Updated August 13, 2020.
The following document provides guidance for detecting, reporting, and responding to cases of COVID-19 as well as outbreaks of COVID-19 among students and staff in child care and schools. The guidance is based on the information available as of August 2020. Data and knowledge about COVID-19 in child care, school, and school-age children is limited. As we obtain additional information and experience with COVID-19 in schools and child care facilities, we will update the guidance. Expect frequent updates to the guidance over the school year.
Schools, child care providers, and public health share responsibility for applying the guidance in this document. If you have questions about scenarios or situations that are not covered in this document, please consult with your local public health agency.
This guidance applies to all circumstances where a teacher or caregiver cares for multiple children outside the usual home of the children. These circumstances include, but are not limited to:
- K-12 schools, both public and private.
- Licensed child care settings.
- Home-based family child care settings.
- License exempt child care programs such as single skill building and 72 hour camps.
- Guest child care facilities at ski resorts and courthouses.
- “Pods” and other home learning/homeschooling groups.
On this page
Special Considerations for Child Care
Child care and pre-K settings are different from K-12 settings in important ways. The particular facilities, curriculum, and modes of supervision in child care facilities require modifications to the outbreak guidance developed for K-12 settings. Please take note of special instructions for pre-K and child care settings throughout the document. In the guidance and tools below, the term “schools” includes K-12 schools and child care providers, including in-home providers.
Residential settings, including overnight camps and group homes, have different transmission characteristics and abilities to isolate and quarantine as compared to K-12 schools and other child care settings. These settings should follow the outbreak guidance relevant to their particular circumstances.
Confirmed case: a case in a person who has tested positive for the COVID-19 virus using certain laboratory tests (usually PCR). Public health professionals will assign the case a definition using the Colorado COVID-19 case and outbreak definitions.
School outbreak-associated case: a case among students, teachers, or staff that meets the outbreak definition. Family members or others outside the school who get sick should not be classified as outbreak-associated.
COVID-like symptoms: cough, shortness of breath, fever, chills, loss of taste or smell, fatigue, headache, sore throat, muscle or body aches, congestion or runny nose, nausea or vomiting, diarrhea. A person can be contagious two days before they start having symptoms. In children too young to reliably report their symptoms, caregivers and teachers should monitor for symptoms and other age-appropriate signs of disease, including decreased appetite or activity. Symptoms of COVID-19 in this age group have not been well-defined.
Isolation: staying home from work, school, and activities when a person is sick or diagnosed with COVID-19. Isolation lasts for at least 10 days after the onset of symptoms-- and for 24 hours after being fever-free without the aid of fever reducing medication and if the person shows an improvement of symptoms. For people who have not had symptoms, isolation lasts 10 days from the day they had their first positive test. In rare instances (for example, if a person was very sick or has certain medical problems), isolation may last 20 days. Public health experts do not recommend repeat testing to decide when to end the period of isolation except in rare circumstances in consultation with a medical provider.
Quarantine: staying home from work, school, and/or activities after a person was in close contact with someone with COVID-19. Quarantine lasts for 14 days (unless the person develops symptoms, then they will be put in isolation). Negative tests should not be used to release a person from quarantine.
Close contact: a person who:
- was within 6 feet of someone who has COVID-19 (even if they did not have symptoms) for at least 15 minutes total.
- provided care for someone who is sick with COVID-19.
- had direct physical contact with someone who is sick with COVID-19.
- shared eating or drinking utensils with someone who is sick with COVID-19.
- got exposed to respiratory droplets from someone who is sick with COVID-19 (through sneezing, coughing, shouting, etc.).
- was in the same class/cohort as a person with COVID-19.
- Note: for pre-K and child care settings, consider additional types of close contact, including feeding, diapering, and holding. Due to the close proximity of caregiver and child in these circumstances, very short durations of exposure will warrant quarantine if a case is detected in a caregiver or child.
Cohorting: the practice of keeping the same individuals in the same group at all times during the school day. Changes in cohorts are timed to align with school semesters or trimesters after lengthy breaks. Cohorting helps limit the number of contacts each individual has. As a result, if quarantines, dismissals, or school closures are needed, they may affect fewer people. Students may be in multiple cohorts (for example, bus ride to school, after-school sports, classroom).
Physical distancing: maintaining at least 6 feet between each student, teacher, and staff member for as much of the school day as possible. During contact tracing, classroom contacts are considered exposed (and required to quarantine for 14 days), even if physical distancing was practiced in the classroom. While 3 feet of distance is an option within school cohorts/classrooms, 3 feet is not considered physical distancing.
