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COVID-19 School Health Resources for School Nurses and Other School Health Care Personnel

Frequently Asked Questions

October 06, 2020


This document is intended as a reference tool for school-based nurses, administrators and staff managing potential COVID-19 cases in a school setting grades pre-K to 12 in Pennsylvania.  Further detailed guidance is provided on the Pennsylvania Department of Education website.

Additional consultation is available by calling the Pennsylvania Department of Health (DOH) or your County or Municipal Health Department (CMHD) at: 1-877-PA Health (1-877-724-3258)


Managing Symptoms Among Students

Should COVID-19 be suspected when a student presents with sniffles or mild allergy-type of symptoms?

No.  In general, COVID-19 would not be suspected with mild symptoms unless there are known COVID-19 exposures.  Even though school-aged children can have mild symptoms when infected with COVID-19, it is best to apply the clinical criteria (provided below) to assess whether a student without any known exposures to COVID-19 might need further evaluation.
Clinical Criteria for COVID-19 Evaluation

1 or more symptoms
2 or more symptoms
Cough
Shortness of breath
Difficulty breathing
New olfactory disorder
New taste disorder
OR
Fever (>100.4 F oral or equivalent)
Chills
Rigors
Myalgia
Headache
Sore throat
Nausea or vomiting
Diarrhea
Fatigue
Congestion or runny nose

If influenza and other respiratory viruses are known to be commonly circulating, does this change the approach to assessing a student with upper respiratory symptoms for COVID-19? 
 
No.  As long as COVID-19 is circulating in Pennsylvania and continues to be of concern, presence of other viruses in the community that may cause similar illness should not change the suspicion for COVID-19 in an individual with compatible symptoms.

If a child has a chronic cough due to asthma or other condition, how should I consider that in determining if the clinical criteria is met for COVID-19?

Cough is an important symptom when evaluating someone for COVID-19; however in someone with a chronic cough, you should look for changes that suggest an infection (worsening cough, cough not improved with inhaler medication, productive cough) as well as other symptoms like presence of fever, headache, myalgias, and gastro-intestinal symptoms.

If a child is excluded from school because of illness and a healthcare provider confirms they have influenza or other diagnosis that explains the symptoms, do they still require a test for COVID-19?

Probably not, but co-infection with COVID-19 may still need to be considered, depending on the level of community transmission of COVID-19, potential exposures, and other factors.  Public health consultation is recommended for such an instance.

Are school nurses and school administrators supposed to notify public health staff of all students and staff meeting clinical criteria for COVID-19 at the time of exclusion? 

No. Notifying DOH or CMHD staff is not necessary for symptomatic students, staff, and faculty as other non-COVID-19 illnesses may present with similar symptoms. School nurses should contact DOH or CMHD staff for further guidance if a parent/guardian/caregiver or staff member notifies the school of potential exposure to COVID-19 by a student, staff member, or school visitor.

If a student has symptoms but does not meet the clinical criteria for COVID-19 evaluation (only fever, for example), what follow up should occur? 

If the clinical criteria for COVID-19 are not met and the student has no known COVID-19 exposures, symptoms may suggest other infection or illness and routine school practices for management of ill students at school should be followed.

Any student or staff with a fever of 100.4 degrees or higher should not be in school. School nurses should continue to follow their current school fever and illness guidelines for determining exclusion from the school setting due to fever/temperature.

If a child has a fever of 100.2 F, should this count as a positive symptom when evaluating for COVID-19? 

No. For COVID-19, the CDC recommends an oral temperature 100.4 F or 38 C as the cut-off to assess fever. School nurses should continue to follow their current school fever and illness guidelines for determining exclusion from the school setting.

A student with no known exposure to someone with COVID-19 presents with symptoms meeting the clinical criteria for COVID-19 evaluation and siblings/household contacts are attending school in other school buildings.  Should asymptomatic siblings/household contacts also be sent home until test results are completed?
 
No. Close contacts of those who are pending test results can continue normal activities until test results are available as long as the close contacts are not exhibiting any symptoms. Schools can be proactive about identifying potential exposures so that exclusions can be done quickly should the test result come back positive.  
 

Managing Symptoms Among Faculty and Staff

If influenza and other viruses are known to be commonly circulating, does this change the approach to assessing a staff member with upper respiratory symptoms for COVID-19? 

No.  As long as COVID-19 is circulating and continues to be of concern, presence of other viruses in the community that may cause similar illness should not change the suspicion for COVID-19 in an individual with compatible symptoms.

If a teacher or staff member becomes symptomatic and requires evaluation for COVID-19, how is that classroom managed?

If the suspicion for COVID-19 exists among a teacher or staff member, they should be excluded and encouraged to visit a healthcare provider and get tested for COVID-19 if clinically appropriate. Pending the test result, students exposed to that teacher/staff member while potentially infectious (i.e., 48 hours before symptom onset) should be identified so that exclusion of these students can be done quickly if the test results comes back positive.  Refer to CDC Guidance for Cleaning and Disinfecting Your Facility When Someone is Ill for additional guidance and recommendations.
 

Evaluation and Testing

What happens if a student meets the clinical criteria and is referred to a health care provider for evaluation/testing for COVID-19, but never gets the test?

