notes written by a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician when determining next steps.
Students or teachers who have fever, cough, or shortness of breath when they are screened upon entry to school or during school should be advised to stay at home or return to home until their symptoms have resolved even if they have been diagnosed with a chronic condition that in the opinion of a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician is causing one of the COVID-19 symptoms.
		
20. Student or teacher staff or volunteer (school employee) had documented and test-confirmed COVID-19 in past 90 days and is a close contact
		If student or school employee was previously diagnosed with laboratory-confirmed COVID-19 and has remained asymptomatic after recovery, retesting or quarantine is not recommended if another exposure occurs or might have occurred within 90 days after the date of symptom onset from the initial SARS-CoV-2 infection
	
21. What if a student or staff member has one of the COVID symptoms but has been diagnosed with another infectious disease or medical condition?
	Students or staff members may also return to school sooner than 10 days if their symptoms have resolved and if a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician has determined that the cause for their symptoms is due to another infectious process or medical condition that is confirmed by diagnostic testing, such as a positive strep test for sore throat, or a positive influenza test for flu symptoms. Students or teachers who have fever, cough, or shortness of breath when they are screened upon entry to school or during school should be advised to stay at home or return to home until their symptoms have resolved even if they have been diagnosed with a condition other than COVID-19.

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22. Can school nurses that are identified as close contacts quarantine under the health care worker guidance?
	Quarantine guidance for school nurses falls under CalOSHA Emergency Temporary Standards.

Transportation Services

Scenario
	
Response and Isolation Steps
	
Communication and Contact Tracing Steps
	
23. Bus driver or student rider on bus tests positive
	Refer to #1 or #9 above.
	Refer to #1 or #9 above. Conduct contact tracing consistent with guidance for school scenarios described above, paying attention to key contributing factors. Consult with FCDPH if questions regarding determining close contacts on bus.
	
After school programs

Scenario
	
Response and Isolation Steps
	
Communication and Contact Tracing Steps
	
24. Student or teacher or staff tests positive, or has symptoms
	Ensure availability of space to isolate children or staff with symptoms, with staff person with appropriate PPE available to monitor while awaiting disposition to home or for higher level of care consistent with guidance in above scenarios.

Refer to #1, #3, and/or #8 above.
	Conduct contact tracing consistent with guidance for school scenarios described above, while determining if any close contacts in alternative settings utilized by after-care program.

If any close contacts with symptoms identified, consider key contributing factors and notify FCDPH.

Refer to #1, #3, and/or #8 above.

Notify school community of positive cases.

Definitions:

COVID Symptoms: People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Anyone can have mild to severe symptoms. People with these symptoms may have COVID-19:
•	Fever or chills •	Cough
•	Shortness of breath or difficulty breathing •	Fatigue
•	Muscle or body aches •	Headache
•	New loss of taste or smell •	Sore throat
•	Congestion or runny nose •	Nausea or vomiting
•	Diarrhea

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Symptoms of COVID-19 | CDC

Testing: Both PCR and rapid antigen tests are available. PCR is considered the, “gold standard”. When rapid antigen testing is used for a symptomatic patient, a negative test should be confirmed with a PCR test. If rapid antigen testing is used for asymptomatic screening and surveillance, a positive test should be confirmed with a PCR test. For more information regarding rapid antigen testing, please refer to the Abbott BinaxNOW Information for Use in Schools at www.fcdph.org/schoolhealth.

10/1: Current CDC guidelines state that the index case must self-isolate for at least 10 days from the date symptoms began (for symptomatic patients) OR at least 10 days from the day the positive test was collected, PLUS one day with no symptoms without the use of medications. If index case has serious underlying medical conditions, contact FCDPH for consultation regarding isolation period.

Index case: person with a positive COVID test. In these scenarios, index case also refers to the person (student, teacher, or staff) who reports symptoms.

