Michigan Q and A for Schools and LHDs The purpose of this document is to assist local health departments in responding to questions from schools ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Michigan Q and A for Schools and LHDs
The purpose of this document is to assist local health departments in
responding to questions from schools as they reopen for in person classes. It is
not intended to be provided to the schools. Recommendations are changing
frequently and the Health Alert Network provides LHDs with timely updates on
many of the questions posed here and many of the recommendations require
public health understanding of the local situation.
Scientific knowledge as well as legal and public health recommendations on COVID-19 are
constantly evolving. The information and recommendations within this document are current
as of the date of publication or latest revision, printed at the bottom of this page. Local health
departments and schools should always consult the appropriate websites for the latest
information and consult with their corporate counsel on public health legal and policy
questions and with their local school boards for educational policies.
Recommendations may be modified depending upon which phase of the pandemic a school
district is in. Different regions of the state may be in different phases and MI Safe Start Phases
may increase or decrease according to levels of local disease transmission. It is important that
schools be aware of current disease status in their regions. Executive Order 2020-142 states
that a district that straddles regions will be treated as if it were located solely in the region
designated as higher risk (EO 2020-142 6e).
Michigan’s policies and recommendations for schools are published in MI Safe Schools:
Michigan’s 2020-21 Return to School Roadmap.
Date of Publication:
August 19, 2020Contents 1. Current Status of COVID-19 in our area ................................................................................................ 3 2. Preventing Transmission of COVID-19 in the Classroom and At School ............................................... 3 3. Masks and Face Covering ...................................................................................................................... 5 4. Screening............................................................................................................................................. 11 5. Testing for COVID-19........................................................................................................................... 13 6. Students and Staff with Symptoms consistent with COVID-19 .......................................................... 14 7. When a child or staff person tests positive for COVID-19 .................................................................. 16 8. School Closure ..................................................................................................................................... 21 9. Associates, Exposure, Quarantine & Returning to School .................................................................. 21 10. Record keeping ............................................................................................................................... 24 11. About the MI Roadmap, EO, State and Local Policies..................................................................... 24 12. Daily Activities & Mental Health ..................................................................................................... 26 13. Cleaning & Sanitizing....................................................................................................................... 28 Appendix A: Other Useful References ........................................................................................................ 31 August 19, 2020 Page 2
1. Current Status of COVID-19 in our area
Q 1.A: Will the Health Department share information about the number and locations of
active COVID-19 cases to help with our decision-making?
Local data is available on our website (LHDs insert their web address here )
Local and statewide daily and cumulative counts are available on Michigan’s Coronavirus Data
page.
Q 1.B: Where are the regional risk levels posted, is that the MI Safe Start map?
There is a bit of confusion among school districts over whether to follow the risk level
map or the economic reopening stage for the MERC region, which do not necessarily
align as per the disclaimer here: https://www.mistartmap.info/
There are many questions about the phases and risks levels. Schools also do not
understand the MERC regions and why smaller towns are in the same areas as larger
cities.
Epidemic phases and risk levels play an important role in planning, but the two are not
connected.
Epidemic phases, indicated in the MI Safe Start Plan, convey necessary precautions and closures
based on epidemiological data. These phases are enforced through Executive Order 2020-160,
and subsequent Executive Orders. Decisions about school closures and mandatory precautions,
outlined in the MI Safe Schools Roadmap, are based on these epidemic phases and Executive
Orders.
Risk levels, indicated on the MI Safe Start Map, convey the risk of spread in a given region. Risk
levels help the public make informed decisions about the places they live in or travel to.
Restrictions under MI Safe Start are shown at https://www.michigan.gov/coronavirus/0,9753,7-
406-100467_100913---,00.html
2. Preventing Transmission of COVID-19 in the Classroom and At
School
Q 2.A: Can kids pass COVID to other people, kids and/or adults?
Yes, young children may pose a lower risk of spreading COVID-19 to other children and adults.
However, kids have a lot of behaviors that encourage spread of germs so we need to err on the side
of caution. Studies suggest that high school age children spread COVID-19 at a rate similar to that of
adults .
August 19, 2020 Page 3Q 2.B: Can students eat in the cafeteria?
Yes, if that is the only option. Schools should consider all possibilities such as outdoor or classroom
spaces to eat meals. If the cafeteria is used, the following protocols must be observed:
● Students must be spaced at 6 ft intervals.
● Staff serving food must wear appropriate Personal Protective Equipment (PPE), including gloves,
face shields and masks.
● All students, teachers and food service staff should wash hands before and after every meal.
● To achieve social distancing requirements, staggered lunch times may be necessary. The size of
the cafeteria will determine capacity but every attempt should be made to limit the total number of
students to 50 or less.
Q 2.C: What is the maximum number of students that should be in that location (cafeteria) at
once?
● Fifty (50). Large scale assemblies or more than 50 students are currently suspended. Prohibit
assemblies that bring together students from more than one classroom.
● It is preferred/recommended that students have a consistent assigned seat and are spaced at six
foot intervals. The square footage will determine the ability to socially distance.
○ Assigned seats are critical for contact tracing.
○ Following cleaning protocols between lunch periods is critical.
Q 2.D: Is the recommendation to eat in classrooms at elementary?
It is recommended that ALL (elementary and secondary) students eat in classrooms,
understanding that needs and capability will vary.
Q 2.E: Is it possible to “cohort” students in an elementary classroom rather than social
distancing at the six foot interval?
● All efforts to keep students six feet apart should be taken. Cohorting is an additional way to
reduce contact between students.
● If cohorting, keep the cohort together as much as possible.
● Classroom cohorts should stay together in the cafeteria and the playground, keeping at least six
feet of space between individuals not in their cohort.
● Cohorts may be by classroom and/or groups within the classroom.
Q 2.F: How can we spread out in classrooms without more staff and space?
How am I to enforce distancing when I don't have enough room in the school building?
