COVID-19 Technical Assistance for Schools TA...2020/12/03 · • All students age 5 years and above, school staff or other adults, and bus drivers must wear a cloth face covering

COVID-19 Technical Assistance for Schools

December 3, 2020

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Webinar Housekeeping

• All participants will be muted throughout the webinar• Please type questions into the chat box

• Questions should be directed to “everyone” in the chat• The webinar will be recorded and available at the following link:

https://coronavirus.maryland.gov/pages/school-resources

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https://coronavirus.maryland.gov/pages/school-resources

Webinar Agenda• Schools Guidance FAQs*• Open Q and A

*The webinar for non-public schools scheduled for December 10, 2020 will review the updated schools guidance in detail

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Guidance and metrics

Are both public and nonpublic schools required to follow instructions from the local health departments?• All Maryland public and nonpublic schools must follow the guidance

contained in this document regarding COVID-19 mitigation actions.• The Secretary of Health and local health officers are responsible for

taking steps to prevent and control the spread of infectious diseases like COVID-19 and may issue special instructions when necessary to do so. See Health-General Article, sections 18-102(b) and 18-208(b), and COMAR 10.06.01.06A.

• Persons in charge of schools at the local and building level must follow the instructions from the Secretary and the health officers,COMAR 10.06.01.06F(2).

5 Source: COVID-19 Guidance for Maryland Schools - Question #2

http://mgaleg.maryland.gov/2020RS/Statute_Web/ghg/18-102.pdfhttp://mgaleg.maryland.gov/2020RS/Statute_Web/ghg/18-208.pdfhttp://www.dsd.state.md.us/comar/comarhtml/10/10.06.01.06.htmhttp://www.dsd.state.md.us/comar/comarhtml/10/10.06.01.06.htm

Will MSDE and MDH call for school closures in the future or is it up to the schools to follow the metrics that have been provided?• Each local school system and nonpublic school, in consultation with

the local health department, should review the school reopening metrics to make reopening decisions and to adjust in-person educational offerings, as necessary, when the metrics indicate an increased level of risk.

6 Source: COVID-19 Guidance for Maryland Schools - Question #3

Face coverings in school

Do staff still need to wear face coverings in the school if all of the students are engaged in virtual learning? Are masks required on the playground?Use of cloth face coverings in school are required as below when not contraindicated due to a medical condition, disability, developmental immaturity, or other health or safety concerns as indicated by the CDC.• All students age 5 years and above, school staff or other adults, and bus drivers

must wear a cloth face covering while on a school bus or school-provided transport;

• School staff must wear cloth face coverings while in the school building and on school grounds;

• Other adults must wear cloth face coverings when they must enter the school building or school grounds;

• Students age 5 years and above must wear cloth face coverings in the school building and on school grounds

8 Source: Guidance for Use of Cloth Face Coverings in Schools

Are masks required on the playground?

• See also Guidelines for Temporary Modifications to Physical Education Programs in Maryland Schools:

http://www.marylandpublicschools.org/about/Documents/DCAA/PE/Physical-Education-Together.pdf

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http://www.marylandpublicschools.org/about/Documents/DCAA/PE/Physical-Education-Together.pdf

Should teachers wear additional PPE if a child in their classroom is unable to wear a mask?Teachers and other staff should wear appropriate PPE based on the specific interactions they are having with students (e.g., instruction, behavior support, personal care, activities of daily living, etc.) and using the considerations below:• Potential for close contact;• Ability to maintain safe physical distance; • Ability of student to appropriately and consistently wear facial covering; • Potential to be splashed or sprayed by bodily fluids (e.g., management of

secretions); • Cognitive level and behavior(s) of student including ability to access information

due to visual, hearing, or other limiting factors; and• Difficulties with change in student’s school routine.

10 Source: School Health Services FAQ – Question #13

School health services staff and PPE

What PPE should a school health services staff person wear when monitoring a sick child in an isolation room?

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The table below reflects Maryland Department of Health and Maryland State Departments of Education guidance on the PPE that is necessary to protect school nurses and other school health services staff who are providing direct care to students/staff in the school setting during the COVID-19 pandemic. Use of a disposable surgical mask is the minimum standard face covering for health room staff. Schools should ensure that adequate supplies of the appropriate PPE are available to school nurses and other school health services staff for safe performance of the direct care activities listed below.

Types of Services Disposable Surgical Mask

N95 or Equivalent

Eye Protection: Face Shield or

Goggles

Disposable Gloves

(non-latex)

Disposable Gowns

Personal care (e.g., diapering, toileting, oral and G-tube feeding) that could expose staff to well student’s bodily fluids.

Required1 Not required Optional Required Optional

Direct care (e.g., first aid, medications, diabetes care) and monitoring of well students unrelated to COVID-19 symptoms.

