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Centers for Disease Control and Prevention

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Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

Isolation and Precautions for People with COVID-19

Isolation and Exposure Calculator

A tool to help you determine if you need to isolate or take other steps to prevent spreading COVID-19.

Isolation & Exposure

If you have COVID-19, you can spread the virus to others. There are precautions you can take to prevent spreading it to others: isolation, masking, and avoiding contact with people who are at high risk of getting very sick. Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19.

These recommendations do not change based on COVID-19 Community Levels. If you have COVID-19, also see additional information on treatments that may be available to you.

This information is intended for a general audience. Healthcare professionals should see Ending Isolation and Precautions for People with COVID-19. This CDC guidance is meant to supplement-not replace-any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations.

Regardless of vaccination status, you should isolate from others when you have COVID-19.

You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results. If your results are positive, follow the full isolation recommendations below. If your results are negative, you can end your isolation.

You can end your isolation

Follow the full isolation recommendations below

When you have COVID-19, isolation is counted in days, as follows:

If you had no symptoms

Day 0 is the day you were tested (not the day you received your positive test result)

Day 1 is the first full day following the day you were tested

If you develop symptoms within 10 days of when you were tested, the clock restarts at day 0 on the day of symptom onset

If you had symptoms

Day 0 of isolation is the day of symptom onset, regardless of when you tested positive

Day 1 is the first full day after the day your symptoms started

If you test positive for COVID-19, s tay home for at least 5 days and isolate from others in your home.

You are likely most infectious during these first 5 days.

End isolation based on how serious your COVID-19 symptoms were. Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.

If you had no symptoms

You may end isolation after day 5.

If you had symptoms and:

Your symptoms are improving

You may end isolation after day 5 if:

You are fever-free for 24 hours (without the use of fever-reducing medication).

Your symptoms are not improving

Continue to isolate until:

You are fever-free for 24 hours (without the use of fever-reducing medication).

Your symptoms are improving. ¹

If you had symptoms and had:

Moderate illness (you experienced shortness of breath or had difficulty breathing)

You need to isolate through day 10.

Severe illness (you were hospitalized) or have a weakened immune system

You need to isolate through day 10.

Consult your doctor before ending isolation.

Ending isolation without a viral test may not be an option for you.

If you are unsure if your symptoms are moderate or severe or if you have a weakened immune system, talk to a healthcare provider for further guidance.

Regardless of when you end isolation

Until at least day 11:

Avoid being around people who are more likely to get very sick from COVID-19.

Remember to wear a high-quality mask when indoors around others at home and in public.

Do not go places where you are unable to wear a mask until you are able to discontinue masking (see below).

For travel guidance, see CDC's Travel webpage.

After you have ended isolation, when you are feeling better (no fever without the use of fever-reducing medications and symptoms improving),

Wear your mask through day 10.
OR

If you have access to antigen tests, you should consider using them. With two sequential negative tests 48 hours apart, you may remove your mask sooner than day 10.

Note: If your antigen test results1 are positive, you may still be infectious. You should continue wearing a mask and wait at least 48 hours before taking another test. Continue taking antigen tests at least 48 hours apart until you have two sequential negative results. This may mean you need to continue wearing a mask and testing beyond day 10.

After you have ended isolation, if your COVID-19 symptoms recur or worsen, restart your isolation at day 0. Talk to a healthcare provider if you have questions about your symptoms or when to end isolation.

[1] As noted in the Food and Drug Administration labeling for authorized over-the-counter antigen tests, negative test results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions.

Isolate and take precautions if you have or suspect you have COVID-19
File Details: 300KB, 1 Page

View PDF

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Important update: Healthcare facilities CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more Isolation and Precautions for People with COVID-19 Isolation and Exposure Calculator A tool to help you determine if you need to isolate or take other steps to prevent spreading COVID-19.

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Every home in the U.S. is eligible to order an additional 4 free at-⁠home tests beginning November 20. If you did not order tests this fall, you may place two orders for a total of 8 tests.

Your order of COVID tests is completely free - you won't even pay for shipping.

Order Free At-Home Tests

Need help placing an order for your at-⁠home tests?
Call 1-800-232-0233 (TTY 1-888-720-7489).

The U.S. government will continue to make COVID-⁠19 tests available to uninsured individuals and underserved communities through existing outreach programs. Please contact a HRSA-funded health center or Increasing Community Access to Testing (ICATT) location near you to learn how to access low- or no-cost COVID-⁠19 tests provided by the federal government.

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Every U.S. household is eligible to order 4 free at-home COVID-19 tests.

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People who purchase over-the-counter test kits and receive a positive result should call the state COVID-19 hotline, 1-800-525-0127 then press # (press 7 for Spanish), as soon as they receive results. The hotline is available Monday from 6 a.m. to 10 p.m., and Tuesday to Sunday (and observed holidays) 6 a.m. to 6 p.m. Language assistance is available.

Why Get Tested

Testing saves lives. Testing allows people to take precautions, like quarantining, in a timely manner to stop the virus from spreading; infected people without symptoms can still spread the virus. Testing also helps public health officials identify and respond to outbreaks, and to track new variants of the virus. Testing is an important component in helping resume normal activities.

Researchers from the University of Washington and the Department of Health (DOH) found that testing for COVID-19 and tracking through WA Notify likely prevented about 6,000 cases from December 2020 to March 2021.

When to Get Tested

Test when you feel sick. COVID-19 has a wide range of symptoms, so if you're not feeling well, it's best to get tested as soon as possible.

Test when you've been exposed to someone who tested positive for COVID-19. Get tested immediately if you're showing symptoms. If you're not showing symptoms, wait five days after the exposure and then test.

Businesses and event spaces in Washington may have testing and/or vaccination requirements before entering an establishment or event. Call ahead or check their website before you visit.

You may need to test before and/or after traveling. Check the CDC's latest travel guidance.

When you're going to gather with a group of people, especially those who are at risk of severe disease or may not be up to date on their COVID-⁠19 vaccines.

Where to Get Tested

The WA State Department of Health website maintains a directory of testing sites available in each county, with operating hours and requirements. For additional information on testing sites, call 2-1-1. Over the counter test kits are also available for ordering and in pharmacies for convenient, at-home testing.

Types of Tests

The current tests available include rapid antigen tests, molecular tests (both lab-based and point of care), and some home self-tests. Supply of any particular test varies according to demand and manufacturer capacity.

Cost

Free at-home tests are available through the federal government, order your free test kit at COVIDtests.gov​​​​

Insurance providers will now reimburse families for up to eight tests per month. Learn more about insurance reimbursement.

There are no out of pocket cost for tests performed at county or state-supported test sites. Many tests, particularly for people experiencing symptoms, can be billed to insurance or subsidized by the Department of Health.

You can also purchase an at-home test at local or online retailers and pharmacies. No insurance or prescription is required.

How To Take An At-Home Test

It's important to follow the instructions inside the kit of rapid at-home tests for the most accurate results. Several brands also offer video instructions. For more best practices, check out the CDC's tips for at-home testing.

False negatives can occur with rapid tests. Some testing kits may include two tests (you should follow the instructions on the box for when to test).

For more on how testing works, visit our testing frequently asked questions page.

When to Quarantine or Isolate

You may need to quarantine or isolate prior to taking your test and after receiving your results. This will depend on your vaccination status and whether you're showing symptoms. The latest CDC guidance breaks this down by scenario. You can also follow our guide for people who are symptomatic and/or exposed to COVID-19.

Follow-Up

Stay home as much as possible if you have symptoms. If you test positive for COVID-19, the good news is there are steps you can take to help keep yourself and others safe. Further information can be found here: What to do if you test positive.

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People who purchase over-the-counter test kits and receive a positive result should call the state COVID-19 hotline, 1-800-525-0127 then press # (press 7 for Spanish), as soon as they receive results. The hotline is available Monday from 6 a.m. to 10 p.m., and Tuesday to Sunday (and observed holidays) 6 a.m.

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K-12 Requirements and Guidance for COVID

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K-12 Requirements and Guidance for COVID

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Gmail is email that's intuitive, efficient, and useful. 15 GB of storage, less spam, and mobile access.

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Centers for Disease Control and Prevention

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Self-Checker

Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

What to Do if a Student Becomes Sick or Reports a New COVID-19 Diagnosis at School1

Student(s) shows signs of infectious illness consistent with COVID-19.2

Teacher or staff excuses student(s) from classroom, cohort or area within the school. Alert the COVID-19 POC. If masking is not required at the school, provide student with mask as soon as possible.

COVID-19 POC takes student(s) to isolation room/area and ensures student(s) is properly supervised and masked. The parent, guardian, or caregiver is called. Arrangements are made for student(s) to either go home or seek emergency medical attention3. Note: If multiple ill students must be placed in the same isolation room/area, ensure mask use and stay at least 6 feet apart while supervised.

Parent, guardian, or caregiver picks up student(s). Parent, guardian, or caregiver contacts healthcare provider for evaluation and possible COVID-19 test. Note: If a school does not have a routine screening testing program, the ability to do rapid testing on site could facilitate COVID-19 diagnosis and inform the need for quarantine of close contacts and isolation.

Clean and disinfect areas that the ill student(s) occupied. Ventilate the area(s), wait as long as possible before cleaning to let virus particles settle (at least several hours), and use personal protective equipment (including any protection needed for the cleaning and disinfection products) to reduce risk of infection.

Student negative COVID-19 test result.4

Student(s) return to school following existing school illness management policies.

Student positive COVID-19 test result.

Student(s) found to have COVID-19 and begins home isolation.

COVID-19 POC starts a list of close contacts of the ill student(s) and informs staff, parents, guardians, or caregivers of close contacts of possible exposure5.

COVID-19 POC works with local health officials to assess spread and support follow up with staff, parents, guardians, or caregivers of student(s) that had contact with the ill student(s).6

Parents, guardians, or caregivers of close contacts are advised to keep their children home (quarantine according to local health department requirements) and to consult with the student(s)' healthcare provider for evaluation and possible COVID-19 test7.

Members of the ill student(s)' household and staff who had close contact with the student are advised to quarantine according to local health department requirements7.

The ill student(s) can return to school and end isolation once the following are met:

10 days out from the start of the symptoms, AND

Fever free for 24 hours without fever reducing medication, AND

Symptoms have improved.

Footnotes
Note: COVID-19 POC = the designated point of contact (a staff person that is responsible for responding to COVID-19 concerns, such as director)

¹ Scenario based on geographic area with community transmission of SARS-COV-2, the virus that causes COVID-19.

² The most common symptoms of COVID-19 in children include fever or chills, cough, nasal congestion or runny nose, new loss of taste or smell, shortness of breath or difficulty breathing, diarrhea or vomiting, stomachache, tiredness, headache, muscle or body aches, and poor appetite or poor feeding (especially in babies under 1 year old).

³ Schools that do not have a universal mask requirement could require masking by students, teachers, and staff if they are experiencing onset of upper respiratory infection symptoms at school while waiting to be picked up or leave the school.

⁴ With no known close contact.

⁵ Close contact is defined as someone who was within 6 feet for a total of 15 minutes or more within 2 days prior to illness onset,regardless of whether the contact was wearing a mask. See exception in the definition for the exclusion of students in the K-12 indoor classroom: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact

⁶ To the extent allowable by applicable laws regarding privacy.

⁷ CDC guidance provides that people who are fully vaccinated and do not have COVID-19 symptoms do not need to quarantine, but should get tested after an exposure to someone with COVID-19.

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Self-Checker Important update: Healthcare facilities CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more What to Do if a Student Becomes Sick or Reports a New COVID-19 Diagnosis at School1 Student(s) shows signs of infectious illness consistent with COVID-19.2 Teacher or staff excuses student(s) from classroom, cohort or area within the school.

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The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of the Department of Health and Human Services (Secretary) to issue a PREP Act declaration. The declaration provides immunity from liability (except for willful misconduct) for claims:

of loss caused, arising out of, relating to, or resulting from administration or use of countermeasures to diseases, threats and conditions

determined by the Secretary to constitute a present, or credible risk of a future public health emergency

to entities and individuals involved in the development, manufacture, testing, distribution, administration, and use of such countermeasures

A PREP Act declaration is specifically for the purpose of providing immunity from liability, and is different from, and not dependent on, other emergency declarations.

Current Declarations

COVID-19 PREP Act Declarations

Declaration and Amendments

Advisory Opinions of the General Counsel

HHS Guidance

Guidance for National Guard Personnel Regarding COVID-19 Vaccines and Immunity under the PREP Act (December 18, 2020)

Guidance for Department of Defense Personnel, Contractors, and Volunteers Regarding COVID-19 Vaccines and Immunity under the PREP Act (February 2, 2021)

PREP Act Authorization for Pharmacies Distributing and Administering Certain Covered Countermeasures (October 29, 2020)

Guidance for PREP Act Coverage for Qualified Pharmacy Technicians and State-Authorized Pharmacy Interns for Childhood Vaccines, COVID-19 Vaccines, and COVID-19 Testing (October 20, 2020)

Guidance for Licensed Pharmacists and Pharmacy Interns Regarding COVID-19 Vaccines and Immunity under the PREP Act (September 3, 2020)

Guidance for Licensed Pharmacists, COVID-19 Testing, and Immunity under the PREP Act (April 8. 2020)

Guidance for PREP Act Coverage for COVID-19 Screening Tests at Nursing Homes, Assisted-Living Facilities, Long-Term-Care Facilities, and other Congregate Facilities (August 31, 2020)

Marburgvirus and Marburg Disease

Nerve Agents and Insecticides

Pandemic Influenza

Acute Radiation Syndrome

Botulinum Toxin

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Public Readiness and Emergency Preparedness Act

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The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of the Department of Health and Human Services (Secretary) to issue a PREP Act declaration.

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Curative Log in

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Travel Advisory

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Centers for Disease Control and Prevention

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Before You Consider Traveling

Travel increases your chance of spreading and getting COVID-19. CDC recommends that you do not travel at this time. Delay travel and stay home to protect yourself and others from COVID-19.

If you must travel, here are some important questions to ask yourself and your loved ones beforehand.

Are you, someone in your household, or someone you will be visiting at increased risk for getting very sick from COVID-19?
If you get infected you can spread the virus to loved ones during travel and when you return, even if you don't have symptoms. If your household includes one or more individuals at increased risk for severe illness, all family members should act as if they, themselves are at increased risk. Learn how to protect yourself and others.

Are hospitals in your community or your destination overwhelmed with patients who have COVID-19? To find out, check state, territorial, and local department websites.

Does your home or destination have requirements or restrictions for travelers? Check state, territorial, and local requirements before you travel.

During the 14 days before your travel, have you or those you are visiting had close contact with people they don't live with?
The following activities can put you at higher risk for COVID-19:

Going to a large social gathering like a wedding, funeral, or party.

Attending a mass gathering like a sporting event, concert, or parade.

Being in crowds like in restaurants, bars, fitness centers, or movie theaters.

Taking public transportation like planes, trains, or buses, or being in transportation hubs like airports.

Traveling on a cruise ship or riverboat.

Do your plans include traveling by bus, train, or air, which might make staying 6 feet apart difficult?

Are you traveling with people who don't live with you?

If the answer to any of these questions is "yes," you should delay your travel.
If You Must Travel

If you must travel, take these steps to protect yourself and others from COVID-19:

If you are eligible, get fully vaccinated for COVID-19. Wait 2 weeks after getting your second vaccine dose to travel-it takes time for your body to build protection after any vaccination.

Get tested with a viral test 1-3 days before you travel. Keep a copy of your test results with you during travel in case you are asked for them. Do NOT travel if you test positive.

Check travel restrictions before you go.

Wear a mask over your nose and mouth when in public settings. Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.

Avoid crowds and stay at least 6 feet/2 meters (about 2 arm lengths) from anyone who did not travel with you. It's important to do this everywhere - both indoors and outdoors.

Wash your hands often or use hand sanitizer (with at least 60% alcohol).

Bring extra supplies, such as masks and hand sanitizer.

Avoid contact with anyone who is sick.

Avoid touching your eyes, nose, and mouth.

Do NOT travel if you were exposed to COVID-19, you are sick or you test positive for COVID-19. Learn when it is safe for you to travel. Don't travel with someone who is sick.

Get Tested Before and After Travel

If you are traveling, get tested with a viral test 1-3 days before your trip. Make sure you have the results of your negative test before you travel. Keep a copy of your results with you during travel; you might be asked for them.

Do not travel if you test positive. Immediately isolate yourself, and follow public health recommendations.

Get tested again with a viral test 3-5 days after your trip and stay home and self-quarantine for a full 7 days after travel, even if your test is negative. If you don't get tested, stay home and self-quarantine for 10 days after travel.

You may have been exposed to COVID-19 on your travels. Regardless of where you traveled or what you did during your trip, take these actions to protect others from getting COVID-19 after travel:

Avoid crowds and stay at least 6 feet/2 meters (about 2 arm lengths) from anyone who did not travel with you. It's important to do this everywhere - both indoors and outdoors. Wear a mask over your nose and mouth when in public settings. Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.

If there are people in the household who did not travel with you, wear a mask and ask everyone in the household to wear masks in shared spaces inside your home for 14 days after travel.

Wash your hands often or use hand sanitizer with at least 60% alcohol.

Avoid being around people who are at increased risk for severe illness.

Watch your health: Look for symptoms of COVID-19.

Check Travel Restrictions

State, local, and territorial governments may have travel restrictions in place, including testing requirements, stay-at-home orders, and quarantine requirements upon arrival. For up-to-date information and travel guidance, check the state or territorial and local health department where you are, along your route, and where you are going. Prepare to be flexible during your trip as restrictions and policies may change during your travel. Follow all state, local, and territorial travel restrictions.