School districts are developing detailed plans on how they will implement the requirements for
opening schools. Please consult your local school district plans to see how social distancing will
be achieved.
Q 2.G. Hand blow dryers - are they acceptable?
It is unknown whether hand dryers disperse potentially infectious droplets. CDC guidance
for hand hygiene recommends drying hands with a clean towel or air drying.
August 19, 2020 Page 4Q 2.H: How high should Plexiglas barriers be between students?
We do not currently have guidance on the use of Plexiglas in schools. The American College of
Occupational and Environmental Medicine has stated that “The height of the partition needs to be
greater than the tallest standing user.” (See https://acoem.org/COVID-19-Resource-Center/COVID-
19-Q-A-Forum/Could-you-provide-guidance-on-the-use-of-plexiglass-barriers-for-workplaces-for-
sneeze-guard%E2%80%9D-dropl).
Q 2.I: What if I can't cohort my students?
Schools should try to cohort groups of students to isolated hallways or areas that, if there is a
COVID-19 exposure, can be monitored for additional positive cases. Students who are not part of a
cohort should remain six feet from all other students and wear a mask, if age appropriate, as
outlined by the MI Safe Schools Roadmap.
Q 2.J: What about drinking fountains in schools?
The virus that causes COVID-19 has not been detected in drinking water. Conventional water
treatment methods that use filtration and disinfection, such as those in most municipal drinking
water systems, should remove or inactivate the virus that causes COVID-19.The Centers for Disease
Control and Prevention (CDC) recommends that drinking fountains are cleaned and sanitized, but
encourage staff and students to bring their own water to minimize use and touching of water
fountains.
Additional suggestions to reduce transmission of disease through drinking fountains include:
Installation of foot pedals or motion sensor bottle fill stations
Hall monitoring by adults to prevent congregation of students
Support and reinforce a culture of handwashing after getting a drink
o Post signs by drinking fountains to remind of hand washing and sanitation
o Place hand sanitizer by drinking fountains
3. Masks and Face Covering
Face coverings are required in schools and classrooms as outlined in Executive Order 2020-142. Refer to
MI Safe Schools Roadmap for detailed guidance. School districts may have facial covering requirements
approved by their Board of Education for Phase 5, when face coverings are recommended, not required
per the MI Safe Schools Roadmap.
For the purposes of Executive Order 2020-153, classrooms are not considered an enclosed public space.
The use of face coverings in classrooms is mandated through Executive Order 2020-142.
A mask may not protect the wearer, but it may keep the wearer from spreading the virus to others. The
purpose of masks is to keep respiratory droplets from reaching others to aid with source control. Masks
with one-way valves or vents allow exhaled air to be expelled out through holes in the material. This
can allow exhaled respiratory droplets to reach others and potentially spread the COVID-19 virus.
August 19, 2020 Page 5Therefore, CDC does not recommend using masks if they have an exhalation valve or vent. (CDC
recommendation August 6, 2020)
Q 3.A: Who is required to wear a face covering?
This will depend upon the policies of the local school district. Each school district will need to
determine its own policy on face coverings, what documentation they will accept for a waiver, what
to do with students who cannot/will not wear a face covering, how they will enforce their rules and
other issues related to face coverings.
Q 3.B: Who should not wear a face covering?
The requirement to wear a face covering does not apply to:
Children under 2 years of age.
Students and staff who are unconscious, incapacitated or unable to remove the covering
without assistance.
Students and staff who cannot medically tolerate a face covering such as people who have
trouble breathing.
Schools should require documentation from a medical professional, as they do for other types of
accommodations.
Q 3.C: Are plastic face shields acceptable instead of the face mask?
Are face shields the same as face coverings?
Will mask use be enforced and are face shields a good alternative?
For staff who work with students who are hearing impaired and/or those with significant
disabilities is a Humanity Shield a safe option in lieu of a clear face mask? (looking for this
being the case for pre-K, 1, 2, 3 as well)
Could we require a shield if the doctor says they can’t medically tolerate a mask?
It is not known if face shields provide any benefit as source control to protect others from the spray
of respiratory particles. CDC does not recommend use of face shields for normal everyday activities
or as a substitute for masks.
Consider the use of clear masks for people who rely on lip-reading to communicate and for
those communicating with them.
It has not been determined if face shields fulfill the requirement of a face covering in the MI
Safe School Roadmap. Make sure to ask legal counsel if a face shield will comply with order. The
use of face shields may be reasonable accommodation if a doctor has determined that an
individual is unable to tolerate face masks or coverings.
If face shields are used without a mask, they should wrap around the sides of the wearer’s face
and extend to below the chin, fully covering the eyes, nose and mouth.
August 19, 2020 Page 6Q 3.D: Will a doctor’s note be required for staff and students who medically cannot tolerate
wearing a face covering?
Schools should require documentation from a medical professional, as they do for other types of
accommodations.
Q 3.E: What PPE and training is required or recommended for our school nurse?
When is an N95 mask required?
Am I, as the nurse, able to get fit tested for an N 95?
School health staff should be provided with appropriate medical PPE to use in health suites. This
PPE should include N95 masks, surgical masks, gloves, disposable gowns, and face shields or
other eye protection. School health staff should be aware of CDC’s Infection Control Guidance
for Healthcare Professionals about Coronavirus.
Also of note, asthma treatments using inhalers with spacers are preferred over nebulizer
treatments whenever possible. The CDC recommends that nebulizer treatments at school
should be reserved for children who cannot use or do not have access to an inhaler (with
spacer or spacer with mask). Nebulizer treatments are an aerosol generating procedure,
which is the highest risk for spreading COVID-19.
Health staff should be trained on proper donning and doffing procedures and follow the
CDC guidance regarding precautions when performing aerosol-generating procedures.
Nebulizer treatments should be performed in a space that limits exposure to others and
with minimal staff present. Rooms should be well ventilated, or treatments should be
performed outside. After the use of the nebulizer, the room should undergo routine
cleaning and disinfection.
