School Health Services Procedures, 2020-21

The CDC recommends daily at-home health screenings of students for COVID-19 symptoms.

Each school day, prior to allowing their child to board a school bus or enter a school building, parents/guardians are responsible for completing an at-home health screening of their child for COVID-19 symptoms. (See Daily At-Home COVID-19 Screening for Students.)

Older students may be reliable in self-evaluation, while younger students will require their parent/guardian to conduct the screening. Ultimately, it is the responsibility of the parent/guardian to affirm that they believe their child is free of COVID-19 symptoms.

All employees are required to perform a self-assessment for COVID-19 symptoms before reporting to work and again upon building entry. Employees also must signify in writing that they are free of COVID-19 symptoms that are not attributable to another condition.

All visitors to ACPS facilities will be required to undergo a health screening for COVID-19 symptoms upon building entry. (See Building Entrance Screening Procedure for Employees and Visitors and ACPS Facilities COVID-19 Screening for Employees & Visitors.)

Student absenteeism will be monitored daily. Front office staff or the school nurse will contact the parent/guardian of a student without a scheduled absence to determine the reason for the student’s absence. Codes will be added to the student information system to indicate absences due to COVID-19-like illness and those due to quarantine or parent choice. The school will note trends and report increased absences to the ACPS COVID-19 Coordinator, who will notify the health department.

The nurse’s area will be set up to accommodate the following:

1. Waiting area/triage
2. Well-student visits (medications, routine procedures, first aid for injuries)
3. Sick area
4. Isolation room or “health annex”
   • The isolation room must:
     • Be large enough to accommodate 2-3 individuals spaced 6 feet apart.
     • Be located close enough to the school nurse—ideally within sightline—so that students can be observed and cared for as needed, or if this is not possible, placed under the direct supervision of a designated staff member.
     • Contain a window.
     • Be located fairly close to restroom facilities with hand washing capacity and to an exit.
     • Be identified with signage as the isolation room.
     • Limit access to the school nurse, ill individuals, and custodians.
   • If a space adjacent or close to the nurse’s space is not available for use as an isolation room, the school division will consider moving the school nurse’s work area to larger location that provides enough space to accommodate a treatment station and a distanced area for isolating sick students separated by some type of screen or room divider. The space must meet the same criteria listed above.
   • If no isolation area is available, the school division will consider using the clinic as the isolation area and manage first aid and medication distribution at the entrance or front of the clinic.
5. The nurse’s space must provide access to a computer, phone and internet.

To reduce congestion, the clinic or nursing space may be reserved for students and staff with illness symptoms/complaints or warranted injuries, while a satellite location may be used for routine medication and minor first aid may be managed in the classroom. With classroom management as a first resort for minor first aid only, classrooms will be stocked with bandages and other first aid essentials that could allow students to perform supervised self-care in the classroom, when possible, and teachers would receive enhanced first aid training. (See Clinic Visit Triage.)

1. Access to the clinic will be restricted to the school nurse, ill or injured students and staff, and custodians. Students will be instructed to stop at the doorway for triage, and there will be marked “waiting spots” that are 6 feet apart. To prevent clinic overcrowding, the school may implement a “call first” procedure whereby teachers will call the clinic before sending a student to see the nurse.
2. Nebulizer treatments for inhaled bronchodilator medication will not be permitted. Students who require tracheal suction will be provided with alternative options to in-person instruction.
3. School nurses will no longer administer acetaminophen or ibuprofen to students or staff, which may mask the development of a fever, except to students experiencing menstrual cramps, dental/orthodontic pain, migraine headaches, or other ongoing pain per an established standing order. Other use will require a physician’s order.

The protocol listed below apply to a student or staff member who develops symptoms during the school day; however, school exclusion and return to school criteria also apply to a student or staff member who develops symptoms when not in school. While awaiting evaluation and/or testing, all siblings or other household members who attend Albemarle County Public Schools must also remain at home.

1. Any student or staff member who develops a fever (100.0ºF or 37.8ºC ) will be excluded from school.
    
2. Students who present with a fever and other illness symptoms such as cough or shortness of breath will be asked to wear a mask or face covering and be isolated in the designated “isolation room.” The school nurse may wear a medical mask and goggles or a face shield if providing care to symptomatic individuals in the isolation room. (See the National Association of School Nurses’ Facemask Considerations for Healthcare Professionals in Schools.)
    
3. A student or staff member will be excluded from school AND referred to a health care provider to see if testing is warranted if they develop a fever (100°F or higher) and/or any of the following: known exposure to a sick individual such as a family member; cough of more than one day not attributable to other causes; sudden unexplained shortness of breath or difficulty breathing; chills; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea; and/or loss of appetite. (This criteria may change.) Note: For common complaints such as stomachache, headache, and minor sore throat, the school nurse may try interventions (e.g., drink of water, use of bathroom, rest, snack) to see if the symptom improves before excluding the student or staff member from school and referring for a medical evaluation.
    
4. The nurse will notify parents that the student must be picked up within one (1) hour. Upon parent/guardian/designee arrival, the nurse will escort the sick student to the vehicle and provide written instructions regarding the need for evaluation by a health care provider and testing; testing site choices in the area; and protocols for returning to school. (See COVID-19 Screening Flowchart.)
    
5. Any student who displays or reports symptoms of COVID-19 will be given a Return to School Letter (Carta de Regreso a la Escuela) including instructions for next steps, along with the Return to School Plan Form (Formulario de Plan de Regreso a la Escuela), which must be completed by a health care provider before the symptomatic individual can return to school. If the student does not see a doctor, the student may return to school when they receive a negative COVID-19 test result and have been fever-free for 24 hours without the use of fever-reducing medication, or the student may return to school 10 days after the onset of symptoms, so long as they have been fever-free for at least 24 hours without the use of fever-reducing medication.
    