Close contact*: Close contact is defined as someone who has been within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period, cumulative time, during the infectious period. For the purposes of determining a close contact, cumulative time is defined as the period of time of exposure to ANY/ALL COVID-19 positive person(s), and is calculated as 15 minutes or more of time where a close contact has been in contact to a person(s) positive with COVID-19 while that person(s) was infectious, i.e. 2 days prior to symptom onset while symptomatic, or 2 days prior to test date if asymptomatic, up to the last contact with the COVID-19 positive person(s). The close contact definition applies in both the indoor and outdoor settings. If questions about whether an individual meets the criteria for a close contact, refer to key contributing factors. Refer additional questions regarding close contact criteria to FCDPH.

Outbreak: Two or more confirmed COVID positive cases in a classroom OR three or more confirmed COVID positive cases on the school campus within 14 days.

Quarantine: Applies in both indoor and Separates individuals who are close contacts of a confirmed COVID positive case but who are not yet ill. Individuals who are close contacts and asymptomatic may discontinue quarantine after Day 10 from the date of last exposure without testing. Household close contacts quarantine for 10 days after last close contact with index case while they are in isolation. All contacts released from quarantine before Day 14 must Self-monitor for COVID-19 symptoms through Day 14 and if symptoms occur, immediately self-isolate and contact their local public health department or healthcare provider and seek testing.

School nurses may return to work during staffing shortages after Day 7 from the date of last exposure with a PCR test performed after Day 5 and a negative result. After this time, contacts must use surgical face masks at all times during work and continue to use face coverings when outside the home through Day 14 after last exposure.

1. Modified Quarantine: When both parties were wearing a mask in the indoor classroom setting, unvaccinated students who are close contacts (more than 15 minutes over a 24-hour period within 0-6 feet indoors) may undergo a modified 10-day quarantine as follows. They may continue to attend school for in-person instruction if they:

i.	Are asymptomatic;

ii.	Continue to appropriately mask, as required;

iii.	Undergo at least twice weekly testing during the 10-day quarantine; and

iv.	Continue to quarantine for all extracurricular activities at school, including sports, and activities within the community setting.

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v.	Quarantine can end after Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative.

Modified quarantine or quarantine can end after Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative as described in scenario #1.

Isolation: Separates infected people who have a confirmed COVID test from others. Symptomatic COVID positive individuals must isolate for a minimum of 10 days from onset of symptoms and at least one day without fever and an improvement in respiratory symptoms. Asymptomatic COVID positive individuals must isolate for 10 days from test collection date.

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Covid-19 School Scenario Guidance

Potential Scenarios	Key Contributing Factors	Potential Responses/Actions

□ Student has tested positive for COVID-19

□ Student feels ill and is waiting for test results

□ Student develops COVID symptoms while at school

□Member of student’s household tests positive

□ Teacher tests positive

□ Student feels ill with COVID symptoms but parent will not be testing child

□ Student tests negative but has COVID symptoms (possible false negative)

□ Administrator or staff member, or volunteer tests positive

□ Administrator or staff, or volunteer feels ill with COVID symptoms

□ AM Kindergarten student or teacher tests positive

□ Outbreak of cases on campus

□ Bus driver, or student rider on bus, tests positive

□ Student or teacher in after school program tests positive
	
□ Was index case wearing mask properly?

□ Was social distancing maintained?

□ Duration of exposure to index case.

□ COVID-19 confirmed or suspected

□ Index case symptomatic or asymptomatic

□ Location of exposure -classroom, outdoors, other indoor setting

□ Proper PPE used?

□ Prior positive cases in classroom?

□ Prior positive cases on school campus?

□ Type of transportation to and from school

□Windows open or closed on bus

□ Presumed source of spread to index case-school vs community

□ Household contacts at other schools

□ Close contacts in school sports or other after-school programs
	
□ Notify school community of COVID positive cases in the child’s classroom or school

□ Complete contact tracing

□ Quarantine close contacts

□ Inform potential close contacts to self-monitor, follow up with physician if symptoms develop.