Staff, such as school nurses and other school staff, who are caring for children and providing
medical care that includes aerosol generating procedures (e.g. nebulizers) need to wear an
N95 mask. If you need to use an N95 mask, go to your occupational health clinic to get
medically cleared and fit-tested.
Also see Guidance for Healthcare Personnel on the Use of Personal Protective Equipment (PPE) in
Schools during COVID-19.
Q 3.F.i: Waivers- Does the Health Department have a form for doctors to complete stating
a student or employee cannot wear a mask?
We have had several parents say they are going to get doctor's notes to say they don't
have to wear a mask in school. They are asking about signing a waiver (like we have for
immunizations) - is this something that the Health Department would provide/allow?
No, local health departments do not have waiver forms for mask use by students or staff.
Keep in mind that health care providers are currently overwhelmed with requests for medical
exemptions to masks and some are simply refusing to provide them. There are only a few medical
reasons to not wear a mask, but these are not black and white, and require a medical evaluation. If a
August 19, 2020 Page 7student or teacher is unable to provide you with a note, if this is what you require, by the first day of
school, know how you plan to handle this.
Q 3.F.ii: Waivers - Are there alternatives for students or staff who have a physician’s mask
waiver or will they need to be excluded?
Q 3.F.iii: Waivers - Should we have documentation of why a staff/child is unable to wear a
mask?
This will depend upon the policies on face coverings within your school district. But remember that
schools should require documentation from a medical professional.
Q 3.G: I am very concerned about young children wearing masks. I do not think this is a
healthy option for them. Please address this.
Should young children wear masks (K-2)?
Younger children (e.g., preschool or early elementary aged) may be unable to wear a cloth face
covering properly, particularly for an extended period of time. Wearing of cloth face coverings may
be prioritized at times when it is difficult to maintain a distance of six feet from others (e.g., during
carpool drop off or pick up, or when standing in line at school). Ensuring proper cloth face covering
size and fit and providing children with frequent reminders and education on the importance and
proper wear of cloth face coverings may help address these issues.
Q 3.H: What are the most important precautions that should be taken?
There is no single precaution that is the most important. Everyone should:
Stay home when they are sick
Wear a face mask around others, especially when a six-foot distance cannot be maintained
Wash hands frequently
Disinfect commonly touched objects and surfaces frequently
Cover coughs and sneezes
Avoid touching face
Q 3.I: What about masks on mass transit like Dial-A-Ride, other public transportation?
All the same recommendations apply. Most public transportation programs have similar
policies regarding masking, distancing, hygiene, etc.
Q 3.J: Why is social distancing not required on buses?
It is encouraged, but just like in classrooms, may not be possible to do without more busses and bus
routes, which is usually not possible. That is why masking is required on the bus and in transit.
Schools should consider assigned seating on buses so that children sit next to the students on each
August 19, 2020 Page 8occasion, which could facilitate contact tracing as well as limit the number of students that might
have to be quarantined.
Q 3.K: Are masks required for all staff and students in school now?
For schools in regions that are in phase 4, 5 or 6, which is when schools are permitted to be open, the
MI Safe Schools Road Map and the Executive Order 2020-142 provide guidance on the use of face
coverings in specified situations.
Pages: pg. 22 for phase 4, pg. 38 for phase 5, pg. 54 for phase 6. This includes the following:
● Facial coverings must always be worn by staff except for meals.
● Facial coverings must always be worn in hallways and common areas by pre K-12 student in
the building except for meals.
● Facial coverings must be worn in classrooms by all students in grades 6-12.
● All students in grades K-5 must wear facial coverings unless students remain with their classes
throughout the school day and do not come into close contact with students in another class.
● Refusal to wear a mask or shield will result in being prohibited from entering the building.
● Students may be placed in remote/virtual learning.
● IEP, 504 and IFSP’s will need to address any medical needs that require supports due to
COVID-19.
Q 3.L: Is it OK to have mask free breaks?
Yes, scheduling times for staff and students to be outside and maintaining social distancing or having
quiet time in a classroom and maintaining social distancing are acceptable practices for breaks from
wearing masks.
Q 3.M: Does the new EO impact the wearing of face mask at all?
EO 2020-153 says any individual who leaves their home or place of residence must wear a face
covering over their nose and mouth when in any indoor public space. We have been advised that
with regards to this order, schools do not qualify as a public space. Therefore, the requirements in
the MI Safe School Roadmap takes precedent.
Q 3.N: There are times the bus and school become very warm, as we have no air conditioning.
Is there a certain temperature where it isn't recommended for students/staff to wear
masks?
No, but it is recommended that the windows are kept open on the bus and in classrooms to
improve airflow, weather permitting.
Q 3.O: Facial Coverings: Both Phases 4 and 5 indicate that PreK-5 and special education
teachers should consider wearing clear masks. Is a clear mask the same thing as a face
shield?
The clear mask is suggested to aid with communication for young children.
August 19, 2020 Page 9 A face shield is not the same thing as a clear face mask. Clear face masks are thought to
offer a greater level of protection.
Q 3.P: I see face shields are single use only for health care. Can they be reused in schools?
Most face shields are disposable and intended to be discarded after use. However, in the current
critical shortages, you could reuse face shields by cleaning and disinfecting until wear and tear is
visible. The CDC provides suggestions for cleaning of face shields for healthcare providers facing
critical shortages:
Carefully wipe the inside, followed by the outside of the face shield or goggles using a clean cloth
saturated with neutral detergent solution or cleaner wipe.
Carefully wipe the outside of the face shield or goggles using a wipe or clean cloth saturated
with EPA-registered hospital disinfectant solution.
Wipe the outside of face shield with clean water or alcohol to remove residue.
Fully dry (air dry or use clean absorbent towels).
Perform hand hygiene.