If traveling by air, check if your airline requires any health information, testing, or other documents. Local policies at your destination may require you to be tested for COVID-19. If you test positive on arrival, you may be required to isolate for a period of time.
All air passengers coming to the United States, including U.S. citizens, are required to have a negative COVID-19 test result or documentation of recovery from COVID-19 before boarding a flight to the United States. See the Frequently Asked Questions for more information. Get Tested and Stay Home After Travel
After You Travel

You may have been exposed to COVID-19 on your travels. You may feel well and not have any symptoms, but you can still spread the virus to others. You and your travel companions (including children) may pose a risk to your family, friends, and community after your travel.

Get tested with a viral test 3-5 days after travel AND stay home and self-quarantine for a full 7 days after travel.

Even if you test negative, stay home and self-quarantine for the full 7 days.

If your test is positive, isolate yourself to protect others from getting infected.

If you don't get tested, stay home and self-quarantine for 10 days after travel.

Avoid being around people who are at increased risk for severe illness for 14 days, whether you get tested or not.

Follow all state and local recommendations or requirements after travel.

Also, take these actions after you return from travel to protect others from getting COVID-19:

Avoid crowds and stay at least 6 feet/2 meters (about 2 arm lengths) from anyone who did not travel with you. It's important to do this everywhere - both indoors and outdoors.

Wear a mask over your nose and mouth when in public settings. Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.

If there are people in the household who did not travel with you, wear a mask  and ask everyone in the household to wear masks in shared spaces inside your home for 14 days after travel.

Wash your hands often or use hand sanitizer with at least 60% alcohol.

Avoid being around people who are at increased risk for severe illness.

Watch your health: Look for symptoms of COVID-19.

Considerations for Types of Travel

Travel increases your chances of spreading and getting COVID-19. Delay travel and stay home. If you must travel, consider which activities you will be doing and their risk.

The type of transportation you use, type of accommodation you stay in, and the activities you do during travel, can increase your risk of getting and spreading COVID-19. Your chances of getting or spreading COVID-19 while traveling also depend on whether you and those around you take steps to protect yourselves and others, by wearing masks, avoiding crowds, and staying 6 feet from anyone who is not traveling with you ( social distancing). Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.

Airports, bus and train stations, and rest stops are all places travelers can be exposed to the virus in the air and on surfaces. These are also places where it can be hard to social distance. In general, the longer you are around a person with COVID-19, the more likely you are to get infected.
Tips for staying overnight or hosting overnight guests
Considerations for Staying with Family or Friends

If you, someone you live with, or anyone you plan to visit is at increased risk for severe illness from COVID-19, delay travel and stay home. If you must travel, stay in a separate accommodation like a hotel, guest house, or short-stay rental.

Wear masks while in shared spaces inside the house. Masks may be removed for eating, drinking, and sleeping, but individuals from different households should stay at least 6 feet/2 meters (about 2 arms lengths) away from each other at all times.

Wash hands often with soap and water for at least 20 seconds, especially upon arrival.

Improve ventilation by opening windows and doors or by placing central air and heating on continuous circulation.

Spend time together outdoors. Take a walk or sit outdoors at least 6 feet apart for interpersonal interactions.

Avoid singing or shouting, especially indoors.

Be prepared. Know what you will do if you, a family member or friend becomes sick during the visit. Make plans for isolation, medical care, basic care, and quarantining exposed people.

Tips to avoid getting and spreading COVID-19 in common travel situations:

In public:

Wear a mask over your nose and mouth when in public Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.

Avoid crowds and stay at least 6 feet/2 meters (about 2 arm lengths) from anyone who is not traveling with you.

Bathrooms and rest stops:

Wash your hands with soap and water for at least 20 seconds after using the bathroom and after you have been in a public place.

If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

Getting gas:

Use disinfecting wipes on handles and buttons at the gas pumps before you touch them.

After fueling, use a hand sanitizer with at least 60% alcohol. When you get to your destination, wash your hands with soap and water for at least 20 seconds.

Hotels and accommodations:

Food stops:

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There are several things to consider when deciding whether it is safe for you to travel in the United States.

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Governor Proclamation

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PCR vs Antigen

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Centers for Disease Control and Prevention

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Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community

CDC is reviewing this page to align with updated guidance.

Summary of Recent Changes

Updated guidance from HHS and CDC [287 KB, 9 pages] no longer requires reporting of negative results for non-NAAT tests (rapid or antigen test results).

Reporting of positive or negative antibody test results is no longer required.

View Previous Updates

Key Points

This guidance is intended for healthcare providers who order antigen tests, receive antigen test results, or perform point-of-care testing, as well as for laboratory and testing professionals and public health practitioners who perform antigen testing and reporting in a laboratory setting or at the point-of-care.

The purpose of this guidance is to support effective clinical and public health use of antigen tests for different testing situations.

This guidance incorporates considerations for people who are up to date with their vaccines and should be used in conjunction with CDC's Stay Up to Date with Your Vaccines | CDC

This guidance focuses on the use of antigen tests to diagnose new infections. See CDC's guidance on Quarantine and Isolation for testing to end isolation.

Guidance for individuals who are performing antigen self-tests can be found on CDC's Self-Testing webpage

Antigen Testing for SARS-CoV-2

General Guidance

Antigen tests are commonly used in the diagnosis of other respiratory pathogens, including influenza viruses and respiratory syncytial virus (RSV). The U.S. Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for antigen tests that can identify SARS-CoV-2. See FDA's list of In Vitro Diagnostics EUAs.

Antigen tests are immunoassays that detect the presence of a specific viral antigen, which indicates current viral infection. Antigen tests are currently authorized to be performed on nasopharyngeal, nasal swab, or saliva specimens placed directly into the assay's extraction buffer or reagent. The currently authorized antigen tests include point-of-care, laboratory-based, and self-tests. Certain tests have age limitations; refer to FDA's website for more details. See Table 1 for additional information about antigen tests.

Antigen tests produce results quickly (within approximately 15-30 minutes), and most can be used at the point-of-care. Antigen tests for SARS-CoV-2 are generally less sensitive than real-time reverse transcription polymerase chain reaction (RT-PCR) and other nucleic acid amplification tests ( NAATs), which detect and amplify the presence of viral nucleic acid. However, NAATs may remain positive for weeks to months after initial infection and can detect levels of viral nucleic acid even when virus cannot be cultured, suggesting that the presence of viral nucleic acid may not always indicate contagiousness.

Antigen tests and NAATs (when indicated) require proper interpretation for both accurate clinical management of people with suspected COVID-19, and for identification of people with infection when used for screening.

The clinical performance of diagnostic tests largely depends on the circumstances in which they are used. Both antigen tests and NAATs perform best if the person is tested when they are symptomatic. Although antigen tests generally have lower sensitivity compared to NAATs, they can also be used to test for infection with specific attention to the context in which they are used, described below.

Antigen test performance data have helped guide the use of these tests as screening tests in asymptomatic people to detect SARS-CoV-2 infection. See FDA's recommendations for healthcare providers using SARS-CoV-2 diagnostic tests for screening asymptomatic individuals for COVID-19. Also see information from the Centers for Medicare & Medicaid Services (CMS) on the .

Antigen tests have been used for screening testing for COVID-19 in congregate settings such as nursing homes, dormitories, homeless shelters, and correctional facilities. Screening testing has quickly identified people with COVID-19, informing infection prevention and control measures, thus preventing transmission. In this case, and where rapid test turnaround time is critical, there is value in providing immediate results with antigen tests.

Healthcare providers and public health practitioners should understand test performance characteristics for interpretation of results, to recognize potentially false negative or false positive test results, and to guide additional confirmatory testing and management of the person tested. Laboratory and testing professionals who perform antigen tests should understand the factors that affect the accuracy of antigen testing, as described in this guidance. Healthcare providers, laboratory and testing professionals, and public health practitioners should also understand the differences among diagnostic, screening, and surveillance testing. See FDA's FAQs on Testing for SARS-CoV-2.

This guidance supplements and is consistent with CDC's Overview of Testing for SARS-CoV-2 and SARS-CoV-2 Point-of-Care and Rapid Testing guidance. CDC has also published guidance on SARS-CoV-2 Antigen Testing in Long Term Care Facilities, Interim Guidance for SARS-CoV-2 Testing in Correctional and Detention Facilities, Interim Guidance for SARS-CoV-2 Testing in Homeless Shelters and Encampments, and Guidance for COVID-19 Prevention in K-12 Schools.

Regulatory Requirements for Using Antigen Tests for SARS-CoV-2

FDA regulates in vitro diagnostic devices and has provided recommendations and information regarding EUA requests for COVID-19 diagnostic tests in the Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency (Revised) ("Policy for COVID-19 Tests") and the EUA templates referenced in that policy. COVID-19 tests and test systems used for diagnostic or screening testing, including those for antigen testing, must have received an EUA from FDA or be offered under the policies in FDA's Policy for COVID-19 Tests. Every antigen test for SARS-CoV-2 authorized for use by FDA is included on FDA's list of In Vitro Diagnostics EUAs. The intended use of each test, available in the Instructions for Use and in the Letter of Authorization, defines the population in which the test is intended to be used, the acceptable specimen types, and how the results should be used.

Laboratory and testing professionals who conduct diagnostic or screening testing for SARS-CoV-2 with antigen tests must also comply with Clinical Laboratory Improvement Amendments ( CLIA) regulations. Any laboratory or testing site that intends to report patient-specific test results to a person or healthcare provider must first obtain a CLIA certificate and meet all requirements to perform that testing. For more information, see CMS' . CMS has provided additional information on

Performance of Antigen Tests for SARS-CoV-2

It is important for healthcare providers and testing professionals to understand the performance characteristics, including sensitivity, specificity, and positive and negative predictive values, of the antigen test being used, and to follow the manufacturer's instructions for use, which summarize performance characteristics. See FDA's In Vitro Diagnostics EUA for detailed information about specific authorized tests.

The "gold standard" for clinical diagnostic detection of SARS-CoV-2 remains laboratory-based (moderate- and high-complexity) NAATs. Thus, providers may choose to confirm an antigen test result with a laboratory-based NAAT, especially if the result of the antigen test is inconsistent with the clinical context. Table 1 summarizes some of the differences between NAATs and antigen tests. Clinical performance of NAATs and antigen tests may differ from clinical utility when considering issues of test availability, quality of specimen collection and transport, and turnaround times of results. Based on their instructions for use, some point-of-care NAATs may not be used for confirmatory testing. NAATs that generate presumptive results are not appropriate for use in confirmatory testing.

The antigen level in specimens collected either before symptom onset, or late in the course of infection, may be below the tests' limit of detection, resulting in a false negative antigen test result, while a more sensitive test, such as most NAATs, may return a positive result. Studies have shown that antigen tests have comparable sensitivity to laboratory-based NAATs when viral load in the specimen is high and the person is likely to be most contagious.

The specificity of antigen tests is comparable to NAATs, which means that false positive test results are unlikely when an antigen test is used according to the manufacturer's instructions. Despite the high specificity of antigen tests, false positive results can occur, especially when used in situations where the pre-test probability or prevalence of infection is low - a circumstance that is true for all in vitro diagnostic tests. In general, for all diagnostic tests, the lower the prevalence of infection in the community, the higher the proportion of false positive test results.

Positive and negative predictive values of all in vitro diagnostic tests (e.g., NAAT and antigen tests) vary depending upon the pretest probability. Pretest probability considers both the prevalence of the target infection in the population that is being tested as well as the clinical context of the individual being tested. If the prevalence of infection in the community is high, the person being tested is symptomatic, and the likelihood of alternative diagnoses is low, then the pretest probability is generally considered high. If the prevalence of infection in the community is low, and the person being tested is asymptomatic and has not had close contact to a person with COVID-19, then the pretest probability is generally considered low. State health departments generally publish COVID-19 data on case rates for their communities. See CDC's Interpreting Results of Diagnostic Tests for additional information on the relationship between pretest probability and the likelihood of positive and negative predictive values.

Processing of Antigen Tests for SARS-CoV-2

The Conditions of Authorization in the antigen EUAs specify that CLIA-certified laboratories and testing sites are to follow the manufacturer's instructions for use, typically found in the package insert, when performing the test and reading test results. The authorized instructions for use for each test, including when and how to read each test, can also be found at FDA's In Vitro Diagnostics EUA. Also see FDA's, At-Home COVID-19 Diagnostic Tests: Frequently Asked Questions. All testing for SARS-CoV-2, including antigen testing, depends on the integrity of the specimen, which is affected by procedures for both specimen collection and handling. See CDC's Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19 Testing.

Quality assurance procedures should be followed to prevent cross-contamination and inaccurate test results. For more information on proper specimen processing and handling for COVID-19 testing, including point-of-care tests, see CDC's guidance on Point-of-Care Testing, and Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19).

Interpreting the Results of Antigen Testing for SARS-CoV-2

Interpreting the results of an antigen test for SARS-CoV-2 depends primarily on the clinical and epidemiological context of the person who has been tested (e.g., symptoms, close contact to others with COVID-19, setting in which they live, likelihood of alternative diagnoses, or disease prevalence in their geographic location). For additional details on testing recommendations see CDC's Overview of Testing for SARS-CoV-2. When evaluating the results of an antigen test for SARS-CoV-2 the performance characteristics (e.g., sensitivity, specificity) and the instructions for use of the FDA-authorized test, and the prevalence of SARS-CoV-2 infection in that community (number of cases in the community relative to the population size) should be considered.

The evaluation of an antigen test result should also consider whether the person has experienced symptoms, and if so for how long. Generally, healthcare providers can rely upon a positive antigen test result for a symptomatic patient because the specificity of current FDA-authorized antigen tests is high.

The sensitivity of current FDA-authorized antigen tests varies, and thus negative diagnostic testing results should be handled depending on the circumstances. In most circumstances, the manufacturers' instructions for use of antigen tests indicate that negative test results should be considered "presumptive," meaning that they are preliminary results. See FDA's In Vitro Diagnostics EUA.

It may be appropriate to confirm antigen test results with a laboratory-based NAAT, as described below. For confirmatory testing, CDC recommends using a laboratory-based NAAT that has been evaluated against the FDA reference panel for analytical sensitivity. See FDA's SARS-CoV-2 Reference Panel Comparative Data. NAATs that generate presumptive results are not appropriate for use in confirmatory testing.

CDC has developed an algorithm for community testing for people who do not live in congregate settings. The primary objective of this testing is to reduce the transmission of SARS-CoV-2 in the community, where there are concerns for introduction and widespread transmission, by quickly identifying and isolating people who are infected. See Figure 1, also available as a PDF [1 page, 105 KB] .

Additional guidance has been developed for those who live in congregate settings. In these settings, correct case identification is particularly important because of the need to group isolated people together or in close proximity, so false positive test results can have significant consequences. See additional guidance for these settings: long-term care facilities, correctional and detention facilities, homeless shelters and other group shelters, and higher education shared housing settings.

Using Antigen Tests for SARS-CoV-2 in Community Settings

Figure 1. Antigen Test Algorithm for Community Settings

¹ If testing after a suspected exposure, test 5 days after last close contact with a person with COVID-19. For those who are traveling or have recently traveled, please refer to CDC's guidance for domestic and international travel during the COVID-19 pandemic. Take precautions while traveling.

² Consider confirmatory testing with a NAAT or serial antigen testing for a negative antigen test result if the person has a higher likelihood of SARS-CoV-2 infection (e.g., in an area where the COVID-19 Community Level is high or the person has had close contact with or suspected exposure to someone infected with SARS-CoV-2 ) or if the person has symptoms of COVID-19.

³ A positive antigen test result generally does not require confirmatory testing; however, it could be considered when the person has a lower likelihood of infection (e.g., in an area where the COVID-19 Community Level is low and no known close contact with someone infected with SARS-CoV-2).

⁴ Confirmatory NAAT testing should take place as soon as possible after the antigen test, and not longer than 48 hours after the initial antigen testing. If the results are discordant, the confirmatory test result should be interpreted as definitive for the purposes of clinical diagnosis. If performing serial antigen testing, wait 24-48 hours between tests. See CDC's guidance on Quarantine and Isolation.

⁵ See CDC's guidance on treatments for COVID-19, particularly if individual is at high-risk of severe disease from COVID-19. Also see CDC's guidance on Quarantine and Isolation.

Testing a symptomatic person in a community setting

In a community setting, when testing a person who has symptoms compatible with COVID-19, the healthcare provider generally can interpret a positive antigen test to indicate that the person is infected with SARS-CoV-2; this person should follow CDC's guidance for isolation.

A positive antigen test result for a symptomatic person generally does not require confirmatory testing; however, it could be considered if the person has a lower likelihood of SARS-CoV-2 infection. Factors that might indicate a lower likelihood of infection include, living in an area where the COVID-19 Community Level is low and no known close contact with someone infected with SARS-CoV-2.

A negative antigen test result for a symptomatic person should generally be confirmed with a laboratory-based NAAT. In this case, serial antigen testing that is performed every 2-3 days while symptomatic may be used as an alternative to confirmatory NAAT testing. A negative antigen result for a symptomatic person may not need confirmatory testing if the person has a lower likelihood of SARS-CoV-2 infection (see above).

A symptomatic person who has received a negative antigen test result and then a positive confirmatory NAAT should follow CDC's guidance for isolation from the date of the first test. A symptomatic person who has received a negative antigen test result and then a negative confirmatory NAAT should be considered for alternative diagnoses and avoid close contact with others to prevent spreading illness.