□ Sanitize and disinfect potentially contaminated equipment, supplies, and rooms

□ Close classroom

□ Contact the Fresno County Department of Public Health (FC DPH)

□ Recommend testing if not already done

□ Recommend evaluation from physician

□ Follow up contact with index case and/or close contacts scheduled

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Sample Notification Letter – Symptoms

Dear Parent or Guardian:

Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms can range from mild (or no symptoms) to severe illness. You can become infected by coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread from person to person. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.

Because your student has symptoms of COVID-19 and because your school wants to protect your student’s health and the health of others, your student cannot return to school until the following are true:
1. Your student had a negative test result for COVID-19 and has no further symptoms (be prepared to show proof of either a negative PCR COVID-19 test from your school, or any COVID test ordered by a nurse practitioner, physician assistant working with a physician, or a physician who has checked your student for their symptoms)
OR
2. At least 10 days have passed from the day symptoms were first identified AND
At least 24 hours without symptoms and fever free without fever reducing medication.
3. If your student has a chronic condition that in the opinion of a licensed health care provider is causing one of the COVID-19 symptoms can return to school if they have a note from a licensed health care provider indicating that their symptoms are related to a chronic condition and are not new or worsening.
4. If a health care provider has made an alternative diagnosis based on a diagnostic test such as a positive strep screen or a positive screen for influenza, they may stop isolation after improvement of symptoms for 24 hours without the use of fever reducing medications.

COVID-19 and other illnesses are potentially very serious. Please consult your medical provider for any questions you may have regarding your students condition or testing. If your student has symptoms that are worsening, particularly any trouble breathing, continued pain or pressure in the chest, or bluish lips or face, immediately contact your medical provider or go to the emergency room or call 911.

If you do not have a negative COVID-19 test for your student, the earliest date your ill student can return is ___________________________ (NOTE: Calculate based on 10 days from date symptoms were identified)

In addition, any other students living in the household of the sick student may not return for 10 days after the last day they were in contact with the ill child. Other students living in the household may return if the sick student is cleared to return prior to 10 days for one of the reasons noted above.

Names of other students in house: _______________________________________________________

Return to school date if able to isolate other students from your student: __________ (NOTE: Calculate based on 10 days from last date of close contact with index case. Recommend follow-up to determine if close contact was able to remain quarantined from index case- if not will need to extend date of return to school to end of isolation period for index case, plus additional 10 days of quarantine)

Staff name: ___________________________________________________________

For additional information on isolation and quarantine, please visit the Fresno County Dept of Public Health website at:
https://www.co.fresno.ca.us/departments/public-health/covid-19/covid-19-orders Please contact the site health service staff if you have questions regarding returning.

Sample Notification Letter – Exposure- Quarantine One Party Without Mask
Dear Parent or Guardian:

Your student may have been exposed to COVID-19 on ___________________ at ___________________.

Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms can range from mild (or no symptoms) to severe illness. You can become infected by coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread from person to person. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.

We have determined that either the person who had COVID or your student was not wearing a mask. In this circumstance, _________________________ and the Fresno County Department of Public Health requires the following steps:

1. Your student must quarantine for 10 days from the date listed above. 2. Your student may return to school:
a. If 10 days have passed and no symptoms have developed. Return date would be: b. ____________.
3. Alternatively, quarantine can end for close contacts and household members after Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative if they:
a. Are asymptomatic;

b. Continue to appropriately mask, as required.

4. People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
•	Fever or chills •	Cough
•	Shortness of breath or difficulty breathing •	Fatigue
•	Muscle or body aches •	Headache
•	New loss of taste or smell •	Sore throat
•	Congestion or runny nose •	Nausea or vomiting
•	Diarrhea

o If any of these symptoms develop,

i. contact your medical provider for evaluation or go to the emergency room if getting worse or trouble breathing. The medical provider may or may not recommend testing for COVID-19.

ii. Student must be isolated, as much as possible, from the rest of the household. iii. Student may return to school after being completely symptom free for 24 hours
without the use of medication, AND a minimum of 10 days have passed since the symptoms began, which may extend the quarantine period beyond the original 10 days.
iv. Notify the school of any changes in status.