Q 3.Q: Do neck gators work for face coverings?
Any face covering is better than nothing and the requirement is for a “facial covering”, no
specification regarding what type. According to the CDC, an appropriate facial covering has multiple
layers of fabric. Neck gators are not recommended unless they can be folded over to have multiple
layers covering the mouth and nose.
Neck gators are usually a single layer of cotton or synthetic materials. The material is thin and
stretchy, which means a decreased ability to contain droplets. Anything stretchy will be worse as
the size of the “filter” will get bigger and less effective.
Two layers of tightly woven cotton, such as quilting fabric or cotton sheets are preferred for
cloth face coverings.
According to the CDC an appropriate mask:
fits snugly but comfortably against the side of the face
completely covers the nose and mouth
is secured with ties or ear loops
includes multiple layers of fabric
allows for breathing without restriction
can be laundered and machine dried without damage or change to shape
Q 3.R: Rural Country Schools: if classrooms have multiple grades in each room, do even the k-
5 have to wear masks all day?
K-5 students wearing masks in the classroom is strongly recommended but not required if they are
strictly cohorted.
Q 3.S: Can someone who won't wear a mask come to school anyway?
If face coverings are required in the MI Safe Schools Roadmap, then no, they cannot come to school,
unless that person cannot medically tolerate a mask.
August 19, 2020 Page 10Q 3.T: Do all students (5yrs and up) and staff need to wear masks at all times at school with
the new executive order? There is confusion due to the roadmap strongly recommending
mask outside of the classroom but not requiring it.
The requirement to wear masks is different for each epidemic phase. “Strong recommendations” in the
MI Safe Schools Roadmap should be considered to best protect students and staff, however only
“Requirements” are required within a given phase. Refer to the MI Safe Schools Roadmap for full details.
Schools are not considered “public places” for the purpose of the Executive Order 2020-147.
4. Screening
Q 4.A: Our task force group had many questions regarding screening for both employees and
students. Our current Preparedness and Response Plan included a self-check by staff
before work. We do not track staff coming and going from the building. Do we need to put
a formal check in place? If so, I would like to copy what your school does - a text message
every morning that someone can just react to!
All schools, public and private, are subject to the rules governing workplace safeguards established
in section 1 of Executive Order 2020-114 (now replaced by 145)
https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-531123--,00.html
Per EO 2020-145: Conduct a daily entry self-screening protocol for all employees or contractors
entering the workplace, including, at a minimum, a questionnaire covering symptoms and suspected
or confirmed exposure to people with possible COVID19.
You can also use a virtual screener. One option from the state is
https://misymptomapp.state.mi.us/login
Q 4.B: Do we have to formally screen students with a health check?
How do we screen kids without bogging the whole schedule down?
What are options for screening of students - the how and where?
Temperatures before getting on the bus- are they required, or can be done at the
schools?
How best to handle screening either by the school or self-screening for students?
Questions on investing in screening machines and whether they can ask screening
question.
It is recommended you screen students daily. The school should determine the screening
method to use depending upon local school conditions.
August 19, 2020 Page 11Due to the time and interruption to education doing this on-site prior to school entry this would
cause, the health department feels that instructing parents to do this prior to sending their kids
to school is acceptable. They can do this remotely through an app or text message or you can
send them with a card, magnet, door hanger, etc. that reminds them to do this each day.
Recommended information for such a tool are:
Before leaving for school please make sure of the following:
Has your child(ren) started to have any of the following, not due to some other known health
problem?
Temperature over 100.4 Fahrenheit when taken by mouth?
Sore throat
New, uncontrolled cough that causes difficulty breathing (for students with chronic
allergy/asthmatic cough, a change in their cough from baseline)
New onset of severe headache, especially with a fever
Diarrhea, vomiting or abdominal pain
Has your child(ren) had close contact with someone diagnosed with COVID-19?
Since they were last at school, has you child(ren) been diagnosed with COVID-19?
If the answer is YES to any of these questions, keep your child(ren) home from school. Call the
school as soon as possible to let them know the reason your child(ren) will not be there today. Call
your healthcare provider right away. If you don’t have one or cannot be seen, go to
Michigan.gov/CoronavirusTest or call 2-1-1 to find a location to have your child(ren) tested for
COVID-19.
Q 4.C: Is it legal to take temperature and ask questions about a student's health - HIPPA
comes up often. Will schools be violating HIPPA if we ask questions?
No. Schools are not a “covered entity” with regards to HIPPA. HIPPA does not apply to you. FERPA
applies to schools.
Q 4.D: Are we required to record the current temperature or simply certify that it is below at
100.4 F?
There is no specific requirement to check a temperature. You should, at a minimum, have staff and
students self-monitor and report if they feel feverish. If you have a thermometer, you can check
temperatures to ensure everyone is under 100.4oF.
Q 4.E. How does taking temperature relate to people who are asymptomatic? Is it accurate
that someone without a higher temperature reading can still pass COVID-19 to someone
else?
About 40% of people infected with COVID-19 are thought to have no symptoms at all (are
asymptomatic). That includes having no fever. Of children with symptomatic COVID-19, nearly half
do not have a fever, and nearly one in four adults do not have a fever. Having a fever is very
suggestive of COVID-19 but you can have COVID-19 and not have a fever.
August 19, 2020 Page 12Q 4.F: Screening Students and Staff
We do not recommend the schools do health screening, nor does the CDC
(see https://www.cdc.gov/coronavirus/2019-ncov/community/schools-
childcare/symptomscreening.html). We recommend, as does the CDC, that parents do this prior to
sending children to school.
Q 4.G: How often do symptoms need to be checked during the day?
Students should be screened for symptoms of COVID-19 before the start of their school day.
5. Testing for COVID-19
Q 5.A: If we have students/parents/staff needing COVID tests, are those free?
Who is going to pay for suggested testing?
