Updated: Cases and outbreaks in child care and schools

Updated April 29, 2021. 

Downloadable guidance: English | Español | Tiếng Việt | 中文 | Soomaali | العربية | नेपाली 

Executive summary: English

 

 

 

 

 

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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 March 2021. As we continue to obtain information and experience with COVID-19 in schools and child care facilities, we will update thise 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 and copy CDPHE’s school team at cdphe_covid_school_childcare@state.co.us

On This Page

Definitions
Defining COVID-19 outbreaks in schools
     Confirmed outbreak definition
     Suspected outbreak definition
Tools to determine who needs to be home from school
     1. “At-home COVID-19 symptom screening tool for parents and staff.” A home symptom screening checklist for parents and staff.
     2. “Child/staff feels/appears unwell after arriving at school.” A screening tool to determine who needs to be sent home from school.
     3. “Return to learn: guidance following a positive symptom screen for COVID-19.” A tool to determine how long a person needs to stay home after staying/going home sick.
     4. “Who is a close contact?” A tool to determine who is a close contact in schools based on exposure risk.
     5. “What happens to the contacts?” A tool to determine if classmates or cohort members or close contacts of a sick or confirmed positive person need to quarantine.

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.

Case and outbreak guidance should also be followed for sports where the participants are within grades P-12. Additional guidance for sports is found on the Organized Sports 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. 
 


Definitions 

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: loss of taste or smell, fever (100.4°F or higher), chills, new or worsening cough, shortness of breath or difficulty breathing, headache, sore throat, muscle or body aches, congestion or runny nose, fatigue, nausea or vomiting, diarrhea. A person can be contagious two days before they start having symptoms and for 10 days after symptoms start. In children too young or unable 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. Find information about how to isolate here

Quarantine: staying home from work, school, and/or activities after a person was in close contact with someone with COVID-19. Find guidance on how to quarantine and how long quarantine lasts.  A person should not attend work, school, or out of school activities if they are under quarantine following an exposure in school. If a person develops symptoms of COVID-19 during their quarantine period, they should begin isolation.

Close contact: a person who was close enough to a person with COVID-19 or symptoms of COVID-19 to be at risk of becoming ill. Some circumstances in which someone might be considered a close contact include:

  • was within 6 feet of someone who has COVID-19 (even if they did not have symptoms) for  a cumulative total of 15 minutes or more over 24 hours.

  • provided care for someone who is sick with COVID-19.

  • was a household contact of 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.

Close contacts can be determined using the “Who is a close contact?” tool when schools meet specific criteria for transmission risk mitigation strategies. This tool is not to be used in schools that are using small cohorts of students and staff where the same group of students and staff limit their exposures by staying together for more than one class period.

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 students and teachers in the same small group at all times during the school day. Ideally, changes in cohorts are timed to align with school semesters or trimesters after lengthy breaks, but even shorter blocks of time, such as two weeks, can be effective. Effective cohorting includes limiting shared spaces such as restrooms and break rooms between separate cohorts to the degree possible as well as staggering mealtimes, passing periods and the use of common areas. Cohorting helps limit the number of contacts each individual has. As a result, if quarantines or dismissals are needed, they may affect fewer people, resulting in fewer disruptions to in-person learning. 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 may be considered exposed and required to quarantine, even if physical distancing was practiced in the classroom. While 3 feet of distance is more protective than shorter distances within school cohorts/classrooms, 3 feet is not considered adequate physical distancing to avoid being identified as a close contact.

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. False negatives do happen and the virus is not always detected.

Molecular test: A test that detects genetic material from a virus in the nose or mouth. The sample is collected on a swab and tests are available within a few minutes. These tests are slightly less sensitive than PCR tests, but still may be used to determine whether or not a person has COVID-19. False negatives do happen and the virus is not always detected. Examples of molecular tests include Abbott IDNow.

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, due to lower test sensitivity with these types of tests, infections may not be detected. For this reason, a health care provider may send a PCR test to confirm the result if the antigen test is negative. Examples of antigen tests include the Abbott BinaxNow.

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.

Testing types are explained further here: https://www.fda.gov/consumers/consumer-updates/coronavirus-disease-2019-testing-basics

    Defining COVID-19 outbreaks in schools

    Confirmed outbreak definition

    Two or more confirmed COVID-19 cases among students/teachers/staff from separate households with onset within 14 days in a single classroom/cohort/activity OR with evidence of transmission in the school setting (including transportation to- from- school and affiliated events).

    OR

    One confirmed case and two or more probable cases of COVID-19 among students/teachers/staff from separate households with onset within 14 days in a single classroom/cohort/activity OR with evidence of transmission in the school setting (including transportation to- from- school and affiliated events).
     
    Outbreaks will be named for the school, not cohort or activity, regardless of whether they are identified in a class/cohort, school, or extracurricular activity associated with the school. Subsequent cases will be included under the current active outbreak. Investigation may still occur at the cohort level. 

     

    Suspected outbreak definition

    One confirmed COVID-19 case and one probable case of COVID-19 with COVID-like symptoms among students/teachers/staff from separate households with onset within 14 days in a single classroom/cohort/activities.