Required1 Not required Optional Required Not required

Direct care (e.g., assessment) or close contact with ill staff/students when there may be exposure to bodily fluids (e.g., cough, sneezing, runny nose, vomiting).

Required Not required Required Required Required

Direct care (e.g., assessment) or close contact with ill staff/students when exposure to bodily fluids is not expected (e.g., headache, muscle aches, sore throat, fatigue, fever).

Required Not required Required Required Optional

Direct care (e.g., assessment) or close contact with staff/students who have confirmed COVID-19 or probable COVID-19 (e.g., COVID-19 symptoms and known exposure)2

Not required Required Required Required Required

Performing or present during aerosol generating procedures including nebulizers, open trach suctioning, and trach care.

Not required Required Required Required Required

Collecting nasal specimens for COVID-19 testing. Required Not Required Required Required Optional

1Required because it is the minimum standard for face covering within the school setting for school nurses and other school health services staff, not due to infection risk from these specific services. 2School nurses and other school health staff should not routinely need to provide direct care for individuals with confirmed or probable COVID-19 if recommended notification, isolation, and quarantine procedures are being implemented. Table adapted from the Minnesota Department of Health: https://www.health.state.mn.us/diseases/coronavirus/schools/directsupport.pdf October 21, 2020

Source: Appendix A: PPE for School Health Services Staff

Appendix A: Personal Protective Equipment (PPE) for School Health Services Staff

The table below reflects Maryland Department of Health and Maryland State Departments of Education guidance on the PPE that is necessary to protect school nurses and other school health services staff who are providing direct care to students/staff in the school setting during the COVID-19 pandemic. Use of a disposable surgical mask is the minimum standard face covering for health room staff. Schools should ensure that adequate supplies of the appropriate PPE are available to school nurses and other school health services staff for safe performance of the direct care activities listed below.

Types of Services

Disposable Surgical Mask

N95 or Equivalent

Eye Protection: Face Shield or Goggles

Disposable Gloves

(non-latex)

Disposable Gowns

Personal care (e.g., diapering, toileting, oral and G-tube feeding) that could expose staff to well student’s bodily fluids.

Required1

Not required

Optional

Required

Optional

Direct care (e.g., first aid, medications, diabetes care) and monitoring of well students unrelated to COVID-19 symptoms.

Required1

Not required

Optional

Required

Not required

Direct care (e.g., assessment) or close contact with ill staff/students when there may be exposure to bodily fluids (e.g., cough, sneezing, runny nose, vomiting).

Required

Not required

Required

Required

Required

Direct care (e.g., assessment) or close contact with ill staff/students when exposure to bodily fluids is not expected (e.g., headache, muscle aches, sore throat, fatigue, fever).

Required

Not required

Required

Required

Optional

Direct care (e.g., assessment) or close contact with staff/students who have confirmed COVID-19 or probable COVID-19 (e.g., COVID-19 symptoms and known exposure)2

Not required

Required

Required

Required

Required

Performing or present during aerosol generating procedures including nebulizers, open trach suctioning, and trach care.

Not required

Required

Required

Required

Required

Collecting nasal specimens for COVID-19 testing.

Required

Not Required

Required

Required

Optional

1Required because it is the minimum standard for face covering within the school setting for school nurses and other school health services staff, not due to infection risk from these specific services.

2School nurses and other school health staff should not routinely need to provide direct care for individuals with confirmed or probable COVID-19 if recommended notification, isolation, and quarantine procedures are being implemented.

Table adapted from the Minnesota Department of Health: https://www.health.state.mn.us/diseases/coronavirus/schools/directsupport.pdf October 21, 2020

When do school health services staff need to quarantine? What is an N95 “equivalent”?

The school nurse/school health services staff should quarantine if they had close contact with a student or staff person with confirmed COVID-19 under any of the following circumstances:• Close contact while NOT wearing an N95 respirator or equivalent or

surgical facemask; • Close contact while NOT wearing eye protection if the person with

COVID-19 was not wearing a cloth face covering or surgical facemask; or

• Performance of an aerosol-generating procedure while NOT wearing all of the recommended PPE (i.e., gown, gloves, eye protection, N95 respirator or equivalent).

13 Source: School Health Services FAQ - Question #2

Close contacts in school/school activities

Does the cumulative close contact definition apply to teachers in the classroom? How do we identify close contacts on a school sports team?A close contact of someone with COVID-19 (or suspected of having COVID-19) includes, but is not necessarily limited to:• Being within 6 feet of that person • For a cumulative total of 15 minutes or more over a 24-hour period

(e.g., three 5-minute exposures for a total of 15 minutes)Regardless of whether a mask (cloth face covering) was worn.