Most doctors’ offices, as with other tests, will bill insurance. If someone does not have insurance,
they can bill CARES Act. There are also testing sites that will test for free. One can find these testing
sites at this link by calling 211 or go to Michigan.gov/CoronavirusTest
Q 5.B: If a student is symptomatic, besides sending them home, can we require a COVID-19
test?
Consult your school district policies and possibly your legal counsel.
Q 5.C: Do all students or staff that were working in close proximity to others who tested
positive, now have to get tested? Who pays for those tests? Are they happening at school?
How are the parents being notified? Does everyone in each of those kids' families need to
get tested?
In general, people that are considered a close contact to a case are recommended to be tested, but
it is not required. It helps to identify more cases and identify and quarantine more contacts, but if
they test negative, they cannot be released from quarantine early.
It is billed to their insurance; however, there are testing sites that provide free testing from the
state: they can call 211 for locations or go to Michigan.gov/CoronavirusTest
Parents will be notified by the school that there is an identified or suspected COVID-19 case. The
local health department will notify parents if a student is a close contact and if the student needs to
quarantine.
Q 5.D: How will testing be handled in the event of an outbreak?
When a case is identified in a school, the local health department must be notified as soon as
possible. The local health department will work with the school to develop a plan for addressing the
outbreak, including any testing that might be recommended.
August 19, 2020 Page 13Q 5.E: How do we handle the students/staff in a classroom where someone has been tested
but test results are pending?
Close contacts of someone who is symptomatic should follow quarantine guidelines. While the test
result is pending, all students and staff should be vigilant about social distancing, hygiene, and self-
monitoring for symptoms. Work with your local health department to determine if class should not
be held until the test results are known.
Q 5.F. Where are local COVID-19 testing sites?
Testing locations frequently change. The most updated list of testing locations can be found by calling
211 or visiting Michigan.gov/CoronavirusTest .
Q.5.G: Are there consistent guidance for LHDs on screening and testing for schools to allow
for consistency between LHDs particularly because ISDs, RESAs, and local school districts
cross LHD jurisdictional boundaries and MERC regions?
Routine testing for COVID-19 in schools is not recommended. See the section on Screening above.
6. Students and Staff with Symptoms consistent with COVID-19
Q 6A: How are we to differentiate between allergies or common flu symptoms and COVID
symptoms?
This is very difficult. We know that there is overlap between the list of symptoms associated with
COVID-19 and other common causes, including seasonal allergies. A student or staff member
showing symptoms of COVID-19 must follow the same procedure as any other individual before
returning to the school. Students or staff with pre-existing health conditions that present with
specific COVID-19 – like symptoms, such as seasonal allergies, may not need to be excluded if they
have been evaluated by a health care provider for those specific symptoms and the health care
provider determined them to not be due to COVID-19. However, if those symptoms worsen or
change, the student or staff member may still be required to be excluded and not return until re-
evaluated or tested as described above. There have been many cases of COVID-19 that seemed to
be nothing more than worsening allergies.
Q 6.B: A child or staff has symptoms of COVID-19 and tests positive for COVID-19*:
● Keep out of school until it has been at least 10 days from the first day they had symptom AND they
have had 24 hours with no fever and symptoms have improved
o After criteria are met, they may return to school. They do not need to take an additional
test with a negative result to return to school.
*If they have symptoms, they must stay out of school until test results are available
Q 6.C: A child or staff has symptoms of COVID-19 and no testing for COVID-19 was done:
August 19, 2020 Page 14● If they have symptoms AND have had potential exposure/close contact, then keep out of school
until it has been at least 10 days from the first day they had symptoms AND they have had 24 hours
with no fever and other symptoms have improved.
● Encourage evaluation by a health care provider.
● If a student has symptoms but NO potential exposure/close contacts, then their symptoms can be
managed as a non-Covid condition even without a test. See CDC’s guidance
at https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/symptom-
screening.html
● They may return to school if
o their health care provider diagnoses them with another cause for their symptoms (e.g.,
urinary tract infection, strep throat, allergies) and presents a note from that provider AND
o their return is based on the guidance for their diagnosis (see “Managing Communicable
Diseases in Schools”
https://www.michigan.gov/documents/mdch/Managing_CD_in_Schools_FINAL_469824_7.P
DF
Q 6.D: A child or staff has symptoms of COVID-19 and tests negative for COVID-19*:
If they were exposed to COVID-19 within the previous 14 days: Keep out of school until it has been
at least 10 days from the first day they had symptoms AND they have had 24 hours with no fever
and other symptoms have improved. The child or staff may need to complete a full 14-day
quarantine, depending on guidance from the local health department.
*if they have symptoms, they must stay out of school until test results are available
Q 6.E: Child or staff that has been exposed to COVID-19 but has no symptoms:
They must be in quarantine (exclude from school) for 14 days from the last day they were exposed.
Q 6.F: What are the Health Department recommendations when a student comes to school
and is suspected of being sick?
I know we can suggest talking to a doctor. Do they return when they are not
symptomatic?
What if the parent insists their symptoms are “just a cold” etc. Can they return the next
day (as long as no temp) Do we have any room to request Dr. note to return etc.?
A child is sent home because they don’t feel well and then show back up the next day –
should the child be tested for COVID? Should the child be allowed back in school?
What to do with the kid who has a runny nose?
School should have policies and procedures in place to address this situation as part of their Return
to School plans.
Students who become ill with symptoms of COVID-19 should be placed in an identified quarantine
area and wear a surgical mask. Note that a wide range of symptoms may indicate COVID-19
August 19, 2020 Page 15including 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, and or diarrhea. See Q 6.C above
A Designated staff person should be identified to care for the student until the student can be
picked up. This staff should likewise be masked with a minimum of face mask and goggles/face
shield.