PCR Test: a test that detects genetic material from a virus in the nose or mouth. The sample is collected on a swab or in a test tube which is sent to a lab for analysis. The test usually takes a few days to come back. Because this test is very sensitive, it is very good at detecting even small traces from a virus. This test can be used to determine whether or not a person has COVID-19.
Antigen Test: a test that detects specific, small pieces of the virus in the nose or mouth. The sample is collected on a swab or in a test tube and is usually analyzed on-site. This test can come back in just a few minutes. Because this test looks for specific pieces of the virus, if the test is positive it is very likely that a person has COVID-19. However, if the antigen test is negative a person still may have COVID-19, because the test may miss an infection. For this reason, a health care provider may send a PCR test to confirm the result if the antigen test is negative.
Serology Test: a test that detects the antibodies the body starts to make a few days after the start of an infection. These antibodies can last many months, or even longer. For this reason, serology tests are useful for showing that a person had COVID-19 in the past, but may not detect early COVID-19 infections and can’t give any information about when a person was infected.
If one or more criteria below are met, there is a confirmed outbreak. Outbreak response will vary by criteria met. All confirmed outbreaks will be posted on the CDPHE website at covid19.colorado.gov/data/outbreak-data.
Classroom/cohort outbreak: Two or more confirmed COVID-19 cases among students/teachers/staff from separate households with onset within 14 days in a single classroom or cohort.
In schools practicing cohorting, three or more classrooms or cohorts with cases from separate households that meet the classroom/cohort outbreak definition that occurs within 14 days;
In schools not practicing cohorting, two or more confirmed COVID-19 cases from separate households with onset within 14 days in the same school. [Note: Cases can include student, teachers, and other staff];
5% or more unrelated students/teachers/staff have confirmed COVID-19 within a 14 day period [minimum of 10 unrelated students/teachers/staff].
Staff outbreak: Two or more teachers/staff with confirmed COVID-19 who are close contacts within the school setting with onset within 14 days.
If one or more criteria below are met, there is a suspected outbreak. Outbreak response will vary by criteria met. Suspected outbreaks are not currently posted to the website.
- Classroom/cohort outbreak: One confirmed COVID-19 case and one or more people sick with COVID-like symptoms among students/teachers/staff from separate households with onset within 14 days in a single classroom or cohort.
- Single confirmed COVID-19 cases in two or more classrooms.
- 10% absenteeism (among expected in-person students/teachers/staff) in the whole school for any reason.1
1 Overall school absenteeism (for any reason) is an established measure of disease transmission in a school.
Note: Some of the tools have different versions if there is low COVID-19 transmission in your community (e.g. if your community is at Protect Your Neighbor) or sustained COVID-19 transmission in your community (e.g. if your community is at Safer at Home or Stay at Home). These tools apply to students, teachers, and staff at the schools.
One student with confirmed COVID-19 within a school.
One student with COVID-like symptoms within a school.
One teacher/ staff member with confirmed COVID-19.
One teacher/staff member with COVID-19-like symptoms.
Two or more people from separate households with confirmed COVID-19 with onset within 14 days in a single classroom or cohort. (classroom/cohort outbreak)
Three or more outbreak classrooms/cohorts. (school outbreak)
In schools not cohorting, two or more people, from separate households, with confirmed COVID-19 with onset within 14 days in the same school. (school outbreak)
5% or more students/staff have confirmed COVID-19 within a 14-day period. (school outbreak)
Two or more teachers/staff with confirmed COVID-19 are close contacts within the school setting. (school staff outbreak)
One person with confirmed COVID-19 and one or more people with COVID-like symptoms from multiple households with onset within 14 days in a single classroom or cohort.(classroom/cohort suspect outbreak)
Individuals with confirmed COVID-19 in multiple classrooms. (not meeting overall school outbreak threshold)
Suspected Outbreak: 10% absenteeism (among expected in-person students/staff) for any reason. (suspect outbreak)
School closure: A school should be closed when:
- Five or more classroom/cohort outbreaks (defined above) occur within a 14-day period. Length of closure: 14 days.
- 5% or more unrelated students/teachers/staff have confirmed COVID-19 within a 14-day period [minimum of 10 unrelated students/staff]. Length of closure: 14 days.
- Additional time is needed to clean the school before students/teachers/staff return. Length of closure: time necessary to complete cleaning.