If your student is confirmed positive for COVID 19, please follow these guidelines:

1. Your student must be isolated, as much as possible, from the rest of the household.

2. We recommend evaluation by your student’s medical provider if their symptoms worsen or go to the emergency room if any trouble breathing.
3. Any other children or adults in the household are now considered close contacts and must quarantine for 10 days.
a. If any household contacts develop symptoms during the 10 days, please contact your physician for evaluation. The physician may or may not recommend testing for COVID-19.
4. Your student may return to school after being completely symptom free for 24 hours without the use of medication, AND a minimum of 10 days have passed since the symptoms began OR when the positive test was completed.
5. Notify the school(s) of any changes in status.

If you have general questions about COVID-19, you can visit the health department’s web site at www.fcdph.org/covid19.

If you need resources, please contact ____________________.

If you would like to speak to someone on the school campus, please contact ______________________.

Sample Notification Letter – Exposure- Quarantine

Dear Parent or Guardian:

Your student may have been exposed to COVID-19 on ___________________ at ___________________.

Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms can range from mild (or no symptoms) to severe illness. You can become infected by coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread from person to person. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.

We have determined that both the person who had COVID-19 and your student were wearing a mask. In this circumstance, _________________________ and the Fresno County Department of Public Health requires the following steps:

Your student may continue to attend school for in-person instruction if they:

i.	Do not have any symptoms of COVID-19;

ii.	Continue to mask as required indoors and outdoors if less than six feet from others; iii.	Undergo at least twice weekly testing for 10-days; and
iv.	Do not participate in all extracurricular activities at school, including sports, and activities within the community setting for 10 days (__________).

Alternatively, your student may complete their testing and return to extracurricular activities after Day 7 (______________) if a COVID-19 test is collected after Day 5 (___________) from the date of last exposure and if they test negative.

If you decide that you do not want your student to be tested, your student must quarantine by staying at home for 10 days from the last day of their exposure (__________).

Whether your student is tested or not, they are expected to:
i.	Continue daily self-monitoring for symptoms through Day 14 from last known exposure; AND
ii.	Follow all other recommended steps to stop the spread of COVID-19 including wearing a mask when around others, hand washing, and avoiding crowds through Day 14 from last known exposure.
iii.	 If any symptoms develop during this 14-day period, your student should immediately isolate, get tested and contact their healthcare provider with any questions regarding their care

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

•	Fever or chills •	Cough
•	Shortness of breath or difficulty breathing •	Fatigue
•	Muscle or body aches •	Headache
•	New loss of taste or smell •	Sore throat
•	Congestion or runny nose •	Nausea or vomiting
•	Diarrhea

o If any of these symptoms develop,

i. contact your medical provider for evaluation or go to the emergency room if getting worse or trouble breathing. The medical provider may or may not recommend testing for COVID-19.
ii. Student must be isolated, as much as possible, from the rest of the household. iii. Student may return to school after being completely symptom free for 24 hours
without the use of medication, AND a minimum of 10 days have passed since the symptoms began, which may extend the quarantine period beyond the original 10 days.
iv. Notify the school of any changes in status.

If your student is confirmed positive for COVID 19, please follow these guidelines:

1. Your student must be isolated, as much as possible, from the rest of the household.

2. We recommend evaluation by your student’s medical provider if their symptoms worsen or go to the emergency room if any trouble breathing.
3. Any other children or adults in the household are now considered close contacts and must quarantine for 10 days.
a. If any household contacts develop symptoms during the 10 days, please contact your physician for evaluation. The physician may or may not recommend testing for COVID-19.
4. Your student may return to school after being completely symptom free for 24 hours without the use of medication, AND a minimum of 10 days have passed since the symptoms began OR when the positive test was completed.
5. Notify the school(s) of any changes in status.