The Health Department will work with local school districts to provide serial testing for staff that
are designated to monitor ill students.
o Testing may alleviate staff concern regarding exposure; May provide confidence for staff,
potentially increasing attendance.
o Individuals may go to doctors or testing sites across the county. It may be possible for the Local
Health Department to create a team that would come to a site to test. (Mobilized only as
necessary). This will be reviewed when there is an outbreak at a building. Testing strategies will
be developed as necessary as conditions change.
Students should be transported by a household member and should not be sent home on the bus.
A script should be provided by the school for secretaries/staff who are calling home
Q 6.G: Do ill students need to be tested?
Ideally, yes. Testing should be done off-site. It would be very helpful if this process was established
for each school district in case a primary care doctor was not accessible.
Q6.H: What about individuals that have chronic medical conditions that result in COVID like
symptoms or another diagnosis is made (i.e. strep throat, allergic reaction, asthma attack) do
those individuals need to stay home for 10 days?
They may return to school if their health care provider diagnoses them with another cause for their
symptoms (e.g., urinary tract infection, strep throat, allergies) and presents a note from the
provider. See also Q.6.C above.
Q 6.I: When a student or staff member is sent home for symptoms, do they really need to be
out for 10 days if they do not get a test?
See question Q.6.C above.
Q 6.J: If we have multiple people with symptoms, how do we hold them safely?
Schools should address this in their plans.
7. When a child or staff person tests positive for COVID-19
August 19, 2020 Page 16All schools, public and private, must cooperate with the local public health department if a confirmed
case of COVID-19 is identified, and in particular, must collect the contact information for any close
contacts of the affected individual from two days before he or she showed symptoms to the time when
he or she was last present at the school.
Q 7.A: What will this look like?
For the most part, this should be similar to any other communicable disease (whooping cough,
chicken pox, etc.). It will be ideal to designate 2 or 3 primary contacts at your school that will be
liaisons to the communicable disease staff at the local health department. Typically, this would be
your school nurse, secretary, administrative assistant, and so on. First, we make sure both the
school and the health department know about the case. Only a select few at the school should know
the identity of the person. Those few individuals are needed to help the health department figure
out who were close contacts to the case and determine what areas of the school need special
attention for disinfection and cleaning. Other than those few individuals, the person’s identity is
kept confidential in respect of their privacy as well as following regulations of FERPA (for schools)
and HIPAA (for the health department).
Q 7.B: What is a close contact to COVID-19
If an infected staff member is in a class with students or is working in close proximity to
others, do they all then stay home and quarantine for 14 days if there is a positive case?
Many things affect what a close contact is and these need to be determined on a case-by-case basis
with help from the local health department.
A close contact will be, at a minimum, an individual who has been within 6 six feet of an infected
person for at least 15 minutes starting 2 two days before the contagious person started having
symptoms (or 2 days before a positive specimen was collected if they never have symptoms). The 15
mins may not necessarily be continuous, but may be cumulative. The Council for State and
Territorial Epidemiologists in their updated Case definition (Interim 20-ID-02) notes that “However,
it depends on the exposure level and setting”. They also note that “Data are insufficient to precisely
define the duration of exposure that constitutes prolonged exposure and thus a close contact”.
Close contacts will need to be quarantined for 14 days.
Q 7.C: What happens when a staff person or student tests positive for COVID-19
What are the school plans, we need protocol/template from LHDs for handling: 1)
positive tested COVID Teacher/staff and a symptomatic teacher/staff and 2) positive COVID
tested student and situation with a symptomatic student in the classroom?
What are close contacts as opposed to regular contacts?
How will we determine who needs to be quarantined after an exposure at a school?
Is it possible a whole class can put on quarantine?
August 19, 2020 Page 17The school district should have developed plans and protocols for how they will handle a case of
COVID-19 in a staff person or a student. The local health department also has procedures for
investigating and mitigating COVID-19, and these include a determination as to who are close
contacts. For example:
o Students in a classroom where a contagious teacher was not keeping 6 feet away from
students while teaching (i.e., walking around while lecturing, doing a lot of one on one, face to
face instruction),
o For COVID-19, a close contact is defined as any individual who was within 6 feet of an infected
person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic
patients, 2 days prior to positive specimen collection) until the time the patient is isolated.
This would typically be the one to two rows of students sitting closest to the contagious
individual.
o Lunch-mates of student, if sitting within 6 feet of a contagious individual. This is a higher risk
time as face coverings cannot be worn.
o Playmates on the playground or in gym within 6 feet of the contagious individual, unless
interactions are consistently kept very brief and no common items are shared, and locker
room time is not shared.
o Sports teammates within 6 feet of the contagious individual unless interactions are
consistently kept very brief and no common items are shared, and locker room time is not
shared.
o Opposing teammates in sporting events that shared time on the field or court with the
contagious individual unless it can be confirmed that there were no potential interactions
within 6 feet between the contagious individual and specific teammates and no contact with
shared items (i.e., the contagious person didn’t touch the ball, others did not touch the ball).
o Classmates or others that had interactions with the contagious individual lasting over 15
minutes in confined areas such as bathrooms, office room, where distancing of 6 feet is
difficult.
● Any other person outside of school that had similar exposure to a contagious individual is
considered a close contact.
The health department may determine close contacts from additional information as well, but these are
basic guidelines.
Assigned seating in the classroom, during meals and on buses could make determination of close
contacts easier and could also reduce the number of students who need to be quarantined.
The health department can help with drafting letters to send home to parents regarding the case as
well as any press releases and social media communications if needed.
These are guidelines and are open to interpretation. Local health departments should use their
judgement and experience to determine who would be considered a close contact. Also see Q 9.A
August 19, 2020 Page 18Q 7.D: What if someone who lives in the same house as a staff member tests positive? Does
that staff member now need to take 14 days off of work to quarantine?