If the student is evaluated by a healthcare provider and it is determined that symptoms are associated with another illness/infection and they have no known COVID-19 exposures, routine school practices for management of ill students at school should be followed.

A symptomatic child/individual who is not tested for COVID-19 should be excluded until:

  • At least 10 days have passed since symptoms first appeared and  
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved. 

What should school nurses and school administrators do if a student was excluded from school for COVID-19 evaluation and the test result is indeterminate or inconclusive?

If the student had clinical illness suggestive of COVID-19, it is best to recommend a retest.

If a retest does not occur, exclusion should be maintained until:

  • At least 10 days have passed since symptoms first appeared and 
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved.

Since the test result is unclear, public health action is warranted with these cases. DOH or CMHD staff will work with the school to identify close contacts of these students and direct quarantine when appropriate if the student was found to be positive.

If a parent informs a school that their excluded child tested negative for COVID-19, should the school nurse or school administrator require proof that the test occurred and of the negative result to allow them to come back to school before the 10 days has elapsed?

No. For a symptomatic individual/child with a negative test, you should exclude the child from school until afebrile for 24 hours (if fever present) AND improved respiratory symptoms.  Refer to COVID-19 Symptomatic K-12 Student or Staff Process Flow for additional guidance.
 
Is a negative test required before a confirmed case may return to school?

No.  A student or staff member diagnosed with COVID-19 does not need a negative test to return to school.
 
Students and staff may return to school when:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved.


Exclusion from School

When should school nurses and school administrators exclude children from school before a COVID-19 test is performed?

If the clinical criteria for COVID-19 is met or the student/staff member has known exposure to a confirmed case, the individual should be promptly sent home with a referral to a healthcare provider.

How long should students be excluded from school?

Ill students who meet the clinical criteria for COVID-19 should be excluded for a minimum of 10 days after illness onset.  A student may return when:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved. 

Students who are being excluded and monitored for the start of symptoms because they are close contacts of a case must be excluded for 14 days from their last known exposure. The entire 14-day quarantine time period must be completed and still applies even if the students receive a negative test result during the quarantine period.  Only after the 14-day quarantine period may the student return to school. For household members of a confirmed case, such as a student, that could be at least 24 days since the case developed symptoms. When a case can't separate themselves from the rest of their household, the risk of infecting their household contacts continues during their 10-day isolation period. Because of that ongoing exposure, the quarantine period for the healthy household contact starts at the end of the case's 10-day isolation period. That quarantine period is 14 days after the end of the case's 10-day isolation period, which totals 24 days.

How should a school nurse or school administrator respond to a parent who asks how many COVID-19 cases are in the school or a classroom?

Schools should follow existing school policies and procedures for parental notification of school-related health and safety information. Schools must take appropriate actions to protect the privacy of people infected or under suspicion of infection with COVID-19.  DOH or CMHD staff are responsible for contacting a student or staff person with COVID-19, informing close contacts of their possible exposure, and instructing individuals, including siblings and other household members, on self-quarantine and exclusions. Parents can be told that they will be contacted by public health staff if their child has been exposed and  reminded to always monitor for symptoms, to wash hands frequently, and to keep their child home if illness does develop.

Reporting Cases and the Role of Government

If a case of COVID-19 is suspected or confirmed in a school, who is responsible for identifying potential contacts of the case? 

Case investigation and contact tracing in Pennsylvania are functions of state and local health departments. DOH or CMHD staff are responsible for contacting a student or staff member with COVID-19, informing close contacts of their possible exposure, and instructing individuals, including siblings and other household members, on self-quarantine and exclusions. DOH or CMHD staff will assist schools with contact tracing and may request information regarding potential close school contacts from school nurses or other school health staff. School nurses are required to report information about known cases and maintain ongoing contact with public health departments to help control transmission. DOH or CMHD staff may reach out to request information related to potential school exposures for students or staff with COVID-19.
 
Before sending home an ill student, should a school nurse or school administrator interview the student to understand which parts of the school may have been contaminated and who else may have been exposed?

No.  In general, it is best not to delay sending an ill child home or to their health care provider. DOH or CMHD staff will get this information for cases and may request help with information collection at that time. The date of illness onset, symptoms, and nursing assessment should be documented when the student visits the health office.


Miscellaneous Situations

A student who plays team-based sports has just been excluded for evaluation for COVID-19.  Should the school stop the rest of the team from practicing or playing in any games?

Control measures in a situation like this depend on the likelihood that such a student may have COVID-19.  Test results, known exposures, severity of symptoms, and close contact activities while potentially infectious should be considered when determining appropriate actions.  Public health consultation also is recommended for such an instance.

The administration is concerned that holding school sports before January 2021 presents significant health risks to participants and the public, and strongly recommends against holding such events. The administration strongly recommends that Pre-K to 12 school sports be postponed until at least Jan. 1, 2021. Refer to Guidance for All Sports Permitted to Operate During the COVID-19 Disaster Emergency to Ensure the Safety and Health of Employees, Athletes and the Public for more information.

If a student is ill but does not meet the clinical criteria for COVID-19 evaluation and reports travel to another country or state where COVID-19 transmission is occurring, should we recommend testing for COVID-19?  

Not necessarily. As long as the clinical criteria capture likely COVID-19 illness, travel may not be an important factor in assessing risk.  However, awareness of travel advisories and consultation with public health would be advised.