If you have general questions about COVID-19, you can visit the health department’s web site at www.fcdph.org/covid19.

If you need resources, please contact ____________________.

If you would like to speak to someone on the school campus, please contact ______________________.

Sample Notification Letter for Positive Case

Dear Parent or Guardian:

Your student had a positive COVID-19 test.

Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms can range from mild (or no symptoms) to severe illness. You can become infected by coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread from person to person. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.

___________________________ and the Fresno County Department of Public Health recommend the following steps:

1. Your student is required to self-isolate at home, including complete separation from others in the house. This means no contact, no time together in the same room, and no sharing of any spaces, such as same bathroom or bedroom.
2. Your student may return to school:

a. after being completely symptom-free for 24 hours without the use of medication, b. AND a minimum of 10 days have passed since the symptoms began OR when the
positive test was completed. Based on the information we collected, the date your student may return to school is ___________.
3. Any other students or adults in the household are now considered close contacts and must quarantine for 10 days.
a. Quarantine for 10 days following date of last exposure to the student with a positive COVID-19 test, including complete separation from the person in your house with COVID-19.
i. If unable to completely separate from student with COVID-19, any other students or adults in the household must quarantine for 10 days after the last contact with the student with COVID-19 during their isolation period.
b. If any household contacts develop symptoms during the 10 days, they should contact their medical provider for evaluation. The medical provider may or may not recommend testing for COVID-19.
4. We recommend evaluation by your student’s medical provider if you have any questions or if their symptoms worsen, or go to the emergency room or call 911 if your student has any trouble breathing, continued pain or pressure in the chest, or bluish lips or face.
5. Notify the school(s) of any changes in status.

If you have general questions about COVID-19, you can visit the health department’s web site at www.fcdph.org/covid19.

If you need resources, please contact __________________.

If you would like to speak to someone on the school campus, please contact ______________________.

County of Fresno DEPARTMENT OF PUBLIC HEALTH

Health Update March 25, 2021

Evaluating Workers or Students with COVID-19 Symptoms

To protect the health and well-being of everyone in the workplace or classroom, the Fresno County Department of Public Health (FCDPH) has required that workers or students with COVID-19 symptoms isolate for 10 days and that health care providers have the ability to test for COVID-19.

This health message provides updated information to the Health Advisory dated December 3, 2020 and includes information on using rapid antigen testing.

We are in the midst of a deadly, global pandemic. The FCDPH strongly encourages you to do a COVID-19 test on any individual with COVID-19 symptoms. When using rapid antigen testing, negative results should be treated as presumptive and confirmation with a molecular assay, if necessary, for patient management, may be performed. Negative results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions. Negative results should be considered in the context of a patient’s recent exposures, history and presence of clinical signs and symptoms consistent with COVID-19. For this reason, FCDPH recommends not confirming positive BinaxNOW rapid antigen tests that are done within seven days of becoming symptomatic, but does recommend confirming a negative BinaxNOW result with a PCR test in symptomatic individuals: https://www.fda.gov/media/141567/download. If an individual tests negative for COVID-19, they can return to their place of work or school once symptoms have improved and they have had no fever for 24 hours without any medication use.

Your patient may have a chronic condition that is causing COVID-19 like symptoms. Symptoms of COVID-19 includes new or worsening presence of the following:

•	Fever or chills •	Cough
•	Shortness of breath or difficulty breathing •	Congestion or runny nose
•	Fatigue

Categories of Health Alert Messages:

Health Alert: Conveys the highest level of importance; warrants immediate action or attention
Health Advisory: Provides important information for a specific incident or situation; may not require immediate action Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action Health Information: Provides general health information which is not considered to be of emergent nature

Promotion, preservation and protection of the community’s health 1221 Fulton Street, Fresno, CA 93721      P.O. Box 11867, Fresno, CA 93775 (559) 600-3200      FAX (559) 600-7687
The County of Fresno is an Equal Employment Opportunity Employer www.co.fresno.ca.us      www.fcdph.org Page 1 of 2