Yes, an exposed student or staff member with a household contact with COVID-19 would be asked
to quarantine at home for 14 days from the last close contact. If ongoing care of the person with
COVID-19 is required in the home, and the student or staff member has to be that caregiver and is
repeatedly exposed, their quarantine would be 14 days from the time that person is no longer
deemed infectious (at least 10 days after symptom onset or positive test result, and 24 hours fever-
free without the use of fever reducing medications and other symptoms have improved), totaling up
to 24 days. The staff member could work remotely during this time.
Q 7.E: Substitutes teach in multiple schools. What if they are diagnosed with COVID-19? Do all
the kids in each school now have to quarantine and get tested?
All of the individuals in each school determined to be close contacts while the teacher was
contagious would need to be in quarantine. It is recommended that close contacts get tested to see
if they are infected, but it is not required. A negative test result does not allow someone to get out
of quarantine early. Work with the local health department to determine who are close contacts
and what actions schools should take.
Q 7.F: How long until COVID-positive student or staff member may return to school?
At least 10 days from the onset of their symptoms, and
24 hours without fever, and
Other symptoms have improved.
[Note, this is a recent change in recommendation from CDC. Previous guidance required 3 days
without fever). Guidelines for return to school are subject to change based on phase and
progression of the pandemic.
Q 7.G: What is the notification process for students and/or staff suspected and/or confirmed
of having COVID? *
Will local health departments provide letters to send to parents?
Schools must cooperate with the local public health department if a confirmed case of COVID-19
is identified.
Each school district should develop policies and procedures for communication should a student
or staff member have a suspected or confirmed case of COVID-19. Schools should designate a
staff person to be responsible for responding to COVID-19 concerns (e.g., school nurse) as well
as a secondary person to help with difficult situations and cover absences. All school staff and
families should know who this person is and how to contact them.
The contact person will communicate daily reporting of illness and referrals for testing (if
occurring) and weekly absenteeism rates to the local health department. This person must be
August 19, 2020 Page 19able to be contacted outside of normal business hours. It may be prudent to assign more than
one staff person to this role.
● The contact person must follow all HIPAA/FERPA regulations
● They will be required to notify the local health department of a potential exposure;
exposure occurs when a person has had contact with an individual who has had a positive
COVID-19 test and is still considered contagious.
The School District should work with the local health department to develop notification letters.
The School District will be responsible for sending these letters after the local health
department (or a physician) has confirmed a positive result
○ A general letter to everyone (parents).
○ A general letter to staff.
○ A more specific letter which goes to those who have had contact with the positive
individual.
○ The local health department will follow up with individuals.
Examples of letters can be found in the Local Health Department’s Schools Toolkit
● The health department will initiate contact tracing as needed. There are other actions that
the local health department will undertake, which may include:-
○ Obtain a list of students in the cohort; identified staff members, seating charts.
○ Talk with teachers and staff.
○ Contact family members, including siblings as part of their contact tracing protocols.
○ Determine any close contacts to the case, as it is likely that they may be quarantined
for 14 days. This will be directed by the local health department.
○ Provide a script for building secretaries to use when calling parents regarding
contact tracing and/or COVID inquiries.
Q 7.H: Any HIPAA or other privacy concerns with sharing medical information?
What information can they share with the LHD considering FERPA?
You are required to provide the local public health department pertinent information. However,
families, students and staff should not be given names or any other identifying information.
Q 7.I: What is a possible case of COVID-19? The road map states to notify the Health
Department of a possible COVID-19 case?
A possible case is a student who has symptoms of COVID-19 but has not yet been tested or is awaiting
test results. Identifying possible cases as soon as possible allows the health department to investigate
and mitigate potential outbreaks.
Schools will need to be prepared to flip back and forth between remote and in-person learning for
families when there is an exposure.
August 19, 2020 Page 208. School Closure
Q 8.A: What is a guideline for districts when determining when closures should occur? How
many cases or percentage of students, team members, staff?
When schools will have to close when there is a confirmed case? General Guidance?
What is the case threshold to close schools?
What is a good guide/threshold for closing school if cases pop up among students/staff (one positive,
3, 20, etc.)
What are the triggers for closure? Who is making the ultimate decision on closure?
If there a positive case how much of the school has to be shut down?
School districts will retain the authority to close their school buildings even if they have not been
mandated to do so. This decision would be made with assistance from your health department.
There is an group working on this. It is our sincere desire that this guidance will be consistent across
the state. Implicit in this would be the teaching staff capacity and MDE decisions about counting
school days.
Q 8.B: What is considered an outbreak number, and is it per building or classroom?
A cluster of COVID-19 cases is considered an outbreak when there is one known index case and at
least one case associated with that index case. This may occur across classrooms or buildings. The
local health department will determine any outbreak status and will advise on the appropriate
response for classrooms and buildings.
9. Associates, Exposure, Quarantine & Returning to School
Q 9.A: If a student must quarantine for 14 days, do the rest of their classmates AND their
siblings have to as well?
Only students and staff considered a close contact to case are required to quarantine. Decisions
about close contacts will need to take into account the exposure level and setting.
For COVID-19 it is typically said it is being within 6 feet (about 2 arms’ length) of an infected person
for at least 15 minutes. In reality, it isn’t always this simple. The important things to consider, when
deciding if someone could be at risk for getting COVID-19, include the intensity, frequency, and
duration of exposure to someone while they are contagious with COVID-19.