- Additional time is needed to gather student/teachers/staff illness data and confer with public health. Length of closure: time necessary to gather student/teachers/staff illness data and confer with public health.
- A school cannot operate because a large number of students/teachers/staff are absent. “Large number” is determined by the school/district. Length of closure is determined by the school/district.
District-wide closure: District-wide closure in accordance with Colorado Department of Education Reopening Guidance.
Note: In lieu of closure, schools can switch to remote learning.
Templates for schools to send notification letters to parents.
The siblings of people with COVID-19 will likely be considered close contacts because they often live in the same house as the person who has COVID-19. They will stay home for a 14-day quarantine. Public health may recommend siblings get tested for COVID-19 about 7 days after they were in contact with their sick sibling.
The siblings of people who are home for quarantine because they were exposed to COVID-19 do not need to stay home or be tested unless the sibling in quarantine develops symptoms or tests positive for COVID-19. Parents should closely monitor all of their children for symptoms.
It is important that people who are sick get tested for COVID-19. People who are not sick, but were a close contact of someone with COVID-19 should get tested for COVID-19 about 7 days after they were in contact with a sick person. Students, teachers, and staff should work with their health care provider to get tested. Public health can help with testing if a person does not have a health care provider.
Testing everyone in a school (either before school starts or during school) is not recommended at this time. Physical distancing and wearing masks are more important ways to prevent COVID-19. A negative test means that the person did not have COVID-19 detected when they were tested. A negative test does not mean they are “safe” or “cleared” to be at school.
Considerations for concurrent respiratory infections
Note: All sections are subject to change including this section. This section is subject to change due to further discussion with subject matter experts and local public health agencies.
- Prevent respiratory disease:
- Recommend annual flu vaccine - consider hosting school vaccination clinics.
- Stay home when sick.
- If symptoms are consistent with COVID-19, send the student/teachers/staff home to isolate.
- Teach and practice respiratory etiquette -- covering coughs and sneezes properly, wash hands, properly dispose of tissues.
- Teach and practice proper handwashing. Provide adequate hand-washing supplies. Schedule times for hand-washing during the school day.
- Practice surface cleaning, especially for things that are touched a lot (e.g., door knobs, light switches, desks etc.) and other surfaces.
- Clean between each group of students.
- Use EPA-approved cleaning sources (www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19) and follow the label instructions.
- Educate parents, teachers, staff, and students on what to do if someone is sick, including:
- Identifying symptoms and high-risk groups.
- Separating students in the event of illness occurring at school.
- Knowing when to see a doctor and where to seek treatment.
Note: This section subject to change following further discussion with subject matter experts and local public health agencies.
CDPHE is establishing an Absenteeism School Surveillance Program beginning in August 2020 to collect data on absenteeism due to illness among teachers, staff, and students. CDPHE will also collect methods and practices used for school cohorting of teachers, staff students from schools and school districts. The Absenteeism School Surveillance Program is only for K-12 schools and does not apply to child care providers.
CDPHE will send a weekly survey via REDCap to school contacts to obtain the following information to describe respiratory illness in schools:
- School Name.
- School Type:
- Elementary school (K-5).
- Middle school (6-8).
- High school (9-12).
- Other, specify.
- Total number of students attending school in person on average during the previous week.
- Total number of teachers/staff working in the school.
- What percentage of students attended school in-person during the previous week?
- School cohorting practices.
- Whether the school is enforcing any prevention measures such as temperature checks and symptom screening, mask-wearing, or physical distancing.
- School or classroom/cohort closures during the previous week.
- Optional notes.
Student and teacher/ staff information:
- Total number of students enrolled.
- Total number of teachers/staff employed, number of in-person teachers/staff per week.
- Total number of weekly health visits to the school health office (need baseline average). If available, total number of visits specific to COVID-like or other respiratory illness symptoms.
- Number of students absent due to illness during the previous week (Monday - Friday).
- Number of teachers/staff absent due to illness during the previous week (Monday - Friday).
Aggregate information about percent absenteeism statewide will be shared on CDPHE’s website, and more detailed information will be shared with local public health agencies through the CDPHE local public health agency portal by county.
Clinical labs and/or health care providers report cases to public health, which interviews the people who have COVID-19 and conducts contact tracing. However, schools and child care providers also are encouraged to report single cases of COVID-19 to their local public health agency.
Schools and child care providers are required to report all outbreaks to their local public health agency or CDPHE within four hours per statute. Schools and child care providers must report both suspected and confirmed outbreaks.