    OR

    Two or more probable COVID-19 cases among students/teachers/staff from separate households with onset within 14 days in a single classroom/cohort/activities.

     

    Tools to determine who needs to be home from school

    Note: Some of the tools have different versions based on where your community is on Colorado’s COVID-19 dial dashboard and based on stricter local or district guidelines. These tools apply to students, teachers, and staff at the schools.

    1. At-home COVID-19 symptom screening tool for parents and staff” A home checklist for parents and school staff.

    2. Child/teacher/staff feels or appears unwell after arriving at school” A screening tool to determine who needs to be sent home from school.

    3. Return to learn: guidance following a positive COVID-19 symptom screen” Tools to determine how long a person needs to stay home after staying/going home sick.

    4. Who is a close contact?” A tool to determine who is a close contact in schools based on transmission risk and mitigation strategies.

    5. What happens to the contacts?”  A tool to determine if classmates or cohort members or close contacts of a sick person need to quarantine.

    Responding to COVID-19 cases and outbreaks in schools and child care

    Single cases Response

    One person (student/teacher/staff) with confirmed COVID-19 within a school.

    • Person stays home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Class/cohort stays home for quarantine (dating from the last day that the person with confirmed COVID-19 attended school or care), after using the “Who is a close contact?" tool to determine which classmates, staff, or cohort members are close contacts of a sick person and need to stay home.

    • If school is not practicing cohorting or there is some mixing of cohorts, work with public health staff to identify close contacts (including providing class schedules, seating charts, and class rosters). Contacts should stay at home until released from quarantine.

      • Anticipate grade-wide or school-wide dismissal for several days while identification and notification of close contacts is ongoing.

      • In schools meeting specific criteria for transmission risk strategies the “Who is a close contact?” tool may be used. Public health experts recommend testing of close contacts (about 7 days after exposure, or earlier if contact develops symptoms).

      • Cost and logistics of testing is the responsibility of the individual, parent, or caregiver. CDPHE lab can analyze samples on a case-by-case basis. Local public health should work with state public health epidemiology teams. Assess feasibility with local public health.

    • In the event that a variant of COVID-19 is identified, a full 14 day quarantine is required for all close contacts.

    One person (student/teacher/staff) with COVID-like symptoms within a school.

     

    Confirmed outbreak
    Single cases Response

    Two or more people from separate households with confirmed COVID-19 with onset within 14 days in a single classroom or cohort

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Close contacts must quarantine. Individuals within 90 days of a previous positive viral diagnostic test (not antibody test) do not need to quarantine following a close contact unless symptomatic.  Symptomatic individuals within 90 days of a previous positive viral diagnostic test should be evaluated for potential reinfection in consultation with public health officials and may require COVID-19 diagnostic testing and evaluation by a health care provider.

    • Public health experts recommend testing close contacts (about 7 days after exposure or earlier if contact develops symptoms).

      • Cost and logistics of testing is the responsibility of the individual, parent, or caregiver. The state public health lab can test on a case-by-case basis. Local public health should work with state public health epidemiology teams. Assess feasibility with local public health. 

    • If outbreak and exposures are limited to one classroom or cohort, school closure may not be necessary.

    • Consider a school-wide testing event.

    Three or more outbreak classrooms/cohorts.

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Class/cohort stays home for quarantine, after using the “What happens to the contacts?” tool to determine if classmates, cohort members, or close contacts of a sick person need to stay home.

    • In schools meeting specific criteria for administrative capacity and transmission risk strategies the “Who is a close contact?” tool may be used.

    • Public health experts recommend testing of close contacts (about 7 days after
      exposure or earlier if contact develops symptoms).

    • Consider school closure, especially if there is evidence of transmission between classrooms/cohorts within the school (as opposed to two distinct classroom outbreaks both starting with known household exposures). See information below on school closure.

    • Consider a school-wide testing event.

    In schools not cohorting, two or more people, from separate households, with confirmed COVID-19 with onset within 14 days in the same school.

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Work with public health staff to identify contacts. All contacts must quarantine.

    • In schools meeting specific criteria for administrative capacity and transmission risk strategies the “Who is a close contact?” tool may be used.

    • Public health experts recommend testing of close contacts (about 7 days after exposure or earlier if contact develops symptoms).

    • Consider a school-wide testing event.

    • Consider school closure if teachers/staff staying home interferes with the ability of the school to operate.

    5% or more students/staff have confirmed COVID-19 within a 14-day period.

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Work with public health staff to identify contacts. All contacts (students, teachers, and staff) must quarantine.

    • In schools meeting specific criteria for administrative capacity and transmission risk strategies the “Who is a close contact?” tool may be used.

    • Public health experts recommend testing close contacts (about 7 days after exposure or earlier if contact develops symptoms).

    • Recommend school closure for 14 days.

    • Consider a school-wide testing event.

    Two or more teachers/staff with confirmed COVID-19 are close contacts within the school setting.

    • Teachers, staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Public health investigation to determine close contacts among teachers, staff, and students.

    • Close contacts stay home for quarantine, after evaluation using the “What happens to the contacts?” tool to determine if classmates, cohort members, or close contacts of a sick person need to stay home.