The intensity of exposure refers to how much virus you were exposed to. Was the sick person really
contagious when you were exposed to them? Were they coughing and sneezing without a mask on
versus having no symptoms with a mask on? Did you kiss them? Did you share personal items like a
drink or a vape pen? Did you sit right next and have a face to face conversation to them or were you
6 feet away with your back to them? You can see how some situations can cause you to be exposed
August 19, 2020 Page 21to a lot more virus than other situations. The more virus you are exposed to, the more likely you are to get sick. The frequency of exposure refers to how often you had contact with someone who was contagious. If you had a brief face-to-face conversation with a teacher each day for several days while the teacher was contagious with COVID-19, those exposures may add up to be enough to overwhelm your system and lead to an infection. The duration of exposure refers to how long were you exposed. If you were in a classroom with someone contagious for COVID-19 for 6 hours a day while they were contagious for several days, yet your seat was not within 6 feet of them, you may still have had a long enough duration of exposure to that person, particularly to aerosols and objects in that classroom. Q 9.B If my spouse tests positive for COVID-19, but I have not been diagnosed (yet), should I let everyone who was at our ad staff meeting know to monitor symptoms? No – contacts of contacts do not need to be notified. The undiagnosed spouse should remain in quarantine to limit possible exposures, however. Another example of a contact of a contact: Bob sits next to Fred in class. Fred gets sick with COVID-19. Bob needs to be in quarantine but is healthy at this time. Bob plays on the football team. No one on the football team has been near Fred. Therefore, the football team doesn’t need to be notified about Fred being sick or worry about Bob being on quarantine at this time. Q 9.C: Here is the hypothetical scenario: A high school student tests positive for COVID-19. He/She was in multiple classrooms immediately before the positive test. How would the other students in attendance be handled in terms of tracing, testing, and quarantining? Depending on COVID-19 prevention used, distancing between students, if student sat by same people every day, symptoms (coughing/sneezing/etc or minimal) and how many days in class with symptoms, the need for quarantine may only apply to the students nearest the case or to the entire classrooms. Health Department staff are experienced at determining who are close contacts to infectious diseases and will contact the students that need to be quarantined. Q 9.D. What will happen if one Nutrition Staff Member is diagnosed positive with COVID 19 and had been working. Will our kitchen automatically be shut down for 14 days or can staff members from another school building continue to still feed our students? Close contacts would ideally be in quarantine. However, these individuals are considered critical infrastructure workers and can be allowed to continue to work after an exposure IF they follow very strict protocols. See https://www.cdc.gov/coronavirus/2019-ncov/community/critical- workers/implementing-safety-practices.html. Work closely with the local health department to make this determination. If a close contact becomes symptomatic, they should immediately leave work. August 19, 2020 Page 22
Q 9.E. When a student in a classroom this fall, or an athlete on a team in summer practice is tested and COVID positive, what should be our first priority in communication and action? Not to panic, let everyone know you will be working with the health department to identify close contacts and take all the steps that need to be taken. You do not want to get out the wrong message quickly, rather assure people you will get the correct message out as soon as possible. Q 9.F: When can a sick student/staff member return (symptom-free? 14 days? 3 days post symptoms? etc.) See: Q6 B-E Also CDC’s guidance at When You Can be Around Others After You Had or Likely Had COVID-19 Q 9.G: If we do close our schools absent a regional mandate (Regions and Phases) due to a localized outbreak, when can we return (14 days later?, etc.) It isn’t known at this time. Previously the CDC said 5 days. It would typically be a full incubation period or 14 days. Guidance will likely change; health departments and schools should work together on that. Q 9.H: If the school has identified an isolation room for sick children, do they need to have a separate room for each sick child or can multiple children be placed in the same room provided they are masked and kept 6ft apart? Per CDC, “identify an isolation room or area to separate anyone who has COVID-19 symptoms or tests positive but does not have symptoms”. You can keep those you suspect have COVID-19 in the same room, keeping them as far apart as possible. Children should wear surgical masks in the isolation room as long as medically tolerated. Keep all others in a different room. Q 9.I: The initial guidance from the CDC from March indicates that when anyone with COVID- 19 enters a school building we are to “Dismiss students and most staff for 2-5 days. This initial short-term dismissal allows time for the local health officials to gain a better understanding of the COVID-19 situation impacting the school. This also allows the local health officials to help the school determine appropriate next steps, including whether an extended dismissal duration is needed to stop or slow further spread of COVID-19.” Is this still the case? No, only close contacts are dismissed for 14-day quarantine. In the post-pandemic phase of the MI Safe School Roadmap (Phase 6), if a lab confirmed case is identified, then short term dismissals may be required (see pg 54 of MI Safe Schools). Q 9.J: What resources will MDE be providing to school districts? August 19, 2020 Page 23
Schools may want to communicate with their contacts at the MDOE directly.
Q 9.L: What to do with a parent who refuses to quarantine a child and brings them to school?
This can be addressed by the local health department and they may involve local law
enforcement.
Q 9.K: How to maintain school personnel at work after exposure?
Work with your local health department to determine if the exposure meets the criteria for a close
contact. School policies may cover staffing in such situations.
10. Record keeping
Q 9.A: Do we have to keep a health record on each student like employees?
No. The records on employees are OSHA requirement that does not apply to students.
11. About the MI Roadmap, EO, State and Local Policies
Local school districts set policies for their schools to follow during this pandemic and should be in
adherence to any federal and state executive orders, laws, and policies. This includes responsibilities
within the school system for implementation, and enforcement of school policies.
Q 10.A: The roadmap states we need to train our staff and students on proper hygiene re:
handwashing, coughing and sneezing, etc. Are there materials explaining the COVID 19
illness that the health department will be giving to schools to help facilitate this
education?
The CDC has materials available at https://www.cdc.gov/coronavirus/2019-
ncov/communication/toolkits/schools.html
There are also numerous resources available for public use at
https://www.healthwise.org/specialpages/covid-19-resources.aspx#Learning-Topics
Q 10.B: How can the health department help us advocate for extricating our county from our
COVID-19 Region?
You can speak with your elected officials. We do see a lot of travel in our residents and a lot of
fluctuation in community spread and it is very difficult to define and predict disease activity. The
epidemic phases and risk levels are determined by doing careful analysis of data including number
of cases, number of tests, and recent trends, which are outside of school system control.
Q 10.C: Under Phase 4 of the MI Safe Start under athletics Large scale outdoor spectator
events are limited to 100 people, can there still be a concession stand for spectators?
August 19, 2020 Page 24You can also read