6. School personnel will follow established disinfection and ventilation procedures for the isolation room.
    
7. Depending on the degree of community transmission, the health department may be consulted and students and staff identified as close contacts of the symptomatic individual may be notified and may be asked to quarantine.
    
8. If a doctor diagnoses a condition other than COVID-19, the family and school must follow the exclusion criteria for that condition. Any individual who was identified as a close contact and asked to quarantine will be notified that the test result for COVID-19 was negative and will be permitted to return to school.
    
9. If the individual is diagnosed with COVID-19, follow the Return to School or Work Criteria After Diagnosis of COVID-19 and refer to the section addressing Exclusion (Quarantine) of Close Contacts.
    
10. In the absence of the nurse, school staff will refer to the Flowchart for Assessing Illness in the Absence of the School Nurse to manage the care of an ill student or staff member and determine whether to isolate them and/or send them home.

1. The case investigator at the health department will contact the person who tested positive and ask about close contacts.
    
2. Employees should report a diagnosis of COVID-19 to their supervisor as soon as possible. The supervisor should contact the designated infection control officer for their school or department. Parents/Caregivers of students diagnosed with COVID-19 should contact the school nurse as soon as possible. The identity of a person diagnosed with COVID-19 will remain confidential.
    
3. A designated infection control officer will be identified for departments and schools; school nurses will serve in this capacity for schools. These individuals will be trained in contact tracing practices and will work collaboratively with the health department in identifying affected individuals and providing guidance on next steps to all affected individuals.
    
4. If a close contact comes from a school setting, the health department’s investigative team will work with the school to obtain the names of students, their parent/guardian, faculty, and staff who may have been exposed. The investigator will need assistance to obtain contact information.
    
5. The individual who has tested positive will be excluded from school until the Return to School or Work Criteria after Diagnosis of COVID-19 (below) has been met.
    
6. School personnel will follow established disinfection and ventilation procedures for any identified areas:
   • The school division will take specific disinfection measures as detailed in Section C of the Cleaning and Disinfection Protocol: Response to Confirmed/Suspected COVID-19 Case.
   • The school division will make additional modifications to the HVAC system operation as detailed in Section F of the COVID-19 Heating, Ventilation, and Air Conditioning (HVAC) Protocol, HVAC Operational Response to Positive COVID-19 Case.
      
7. The decision to close a building or buildings will be made by the Superintendent of Schools in conjunction with local health officials based on factors that include, but are not limited to, extent of an identified outbreak in an ACPS facility; COVID-19 conditions in the community; absenteeism rates among staff and students; and local and/or state ordinances/orders.

1. The school nurse or other school personnel will work with the contact tracing team at the health department to investigate the activities of the person who tests positive to determine those individuals at risk for disease transmission (i.e., “close contacts”). A close contact is someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period or is directly exposed to the respiratory secretions, such as from a cough or sneeze, of the positive person starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.
    
2. Close contacts will be asked to stay home and self-monitor for symptoms for 14 days from the last day of exposure. View Quarantine Instructions for Staff or Quarantine Instructions for Students (Instrucciones de Cuarentena para Estudiantes).
   
   Based on the CDC's Interim Public Health Recommendations for Fully Vaccinated People (March 2021), fully vaccinated individuals do not need to quarantine following a known exposure, provided they do not develop symptoms. If they develop symptoms, they should seek a medical evaluation to see if testing is warranted. People are considered fully vaccinated two weeks after their second dose in a two-dose series, like the Pfizer or Moderna vaccines, or two weeks after a single-dose vaccine, like Johnson & Johnson’s Janssen vaccine.
    
3. Individuals who live in the same household as the infected person are considered close contacts. Household contacts need to self-quarantine (stay home) and monitor for symptoms while the infected person is home and for 14 days after the infected person has been released from isolation (because exposure is considered ongoing within the house). If the household member is able to have complete separation from the infected person in their home with COVID-19 (this means no contact, no time together in the same room, no sharing of any spaces, such as the same bathroom or bedroom), then they should follow the time frame for non-household contact.
    
4. Individuals who do not develop symptoms after the quarantine period may return to school.
    
5. If a student or staff in quarantine develops symptoms, they should obtain a COVID-19 test at the provider of their choice or the health department can help facilitate testing.
   • If the test is negative, the individual must continue to quarantine until the 14-day quarantine is completed.
   • If the test is positive, the health district investigation team will provide instructions regarding isolation and seeking medical care if necessary.

1. With the assistance of the Communications office, the nurse and principal will work with the health department to determine the type and distributive scope of notification to parents regarding case investigation and possible quarantine.
    
2. If a student or school-based staff member develops symptoms that suggest a possible COVID-19 case, the school will notify the parents/guardians of classmates that the individual has been referred to their physician to see if testing is recommended. (The identity of the ill student or staff member will remain confidential.)
    
3. In the event of a confirmed case at a school, communication will be sent to parents/guardians of all students in the school regarding the incident, the risk to their child, and actions advised by the health department. Individuals considered close contacts will receive separate notification and guidance.

If an individual tests positive in a diagnostic COVID-19 test and has symptoms, they should stay home until:

1. At least 10 days have passed from the onset of symptoms; AND
2. The individual has been fever-free for 24 continuous hours without the use of fever-reducing medications; AND
3. Respiratory symptoms have improved.

If an individual tests positive in a diagnostic COVID-19 test, but has no symptoms and remains asymptomatic, they should stay home until at least 10 days have passed since the positive diagnostic test result.