    • In schools meeting specific criteria for transmission risk strategies the “Who is a close contact?” tool may be used.

    • Public health experts recommend testing close contacts (about 7 days after exposure or earlier if contact develops symptoms).

    • Consider school closure if the number of teachers/ staff staying home interferes with the school’s ability to operate.

    • Consider a school-wide testing event.

     

    Suspected outbreak
    Single cases Response

    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.

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Entire classroom/cohort, including teachers/staff, must quarantine.

    • Public health investigation to determine if this meets the definition for a confirmed outbreak.

    • Public health experts recommend testing close contacts (about 7 days after exposure or earlier if contact develops symptoms).

    • In schools meeting specific criteria for transmission risk strategies the “Who is a close contact?” tool may be used.

    Individuals with confirmed COVID-19 in multiple classrooms.

    • All students, teachers, and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms).

    • Public health investigation to determine close contacts among staff and students.

    • All close contacts must quarantine.

    • Consider holding a mass testing event in coordination with local public health.

    • Consider school closure if the number of teachers/staff staying home interferes
      with the school’s ability to operate.

    Suspected Outbreak: 10% absenteeism (among expected in-person students/staff) for any reason.

    • School collaborates with public health to determine whether there is an outbreak of COVID-19 or another pathogen.

    • Encourage testing of all symptomatic students, teachers, and staff.

      • Cost and logistics of testing is the responsibility of the individual, parent, or caregiver. The state public health lab can test on a case-by-case basis. Local public health should work with state public health epidemiology teams. Assess feasibility with local public health.

    Criteria for closures

    School closure/shift to remote learning: A school shall be closed for in person learning and extracurricular activities, including participation in any in person athletic practice and competition,  when:

    • Five or more classroom/cohort outbreaks (defined above) occur within a 14-day period. Length of closure: 14 days.
      OR

    • 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.
      (For pre-K and child care facilities, attendance may vary significantly day-to-day due to non-illness-related factors, including variability in the number of drop-in attendees. Therefore, attendance-based criteria for outbreak determination should not be utilized in child care and pre-K settings. These settings should nevertheless take note of unexplained periods of decreased attendance and communicate with local or state public health authorities if illness among attendees is suspected.)
      OR

    • Additional time is needed to clean the school before students/teachers/staff return. Length of closure: time necessary to complete cleaning.
      OR

    • 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.
      OR

    • 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.

    Notification letter templates

    Templates for schools to send notification letters to parents. Available in both English and Spanish. 

    Templates for health care providers to send to school with students or staff following onset of symptoms.

    Considerations for ...

    Considerations for siblings and household contacts

    The siblings and other household contacts 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. A person who, as with other close contacts, household close contacts must quarantine, following CDPHE guidance. This quarantine period begins on the last day of exposure to the person with COVID-19 during their 10-day isolation period. If close contact between the person with COVID-19 and household members continues throughout the case’s isolation period, the duration of quarantine for household contacts will be 17 to 24 days (10-day isolation + additional quarantine period beginning on the last day of isolation). Public health may recommend siblings get tested for COVID-19 about 7 days after they were in contact with their sick sibling. 

    The parents or 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 parent or sibling in quarantine develops symptoms or tests positive for COVID-19. Parents should closely monitor all their family members and themselves for symptoms.

     

    Considerations for COVID-19 testing in schools 

    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 the 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. 

    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 — cover coughs and sneezes properly, wash hands, properly dispose of tissues.

      • Teach and practice proper handwashing. Provide adequate hand washing supplies. Schedule times for handwashing during the school day.  In instances where soap and water is not readily available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. 

      • Practice surface cleaning and disinfecting, especially for high-touch surfaces (e.g., door knobs, light switches, desks, etc.) and other shared items.

      • 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.  
           

    Reporting for schools and child care providers

    Case and outbreak reporting for schools and child care providers

    Clinical labs and/or health care providers are required to report cases to public health. Public health then interviews the people who have COVID-19 and conducts contact tracing to determine who might be close contacts of the case, and makes recommendations about isolation and quarantine. However, schools and child care providers also are encouraged to report single cases of COVID-19 to their local public health agency. Schools are able to disclose this information to public health without prior written consent under FERPA’s health or safety emergency exception, because a person with COVID-19 represents a potential threat to the health and safety of others at the school. This is true even if there is not an outbreak. 

    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 can report outbreaks by:

    Appendix

    Click image for a downloadable/printable version of the tool. These tools apply across all dial phases.

    At-home symptom screening tool

    A home checklist for parents and staff

    Available languages: Español   | Tiếng Việt  | 中文  | Soomaali  | العربية  | नेपाली  

    Child/staff feels/appears unwell after arriving at school

    A screening tool to determine who needs to be sent home from school

    Return to learn: guidance following a positive COVID-19 symptom screen

    A tool to determine how long a person needs to stay home after staying/going home sick

    What happens to the close contacts?

    A tool to determine if close contacts of a sick person need to stay home

    Who is a close contact?

    A tool to determine who is a close contact in schools meeting specific criteria for administrative capacity and transmission risk mitigation strategies.