Schools and child care providers an report outbreaks by:
- Completing the CDPHE Outbreak reporting form and emailing it to firstname.lastname@example.org.
- Calling their local public health agency.
- Calling CDPHE at 303-692-2700.
The child should stay home from school for 14 days even if the child is not experiencing COVID-19 symptoms. There is no need for further action in the school unless the child gets sick or ends up having a positive test. Public health experts do not recommend school or public notification in this situation.
Schools are required to disclose names of people with COVID-19 to public health authorities. Schools should not disclose the name(s) of students, teachers or staff members with COVID-19 to other teachers, staff, students, parents, the media, or anyone outside public health. Public health staff are trained in how to manage health information in order to protect your privacy. They will never share your information without your permission and they store records securely and keep them safe.
Regarding student confidentiality and privacy, the federal Family Educational Rights and Privacy Act (FERPA) prohibits sharing of health-related information except in certain well-defined circumstances, including, but not limited to: specified officials for audit or evaluation purposes, and appropriate officials in health and safety emergencies. Notifying the state or local public health agency of a reportable disease in a student or an outbreak in a school does not breach FERPA confidentiality laws. In these situations, schools may disclose personally identifiable information to public health officials without prior parent consent.
No, we do not expect schools to provide testing. Symptomatic students, teachers, and staff should be referred for testing to their health care provider or to a community testing site. In the event of a confirmed case at a school, local public health staff may refer close contacts for testing. Schools may be asked to consider hosting a school-wide testing event in coordination with public health in the event of a large outbreak, but the school would not be expected to be responsible for the cost or logistics.
We strongly recommend that everyone in a classroom or cohort stay home and quarantine when a person in that class/cohort is diagnosed with COVID-19. This is because illness is likely to continue to circulate within that class/cohort if the students continue to have contact with each other, even if they are not experiencing symptoms. Keeping people home prevents further exposure and makes it less likely these individuals will develop COVID-19.
No, the 14-day quarantine period is based on the incubation period of COVID-19. We recommend a PCR test for asymptomatic contacts on day 7 of quarantine. This allows people who test positive to isolate, and allows public health to conduct additional contact tracing. However, a negative test does not mean the individual will not develop COVID-19 later on during the quarantine period. Serology (antibody) testing cannot be used to make decisions about quarantining, returning to school, or cohorting.
Yes. Close contacts of a person with COVID-19 who develop symptoms but test negative are sometimes counted as cases. There are many reasons a test can be negative, even if the person is infected. People with probable COVID-19 should be isolated and treated like a person who has a positive test result.
An outbreak is over when 28 days have passed since the last person started having symptoms and no new cases have occurred. If the last person did not have symptoms, use the day the person was tested.
Isolation separates sick people with a contagious disease (i.e., someone who has COVID-19 symptoms or a positive test) from others while they could spread the disease. Quarantine separates and restricts people who were exposed to COVID-19, but have not developed disease or evidence of infection. Quarantine helps prevent the spread of disease from people who become infectious after exposure. This is very important for COVID-19, because people can spread the disease even when they do not have symptoms.
People do not need a negative test to return to school, and a negative test before the end of their full isolation period does not mean they can return sooner. CDC and CDPHE do not recommend repeat testing to end the isolation period of a person who has confirmed COVID-19, except in very rare circumstances when recommended by a medical provider.
They must quarantine for 14 days from the date they were last with that person. Any coworkers or students of the person under quarantine do not need to quarantine, unless the quarantined person subsequently is diagnosed with COVID-19.
Masks reduce the likelihood of spreading disease across the school campus. Masks and physical distancing are important steps to protect others. However, the use of a mask does not completely eliminate the risk of spread from an infected person to a close contact, so close contacts of people with COVID-19 still must quarantine for 14 days. The exception is a health care provider, such as a school nurse, wearing personal protective equipment according to CDC guidelines. In this situation, quarantine may not be needed (www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html).
All students in any cohort with a case must quarantine for 14 days. If a student with COVID-19 attends a before-school program with a different set of students than their classroom cohort and is also on a sports team, people in all three of those groups must be quarantined.
Yes, it is rare for children to get very sick or die from COVID-19. Unfortunately, it does happen. Older children in particular can develop Multisystem Inflammatory Disease in Children, which can make them seriously sick. Older children also are more likely to spread the virus to people outside the school. Keeping COVID-19 outbreaks from spreading in schools protects students, teachers, staff, and families.