Health Update March 25, 2021

Evaluating Workers or Students with COVID-19 Symptoms

•	Repeated shaking/ tremors •	Muscle pains or body aches •	Headache
•	Sore throat
•	New loss of taste or smell
•	Nausea, vomiting or diarrhea

As a licensed health care provider, you can determine that your patient’s symptoms are not new, or worsening based on a chronic medical condition. If this is the case, we ask that you provide a note for their school or workplace stating that your patient has a chronic condition and indicate the symptoms that it may be causing. As a licensed health care provider, you may also make an alternative diagnosis based on a diagnostic test such as a positive strep screen or influenza screen to explain your patient’s symptoms and clarify that on the note.

We want our workplaces to remain open and our children to return to school. If there is someone with COVID-19 symptoms in the workplace or classroom, co-workers, teachers and classmates are understandably very concerned. Testing all individuals with COVID-19 symptoms will help alleviate these concerns and help us control this pandemic.

Thank you for ensuring the health and safety of your patient as well as the health and safety of the other children and staff they encounter at school and in our community.

If you have questions about COVID-19 or COVID-19 testing, you may contact the Fresno County Department of Public Health at (559) 600-3332.

For COVID-19 testing events in Fresno County, visit www.fcdph.org/covid19testing.

###

Page 2 of 2

Important Information for Health Care Providers when Evaluating Workers or Students with COVID-19 Symptoms

This worker or student or staff was unable to attend work or school because they developed new or worsening symptoms of COVID-19.

Symptoms of COVID-19 includes the new or worsening presence of the following:

• Fever or chills • Cough
• Shortness of breath or difficulty breathing • Congestion or runny nose
• Fatigue
• Repeated shaking/tremors

• Muscle pains or body aches • Headache
• Sore throat
• New loss of taste or smell
• Nausea, vomiting or diarrhea

To protect the health and well-being of everyone in the workplace or classroom, the Fresno County Department of Public Health requires that workers or students with COVID-19 symptoms isolate for 10
days and that health care providers have the ability to test for COVID-19.

We strongly encourage you to do a COVID-19 test on any individual with COVID-19 symptoms. If an individual tests negative for COVID-19, they can return to their place of work or school once symptoms have improved and they have had no fever for 24 hours without any medication use.

Your patient may have a chronic condition that is causing COVID-19 like symptoms. As a licensed health care provider, you can determine that your patient’s symptoms are not new, or worsening based on a
chronic medical condition. As a licensed health care provider, you may also make an alternative diagnosis based on a diagnostic test such as a positive strep screen or influenza screen to explain your patient’s symptoms.

Please indicate below how you determined if your patient’s symptoms were related to COVID-19. At least one of the three lines below must be completed for this form to be accepted.

Patient’s name: _____________________________________ Date of evaluation: ________________

1) COVID-19 Test Result: Positive: ☐	Negative: ☐	Date of Test: ________________

2) If patient has chronic medical condition explaining the COVID-like symptom, indicate symptom and chronic medical condition below:

COVID-Like Symptom: _________________________________________________________

Chronic Medical Condition: ______________________________________________________

3) If patient has an alternative diagnosis based on a diagnostic test, indicate alternative diagnosis and diagnostic test below:

Alternative diagnosis: ______________________________	Diagnostic test: _______________

He/she may return to school/work as noted: Yes: ☐ No: ☐	Date: ____________________

If you have questions about COVID-19 or COVID-19 testing, you may contact the Fresno County Department of Public Health at (559) 600-3310. Thank you for ensuring the health and safety of your patient as well as the health and safety of the other children and staff they come into contact with at school and in our community.

Provider Name Printed: _______________________________

Provider Signature: __________________________________	Date: _________________

Provider Phone Number: _____________________________	FAX: _________________

5/10/21