Testing an asymptomatic person in a community setting

When testing an asymptomatic person in a community setting for COVID-19, the healthcare provider generally can interpret a positive antigen test to indicate that the person is infected with SARS-CoV-2; this person should follow CDC's guidance for isolation. A positive antigen test result from an asymptomatic person may need confirmatory testing if the person has a low likelihood of SARS-CoV-2 infection. For example, a low likelihood of SARS-CoV-2 infection would be a person who has had no close contact to a person with COVID-19 and resides in a community where the COVID-19 Community Leve l is low.

When testing an asymptomatic person for COVID-19, the healthcare provider can generally interpret a negative antigen test result to indicate that the SARS-CoV-2 virus was not detected. However, a negative antigen test result may need confirmatory testing with a laboratory-based NAAT if that asymptomatic person has a higher likelihood of SARS-CoV-2 infection. For example, a higher likelihood of SARS-CoV-2 infection would be a person who has had close contact or suspected exposure to a person with COVID-19.

An asymptomatic person who has received a negative antigen test result should follow CDC's guidance for quarantine if they have had close contact or suspected exposure to a person with COVID-19 and are not up to date on their vaccines.

Confirmatory Testing When Using Antigen Tests for SARS-CoV-2

As the antigen testing algorithms indicate, confirmatory testing may be needed regardless of the symptom or exposure status of the person being tested. Confirmatory testing should take place as soon as possible after the antigen test, and not longer than 48 hours after the initial antigen testing. If more than 48 hours separate the two specimen collections, or if there have been opportunities for new exposures, a laboratory-based NAAT should be considered a separate test - not a confirmation of the earlier test. If the results are discordant between the antigen test and the confirmatory NAAT, in general the confirmatory test result should be interpreted as definitive for the purpose of clinical diagnosis.

CDC recommends laboratory-based NAATs for confirmatory testing. CDC does not recommend NAATs that use oral specimens (e.g., saliva) for confirmatory testing and instead suggests the use of specimens that are considered optimal for detection, such as nasopharyngeal, nasal mid-turbinate, and anterior nasal swabs. See CDC's guidance for Nucleic Acid Amplification Tests (NAATs).

Several studies have documented persistent or intermittent detection of virus using RT-PCR after recovery; in these cases, the people did not seem to be infectious to others. Thus, if the person being tested has recently had COVID-19 and completed their period of isolation, it is possible for that person to receive a negative antigen test result and a positive confirmatory NAAT, potentially indicating a persistent detection of SARS-CoV-2 after recovery from COVID-19. For this reason, repeat testing after the initial diagnostic test is not recommended during the period of isolation or as a test of cure. See CDC's Clinical Questions about COVID-19: Questions and Answers.

If confirmatory testing is not available, clinical discretion can determine whether to recommend that the patient isolate or quarantine. See CDC's guidance on Testing in Nursing Homes, Quarantine and Isolation, Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings, Discontinuation of Transmission-Based Precautions of Patients in Healthcare Settings, Return to Work for Healthcare Personnel, Recommendations for Quarantine Duration in Correctional and Detention Facilities, and Guidance for COVID-19 Prevention in K-12 Schools.

Serial Testing When Using Antigen Tests

Depending on the circumstances and setting, it may be useful to implement serial antigen testing for persons who receive a negative antigen test result. There is evidence that serial antigen testing every few days can identify SARS-CoV-2 during early stages of infection, and thus reduce disease transmission. Serial antigen testing within a congregate living setting, such as a long-term care facility or a correctional or detention facility, could quickly identify someone with a SARS-CoV-2 infection and help to prevent further transmission. It may not be necessary to perform confirmatory testing with a NAAT when conducting serial antigen testing on those who have received a negative antigen test result.

Reporting Antigen Test Results for SARS-CoV-2 to Health Departments and Patients

A CLIA-certified laboratory or testing site must report positive antigen diagnostic test results to the local, state, tribal, or territory health department in accordance with Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act. CLIA-certified laboratory or testing sites are no longer required to report negative test results for non-NAAT tests (rapid or antigen test) or antibody test (negative or positive). Antigen test results that are reported to public health departments must be clearly distinguished from other COVID-19 tests, such as NAATs and antibody tests.

On January 8, 2021, the U.S. Department of Health and Human Services updated its published guidance on that specifies what additional data should be collected and electronically reported to health departments along with COVID-19 diagnostic or screening test results. Laboratory and testing professionals should collect and report complete patient demographic information and ensure that they report positive antigen test results using the proper LOINC code for their particular FDA-authorized tests. Facilities should refer to CDC's LOINC In Vitro Diagnostic (LIVD) Test Code Mapping for SARS-CoV-2 Tests.

A CLIA-certified laboratory or testing site must report positive antigen test results to the individual or the individual's healthcare provider according to the instructions for use of the FDA-authorized SARS-CoV-2 in vitro diagnostic device that was used. Reporting of negative results for non-NAAT tests (rapid or antigen test results) is no longer required.

For long-term care facilities that are enrolled in CDC's National Healthcare Safety Network (NHSN), the preferred method for reporting point-of-care SARS-CoV-2 testing data, including positive antigen test results, is through the NHSN.

Table 1. Summary of Some Differences Between Nucleic Acid Amplification Tests (NAATs) and Antigen Tests

* The decreased sensitivity of antigen tests might be offset if the point-of-care antigen tests are repeated more frequently (i.e., serial testing at least weekly).

^Costs for: NAATs, Antibody tests

⁺ Refers to point-of-care antigen tests only.

As of March 3, 2022

Updated information on when to consider confirmatory testing in symptomatic and asymptomatic individuals

Updated antigen testing algorithm figure

Removed general guidance for congregate settings and added links to setting-specific guidance

Removed general guidance for processing and handling SARS-CoV-2 clinical specimens and added links to guidance on quality assurance procedures

As of September 9, 2021

Updated footnotes for the Antigen Test Algorithm for Congregate Living Settings.
As of May 13, 2021

Updated guidance based on new published studies on antigen test performance.

Clarification about which nucleic acid amplification tests (NAATs) should be used for confirmatory testing.

Considerations for people who have had previous SARS-CoV-2 infections and those who have been fully vaccinated.

Two new antigen testing algorithms, one for congregate living settings, and one for community settings.

Updates to testing suggestions for fully vaccinated, asymptomatic people.

As of December 5, 2020

The word "rapid" has been deleted because FDA has authorized laboratory-based antigen tests.

New section on processing of antigen tests, reflecting what has been learned on how to minimize the risk of false results.

Revised section on evaluating the results of antigen tests, introducing a new testing algorithm, and reflecting what has been learned about the performance of antigen tests and the need to implement confirmatory testing.

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Important update: Healthcare facilities CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more Guidance for Antigen Testing for SARS-CoV-2 for Healthcare Providers Testing Individuals in the Community CDC is reviewing this page to align with updated guidance.

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Fully vaccinated

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Centers for Disease Control and Prevention

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When You've Been Fully Vaccinated

How to Protect Yourself and Others

COVID-19 vaccines are effective at protecting you from getting sick. Based on what we know about COVID-19 vaccines, people who have been fully vaccinated can start to do some things that they had stopped doing because of the pandemic.

We're still learning how vaccines will affect the spread of COVID-19. After you've been fully vaccinated against COVID-19, you should keep taking precautions in public places like wearing a mask, staying 6 feet apart from others, and avoiding crowds and poorly ventilated spaces until we know more.

Have You Been Fully Vaccinated?

People are considered fully vaccinated:

2 weeks after their second dose in a 2-dose series, like the Pfizer or Moderna vaccines, or

2 weeks after a single-dose vaccine, like Johnson & Johnson's Janssen vaccine

If it has been less than 2 weeks since your shot, or if you still need to get your second dose, you are NOT fully protected. Keep taking all prevention steps until you are fully vaccinated.

What's Changed

If you've been fully vaccinated:

You can gather indoors with fully vaccinated people without wearing a mask.

You can gather indoors with unvaccinated people from one other household (for example, visiting with relatives who all live together) without masks, unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.

If you've been around someone who has COVID-19, you do not need to stay away from others or get tested unless you have symptoms.
However, if you live in a group setting (like a correctional or detention facility or group home) and are around someone who has COVID-19, you should still stay away from others for 14 days and get tested, even if you don't have symptoms.

What Hasn't Changed

For now, if you've been fully vaccinated:

You should still take steps to protect yourself and others in many situations, like wearing a mask, staying at least 6 feet apart from others, and avoiding crowds and poorly ventilated spaces. Take these precautions whenever you are:

You should still avoid medium or large-sized gatherings.

You should still delay domestic and international travel. If you do travel, you'll still need to follow CDC requirements and recommendations.

You should still watch out for symptoms of COVID-19, especially if you've been around someone who is sick. If you have symptoms of COVID-19, you should get tested and stay home and away from others.

You will still need to follow guidance at your workplace.

What We Know and What We're Still Learning

We know that COVID-19 vaccines are effective at preventing COVID-19 disease, especially severe illness and death.
We're still learning how effective the vaccines are against variants of the virus that causes COVID-19. Early data show the vaccines may work against some variants but could be less effective against others.

We know that other prevention steps help stop the spread of COVID-19, and that these steps are still important, even as vaccines are being distributed.

We're still learning how well COVID-19 vaccines keep people from spreading the disease.

Early data show that the vaccines may help keep people from spreading COVID-19, but we are learning more as more people get vaccinated.

We're still learning how long COVID-19 vaccines can protect people.

As we know more, CDC will continue to update our recommendations for both vaccinated and unvaccinated people.

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When You've Been Fully Vaccinated How to Protect Yourself and Others COVID-19 vaccines are effective at protecting you from getting sick. Based on what we know about COVID-19 vaccines, people who have been fully vaccinated can start to do some things that they had stopped doing because of the pandemic.

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Centers for Disease Control and Prevention

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Key Things to Know About COVID-19 Vaccines

Because COVID-19 is a new disease with new vaccines, information is rapidly emerging about how vaccines can help us stop the pandemic. CDC will update this page with more information about what we know-and what we don't know-as it becomes available. Learn more facts about COVID-19 vaccines.

Currently, two vaccines are authorized and recommended to prevent COVID-19:

Learn more about the different COVID-19 vaccines.

More Information for Healthcare Professionals

Help stop the pandemic by getting vaccinated

What we know

Studies show that COVID-19 vaccines are effective at keeping you from getting COVID-19. Experts also think that getting a COVID-19 vaccine may help keep you from getting seriously ill even if you do get COVID-19.

COVID-19 vaccination is an important tool to help us get back to normal. Learn more about the benefits of getting vaccinated.

COVID-19 vaccines teach our immune systems how to recognize and fight the virus that causes COVID-19. It typically takes a few weeks after vaccination for the body to build protection (immunity) against the virus that causes COVID-19. That means it is possible a person could still get COVID-19 just after vaccination. This is because the vaccine has not had enough time to provide protection.

There are steps you can take to protect yourself until you can get vaccinated. Even after you get vaccinated it's important to continue using all the tools available to help stop this pandemic as we learn more about how COVID-19 vaccines work in real-world conditions. Even after vaccination, take steps to protect yourself and others from COVID-19.

What we do not know

Protect Yourself and others from COVID-19

Wearing a mask over your nose and mouth

Staying at least 6 feet away from others

Avoiding crowds

Avoiding poorly ventilated spaces

Washing your hands often

Although COVID-19 vaccines are effective at keeping you from getting sick, scientists are still learning how well vaccines prevent you from spreading the virus that causes COVID-19 to others, even if you do not get sick.

If you are vaccinated against COVID-19, you may still be exposed to the virus that causes COVID-19. After exposure, people can be infected with or "carry" the virus that causes COVID-19 but not feel sick or have any symptoms. Experts call this "asymptomatic infection."

For this reason, even after vaccination, we need to continue using all the tools available to help stop this pandemic as we learn more about how COVID-19 vaccines work in real-world conditions.

COVID-19 vaccines are safe

Millions of people in the United States have received COVID-19 vaccines, and these vaccines have undergone the most intensive safety monitoring in U.S. history. This monitoring includes using both established and new safety monitoring systems to make sure that COVID-19 vaccines are safe. These vaccines cannot give you COVID-19. Learn more facts about COVID-19 vaccines.

CDC has developed a new tool, v-safe, to help us quickly find any safety issues with COVID-19 vaccines. V-safe is a smartphone-based, after-vaccination health checker for people who receive COVID-19 vaccines. Learn how the federal government is working to ensure the safety of COVID-19 vaccines.

You may have side effects after vaccination, but these are normal

After COVID-19 vaccination, you may have some side effects. These are normal signs that your body is building protection. The side effects from COVID-19 vaccination, such as chills or tiredness, may affect your ability to do daily activities, and they should go away in a few days. Learn more about what to expect after getting vaccinated.

In the coming months, vaccines will become widely available

How Do I Get a Vaccine?

CDC makes recommendations for who should get the vaccine first, then each state makes its own plan.
Choose your state or territory below to find your health department:

Although the vaccine supply is currently limited, the federal government is working toward making vaccines widely available for everyone at no cost. Learn more about how COVID-19 vaccines get to you and who should get vaccinated first when supplies are limited.

The federal government is providing the vaccine free of charge to people living in the United States. However, your vaccination provider may bill your insurance company, Medicaid, or Medicare for an administration fee. Vaccination providers can be reimbursed for this by the patient's public or private insurance company or, for uninsured patients, by the Health Resources and Services Administration's Provider Relief Fund. No one can be denied a vaccine if they are unable to pay the vaccine administration fee.

In the coming months, doctors' offices, retail pharmacies, hospitals, and clinics will offer COVID-19 vaccine. Your doctor's office or local pharmacy may have contacted you with information about their vaccination plans. Use this tool to find more information on how to get vaccinated in your area:

COVID-19 vaccines and herd immunity

What we know

Herd immunity means that enough people in a community are protected from getting a disease because they've already had the disease or because they've been vaccinated. Herd immunity makes it hard for the disease to spread from person to person, and it even protects those who cannot be vaccinated, like newborns or people who are allergic to the vaccine. The percentage of people who need to have protection to achieve herd immunity varies by disease.

What we do not know

Experts do not yet know what percentage of people would need to get vaccinated to achieve herd immunity to COVID-19. CDC and other experts are studying herd immunity and will provide more information as it is available.

COVID-19 vaccines and new variants of the virus

CDC is continuing to investigate the effectiveness of COVID-19 vaccines. Scientists also are working to learn about new variants of the virus. More studies are needed to understand how new variants may affect the effectiveness of existing COVID-19 vaccines.

Our knowledge of the characteristics of new variants is rapidly growing. CDC will share updates as soon as they are available. For more information, please visit https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html.

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Key Things to Know About COVID-19 Vaccines Because COVID-19 is a new disease with new vaccines, information is rapidly emerging about how vaccines can help us stop the pandemic. CDC will update this page with more information about what we know-and what we don't know-as it becomes available.

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Published Jan. 25, 2021.

Requested actions

Be aware, on Jan. 18, Washington State Department of Health (DOH) expanded COVID-19 vaccine eligibility to Phase 1B Tier 1. DOH will expand eligibility to Tier 2 when at least 50% of people in Tier 1 have received their first dose.
Notify all patients 65 years or older they are eligible for vaccine.

Be aware, DOH's Phase Finder tool tells users if they are eligible for vaccine and where they can get it. Our COVID-19 vaccine webpage lists vaccine providers and pop-up events in Pierce County. Information on events can change quickly, and we will add and remove events accordingly. If you are referring a patient to a vaccination resource other than your office, encourage them to check our website often.

Refer medically stable patients in need of safe quarantine or isolation housing. Call (253) 820-4684, 7 a.m.-7 p.m., 7 days a week. Intake occurs 8 a.m.-4:30 p.m., 7 days a week.

Background

We are distributing and administering Moderna and Pfizer COVID-19 vaccines in Pierce County. As of Jan. 16, more than 29,000 people who live or work in Pierce County received their first dose.

Vaccine eligibility and access

Demand for vaccine is high and supplies remain limited.

DOH's Phase Finder tool is live and available in English and Spanish. The tool tells users if they are eligible to get vaccine and where they can get it. If a user isn't currently eligible, the tool can take the user's email address or phone number and notify them when they become eligible.

People currently eligible for vaccine:

Phase 1B Tier 1:

People 65 years or older.

People 50 years or older who live in multigenerational homes.

Phase 1A:

People who work in healthcare settings and can't work remotely.

Medical first responders.

People who live or work in long-term care facilities.

We encourage all healthcare providers to inform patients 65 years or older to get vaccinated. Connect patients to Phase Finder and help them navigate the online tool. DOH will also help people find vaccination resources by phone at (800) 525-0127 or (888) 856-5819.

Tier 2 will begin when at least 50% of people in Tier 1 have received their primary dose. When Tier 2 begins, to decrease barriers to vaccine delivery, DOH will allow flexibility for Phase 1B Tiers 2 through 4 for easier administration in congregate settings and workplaces.

Vaccine allocation and administration

DOH announced new requirements for vaccine providers. Beginning Jan. 18, 95% of all future primary and booster dose vaccine allocations must be administered within 7 days of receipt. Any vaccine provider with doses on hand may be required to redistribute vaccine if DOH deems the provider's rate of delivery is unsatisfactory.

Do not hold off on giving people their primary dose to save booster doses. Booster doses are allocated and ordered separately from primary doses.

Equity in vaccination administration

DOH plans prioritize certain groups to lessen COVID-19's disproportionate effects. Vaccine providers can promote equity in vaccine delivery by:

Assure onsite translation and interpretation services are available to patients.

Provide printed materials in a patient's preferred language.

Offer additional help and time for patients who may not trust vaccines and healthcare services. Consider using trusted messengers who share background and experience to help with this effort.

