Cases and outbreaks in schools

Updated July 30, 2020.

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Guidance for detecting, reporting, and responding to students/staff with COVID-19 and outbreak of COVID-19 in schools is based on the available information as of July 2020. As additional information and experience with COVID-19 in schools become available, CDPHE will update the guidance. 

Defining COVID-19 outbreaks in schools

Definitions 

Confirmed case: A case in a person who has tested positive for the COVID-19 virus using certain laboratory tests (usually PCR).  
Probable case: A case in a  person who has COVID-like symptoms without another diagnosis. Public health will help assign the case a definition using the Colorado COVID-19 case and outbreak definitions

School outbreak-associated case: a confirmed or probable case among students/teachers/staff that meet the outbreak definition should be classified as outbreak-associated. 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, loss of taste/smell, fatigue, headache, sore throat, muscle or body aches, congestion/runny nose, nausea/vomiting, diarrhea. A person can be contagious two days before they start having symptoms (or two days before they test positive if they don’t have symptoms).

Isolation: staying home from work, school, and/or activities when a person is sick or diagnosed with COVID-19. Isolation lasts for at least 10 days after the onset of symptoms, 24 hours fever-free without fever reducing medication, and 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. Repeat testing is not recommended to decide when to end the period of isolation.

Quarantine: staying home from work, school, and/or activities when a person is a close contact of someone with COVID-19. Quarantine lasts for 14 days (unless the person develops symptoms, then they will be put in isolation). Negative testing does not 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 respiratory droplets from someone who is sick with COVID-19 on them (through sneezing, coughing, shouting, etc.).

  • was in the same class/cohort as a person with COVID-19.

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 breaks. Cohorting helps limit the number of contacts each individual has. As a result, quarantines, dismissals, or school closures in the event of a student or staff member with COVID-19 affect fewer people. Students may be in multiple cohorts (for example, bus ride to school, after-school sports, classroom). 

Social 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 social distancing was practiced in the classroom.  While 3 feet is an option within school cohorts/classrooms, 3 feet is not considered social distancing.

 

Confirmed outbreak definition

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. 

  1. 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. [Note: includes students, teachers, and other staff.]

  2. School-wide outbreak:

    • In schools practicing cohorting, two or more classrooms or cohorts that meet the classroom/cohort outbreak definition (above) that occurs within 14 days

      OR

    • 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 includes student, teachers, and other staff]

      OR

    • 5% or more unrelated students/teachers/ staff have confirmed COVID-19 within a 14 day period [minimum of 10 unrelated students/staff]

  3. Staff outbreak: Two or more teachers/staff with confirmed COVID-19 who are close contacts within the school setting, with onset within 14 days. 

 

Suspected outbreak definition

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. 

  1. Classroom/cohort outbreak: One confirmed COVID-19 case and one or more probable cases among students/teachers/staff from separate households, with onset within 14 days in a single classroom or cohort. [Note: Cases can include student, teachers, and other staff.]

  2. Single confirmed COVID-19 cases in two or more classrooms. 

  3. 10% absenteeism (among expected in-person students/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.

 


Responding to COVID-19 cases and outbreaks in schools

Single cases Response
One student with confirmed COVID-19 within a school 
  • Student stays home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms). 

  • Class/cohort stays home for a 14-day quarantine.

  • If school is not practicing cohorting or there is some mixing of cohort, work with public health to identify close contacts (including providing class schedules and class rosters), exclude contacts until released from quarantine.

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

  • Public health recommends testing of close contacts (~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 test on a case-by-case basis. (Local public health should work with state public health epidemiology teams.)

One student with probable COVID-19 within a school
  • Student stays home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms); recommend testing of the student

  • If school is practicing cohorting, class/cohort should stay home for 14-day quarantine.

  • If school is not practicing cohorting, work with public health to identify close contacts (including providing class schedules and rosters). Exclude contacts until 14 day quarantine has passed. Anticipate grade-wide or school-wide dismissal for several days while public health identifies and notifies close contacts. 

  • Public health recommends 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. 

One teacher/ staff member with confirmed COVID-19 
  • Teacher/staff stays home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms). 

  • All close contacts (students, teachers, and staff) must quarantine for 14 days. Classroom/cohort must quarantine if the teacher has a confirmed case. 

  • Public health recommends 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. 

One teacher/staff member with probable COVID-19
  • Teacher/staff stays home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms); recommend testing the teacher or staff member.

  • All close contacts (students, teachers, and staff) must quarantine for 14 days. Classroom/cohort must quarantine if the teacher has a probable case. 