15 Source: Interim Definition of a Close Contact

Does the cumulative close contact definition apply to teachers in the classroom? How do we identify close contacts on a school sports team?Other factors to consider when determining close contact include:• Direct contact with the infected person or their respiratory secretions

• Being coughed or sneezed on• Being hugged or kissed• Caring for someone while he or she is sick• Sharing eating utensils that someone with COVID-19 just used prior to washing

• If the infected person has symptoms• If the infected person was likely generating aerosols (coughing, singing, etc)• Other environmental factors (crowding, indoors vs. outdoors, etc.)

16 Source: Interim Definition of a Close Contact

School outbreaks

What is considered an outbreak in a school?Classroom/cohort outbreak:

• Two or more laboratory-confirmed COVID-19 cases among students/teachers/staff with onsets (or, if asymptomatic, collection dates) within a 14-day period, and who are epidemiologically linked, but not household contacts.

School outbreak:• Three or more classrooms or cohorts with cases from separate households that meet

the classroom/cohort outbreak definition that occurs within 14 days; OR• 5% or more unrelated students/teachers/staff have confirmed COVID-19 within a 14

day period [minimum of 10 unrelated students/teachers/staff].

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Does the MDH school outbreak dashboard reflect all cases at a school?

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Out of state travel

What is the recommended timing for getting tested for COVID-19 after travel?Do I need to quarantine while waiting for my test result after travel?• Any Marylander returning from out-of-state travel should get tested for

COVID-19 promptly upon arrival in Maryland or within 72 hours before traveling back to Maryland.

• Any Marylander who travels to a state with a COVID-19 test positivity rate above 10% or a case rate above 20 per 100,000 in the past 7 days should get tested and self-quarantine at home until the test result is received. The District of Columbia, the Commonwealth of Virginia, the Commonwealth of Pennsylvania and the states of Delaware and West Virginia are exempt from this recommendation.

• Employee commuters who leave/enter the state on a daily basis and have work-based COVID-19 screening procedures do not need to quarantine

21 Source: COVID-19 Guidance for Maryland Schools – Question #15

Quarantine of close contacts in a school

When do close contacts of a person with COVID-19-like illness need to quarantine? Close contacts of a person with COVID-19-like illness (CLI) should quarantine in the following situations:• Person with CLI has a positive test for COVID-19 (rapid antigen test or PCR)• Person with CLI has a negative rapid antigen test for COVID-19 and no

confirmatory PCR test• Person with CLI does not receive a test for COVID-19 or another specific

diagnosis from their health care provider• Person with CLI had close contact with a person with COVID-19 (the person

with CLI is considered a probable case)• Note: close contacts must continue to quarantine if probable case has a

negative RT-PCR test but their health care provider still suspects COVID-19

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Source: Decision Aid: Exclusion and Return for Laboratory Confirmed COVID-19 Cases and Persons with COVID-19-like Illness in Schools, Child Care Programs, and Youth Camps

When do close contacts of a person with COVID-19-like illness need to quarantine? • Close contacts of a person with CLI do not need to quarantine while

waiting for the person with CLI’s COVID-19 test results UNLESS the person with CLI had close contact with a person with COVID-19 (i.e., the person with CLI is a probable case)

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Source: Decision Aid: Exclusion and Return for Laboratory Confirmed COVID-19 Cases and Persons with COVID-19-like Illness in Schools, Child Care Programs, and Youth Camps

Open Q and A

COVID-19 Technical Assistance for SchoolsWebinar HousekeepingWebinar AgendaSlide Number 4Are both public and nonpublic schools required to follow instructions from the local health departments?�Will MSDE and MDH call for school closures in the future or is it up to the schools to follow the metrics that have been provided?Slide Number 7Do staff still need to wear face coverings in the school if all of the students are engaged in virtual learning? Are masks required on the playground?�Are masks required on the playground?Should teachers wear additional PPE if a child in their classroom is unable to wear a mask?�Slide Number 11What PPE should a school health services staff person wear when monitoring a sick child in an isolation room?�When do school health services staff need to quarantine? What is an N95 “equivalent”?�Slide Number 14Does the cumulative close contact definition apply to teachers in the classroom? How do we identify close contacts on a school sports team?�Does the cumulative close contact definition apply to teachers in the classroom? How do we identify close contacts on a school sports team?�Slide Number 17What is considered an outbreak in a school?Does the MDH school outbreak dashboard reflect all cases at a school?�Slide Number 20What is the recommended timing for getting tested for COVID-19 after travel?Do I need to quarantine while waiting for my test result after travel?�Slide Number 22��When do close contacts of a person with COVID-19-like illness need to quarantine? ��When do close contacts of a person with COVID-19-like illness need to quarantine? �Slide Number 25