Reserve vaccine appointments for patients from communities COVID-19 disproportionately affects.

Vaccine costs

Patients should not pay out-of-pocket costs to get COVID-19 vaccine. Enrolled providers must give the vaccine regardless of a patient's ability to pay. Providers may bill a patient's health plan or program. Providers may not bill the patient for the balance. For details, see CDC's information on filing claims for reimbursement.

Continue to encourage testing

Especially as public focus shifts to COVID-19, it's important to encourage people to get tested if they have COVID-19 symptoms or think they have been exposed. Visit tpchd.org/gettested. The site includes drive-through and home testing options.

Additional resources

COVID-19 situation update

Today we confirmed 198 new COVID-19 cases and 3 new deaths. Our totals are 31,724 cases and 382 deaths.

We reported 3,159 cases in the last 14 days. Our 14-day case rate per 100,000 is 350.2. Our average cases per day over the last 14 days is 225.6. With the 6-day reporting lag, our case rate is 398.7 per 100,000.

Pierce County COVID-19 data continue to show significant disparities by race and ethnicity, particularly affecting American Indian, Alaska Native, Black, Latinx, and Native Hawaiian and Other Pacific Islander communities. You can see these trends on our data dashboard.

17.6% of our cases in the last 2 weeks are under age 20 (our population is 27.0%).

40.7% of our cases in the last 2 weeks are age 20-39 (our population is 27.0%).

17.0% of our total cases are age 60 or older (our population is 22.5%).

The chart below shows our new cases by day. The blue line is a 7-day rolling average to show smoother trends.

COVID-19 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. See current COVID-19 test processing times for in-state private labs below.

Patient education

Share the following materials with patients.

Immediately report COVID-19

Cases in the following people-call (253) 649-1412.

Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).

Public safety workers (e.g., law enforcement, firefighter).

Live or work in a long-term care facility, senior living center, permanent supportive housing or similar congregate setting (e.g., shelter, correctional facility) housing people at high risk for severe outcomes.

Anyone who dies with COVID-19.

Anyone with suspected MIS-C.

All other cases-call (253) 649-1413 or fax a reportable disease fax form to (253) 649-1358.

For all cases, report the race, ethnicity and preferred language of the individual.

Contacting the Health Department

Urgent issues-Call (253) 649-1412.

Non-urgent issues-Call (253) 649-1413 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient's name, date of birth and disease.

Additional resources
Print this health advisory.

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Published Jan. 25, 2021. Be aware, on Jan. 18, Washington State Department of Health (DOH) expanded COVID-19 vaccine eligibility to Phase 1B Tier 1. DOH will expand eligibility to Tier 2 when at least 50% of people in Tier 1 have received their first dose.Notify all patients 65 years or older they are eligible for vaccine.

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Centers for Disease Control and Prevention

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Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2

Summary of Recent Changes

In most circumstances, asymptomatic HCP with higher-risk exposures do not require work restriction.

Updated recommendations for testing frequency to detect potential for variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms.

Previous updates

In general, asymptomatic HCP who have had a higher-risk exposure do not require work restriction, regardless of vaccination status, if they do not develop symptoms or test positive for SARS-CoV-2.

Background

This interim guidance is intended to assist with the following:

1. Determining the duration of restriction from the workplace for HCP with SARS-CoV-2 infection.

2. Assessment of risk and application of workplace restrictions for asymptomatic HCP with exposure to SARS-CoV-2.

Guidance addressing recommended infection prevention and control practices including use of source control by HCP is available in Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Employers should be aware that other local, territorial, tribal, state, and federal requirements may apply, including those promulgated by the Occupational Safety and Health Administration (OSHA).

Evaluating Healthcare Personnel with Symptoms of SARS-CoV-2 Infection

HCP with even mild symptoms of COVID-19 should be prioritized for viral testing with nucleic acid or antigen detection assays.

When testing a person with symptoms of COVID-19, negative results from at least one viral test indicate that the person most likely does not have an active SARS-CoV-2 infection at the time the sample was collected.

If using NAAT (molecular), a single negative test is sufficient in most circumstances. If a higher level of clinical suspicion for SARS-CoV-2 infection exists, consider maintaining work restrictions and confirming with a second negative NAAT.

If using an antigen test, a negative result should be confirmed by either a negative NAAT (molecular) or second negative antigen test taken 48 hours after the first negative test.

For HCP who were initially suspected of having COVID-19 but, following evaluation, another diagnosis is suspected or confirmed, return-to-work decisions should be based on their other suspected or confirmed diagnoses.

Return to Work Criteria for HCP with SARS-CoV-2 Infection

The following are criteria to determine when HCP with SARS-CoV-2 infection could return to work and are influenced by severity of symptoms and presence of immunocompromising conditions. After returning to work, HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen. If symptoms recur (e.g., rebound) these HCP should be restricted from work and follow recommended practices to prevent transmission to others (e.g., use of well-fitting source control) until they again meet the healthcare criteria below to return to work unless an alternative diagnosis is identified.

HCP with mild to moderate illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and

At least 24 hours have passed since last fever without the use of fever-reducing medications, and

Symptoms (e.g., cough, shortness of breath) have improved.

*Either a NAAT (molecular) or antigen test may be used. If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used. If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later
HCP with severe to critical illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met: Test-based strategy HCP who are symptomatic could return to work after the following criteria are met:

At least 10 days and up to 20 days have passed since symptoms first appeared, and

At least 24 hours have passed since last fever without the use of fever-reducing medications, and

Symptoms (e.g., cough, shortness of breath) have improved.

The test-based strategy as described below for moderately to severely immunocompromised HCP can be used to inform the duration of work restriction.

HCP who are not symptomatic could return to work after the following criteria are met:
The exact criteria that determine which HCP will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered when determining the appropriate duration for specific HCP. For a summary of the literature, refer to Ending Isolation and Precautions for People with COVID-19: Interim Guidance (cdc.gov)

HCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.

Use of a test-based strategy (as described below) and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when these HCP may return to work.

Resolution of fever without the use of fever-reducing medications, and

Improvement in symptoms (e.g., cough, shortness of breath), and

Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

Return to Work Criteria for HCP Who Were Exposed to Individuals with Confirmed SARS-CoV-2 Infection

Exposures that might require testing and/or restriction from work can occur both while at work and in the community. Higher-risk exposures generally involve exposure of HCP's eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure.

Other exposures not classified as higher-risk, including having body contact with the patient (e.g., rolling the patient) without gown or gloves, may impart some risk for transmission, particularly if hand hygiene is not performed and HCP then touch their eyes, nose, or mouth. When classifying potential exposures, specific factors associated with these exposures (e.g., quality of ventilation, use of PPE and source control) should be evaluated on a case-by-case basis. These factors might raise or lower the level of risk; interventions, including restriction from work, can be adjusted based on the estimated risk for transmission.

For the purposes of this guidance, higher-risk exposures are classified as HCP who had prolonged ¹ close contact ² with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection ³ and:

HCP was not wearing a respirator (or if wearing a facemask, the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask)⁴

HCP was not wearing eye protection if the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask

HCP was not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while present in the room for an aerosol-generating procedure

Following a higher-risk exposure, HCP should:

Have a series of three viral tests for SARS-CoV-2 infection.

Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.

Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of NAAT is recommended. This is because some people may remain NAAT positive but not be infectious during this period.

Work restriction is not necessary for most asymptomatic HCP following a higher-risk exposure, regardless of vaccination status. Examples of when work restriction may be considered include:

HCP is unable to be tested or wear source control as recommended for the 10 days following their exposure;

HCP is moderately to severely immunocompromised;

HCP cares for or works on a unit with patients who are moderately to severely immunocompromised;

HCP works on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions;

If work restriction is recommended, HCP could return to work after either of the following time periods:

HCP can return to work after day 7 following the exposure (day 0) if they do not develop symptoms and all viral testing as described for asymptomatic HCP following a higher-risk exposure is negative.

If viral testing is not performed, HCP can return to work after day 10 following the exposure (day 0) if they do not develop symptoms.

In addition to above:

HCP with travel or community exposures should consult their occupational health program for guidance on need for work restrictions. In general, HCP who have had prolonged close contact with someone with SARS-CoV-2 in the community (e.g., household contacts) should be managed as described for higher-risk occupational exposures above.

Footnotes:

1. For this guidance an exposure of 15 minutes or more is considered prolonged. This could refer to a single 15-minute exposure to one infected individual or several briefer exposures to one or more infected individuals adding up to at least 15 minutes during a 24-hour period. However, the presence of extenuating factors (e.g., exposure in a confined space, performance of aerosol-generating procedure) could warrant more aggressive actions even if the cumulative duration is less than 15 minutes. For example, any duration should be considered prolonged if the exposure occurred during performance of an aerosol generating procedure.

2. For this guidance it is defined as: a) being within 6 feet of a person with confirmed SARS-CoV-2 infection or b) having unprotected direct contact with infectious secretions or excretions of the person with confirmed SARS-CoV-2 infection. Distances of more than 6 feet might also be of concern, particularly when exposures occur over long periods of time in indoor areas with poor ventilation.

3. Determining the time period when the patient, visitor, or HCP with confirmed SARS-CoV-2 infection could have been infectious:

1. For individuals with confirmed COVID-19 who developed symptoms, consider the exposure window to be 2 days before symptom onset through the time period when the individual meets criteria for discontinuation of Transmission-Based Precautions

2. For individuals with confirmed SARS-CoV-2 infection who never developed symptoms, determining the infectious period can be challenging. In these situations, collecting information about when the asymptomatic individual with SARS-CoV-2 infection may have been exposed could help inform the period when they were infectious.
If the date of exposure cannot be determined, although the infectious period could be longer, it is reasonable to use a starting point of 2 days prior to the positive test through the time period when the individual meets criteria for discontinuation of Transmission-Based Precautions for contact tracing.

4. While respirators confer a higher level of protection than facemasks and are recommended when caring for patients with SARS-CoV-2 infection, facemasks still confer some level of protection to HCP, which was factored into this risk assessment if the patient was also wearing a cloth mask or facemask

Definitions:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, dental healthcare personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.

Immunocompromised: For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the Interim Clinical Considerations for Use of COVID-19 Vaccines.

Other factors, such as end-stage renal disease, may pose a much lower degree of immunocompromise and not clearly affect decisions about need for work restriction if the HCP had close contact with someone with SARS-CoV-2 infection. However, people in this category should still consider continuing to practice physical distancing and use of source control while in a healthcare facility, even if they have received all COVID-19 vaccine doses, including booster dose, as recommended by CDC.

Ultimately, the degree of immunocompromise for the HCP is determined by the treating provider, and preventive actions are tailored to each individual and situation.

SARS-CoV-2 Illness Severity Criteria (adapted from the NIH COVID-19 Treatment Guidelines)

The studies used to inform this guidance did not clearly define "severe" or "critical" illness. This guidance has taken a conservative approach to define these categories. Although not developed to inform decisions about duration of Transmission-Based Precautions, the definitions in the National Institutes of Health (NIH) COVID-19 Treatment Guidelines are one option for defining severity of illness categories. The highest level of illness severity experienced by the patient at any point in their clinical course should be used when determining the duration of Transmission-Based Precautions.

Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.

Moderate Illness: Individuals who have evidence of lower respiratory disease, by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.

Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

In pediatric patients, radiographic abnormalities are common and, for the most part, should not be used as the sole criteria to define COVID-19 illness category. Normal values for respiratory rate also vary with age in children; thus, hypoxia should be the primary criterion to define severe illness, especially in younger children.

Fever: For the purpose of this guidance, fever is defined as subjective fever (feeling feverish) or a measured temperature of 100.0 oF (37.8 o C) or higher. Note that fever may be intermittent or may not be present in some people, such as those who are elderly, immunocompromised, or taking certain fever-reducing medications (e.g., nonsteroidal anti-inflammatory drugs [NSAIDS]).

Facemask: OSHA defines facemasks as "a surgical, medical procedure, dental, or isolation mask that is FDA-cleared, authorized by an FDA EUA, or offered or distributed as described in an FDA enforcement policy. Facemasks may also be referred to as 'medical procedure masks'." Facemasks should be used according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Other facemasks, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer's risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by CDC/NIOSH, including those intended for use in healthcare.

Cloth mask: Textile (cloth) covers that are intended primarily for source control in the community. They are not personal protective equipment (PPE) appropriate for use by healthcare personnel. Guidance on design, use, and maintenance of cloth masks is available.

Summary of Changes
As of December 23, 2021
Due to concerns about increased transmissibility of the SARS-CoV-2 Omicron variant, this guidance is being updated to enhance protection for healthcare personnel (HCP), patients, and visitors, and to address concerns about potential impacts on the healthcare system given a surge of SARS-CoV-2 infections. These updates will be refined as additional information becomes available to inform recommended actions.

Ensure that SARS-CoV-2 testing is performed with a test that is capable of detecting SARS-CoV-2, even with currently circulating variants in the United States.

Updated recommendations regarding when HCP with SARS-CoV-2 infection could return to work

The definition of higher-risk exposure was updated to include use of a facemask (instead of a respirator) by HCP if the infected patient is not also wearing a facemask or cloth mask.

Added options that would allow asymptomatic HCP with a higher-risk exposure who have not received all COVID-19 vaccine doses, including booster dose, as recommended by CDC to return to work prior to the previously recommended 14-day post-exposure period of work restriction, assuming they do not develop symptoms or test positive for SARS-CoV-2.

As of September 10, 2021
The interim guidance was updated to:

Combine information from previously posted CDC guidance addressing when healthcare personnel (HCP) with SARS-CoV-2 infection could return to work and risk assessment and work restriction for HCP with higher-risk exposure to SARS-CoV-2

Clarify the recommended intervals for testing asymptomatic HCP with a higher-risk exposure.

As of March 10, 2021

Clarified that asymptomatic HCP who are fully vaccinated and have a higher-risk exposure as described in this guidance do not need to be restricted from work; possible exceptions and additional information is available here.
As of February 16, 2021:

Clarified that work restriction of asymptomatic HCP with a higher-risk exposure who have recovered from SARS-CoV-2 infection in the prior 3 months might not be necessary. Additional information about this scenario is available here.

Clarified that work restriction of fully vaccinated HCP with a higher-risk exposure continues to be recommended. Additional information is available here.

Updates as of Dec 14, 2020:

Include a link to the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2, which provides guidance on testing potentially exposed healthcare personnel.

Clarify that, in general, healthcare personnel with travel or community-associated exposures where quarantine is recommended should be excluded from work for 14 days after their last exposure.

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asymptomatic healthcare workers during covid-19

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contact tracing of covid-19 exposed healthcare workers

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Important update: Healthcare facilities CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 Summary of Recent Changes In most circumstances, asymptomatic HCP with higher-risk exposures do not require work restriction.

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WEBSITE OF THE STATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH
Kim Malsam-Rysdon, Secretary of Health

You have tested positive and have symptoms: Isolation Calculator

If your symptoms have improved and 24 hours have elapsed without a fever without the use of medication, your last FULL day of isolation is: .

Your isolation ENDS on: .
On this date, you may resume your usual activities but should still take precautions to reduce your risk (i.e. social distancing, frequent handwashing, and wearing a mask when social distancing isn't possible).

You have tested positive but have no symptoms: Isolation Calculator

If you have no symptoms, your last FULL day of isolation is: .

Your isolation ENDS on: .
On this date, you may resume your usual activities but should still take precautions to reduce your risk (i.e. social distancing, frequent handwashing, and wearing a mask when social distancing isn't possible).

You have been identified as a close contact: Quarantine Calculator

Regardless of any negative test results you may have received during this period, your last FULL day of Quarantine is: .

Your quarantine ENDS on: .
On this date, you may resume your usual activities but should still take precautions to reduce your risk (i.e. social distancing, frequent handwashing, and wearing a mask when social distancing isn't possible).

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South Dakota's The South Dakota Department of Health (SD-DOH) continues to monitor the emergence of the novel coronavirus. We are working with the CDC and our healthcare partners across the state to prepare for and respond to a potential case.

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Centers for Disease Control and Prevention

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Infection prevention and control considerations for healthcare personnel with systemic signs and symptoms following COVID-19 vaccination

Note: Strategies are needed for healthcare facilities to appropriately evaluate and manage post-vaccination signs and symptoms among healthcare personnel (HCP). The approach described in this document is intended to reduce the risks for disruptions in care and pathogen (e.g., SARS-CoV-2) transmission resulting from:

unnecessarily excluding HCP with only post-vaccination signs and symptoms from work, and

inadvertently allowing HCP with SARS-CoV-2 or another transmissible infection to work.

These considerations are based on the current understanding of signs and symptoms following COVID-19 vaccination, including timing and duration, and might change as experience with the vaccine accumulates.

Overview

Systemic signs and symptoms, such as fever, fatigue, headache, chills, myalgia, and arthralgia, can occur following COVID-19 vaccination. Preliminary dataexternal icon from mRNA COVID-19 vaccine trials indicate that most systemic post-vaccination signs and symptoms are mild to moderate in severity, occur within the first three days of vaccination (the day of vaccination and following two days, with most occurring the day after vaccination), resolve within 1-2 days of onset, and are more frequent and severe following the second dose and among younger persons compared to those who are older (>55 years). Cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell are not consistent with post-vaccination symptoms, and instead may be symptoms of SARS-CoV-2 or another infection.

Because systemic post-vaccination signs and symptoms might be challenging to distinguish from signs and symptoms of COVID-19 or other infectious diseases, HCP with postvaccination signs and symptoms could be mistakenly considered infectious and restricted from work unnecessarily; this might have negative consequences for HCP, patients, and long-term care facility residents. Hence, strategies are needed to effectively manage post-vaccination systemic signs and symptoms and limit unnecessary work restrictions.