  • Public health recommends 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. 

 

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 (classroom/cohort outbreak)
  • All students 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 must quarantine for 14 days.

  • Public health recommends 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 should not be necessary.

Two or more outbreak classrooms/cohorts (school outbreak)
  • All students and staff with COVID-19 stay home until released from isolation (usually 10 days after symptom onset, 24+ hours fever-free, and improving symptoms). 

  • All classrooms/cohorts, including teachers/staff, must quarantine for 14 days. Public health recommends 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. 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. 

  • Consider school closure, especially if 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.

In schools not cohorting, two or more people, from separate households, with confirmed COVID-19with onset within 14 days in the same school (school outbreak)
  • All students 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 to identify contacts. All contacts must quarantine for 14 days.

  • Public health recommends 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. The state public health lab can test on a case-by-case basis (LPHAs should work with epidemiology teams). Assess feasibility with local public health. 

  • Consider school-wide testing event.

  • Consider school closure if teacher/ 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 (school outbreak)
  • All students 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 to identify contacts. All contacts (students, teachers, and staff) must quarantine for 14 days.

  • Public health recommends 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 (LPHAs should work with epidemiology teams).

  • Recommend school closure for 14 days. 

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

  • All close contacts must quarantine for 14 days. 

  • Public health recommends 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 (LPHAs should work with epidemiology teams).

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

 

Suspected outbreak
Single cases Response
One person with confirmed COVID-19and one or more people with probable COVID-19,from multiple households with onset within 14 days in a single classroom or cohort.
(classroom/cohort suspect outbreak)
  • All students 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 for 14 days.

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

  • Public health recommends 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. 

Individuals with confirmed COVID-19 in multiple classrooms (not meeting overall school outbreak threshold)
  • All students 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 for 14 days.

  • Consider 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 (suspect outbreak)
  • 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).  

 

Notification letter templates

Templates for schools to send notification letters to parents. 

 

Considerations for Siblings

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 the 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.

 

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 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. Testing everyone has not been well-studied. Social distancing and wearing masks are more important ways to prevent COVID-19. A negative test means that the person did not have COVID-19 when they were tested. A negative test does not mean they are “safe” or “cleared” to be at school. 

 

Criteria for closures

Closing a classroom:
A single class/cohort should be closed when:

  • There is a student, teacher or other staff member with confirmed or probable COVID-19n the class/cohort, because all members of the class/cohort will be quarantined for 14 days. Length of closure: 14 days. 

  • There is a classroom/cohort outbreak, because all members of the class/cohort will be quarantined for 14 days. Length of closure: 14 days. 

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. 

    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.

    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.  

 

School surveillance for COVID-19, outbreak reporting, and other considerations

School surveillance

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.

CDPHE will send a weekly survey via REDCap to school contacts to obtain the following information to describe respiratory illness in schools:

School information: 

  • School Name

  • District

  • School Type: 

    • Elementary school (K-5)

    • Middle school (6-8)

    • High school (9-12)

    • K-8

    • K-12

    • Alternative

    • 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 social distancing 

  • School or classroom/cohort closures during the previous week

  • Optional notes


Student & 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 state-wide will be shared on CDPHE’s website, and more detailed information will be shared with local public health agencies through the CDPHE LPHA portal by county.

 

Case and outbreak reporting

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 also are encouraged to report single cases of COVID-19 to their local public health agency.

Schools are required to report all outbreaks to their local public health agency or to CDPHE within four hours per statute. Schools must report both suspected and confirmed outbreaks.
Schools can report outbreaks by:

 

Considerations for concurrent respiratory infections

Note: This section 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 with emphasis on high-touch areas & surfaces.

    • 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.  

Frequently asked questions

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 does 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 withCOVID-19 to other teachers, staff, students, parents, the media, or anyone outside public health.

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 offer testing. Symptomatic students, teachers, and staff should be referred for testing to their own health care provider or to a community testing site. In the event of a confirmed case at a school, local public health 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 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 counted as probable 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 confirmed or probable cases have occurred.  If the last person did not have symptoms, use the day the person was tested instead.

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 work/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 doctor.

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 social 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). 

Yes, because if it is not possible to determine which students and staff within a cohort are close contacts of a person with COVID-19, then the entire cohort should quarantine. 

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 quarantine. 

Yes, it is rare for children to get very ill or die from COVID-19, although unfortunately, it does happen. Older children in particular can develop Multisystem Inflammatory Disease in Children, which can make them seriously ill. 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.