The strategies in this document are intended for use by occupational health programs and public health officials and apply to all HCP working in healthcare settings. Because information is currently lacking on vaccine effectiveness in the general population; the resultant reduction in disease, severity, or transmission; or the duration of protection, vaccinated HCP should continue to follow all current infection prevention and control recommendations to protect themselves and others from SARS-CoV-2 infection.
Considerations to minimize the impact of post-vaccination systemic signs and symptoms on healthcare staffing include:

Vaccinating HCP preceding 1-2 days off, during which they are not required to be in the facility.

Staggering delivery of vaccine to HCP in the facility so that not all HCP in a single department, service, or unit are vaccinated at the same time. Staggering considerations may be more important following the second dose when systemic symptoms after vaccination, such as fever, are more likely to occur.

Informing HCP about the potential for short-term systemic signs and symptoms post-vaccination and potential options for mitigating them if symptoms arise (e.g., nonsteroidal anti-inflammatory medications or acetaminophen).

Developing a strategy to provide timely assessment of HCP with systemic signs and symptoms post-vaccination, including providing or identifying options for SARS-CoV-2 viral testing, so it is readily available if indicated. Testing should have rapid turnaround time from collection time to result reporting (< 24 to 48 hours).

Offering nonpunitive sick leave options (e.g., paid sick leave) for HCP with systemic signs and symptoms post-vaccination to remove barriers to reporting these symptoms.

Suggested approaches to evaluating and managing new-onset systemic post-vaccination signs and symptoms in HCP

The approaches described below apply to HCP who have received COVID-19 vaccination in the prior 3 days (including day of vaccination, which is considered day 1) and are not known to have had unprotected exposure to SARS-CoV-2 in a community or healthcare setting in the previous 14 days. Symptomatic HCP who are within 14 days of an unprotected exposure to SARS-CoV-2 in a community or a higher risk exposure in a healthcare setting should be excluded from work and evaluated for SARS-CoV-2 infection.

The approaches suggested in the table below should be tailored to fit the clinical and epidemiologic characteristics of each specific case. Ultimately, clinical judgement should be used to determine the likelihood of infection versus post-vaccination symptoms and the indicated clinical approach.

Positive viral (nucleic acid or antigen) tests for SARS-CoV-2, if performed, should not be attributed to the COVID-19 vaccine, as vaccination does not influence the results of these tests.

Note: The following signs and symptoms, alone, are not consistent with SARS-CoV-2 infection and should be managed per usual protocols for vaccine-related side effects:

immediate hypersensitivity reactions (e.g., urticaria, anaphylaxis)

local symptoms (e.g., pain, swelling, or redness at injection site)

Signs and symptoms unlikely to be from COVID-19 vaccination:
Presence of systemic signs and symptoms consistent with SARS-CoV-2 infection (e.g., cough, shortness of breath, rhinorrhea, sore throat, loss of taste or smell) or another infectious etiology (e.g., influenza) that are not typical for post-vaccination signs and symptoms.

Exclude from work pending evaluation for possible etiologies, including SARS-CoV-2 infection, as appropriate.

Criteria for return to work depends on the suspected or confirmed diagnosis. Information on return to work for HCP with SARS-CoV-2 infection is available here.

If performed, a negative SARS-CoV-2 antigen test in HCP who have signs and symptoms that are not typical for post-vaccination signs and symptoms should be confirmed by SARS-CoV-2 nucleic acid amplification test (NAAT). Further information on testing is available here: https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html

Signs and symptoms that may be from either COVID-19 vaccination, SARS-CoV-2 infection, or another infection:
Presence of ANY systemic signs and symptoms (e.g., fever, fatigue, headache, chills, myalgia, arthralgia) that are consistent with post-vaccination signs and symptoms, SARS-CoV-2 infection or another infectious etiology (e.g., influenza).

Fever in healthcare settings is defined as a measured temperature of 100.0 oF (37.8 o C) or higher.

Evaluate the HCP.

HCP who meet the following criteria may be considered for return to work without viral testing for SARS-CoV-2:

Feel well enough and are willing to work and

Are afebrile* and

Systemic signs and symptoms are limited only to those observed following COVID-19 vaccination (i.e., do not have other signs and symptoms of COVID-19 including cough, shortness of breath, sore throat, or change in smell or taste).

If symptomatic HCP return to work, they should be advised to contact occupational health services (or another designated individual) if symptoms are not improving or persist for more than 2 days. Pending further evaluation, they should be excluded from work and viral testing should be considered. If feasible, viral testing could be considered for symptomatic HCP earlier to increase confidence in the cause of their symptoms.

*HCP with fever should, ideally, be excluded from work pending further evaluation, including consideration for SARS-CoV-2 testing. If an infectious etiology is not suspected or confirmed as the source of their fever, they may return to work when they feel well enough.

In facilities where critical staffing shortages are anticipated or occurring, HCP with fever and systemic signs and symptoms limited only to those observed following vaccination could be considered for work if they feel well enough and are willing. These HCP should be re-evaluated, and viral testing for SARS-CoV-2 considered, if fever does not resolve within 2 days.

If performed, a negative SARS-CoV-2 antigen test in HCP who have symptoms that are limited only to those observed following COVID-19 vaccination (i.e., do not have cough, shortness of breath, sore throat, or change in smell or taste) may not require confirmatory SARS-CoV-2 NAAT testing. Additional information is available here: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html

Additional Resources:

Infection prevention and control considerations for residents of long-term care facilities with systemic signs and symptoms following COVID-19 vaccination can be found at:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/post-vaccine-considerations-residents.html

Further information on COVID-19 vaccines and recommendations can be found at:
https://www.cdc.gov/vaccines/covid-19/index.html
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html

Adverse events that occur in a recipient following COVID-19 vaccination should be reported to VAERS. Vaccination providers are required by the Food and Drug Administration to report vaccination administration errors, serious adverse events, cases of Multisystem Inflammatory Syndrome, and cases of COVID-19 that result in hospitalization or death following COVID-19 vaccination under Emergency Use Authorization. Reporting is encouraged for any other clinically significant adverse event even if it is uncertain whether the vaccine caused the event. Information on how to submit a report to VAERS is available at https://vaers.hhs.govexternal icon or by calling 1-800-822-7967.

Definitions:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

Healthcare settings refers to places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute care facilities, inpatient rehabilitation facilities, nursing homes and assisted living facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, and others.

Serious adverse event: Serious adverse events are defined as death; a life-threatening adverse event; inpatient hospitalization or prolongation of existing hospitalization; a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions; a congenital anomaly/birth defect; an important medical event that based on appropriate medical judgement may jeopardize the individual and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.

Last Updated Dec. 13, 2020

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Infection prevention and control considerations for healthcare personnel with systemic signs and symptoms following COVID-19 vaccination Note: Strategies are needed for healthcare facilities to appropriately evaluate and manage post-vaccination signs and symptoms among healthcare personnel (HCP).

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Respirator program template

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Centers for Disease Control and Prevention

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Testing during quarantine to reduce the burden; modeled outcomes

CDC scientists modeled the residual post-quarantine transmission risk, expressed as a percent of total transmission, per day of quarantine if quarantine were discontinued that day. The model ² estimated the effect of having a negative diagnostic test prior to discontinuation of quarantine as well as options without any testing, in all cases combined with daily symptom monitoring for COVID-19 illness both during quarantine and after its discontinuation through Day 14. Day 0 was defined as the day of infection*. The precise time of infection is rarely known, but in practice quarantine timing would be based on the last known or possible exposure to a person with SARS-CoV-2 infection. For testing, the model assumed that the diagnostic specimen would be collected up to 48 hours prior to the proposed end of quarantine. For example, for a modeled quarantine that would end on Day 7, the diagnostic specimen could be collected starting on Day 5 or thereafter. These estimates assume that when diagnostic testing was performed, results were available after the diagnostic specimen's collection and before the end of quarantine. The presence of any symptoms would lead to diagnostic testing and management as infected if the test result were positive.

Results are shown in the Figure and Table. Although daily monitoring for symptoms of COVID-19 illness reduced the estimated post-quarantine transmission risk, addition of diagnostic testing for a person who remained asymptomatic substantially reduced the estimated post-quarantine transmission risk, especially after Day 5. For instance, at Day 10 with symptom monitoring but without diagnostic testing, the estimated residual post-quarantine transmission risk was 1.4% (range 0.1%-10.6%). However, with the addition of diagnostic testing of a specimen collected up to 48 hours before Day 10, the estimated post-quarantine transmission risk was reduced to 0.3% (range 0.0%-2.4%) for RT-PCR testing, and 1.1% (0.1%-9.5%) for antigen testing with a test that had a diagnostic sensitivity of 70%.

* The model estimates what occurs in a person who was infected in terms of how likely they would be to infect others were quarantine discontinued.

Table. Estimated residual post-quarantine transmission risk with and without a negative diagnostic test of a specimen collected within 48 hours prior to discontinuation of quarantine on the indicated day for a person monitored daily for symptoms and who has remained asymptomatic until quarantine is discontinued as well as through Day 14. Published data were applied to model residual post-quarantine transmission risk using RT-PCR 3,4; for antigen testing, a diagnostic sensitivity of 70% was applied.

Additional modeling by groups outside of CDC have produced similar findings that align with those presented above.

Quilty and Clifford et al. (preprint pending peer review) modeled the median transmission potential averted by various quarantine strategies with and without testing. They estimated that 14 days of quarantine without testing was approximately equivalent to 7 days of quarantine when a specimen collected on the last quarantine day tests negative by RT-PCR.

Wells et al.⁶ (preprint pending peer review) estimated the post-quarantine transmission risk (PQTR) for persons who have remained asymptomatic during quarantine based on RT-PCR testing performed within 24 hours prior to the date quarantine was discontinued. With average incubation periods of 5.2 days and 8.3 days, the PQTR fell below 1% after a 5-day or 7-day quarantine, respectively.

Higher prevalence translates to greater pre-test probability that an exposed person has been infected. Modelers from the University of Utah School of Medicine estimated the post-quarantine transmission risk accordingly (unpublished data). At community prevalences of 1%, 3% and 5%, the post-quarantine transmission risk at Day 7 of quarantine were 0.25%, 0.84%, and 1.38%, respectively, with a diagnostic test that had 90% sensitivity.⁷

Adding testing at entry to quarantine

Adding testing at entry to quarantine provided little additional benefit in terms of reduction in post-quarantine transmission risk. ⁶ However, testing may be useful to identify infected persons without symptoms for contact tracing efforts, if sufficient resources allow.

1. CDC recommends the following alternative options to a 14-day quarantine:

Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.

When diagnostic testing resources are sufficient and available (see bullet 3, below), then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

2. Persons can discontinue quarantine at these time points only if the following criteria are also met:

No clinical evidence of COVID-19 has been elicited by daily symptom monitoring† during the entirety of quarantine up to the time at which quarantine is discontinued; and,

Daily symptom monitoring continues through quarantine Day 14; and,

Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions (NPIs±, a.k.a. mitigation strategies), especially. They should be advised that if any symptoms develop, they should immediately self-isolate and contact the local public health authority or their healthcare provider to report this change in clinical status.

3. Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.

4. Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.

These recommendations for quarantine options shorter than 14 days balance reduced burden against a small but non-zero risk of post-quarantine infection that is informed by new and emerging science.

† Monitoring can be conducted using any method acceptable to local public health authorities and could include self-monitoring using an approved checklist of signs and symptoms, direct contact daily by public health authorities or their designates, or automated communications systems (e.g., on-line or texting self-checkers).

± NPIs that can be practiced by individuals include the following: correct and consistent mask use, social distancing, hand and cough hygiene, environmental cleaning and disinfection, avoiding crowds, ensuring adequate indoor ventilation, and self-monitoring for symptoms of COVID-19 illness. These are also summarized here.

Persons who must quarantine together, such as households

Quarantine is intended to physically separate a person exposed to COVID-19 from others. Secondary transmission of infection is especially efficient within households. ⁸⁻¹⁰ Thus, when housing is shared (e.g., households or co-housed persons such as families, incarcerated persons, students, or military recruits), every effort should be made to physically separate the quarantined person from others such as by having the quarantined person reside alone in a separate closed room or closed area and with exclusive use of their own bathroom. When this separation is not possible, then the household members risk exposure to COVID-19 if the quarantined person develops the illness. People who are quarantined with others, as well as the person in quarantine, should take steps to prevent spread of infection within the household (e.g., NPIs, a.k.a. mitigating strategies). If the quarantined person is diagnosed with COVID-19, co-housed persons will require evaluation as contacts.

Additional considerations

Burden of additional testing: Diagnostic testing during quarantine will require capacity to produce results within a short period of time, and to report these additional results to public health authorities in a timely manner.

Equity: Public health authorities that choose to use diagnostic testing during quarantine should strive to ensure equitable access for all affected persons and communities within their jurisdictions.

Serologic testing: The utility of serologic testing to provide evidence of prior infection that would permit exclusion from quarantine has not been established and is not recommended for this purpose at this time

Monitoring and evaluation of changes to quarantine recommendations: Documented data-driven experience is critical to ensure that these options for quarantine achieve an acceptable balance of risk to benefit once operationalized. CDC strongly encourages collection of data related to the effect of the recommended changes made herein to include (but not limited to): compliance with contact tracing (e.g., engaging with public health to identify contacts), willingness and ability to complete quarantine, change in burden to public health, and observed post-quarantine transmission rates.

These recommendations are based on the best information available in November 2020 and reflect the realities of an evolving pandemic. CDC will continue to closely monitor the evolving science for information that would warrant reconsideration of these recommendations.

References

1. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review. Annals of internal medicine. 2020.10.7326/m20-3012.

2. Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Annals of internal medicine. 2020.10.7326/m20-1495.

3. Khader K, Thomas A, Hersh AL, Samore MH. Duration of quarantine and post-test risk of infection among individuals exposed to SARS-CoV-2. unpublished data shared through personal communication. 2020.

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CDC scientists modeled the residual post-quarantine transmission risk, expressed as a percent of total transmission, per day of quarantine if quarantine were discontinued that day. The model 2 estimated the effect of having a negative diagnostic test prior to discontinuation of quarantine as well as options without any testing, in all cases combined with daily symptom monitoring for COVID-19 illness both during quarantine and after its discontinuation through Day 14.

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Centers for Disease Control and Prevention

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Stay home if you might have been exposed to COVID-19

Health departments: Detailed CDC recommendations for public health agencies on the duration of quarantine can be found here.

Local public health authorities determine and establish the quarantine options for their jurisdictions. Quarantine is used to keep someone who might have been exposed to COVID-19 away from others. Quarantine helps prevent spread of disease that can occur before a person knows they are sick or if they are infected with the virus without feeling symptoms. People in quarantine should stay home, separate themselves from others, monitor their health, and follow directions from their state or local health department.

Quarantine or isolation: What's the difference?

Quarantine keeps someone who might have been exposed to the virus away from others.

Isolation keeps someone who is infected with the virus away from others, even in their home.

People who have been in close contact with someone who has COVID-19-excluding people who have had COVID-19 within the past 3 months or who are fully vaccinated.

People who have tested positive for COVID-19 within the past 3 months and recovered do not have to quarantine or get tested again as long as they do not develop new symptoms.

People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms.

People who have been in close contact with someone who has COVID-19 are not required to quarantine if they have been fully vaccinated against the disease and show no symptoms.

You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more

You provided care at home to someone who is sick with COVID-19

You had direct physical contact with the person (hugged or kissed them)

You shared eating or drinking utensils

They sneezed, coughed, or somehow got respiratory droplets on you

Stay home and monitor your health

Stay home for 14 days after your last contact with a person who has COVID-19.

Watch for fever (100.4◦F), cough, shortness of breath, or other symptoms of COVID-19

If possible, stay away from others, especially people who are at higher risk for getting very sick from COVID-19

Options to reduce quarantine

Reducing the length of quarantine may make it easier for people to quarantine by reducing the time they cannot work. A shorter quarantine period also can lessen stress on the public health system, especially when new infections are rapidly rising.

Your local public health authorities make the final decisions about how long quarantine should last, based on local conditions and needs. Follow the recommendations of your local public health department if you need to quarantine. Options they will consider include stopping quarantine

After day 10 without testing

After day 7 after receiving a negative test result (test must occur on day 5 or later)

After stopping quarantine, you should

Watch for symptoms until 14 days after exposure.

If you have symptoms, immediately self-isolate and contact your local public health authority or healthcare provider.

Wear a mask, stay at least 6 feet from others, wash your hands, avoid crowds, and take other steps to prevent the spread of COVID-19.

CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus. CDC will continue to evaluate new information and update recommendations as needed. See Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing for guidance on options to reduce quarantine.

Confirmed and suspected cases of reinfection of the virus that causes COVID-19

Cases of reinfection of COVID-19 have been reported but are rare. In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected.

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Stay home if you might have been exposed to COVID-19 Health departments: Detailed CDC recommendations for public health agencies on the duration of quarantine can be found here. Local public health authorities determine and establish the quarantine options for their jurisdictions. Quarantine is used to keep someone who might have been exposed to COVID-19 away from others.

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Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations

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Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations

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Centers for Disease Control and Prevention

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Wear a mask with the best fit, protection, and comfort for you.

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Monitoring and Evaluating Covid-19 Mitigation Strategies in K-12 Schools: Interview Guide

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Monitoring and Evaluating Covid-19 Mitigation Strategies in K-12 Schools: Interview Guide

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Centers for Disease Control and Prevention

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This interview guidepdf icon is meant to be adaptable for your local context. This tool is meant to help the interviewer obtain more in-depth information about perceptions and experiences of mitigation strategies used to reduce the spread of COVID-19 when schools are in in-person learning mode. The tool is intended for government professionals in public health or education, school district administrators, and administrators of K-12 schools who are interested in conducting their own data collection. It may also be adapted to other settings. Local Institutional Review Board (IRB) guidelines should be explored and implemented as required prior to conducting interview activities/or data collection activities. Potential interviewees could include school or school district administrators, school faculty and staff, school-age children, or parents or guardians of school-age children. Interviews can be conducted by phone, virtually, or in person (ensuring appropriate COVID-19 prevention strategies are in place).

Selecting Interview Questions

Depending on your needs and local context, you should select the questions provided in this interview guide that are most relevant to the questions you have identified and the in-depth information you are seeking from participants about their perceptions and experiences of mitigation strategies.

The tool can be adapted for these different audiences. For example, parents may not be aware of all prevention strategies implemented in their child's school so the interviewer would want to adapt this question accordingly.

The specificity of the interview guide will depend on the purpose of the interview, the sociodemographic characteristics (e.g., age, gender, race and ethnicity, education level, and income) of the interviewees, and type of interview.

Not all the interview questions are relevant for all potential interviewees. The questions might be developed or modified for different audiences and presented in separate formats.

You can add, remove, or change the interview questions below to align with the purpose of the interview and your evaluation questions, and to fit within the time allotted to conduct the interview.

Introduction and Welcome

Thank you for agreeing to participate in this [telephone, virtual, or in-person] interview. My name is [your name]. I am an [insert role] at [organization or agency name]. The purpose of this interview is to help us get feedback on the prevention strategies your school implemented to reduce the spread of COVID-19. Prevention strategies are actions that people and communities, such as, K-12 schools, can take to reduce the spread the SARS-CoV-2 virus that causes COVID-19. Some examples of these prevention strategies for COVID-19 are handwashing, physical distancing (you may have heard of social distancing) and wearing a mask.

Your experience and opinions are very important to us. We are especially interested in learning about the prevention strategies implemented at [your school district or school name], the factors that helped or didn't help your school in implementing these strategies, and how these prevention strategies may have impacted student's health (including social, behavioral, and mental) and academic achievement at your school.

The interview should take no more than [X minutes]. An interview is a guided conversation where the interviewer asks specific questions and actively listens to the interviewee. There are no right or wrong answers to these questions. Just be honest. You do not have to answer any questions that you do not feel comfortable with. [Notetaker's name] is here to take notes and keep track of time. We would like to record this interview. The recording will not be heard by anyone outside of this project. The interview is being recorded so that we can fully capture your experience and opinions.

Before we get started, I want to let you know that the information that we learn today will be compiled with other interviews into a final report. The report will include a summary of your comments and some recommendations. It may be shared with the Superintendent, other district leaders, or public health professionals. What you say is confidential, and your name or the name of others will not be used in any reporting. This interview is anonymous and confidential. "Anonymous" means that we will not be using your name and you will not be identified in our report. If, during the interview, you mention other people, we will not use their names and they will not be identified in our report either. "Confidential" means that what we say in this room should not be repeated outside of this room. The tape this interview is recorded on will be kept safely in a locked facility until it is transcribed word for word, and then it will be destroyed. May we have your permission to record this interview?
(Note to interviewer: Please obtain a yes from participant before proceeding. If participant declines permission to record but is willing to participate, the session will not be recorded; however, notes will be taken. Reassure the participant that the notes will not include their name or any other information to reveal their identity.)
Thank you. What questions do you have before we begin?

(Instruction for notetaker: begin taking notes on the interview as the interviewer asks the following questions)

I would like to give you a few minutes to think about your experiences with changes that were made in [your school district, school, or classroom] to reduce the spread of COVID-19. We'll talk about these as 'prevention strategies' (Note to interviewer: consider offering a brief overview of mitigation strategies that can help participants better understand the mitigation strategies that may be discussed and the implementation of such prevention strategies.)

Implementation of Prevention

1. What prevention strategies were implemented in [your school district, school, or classroom] to reduce or prevent the spread of COVID-19? (Notes to interviewer: prompt if don't hear anything about the following categories: masks, physical/social distancing, keeping students in a group throughout the day (cohorts or pods), screening for symptoms at home or in school, changes to meal service, washing hands or using hand sanitizer, changes to extracurricular activities including sports)

1. How were the prevention strategies implemented in [your school district, school, or classroom]?

2. When were the prevention strategies implemented in [your school district, school, or classroom]?

2. In your opinion, how well did [students, teachers, staff] follow or practice these prevention strategies?

1. In your opinion, what strategies were the easiest for [students, teachers, or staff] to implement?
What made them easy?

2. In your opinion, what strategies were the hardest for [students, teachers, or staff] to implement?
What made them hard?

3. What are your school plans for when a [student, teacher, or staff] has been diagnosed by a doctor with COVID-19 or suspected to have COVID-19?

1. Is there a designated area where students, teachers, or staff with symptoms of COVID-19 are asked to wait until they can go home?

2. Is there a number of days [students, teachers, or staff] with suspected or confirmed COVID-19 are asked to stay home from school? (Note to Interviewer: Ask the interviewee to answer the best they can.)

3. To the best of your knowledge, does the [school district or school] try to notify people who came into contact with an individual who has been diagnosed with COVID-19?

4. How did the [school district or school] communicate prevention strategies to [students, parents, teachers, and staff]?

1. What were the messages the [school district or school] communicated to [students, parents, teachers, and staff]?

2. In your opinion, were these messages helpful in communicating prevention strategies?

1. What was it about these messages that made them helpful?

2. What was it about these messages that made them not helpful?

5. What else can be done to help prevent COVID-19 in [your school district, school, or classroom]?

Next, I would like to hear about things that may have helped or hindered your ability to implement the prevention strategies in [your school district, school, or classroom] to reduce the spread of COVID-19.

Facilitators and Barriers

1. What did you find to be helpful when implementing the prevention strategies in [your school district, school, or classroom]?

2. What were the challenges that [you or your school] encountered when implementing the prevention strategies in [your school district, school, or classroom]?

1. What may have led to these challenges?

2. Were these challenges resolved? If so, how? If not, what prevented these challenges from being resolved?

3. What would have helped prevent the challenges?

3. What trainings or resources were provided to help [students, teachers, or staff] implement the prevention strategies to reduce spread of COVID-19? (Notes to interviewer: This could include technology, excused absences, etc.)

1. What resources provided by [school district or school] were most helpful?

2. What resources provided by the [school district or school] were not helpful?

3. What is missing that may have been helpful for successful implementation?

4. How did the [school district] support the implementation of the prevention strategies?

5. What changes have been made to the prevention strategies since the start of the school year?
To the best of your knowledge, what factors contributed to [your school district or school] decisions to reduce or expand COVID-19 prevention strategies over [time period; e.g., fall 2020]?

6. How well do you think [your school district, school, or classroom] did in working to prevent or reduce the spread of COVID-19?

7. What do you think [your school district, school, or classroom] could have done differently to reduce or prevent the spread of COVID-19?

Next, I would like to hear your opinions about the impact of the prevention strategies on [student, teachers, and staff] health (social, behavioral, and mental) and academic achievements.

Outcomes

1. How would you describe any impact the prevention strategies have had on reducing the spread of COVID-19 in your [school district or school] among [students, families, teachers, or staff members]?

1. How many [students, teachers, or staff] have been diagnosed by a medical professional with COVID-19 in [specify time period, e.g., fall 2020]? (Note to Interviewer: Ask the interviewee to answer the best they can.)

2. How many [students, teachers, or staff] believed they had COVID-19, but did not get a COVID-19 test? (Note to Interviewer: Ask the interviewee to answer the best they can.)

3. During the school year, were there any increases of COVID-19 among [students, teachers, or staff] who knew each other? (Note to Interviewer: Ask the interviewee to answer the best they can)

4. How many days was the school shut down [specify time period, e.g., spring or fall 2020] because of COVID-19? (Note to Interviewer: Ask the interviewee to answer the best they can.)

2. What differences did you observe in academic outcomes among students? (Notes to interviewer: This could include student grades, level of engagement in class, comprehension of the material, and other similar outcomes.)
How do you think fall 2020 academic outcomes compare with fall 2019 at the [school or classroom level]?

3. How would you describe any impact the prevention strategies have had on social health outcomes (e.g., treating others with respect or developing and maintaining friendships with peers) among [students, teachers, or staff members]?

4. How would you describe any impact the prevention strategies have had on behavioral health outcomes (e.g., bullying, fighting, or defiance of practicing prevention strategies) among [students, teachers, or staff members]?

5. How would you describe any impact the prevention strategies have had on mental health outcomes (e.g., anxiety, sadness, frustration, or anger) among [students, teachers, or staff members]?

6. How have the prevention strategies affected different populations or groups?

Lastly, I have a few more questions for you about future implementation of prevention strategies.

Recommendations

1. What are your overall suggestions for improving the implementation of prevention strategies in [your school district, school, or classroom]?

2. What advice would you give to [teachers or other schools]?

3. Do you have any other thoughts or comments you would like to share?

Closing

Thank you so much for sharing this useful information with us. Today, we have learned [summarize interview information]. I would like to remind you that any information you provided is anonymous and confidential. If you have any questions or concerns about today's interview, please contact me at [provide contact information].

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This interview guide is meant to be adaptable for your local context. This tool is meant to help the interviewer obtain more in-depth information about perceptions and experiences of mitigation strategies used to reduce the spread of COVID-19 when schools are in in-person learning mode.

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Strategies for Protecting K-12 School Staff from COVID-19

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Strategies for Protecting K-12 School Staff from COVID-19

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Centers for Disease Control and Prevention

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If a parent or a sole caregiver has COVID-19

Everyone in the home should practice everyday preventive actions. Those in the home who are sick with COVID-19 should follow CDC's guidance for what to do if you are sick and when it is safe to end your isolation.

If a child's parent or caregiver is sick with COVID-19, follow the steps below to help protect the child from infection.

Older children

The child should avoid physical contact with the sick parent or caregiver until all sick people have ended their home isolation. For the child to safely have no interaction with the parent or caregiver, the child should be old enough to legally be home alone and mature enough to care for themselves.

Younger children

If the parent or sole caregiver will be caring for the child while sick, they should contact the child's healthcare provider for advice on how to best protect the child from infection.

Young children should be supervised at all times.

If the parent or the sole caregiver is too ill to care for the child, they should see if there is a caregiver outside of the home with whom the child can stay. The caregiver should not be someone who is at higher risk for severe illness from COVID-19, as the child has likely been exposed to the virus. The caregiver will need to help the child quarantine for 14 days since they last had close contact (within 6 feet way from someone for a total of 15 minutes or more) with the sick person.

Children staying in the home with the sick parent or caregiver

If a child needs to stay in the home with you (the parent or caregiver who is sick):

Both you and the child should wear a mask while in the same room.

Note that masks should not be placed on:

Children younger than 2 years old

Anyone who has trouble breathing or is unconscious

Anyone who is incapacitated or otherwise unable to remove the mask without assistance

Wash your hands frequently with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol and rub your hands together until they are dry.

Try to stay 6 feet away from the child, if possible and if safe.

Increase ventilation by opening a window in a room that you are in.

Disinfect any items that you need to bring to the child.

Do not disinfect food that you bring to the child.

Watch for symptoms.

During this time caregivers should monitor themselves for symptoms.

Check the child's temperature twice a day and watch for symptoms of COVID-19, such as fever, cough or shortness of breath, or symptoms specific to children.*

If the child develops symptoms, call the child's healthcare provider for medical advice and follow the steps for caring for someone who is sick.

If possible, the child should stay away from people who are at higher-risk for getting very sick from COVID-19.

Children staying outside the home with a temporary caregiver

If the child will stay outside of their own home with a temporary caregiver, the new caregiver should help the child to quarantine and do the following:

The child should stay inside the caregiver's home until 14 days after their last close contact with the sick person.

Watch for symptoms.

If possible, the child should stay away from people who are at higher-risk for getting very sick from COVID-19.

The caregiver should then quarantine for 14 days after the last day the caregiver had contact with the sick child.

*COVID-19 symptoms can look different in different people. For many people, being sick with COVID-19 would be a little bit like having the flu. People can get a fever, cough, or have a hard time taking deep breaths. Most people who have gotten COVID-19 have not gotten very sick. Only a small group of people who get it have had more serious problems. More information on children and COVID-19.

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Everyone in the home should practice everyday preventive actions. Those in the home who are sick with COVID-19 should follow CDC's guidance for what to do if you are sick and when it is safe to end your isolation. If a child's parent or caregiver is sick with COVID-19, follow the steps below to help protect the child from infection.

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considerations for testing in school settings

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considerations for testing in school settings

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Centers for Disease Control and Prevention

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Interim Considerations for Testing for K-12 School Administrators and Public Health Officials

These interim considerations are based on what is currently known about COVID-19 as of the date of posting, October 11, 2020. These considerations are for testing in school settings and are intended for K-12 school administrators working in collaboration with their state, tribal, local, and territorial (STLT) public health officials. While these considerations were developed with public schools, including charter schools, in mind, private schools may also find these considerations useful.

These considerations are meant to supplement- not replace -any federal, state, tribal, territorial, or local health and safety or privacy laws, rules, regulations, and policies with which schools must comply. The decision to implement testing in schools should be guided by what is feasible, practical, and acceptable. If antigen testing is used, it should be tailored to each community's needs.

This considerations document does not dictate the determination of payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency. U.S. Centers for Disease Control and Prevention (CDC) has no regulatory authority over testing; therefore, this document is intended to assist STLT public health officials and K-12 school officials in making decisions rather than establishing any regulatory requirements.

CDC will update these considerations as needed and as additional information becomes available. Please check CDC website periodically for updated interim guidance.

Revisions made on October 21, 2020

Added links to the updated close contact definition.

Updated language to align with updated definition.

With the increased availability of tests, these considerations are intended to provide guidance on the appropriate use of testing for SARS-CoV-2 (the virus that causes COVID-19) in K-12 schools for surveillance, diagnosis, screening, or outbreak response. Schools can help protect students and their families, teachers, staff, and the broader community and slow the spread of COVID-19. Testing to diagnose COVID-19 is part of a comprehensive strategy and should be used in conjunction with promoting behaviors that reduce spread (e.g., mask use, social distancing, hand hygiene); maintaining healthy environments (e.g., cleaning and disinfection, ventilation); maintaining healthy operations (e.g., scheduling, virtual learning, class sizes); and preparing for when someone gets sick. If an outbreak occurs, schools should immediately notify STLT public health officials. STLT officials will then work closely with school administrators to scale up testing, identify contacts and initiate contact tracing, and determine who will need to be quarantined and isolated.

Schools should work with STLT public health officials to decide and how to use testing. K-12 schools operated by the federal government (e.g., for Department of Defense Education Activity (DoDEA), which operates K-12 schools for DoD Dependents) should collaborate with federal health officials. In addition to state and local laws, school administrators should follow guidance from the Equal Employment Opportunity Commissionexternal icon when offering testing to faculty, staff, and students who are employed by the K-12 school. Schools also should follow guidance from the U.S. Department of Education on the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA)external icon and FERPA and COVID-19external icon and their applicability to students and COVID-19 contact tracing and testing.

Types of tests to identify SARS-CoV-2, the virus that causes COVID-19

Table 1 summarizes the main types and characteristics of tests used to diagnose current SARS-CoV-2 infection, the virus that causes COVID-19. Additional information can be found on CDC's SARS-CoV-2 testing pages. Throughout this document, "testing" refers to viral testing for potential infection. Tests used to show past SARS-CoV-2 infection (i.e., antibody tests) are not included in this document. CDC does not currently recommend using antibody testing as the sole basis for diagnosis of current infection. For more information the Food and Drug Administration (FDA) has provided FAQs on testing for COVID-19external icon .

How is the sample taken?

Nasal or throat swab (most tests); saliva or sputum test (a few tests)

Nasal or throat swab

What does it test?

Diagnose current SARS-CoV-2 infection by detecting viral genetic material (Nucleic acid amplification tests (NAAT), including real-time reverse-transcriptase Polymerase chain reaction (RT-PCR).

Diagnose current SARS-CoV-2 infection by detecting viral proteins.

How are the results used?

Help public health officials identify and recommend isolation for people with active infection in order to minimize COVID-19 transmission.

Help public health officials identify and recommend isolation for people with active infection in order to minimize COVID-19 transmission.

Who administers test?

Nasal or throat swab can be self-collected in the company of a health professional or can be collected by a health professional. Test must be performed by trained staff in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory or point-of-care testing site operating under certificate of waiver.

Test must be administered by trained staff associated with CLIA-certified laboratory or point-of-care site that has a certificate of waiver.

Other information

Considered the gold standard for COVID-19 detection and are typically performed in a specialized laboratory. A few molecular tests have been authorized for and have data supporting use in asymptomatic individuals.

Some molecular tests can be performed at or near the point of care.

May be more likely to miss a current infection than molecular tests such as RT-PCR.

Currently, there are not enough data to know if using antigen tests is effective for people with COVID-19 who do not have symptoms.

Performed at or near the point of care.

How long does it take to get results?

1 to 3 days

Approximately 15 minutes

*Table adapted from U.S Food & Drug Administrationexternal icon Table

School-based testing should NEVER be conducted without consent from a parent or legal guardian (for minor students) or from the individual him or herself (for adults). Assent may also be considered for minor students.

When testing might be performed

Schools can play an important role in assisting public health officials in identifying teachers, staff, or students who have COVID-19 symptoms or who had recent close contact (within 6 feet for a total of 15 minutes or more) with someone with COVID-19. If the school is experiencing an outbreak, the school should immediately notify public health officials and collaborate to facilitate increased testing and contact tracing, as necessary. School administrators working in close collaboration with public health officials might choose to test students, teachers, or staff for purposes of surveillance, diagnosis, screening, or in the context of an outbreak and public health consultation.

School-based testing may be considered for:

People in a school setting who show signs or symptoms consistent with COVID-19 while at school.

Schools in a community where public health officials are recommending expanded testing on a voluntary basis including testing of a sample of asymptomatic individuals, especially in areas of moderate to high community transmission.

Public health officials may consider providing testing for people who, for example:

Have a recent known or suspected exposure to a person with laboratory-confirmed COVID-19.

Have been asked or referred to get testing by their healthcare provider or health department.

Are part of a cohort for whom testing is recommended (e.g., in the context of an outbreak).

When testing is not recommended?

If a school is implementing a testing strategy, testing should be offered on a voluntary basis. It is unethical and illegal to test someone who does not want to be tested, including students whose parents or guardians do not want them to be tested. It is not recommended to retest individuals who have tested positive and do not have symptoms for COVID-19 for up to 3 months from their last positive test. Data currently suggest that some individuals test persistently positive due to residual virus material but are unlikely to be infectious. Parents or guardians may request documentation from their health care provider to indicate the date and type of the student's most recent COVID-19 test.

Which schools and persons should be prioritized for school-based testing?

Health departments and school districts can work together to develop a strategy for prioritizing K-12 schools, depending on resources and goals, for school-based testing.

There are three levels of decision-making when it comes to selecting school-based testing:

Which schools?

Which persons in those schools?

Which strategies?

Which schools?

Schools that have opened for any in-person classes (including hybrid, which includes combination of in-person and virtual classes) can benefit from developing a testing strategy. CDC's Indicators for Dynamic School Decision-Making can be used to determine which schools may provide the best settings for school-based testing.
Schools in communities disproportionately affected or that lack access to testing
Public health officials and school administrators may consider placing a higher priority for testing in schools that serve populations experiencing a disproportionate burden of COVID-19 cases or severe disease. These may include:

Schools with moderate or large proportions of racial and ethnic groups that have experienced higher rates of COVID-19 cases relative to population size.

Schools in geographic areas with limited access to testing due to distance or lack of availability of testing.

Schools in communities with moderate, higher, and highest risk of transmission
The decision to initiate a school-based testing strategy among students, teachers, and staff should be made in consultation with the local health department. CDC recommends taking into consideration the level of community transmission and implementation of mitigation strategies when deciding on school-based testing. Testing in schools located in communities at moderate to highest risk may provide the maximum balance of testing efficiency.
Schools with an active outbreak
Classrooms or schools experiencing an active outbreak may temporarily close for in-person learning. The local health department may facilitate testing for students, teachers, and staff who are in schools with an active outbreak. The health department will also conduct contact tracing in these situations. Schools can assist by providing information to identify close contacts (e.g., class rosters, seating charts, and student emergency contact information). Health departments can use a tiered approach (Table 2) in an outbreak setting to determine which close contacts and other potentially exposed persons could be tested and either isolated or quarantined.

Which persons?

Once public health officials determine the school's risk category, public health officials working in collaboration with school administrators can prioritize which staff, teachers, and students should be offered school-based testing. Persons with symptoms for COVID-19 and close contacts of confirmed or probable COVID-19 patients should be considered the priority for testing. Asymptomatic staff, teachers and students who are not close contacts should also be considered for testing in schools where the risk of transmission is moderate to high. Table 2 shows how to prioritize testing for close contacts using a tiered approach. Schools should work collaboratively with public health officials to consider conduct testing and selection of persons for school-based testing in all levels of the suggested hierarchy.
Students, teachers, and staff with symptoms
Individuals showing symptoms of COVID-19 in schools should be prioritized for testing. People with COVID-19 can report a wide range of symptoms ranging from mild symptoms to severe illness. Symptoms may appear 2 to 14 days after exposure to the virus that causes COVID-19. Students, teachers, and staff members are encouraged to monitor themselves for symptoms. According to CDC guidance, symptoms may include:

fever or chills

cough

shortness of breath or difficulty breathing

muscle or body aches

headache

new loss of taste or smell

sore throat

congestion or runny nose

nausea or vomiting or diarrhea

Hierarchy of testing for SARS-CoV-2 testing
Hierarchy for selection of persons for testing in schools can be as follows

1. Persons with symptoms of COVID-19

2. Persons who have had contact with someone with COVID-19 (see Table 2 for defining and identifying contacts)

3. All students, faculty, and staff with possible exposure in the context of outbreak settings (as described in Table 2)

Defining and identifying close contacts
Table 2 provides an overview strategy for defining and identifying close contacts of individuals of positive COVID-19 cases. It describes tiers of criteria for determining close contacts. In collaboration with local public health officials, the definitions for tiers should be adapted to reflect the specific school setting and to be consistent with the health department's contact tracing strategies.

Tiered approach for SARS-CoV-2 testing of persons with possible exposure in the context of a school Screening for symptoms and testing of symptomatic persons should continue in addition to the additional testing outlined below.

Students, teachers, and staff in Tier, who have a known close contact (within 6 feet for a total of 15 minutes or more) with confirmed or probable COVID-19 should be tested and quarantined as soon as possible to reduce the risk of further transmission. All quarantined individuals should follow existing guidance and stay home and monitor their health for 14 days after last contact with a person who has COVID-19. If possible, stay away from others, especially people who are at higher risk for getting very sick from COVID-19.

Students, teachers, and staff in Tier 2 and Tier 3 (Table 2): Testing may be considered for these individuals based on recommendations from their healthcare provider and assessment of exposure risk or a positive symptom screen from a reputable COVID-19 screener, such as CDC's Coronavirus Self-Checker. Students, teachers, and staff in Tier 2 and Tier 3 should also be considered for testing if during contact tracing an individual is considered as a potential contact or if an individual has symptoms. When determining sequencing for testing of Tier 2 and Tier 3 individuals, schools and public health officials may consider prioritizing teachers and staff over students given the higher risk for severe disease outcomes among adults.

Tier 1 Close contacts
Highest risk of transmission*

Students, teachers, and staff who were within 6 feet apart from the individual with COVID-19 for a total of 15 minutes or more beginning 2 days before the individual with COVID-19 became symptomatic (or, for asymptomatic individuals, 2 days prior to specimen collection) until the time of isolation.** Schools should consider the following example settings in determining close contacts:

Classrooms

Lunchrooms

Athletic teams and other extracurricular activities

After-school care and other events

Tier 2
Potential contacts

Next highest risk of transmission

Students, teachers, and staff in the same classroom/cohort/pod as the person with COVID-19 who always kept 6 feet distance between persons. For example, this includes individuals in the following scenarios:

Students, teachers, or staff in the same hallway, but not sharing a classroom or bathroom.

Students who took the same bus but were farther than 6 feet apart from other riders at the same time as a person with COVID-19.

Tier 3
Potentially exposed individuals

Lowest risk of transmission

Students, teachers, and staff who shared a common space (e.g., teacher's lounge, library) and were not using the space at the same time as the person with COVID-19, but where short duration exposure to those with confirmed COVID-19 cannot be definitively ruled out. For example, this includes:

Students, teachers, and staff who are in-person at the school on a different schedule and in different rooms than the individual with confirmed COVID-19, but exposure cannot be definitively ruled out.

Which strategies?

Health departments and school districts can work together to develop a strategy for prioritizing K-12 schools, depending on resources and goals, for school-based testing. Implementation of mitigation strategies (e.g., social distancing, masks, hand hygiene, enhanced cleaning and disinfection) should be implemented with all of the various testing strategies.

Testing people with symptoms: Schools should advise teachers, staff, and students to stay home if they are sick or if they have been exposed to COVID-19. Encourage these individuals to talk to their healthcare provider about getting testing for COVID-19 in a healthcare or public health facility.

If a teacher, staff, or student becomes sick at school or reports a new COVID-19 diagnosis, schools should follow the steps of the new COVID-19 Diagnosis flowchart on what to do next. This includes notifying a student's parent or guardian, and initiating testing strategies.

In some schools, school-based healthcare professionals (e.g., school nurses) may perform COVID-19 antigen testing in school-based health centers if they receive a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiverexternal icon . It is important schools-based healthcare professionals have access to, and training on the proper use of personal protective equipment (PPE).

Not every school or school-based healthcare professional will have the resources or training to conduct testing. Public health officials should work with schools to help link students and their families, teachers, and staff to other opportunities for testing in their community.

Schools can provide options to separate students with COVID-19 symptoms or suspected or confirmed COVID-19 diagnoses by, for example, placing students in isolation room/areas until transportation can be arranged to send them home or seek emergency medical attention.

If a COVID-19 diagnosis is confirmed, schools can assist public health officials in determining which close contacts and other potentially exposed persons could be tested and either isolated for 10 days (if they have COVID-19) or quarantined for 14 days (if they are a close contact without symptoms or a negative test result; see Table 2).

Note: CDC's Coronavirus Self-Checker is an interactive clinical assessment tool that will assist individuals aged 13 years and older, and parents and caregivers of children aged 2 to 12 years, in deciding when to seek testing or medical care if they suspect they or someone they know has contracted COVID-19 or has come into close contact with someone who has COVID-19.

Testing people without symptoms who are close contacts of positive COVID-19 cases: Schools can assist by providing information, where appropriate, to identify close contacts (e.g., class rosters, seating charts, and information to facilitate outreach to contacts). CDC defines close contacts as those within 6 feet of someone with known or suspected COVID-19 for at least 15 minutes, irrespective of whether the contact was wearing a mask or PPE (see Table 3). Additional factors to consider including are proximity, the duration of exposure (longer exposure time likely increases exposure risk), and whether the exposure was to a person with symptoms (e.g., coughing likely increases exposure risk). The local health department will facilitate contact tracing and testing for close contacts in coordination with parents or guardians and schools.

All persons who are identified as close contacts need to quarantine for 14 days, even if screening test results are negative, because they can still develop COVID-19 for up to 14 days after being exposed. Quarantine helps prevent spread of disease that can occur before a person knows they are sick or if they are infected with the virus without feeling symptoms. Close contacts who are in quarantine who develop symptoms should be re-tested.

Testing of persons in an outbreak setting: Classrooms or schools may temporarily suspend in-person instruction when experiencing an active outbreak. The local health department will facilitate contact tracing and testing for schools with an active outbreak. Schools can assist by providing information to identify close contact (e.g., class rosters, seating charts, and information to facilitate outreach to contacts). Persons who are close contacts of anyone confirmed or suspected of having COVID-19 should be quarantined for 14 days from their last contact. Schools in an outbreak setting can use a tiered approach (see Table 3) to determine which close contacts and other potentially exposed persons should be tested and either isolated or quarantined.
Other testing strategies:

Repeat testing and/or expanded testing of teachers, staff, and students: In schools where the risk of transmission is moderate to high, public health officials working collaboratively with school administrators can determine the appropriateness of offering repeat testing to randomly-selected asymptomatic teachers, staff, and students at the school. Testing teachers and staff should be prioritized over students in any sampling strategy, and older students prioritized over younger students. Persons who have recovered from COVID-19 in the past 3 months should be excluded from random selection. Contact tracing should immediately begin if anyone tests positive for COVID-19. Close contacts of persons with confirmed or probable COVID-19 should be tested and either isolated for 10 days for those with COVID-19, or quarantined for 14 days.

Entry testing or universal one-time testing: It is not known if testing of all staff, teachers, and students at one point in time (referred to as entry testing or universal one-time testing) provides any additional reduction in virus transmission above the key mitigation strategies recommended for schools. Currently, CDC does not have specific recommendations for entry testing of all students, teachers, and staff. However, if infrastructure is in place, and resources are available, schools can serve as a venue for health departments to offer community-based testing to teachers, staff, students and potentially their family members.

How should schools report results of school-based testing?
Every COVID-19 testing site is required to report to the appropriate state or local health officials all diagnostic and screening tests performed. Schools that use antigen testing must apply for and receive a Clinical Laboratory Improvement Amendments (CLIA)external icon certificate of waiver, and report test results to state or local public health departments as mandated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

In addition, school administrators should notify staff, teachers, families and/or emergency contacts or legal guardians immediately of any case of COVID-19 while maintaining confidentiality in accordance with HIPAA,external icon ADAexternal icon , FERPApdf icon external icon , and other applicable laws and regulations. Notifications should be accessible for all students, faculty and staff, including those with disabilities or- limited English proficiency (e.g., through use of interpreters or translated materials).
Challenges of school-based testing
These challenges must be considered carefully and addressed as part of plans for school-based testing developed in collaboration with public health officials.
Considerations before starting ANY testing strategy

Not every school system will have the resources or training (including the CLIA certificate of waiver mentioned above) to conduct school-based antigen testing. Public health officials should work with schools to help link students and their families, teachers, and staff to other opportunities for testing in their community.

School-based testing may require a high degree of coordination and information exchange among health departments, schools, and families.

There may also be legal factors to consider with onsite school-based testing regarding who will administer the tests, how tests will be paid for, and how results will be reported. Such legal factors include local or state laws defining the services school nurses and other school-based health professionals are permitted to provide.

The benefits of school-based testing need to be weighed against the costs, inconvenience, and feasibility of such programs to both schools and families.

Antigen tests usually provide results diagnosing an active SARS-CoV-2 infection faster than molecular tests, but antigen tests have a higher chance of missing an active infection even in symptomatic individuals and confirmatory molecular testing may be recommended. Although antigen tests have not be authorized for use in asymptomatic individuals, FDA and Centers for Medicare and Medicaid Services have allowed the use of these tests in situations where a rapid result is needed.

Before implementing testing in their schools, K-12 administrators should coordinate with public health officials to ensure there is support for this approach from students, parents, teachers, and staff and to put key elements in place:

Dedicated infrastructure and resources to support school-based testing.

CLIA certificate of waiver requirements to perform school-based testing.

Mechanism to report all testing results (both positive and negative) as required by the state or local public health department.

Plans for ensuring access to confirmatory molecular testing when needed through the state and local health department because sometimes antigen tests can give false positive results that represent errors and not true infections.

Ways to obtain parental consent for minor students and assent/consent for the students themselves.

Physical space to conduct testing safely and privately.

Ability to maintain confidentiality of results and protect student privacy.

How can schools adequately plan for testing?
If these conditions are not in place, schools may consider a referral-based testing strategy in collaboration with public health officials.

School Administrators considering testing should work with public health officials to address questions related to feasibility, logistics, and ethics of school-based testing, such as the ones listed in Table 3 below.

Readiness

Does a plan for implementing school-based testing and mitigation strategies exist?

Has the school made contact with public health officials and received consultation on the plan?

Have public health official and school administrators identified needs for adequate overall infrastructure to support the activity?

Have public health officials and school administrators ensured the schools obtained a CLIA certificate waiverpdf icon external icon ?

Who will be responsible for developing a system to report both positive and negative results to the state or local public health department?

How will test results from schools be communicated to state health departments?

How many tests will be needed?

What training is needed for teachers and other school personnel regarding how to have conversations with parents about testing results?

Are school emergency contact lists up to date?

Collection of Specimens

Who will conduct the swabbing and testing?

Are there enough staff who are sufficiently trained in obtaining and storing specimens, how to protect themselves, and the proper use of personal protective equipment (PPE)?

Where will the specimen collection be performed?

When will specimens be collected?

What additional materials and supplies, including PPE, are needed? What quantities will be needed?

Where will the specimen collection and testing supplies, and collected specimens be stored, and temperature controlled?

What will be the protocols for cleaning and disinfection of the testing area and equipment?

How will used PPE and potential biohazard waste be disposed?

Ethics and Feasibility

Who will be tested and how often?

Will a testing rotation be established so that the same people are not tested every time a testing strategy randomly selects teachers, staff, or students?

Based on your supplies, how many tests can be performed over what time period?

When and how often should additional specimen collection supplies, and testing supplies and reagents, be obtained?

Consent and Harm Mitigation

What special considerations are needed to ensure students are still able to engage in learning while they are in quarantine or isolation?

What special considerations are needed for children with special healthcare needs or are immunocompromised?

What special considerations are needed for individuals with disabilities?

What special considerations are needed for individuals with limited English proficiency?

How will parent, guardian, or caregiver consent be obtained?

How will student consent or assent be obtained?

How and to whom will test results be provided?

Are multiple emergency contacts on file and current for each student?

Who will conduct contact tracing and notify people who are determined to be a close contact?

How will student and teacher privacy be addressed to minimize any potential harm?

How will stigma be addressed for students, teachers, or staff who are identified as having COVID-19 or having been tested for COVID-19?

How will potential stigma be addressed for those who choose not to be tested?

What is the emotional impact of testing on children?

How can fear of or resistance to testing be reduced?

Last Updated Oct. 21, 2020

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Communities, Schools, Workplaces, & Events

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Interim Considerations for Testing for K-12 School Administrators and Public Health Officials These interim considerations are based on what is currently known about COVID-19 as of the date of posting, October 11, 2020. These considerations are for testing in school settings and are intended for K-12 school administrators working in collaboration with their state, tribal, local, and territorial (STLT) public health officials.

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Algorithm for Isolation

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BSD COVID Protocol

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You can use this site without being registered or signing in, but registered users who sign in may have access to additional features and information. Please remember that your password is case-sensitive.

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CDC Guidelines for School  & Child Care

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Centers for Disease Control and Prevention

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See ongoing mitigation guidance and prevention and support for administrators, teachers, staff, and parents in schools and child care programs.

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Training for Public Safety Officials

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Child Care Guidance

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DOH FAQ

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Mobile testing stations are in the community so people can get tested for COVID-19. These tests are free. Identification is not required. On-site staff can help you register. Results are available in five to seven days. Complete one form for each person getting tested.
Get tested if you:
Come prepared

Experience fever, chills, cough, shortness of breath, fatigue, muscle pain, headache,
loss of taste or smell, sore throat, stuffy or runny nose, nausea, vomiting, diarrhea.

Were close to a person with COVID-19 or attended a gathering with many people.

Are in an at-risk community including: Alaska Native, American Indian, Black, Latinx, Native Hawaiian and Pacific Islands.

Results
To make the process go faster, please fill out this form in advance so you can be contacted with results. Fill out this form for the lab test. Complete both forms on your device. Print and bring the forms with you to the testing site. Complete one form for each person being tested in your group.
Other options
Test results can take five to seven business days to become available. Positive tests are prioritized for notification. If you have not heard your results after the five to seven days have gone by, call (833) 723-0490.

There are other testing options in Pierce County beyond the mobile testing stations. Tacoma-Pierce County Health Department has an updated list of additional sites where people can get tested.

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Mobile testing stations are in the community so people can get tested for COVID-19. These tests are free. Identification is not required. On-site staff can help you register. Results are available in five to seven days. Complete one form for each person getting tested.

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Dynamics for Decision Making

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Point them to our website, Washington State Department of Health and CDC.

Safe Start for schools

On Aug. 5, Governor Inslee and the Washington State Department of Health issued a report on in-person learning for K-12 students at public and private schools during the COVID-19 pandemic. It includes a decision tree for in-person learning for K-12 schools. The decision tree provides 4 metrics for school administrators and local Health Officers considering in-person instruction:

The 14-day case rate per 100,000. Moderate target range = 75 to 25 per 100,000 population. Low target range = under 25 per 100,000 population.

The trend in percent of COVID-19 tests that are positive. Target = under 5% and stable or decreasing.

The trend in new cases of COVID-19 by day. Target = stable or decreasing.

The trend in hospitalizations because of COVID-19. Target = stable or decreasing.

These metrics are essential benchmarks our community must meet. Then, the Health Officer, working with school partners, will evaluate when a gradual return to in-person education models can begin. We support school districts as they plan to implement a safe return to in-person learning for all students.

All schools to use remote learning to start year.

Read the letter we sent to school superintendents concerning this requirement. You can learn more behind the decision in our blog.

Staff may need to return to buildings for limited activities or to use equipment for remote learning. Staff who need to use school buildings should follow these general guidelines.

Back to school planning.

Parent letters.

Helpful tools for childcare.

Helpful tools for schools.

Helpful tools for parents and families.

Model and encourage healthy habits.

We can all take these steps to safeguard our health.

Wear a cloth face covering.

Wash your hands often with soap and water and for at least 20 seconds.

Avoid touching your eyes, nose or mouth with unwashed hands.

Avoid close contact with people who are sick.

Cover your coughs and sneezes.

Clean and disinfect objects and surfaces.

Stay at home and away from others if you are sick.

Get your flu shot if you haven't yet. Flu activity in the county is still elevated.

Help reduce anxiety about COVID-19.

Teach children how they can protect themselves against illness. Evidence suggests COVID-19 is generally mild in children. Those at risk for severe illness are over age 65, have health conditions or are pregnant.

Helpful tools.

Help reduce stigma.

Worry and misunderstanding can create fear and mistrust. Disease can affect anyone. Use these resources to help reduce COVID-19 stigma.

Review and update your emergency operations plan.

Update your plan to include information about COVID-19. You don't need to start from scratch-you can update your plan from 2009's H1N1 pandemic.

These tools can help shape your plan.

Include this information:

Contact information for Tacoma-Pierce County Health Department.

Options for virtual learning or a plan to make up days.

Process for sharing information with students and families.

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COVID-19 Information for Schools and Childcare

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Point them to our website, Washington State Department of Health and CDC. On Aug. 5, Governor Inslee and the Washington State Department of Health issued a report on in-person learning for K-12 students at public and private schools during the COVID-19 pandemic. It includes a decision tree for in-person learning for K-12 schools.

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Younger learners could be back in school soon.

Safe Start metrics headed in a good direction.

When we decided schools needed to begin the year with remote learning, Pierce County's COVID-19 community transmission activity did not permit a safe return to school.

Today, our case numbers and positivity rates are declining, and we are close to meeting the 4 metrics of the state's decision tree that allow phasing in of in-person learning.

Pierce County is still in the high category of the school decision tree (a case rate of more than 75 per 100,000 over a 14-day period), but we are on track to fall below that very soon.

When we enter the moderate range (25-75 cases per 100,000), expanding in-person learning to elementary students is permissible. The state requires us to report our case rate with a 6-day lag to ensure accuracy. This 6-day data lag has been a required element of reporting Safe Start metrics for movement into phases and other reopening requirements.

Other metrics also are trending positively. The test positivity rate in the county dropped from above 7% in mid-July to under 5% by mid-August. The 14-day average of new cases daily dropped from close to 100 at the beginning of August to just under 50 at the end of the month. And the percentage of hospital beds occupied daily by COVID-19 patients is close to 4% after being more than 6% in early August.

You can track our current Safe Start metrics as they apply to reopening schools at tpchd.org/covidinfoschools.

Working with partners is essential to reopening.

School districts and private schools are key partners to protect and improve the health of all people and places in Pierce County. The Health Department works directly with schools on everything from School Health Reports to tobacco prevention efforts.

Our partnership relies on strong communications, especially during the unprecedented challenges that COVID-19 has brought to our community. Throughout August, we held multiple calls with public and private school leaders.

Last week, we discussed several issues on when to reopen and how to operate safely once we stabilize in the moderate category of the decision tree. Our goal remains to reopen schools safely and to continue to drive disease rates down. We reached consensus on:

Effective immediately, schools will be permitted to offer in-person learning in small groups (five students and two adults) to younger learners and those with the highest needs.

Younger learners are those in grades K-5.

We meet with school leaders again on Sept. 3 to continue the discussion of gradual reopening. We will consider:

How should our community transition to safe in-person learning?

How long will the waiting period be between data reports and bringing back more students?

We have resources and toolkits for school leaders to use as they make decisions and communicate reopening plans.

The next couple of weeks will be crucial in reopening Pierce County schools. We will join with our partners to plan time frames and show flexibility in our partnership.

What can I do to help my child's school reopen?

Help everyone in your family stay the course with healthy habits. Be persistent even as disease rates come down.

Stay close to home.

Wear a mask when you leave home.

Limit your interactions to a small circle of friends and family.

Keep gatherings small, and outside if possible where fresh air circulates.

Stay 6 feet apart from others. Wear a mask when you cannot maintain 6 feet of space.

Get tested for COVID-19 if you are experiencing symptoms, are Black, Latinx, Native Hawaiian, Pacific Island, American Indian, Alaska Native-or have participated in any gatherings-social, civic, business, political, athletic or otherwise.

Wash your hands, cover your cough, and keep up your best hygiene and sanitation.

Especially as we head into the Labor Day holiday weekend, please plan small. We have our recent history of a huge spike after the July 4th holiday. A weekend of fun is not worth rising case counts, isolation or quarantine for many, more deaths, more hospitalizations-and a further delay of in-person learning for our kids.

Even if you and your family feel healthy, you may unwittingly contribute to disease spread if you are gathering with people from outside of your household, moving about in public places without wearing face coverings, and not remaining vigilant about hand and respiratory hygiene. You can have and spread COVID-19 to others even if you do not show symptoms.

With your help, we will make good progress to safely re-open schools for in-person learning. Learn more at tpchd.org/covidinfoschools.

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When we decided schools needed to begin the year with remote learning, Pierce County's COVID-19 community transmission activity did not permit a safe return to school. Today, our case numbers and positivity rates are declining, and we are close to meeting the 4 metrics of the state's decision tree that allow phasing in of in-person learning.

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Clarification of Decision Tree

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These common questions and answers are to help with implementation of Governor Jay Inslee's orders and L&I regulatory policy related to COVID-19 and the use of face coverings, masks and respirators. This information is being updated as new questions come in.

Businesses and workers should also use the following guidance documents for additional information on required face coverings and mask use based on the level of risk for various job tasks:

What does it mean to be "working alone"?

Someone is considered to be working alone when they're isolated from interaction with other people and have little or no expectation of in-person interruption. How often a worker is able to work alone throughout the day may vary.

Examples of working alone include:

A lone worker inside the enclosed cab of a crane or other heavy equipment, vehicle, or harvester.

A person by themselves inside an office with 4 walls and a door.

A lone worker inside of a cubicle with 4 walls (one with an opening for an entryway) that are high enough to block the breathing zone of anyone walking by, and whose work activity will not require anyone to come inside of the cubicle.

A worker by themselves outside in an agricultural field, the woods, or other open area with no anticipated contact with others.

Do fire, police, 911 dispatchers, and the like need to wear a cloth face covering while working at the desk during emergency calls?

Barriers and ventilation should be set up in the call center to provide effective separation between workstations and supervisor locations. Dispatchers do not need to wear masks while sitting in separated workstations or communicating on emergency calls.

Coverings/masks must be used when with other people, in accordance to the L&I guidance chart.

What about police? Should they wear (or not wear) cloth face coverings in a car alone, on the beat, and other situations?

As a general rule, cloth face coverings should be worn when not working alone. When interacting with the public, masks should be worn, but other public safety concerns may necessitate removing the mask for improved communication or to avoid the mask being a hazard. An individual alone in a car is permitted to not wear a facial covering. Two officers in a car is likely medium risk and a covering must be worn; other situations may need to be evaluated. Masks or face coverings are required when law enforcement officers are in a station house or other administrative building with frequent in-person interactions.

What are the requirements for workers with medical and disability issues that prevent the use of a cloth face covering or mask?

Employees with a medical or disability issue, who are requesting accommodation, must provide their employer with an accommodation statement from their medical professional specifying that a face covering or mask should not be worn due to their present health condition. Employers cannot just allow the employee to work without a mask with no other mitigations or accommodations.

Employers should assess any negative impacts that face coverings might have on employees with disabilities and make accommodations per the Americans with Disabilities Act (ADA). For example, workers communicating with people who are deaf or hard of hearing may need to temporarily unmask while staying at least 6 feet away or behind a physical barrier in order to allow for lip reading.

What COVID-19 protections are required for a speaker at a news conference, and witnesses in court trials?

Reporters, on-camera anchors/talent, speakers on camera, and witnesses at court trials may remove their cloth facial covering or mask for the time they are speaking only. A shared podium, witness stand, or equipment should not be touched without being sanitized after each person has used it. All people involved must maintain at least 6 feet of physical distancing from each other. All other workers, including camera operators, production staff, and courtroom staff, must wear masks or face coverings while not working alone.

Do workers have to wear cloth face coverings when interacting with clients while they're behind a Plexiglas barrier and are safe-distanced?

Yes. While the use of barriers is encouraged, it does not remove the requirement that workers have to wear a face covering or mask. The requirement for workers to wear face coverings or better is based on whether they're working alone.

Do workers working alone in 6-foot-high cubicles need to wear cloth face coverings?

If the cubicle has 4 walls and a door opening, and the worker can maintain social distancing, they are considered to be"working alone."With that, they do not have to wear a cloth face covering or better while in their cubicle. When workers leave their cubicles, they need to put the face covering on.

Is a barista working at a drive-through coffee stand considered working alone?

If a drive-through worker is the only person in the stand, they only have to wear a cloth face covering or better while they are interacting with customers.

Do delivery drivers working for companies such as UPS and FedEx need to wear masks?

Delivery drivers must wear masks when they may come within 6 feet of another person. No mask is required while a delivery driver is in their vehicle alone.

Do vendors delivering goods to a store need to wear a mask?

Under Governor Inslee's Safe Start directive, at a minimum all workers are required to wear a cloth facial covering unless they are working alone or are exempt because of medical reasons. Vendors entering a store to deliver supplies or stock shelves must wear a face mask while interacting with others in the store, unless they are working completely alone.

Does wearing a mask create a build-up of carbon dioxide for the person wearing it?

No. That's a myth. You can find more information at the Department of Health (DOH) web page Myths and Facts about Cloth Face Coverings.

Can workers traveling together in a vehicle be closer than 6 feet apart?

Workers traveling together in a vehicle should maintain 6 feet of social distance; however, transporting multiple workers in vehicles for up to 1 hour per trip would be a considered a medium-transmission risk when all of the following conditions are met:

Workers must be seated with at least 3-foot separation. This is measured between breathing zones, the space within about 12 inches of their mouths and noses. For example, it is okay for a worker's feet to extend under the seat of another worker as long as they are not breathing the same air.

Ventilation must be operated at full force, drawing in outside air, or all windows that can be opened should be fully open to provide as much fresh air as possible.

Vehicles must be cleaned between trips, focusing on high-touch surfaces around seating positions.

No more than 2 workers (including the driver) are allowed in a compact car. Up to 4 workers (including the driver) are allowed in larger sedans and work trucks with 2 rows of seats.

Up to 6 - 7 workers are allowed in passenger vans if the minimum 3-foot distancing can be accomplished. It is possible that the design of the vehicle or its seating systems may not allow passenger vans to carry this many people.

Workers in the medium-risk category must wear non-cloth disposables, which include dust masks; KN95 or other non-approved, foreign system, NIOSH-style filtering face-piece respirators; or non-FDA-approved procedure masks.

Using a vehicle for higher occupancy will be considered a high-transmission risk, and workers are required to wear respiratory protection. Businesses must comply with Washington Administrative Code 296-842 Respiratory Protection, which includes medical surveillance, fit testing, training, and a written program.

Can cloth face coverings or masks be removed during lunch?

Yes, but social distancing needs to be maintained.

Can cloth face coverings be laundered at home?

Yes, cloth face coverings can and should be routinely laundered at home.

Are face shields an acceptable substitute for masks or cloth face coverings?

No. Face shields provide good droplet protection for the wearer, but the purpose of using a cloth face covering or mask is to protect others. Because people can be infected and actively transmitting the virus without knowing it, coverings stop the virus at the source - the mouth and nose - from getting into the air. It prevents workers from passing the virus to other workers and customers.

Does an employer have to inform employees about COVID-19 hazards and the possibility of it being in the workplace?

Yes. If the employer is aware there is an above-normal risk of COVID-19 in their workplace, they need to inform employees of the heightened risk. A general statement will suffice.

Do firefighters have to wear masks while sleeping at the station?

No. Beds need to be 6 feet from each other, and if only bunk beds are used, the bottom bunk should be occupied.

Is a face shield with cloth covering the side and bottom edges an acceptable accommodation for workers who have a medical exemption to wearing a mask or cloth face covering?

Yes. A face shield that includes a cloth extension attached to the entire edge of the shield is an acceptable accommodation.

Are there guidelines about cloth weight for face coverings used in low- or negligible-risk settings?

No. There are no official guidelines regarding cloth weight for face masks used in low-risk settings.

What are employer requirements for providing masks?

Employers must provide employees masks free of charge. The employer must immediately replace your mask if you request it, or if it becomes contaminated, wet, dirty, damaged, or when recommended by the manufacturer.

Heat Stress and Face Coverings

Can wearing a mask while I am working and it is hot out cause me to overheat?

No, a face covering alone will not cause a person to overheat. Studies have shown that filtering facepieces such as an N95 respirator do not cause additional physiological stress to most wearers and do not contribute to heat stress. Cloth face coverings and procedural masks are typically not as restrictive as wearing an N95 mask, and so are of even less concern regarding overheating of the wearer.

When can a face shield substitute for coverings/masks for outside heat exposed workers?

While working alone.

Can workers lower their mask below the chin occasionally throughout the day while working, and what steps should workers take to stay safe?

Yes, while working alone and during cool-down breaks, as long as appropriate distance from other people is maintained.

At what temperature above 80 degrees is it appropriate to remove facial coverings and masks when exposed to the hazard of heat stress?

It is not appropriate to remove facial coverings based on the temperature. Removing facial coverings is not an effective way of reducing body temperature. Regular protective measures to control heat stress must be implemented, such as drinking plenty of water, frequent breaks in a cool area, and scheduling work during cooler parts of the day.

Disposable medical masks seem to be better tolerated for outside workers in heat. Are these better than cloth masks during heat?

Cloth face coverings are the minimum that is required for low-transmission-risk work. If the worker prefers to use disposable medical masks, that is acceptable.

Customer Mask Use

What are the minimum requirements for a business to comply with the customer mask order?

The business must post prominent customer mask policy signage at entrances, and they should be in the language of their main customer base (for example, English, Korean, English and Spanish, and so forth).

The business should take steps to engage customers to ensure face coverings are worn to protect workers and other customers, but avoid creating potentially violent situations.

Include customer masking policy and procedures in COVID-19 worker safety programs.

Designate a manager/supervisor to oversee the business's COVID-19 safety program at each facility.

Are employers required to post an employee at each entrance to check on customer masking?

No. However, each employer must decide if posting an employee at each entrance is needed to increase the effectiveness of their COVID-19 customer masking program.

Are public transportation businesses expected to enforce the customer mask order?

Yes. Public transportation providers are expected to display signs that inform riders they need to wear a face covering or mask. When riders do not wear face coverings or masks, the operator should inform the rider of the mask policy and ask that they comply. The transit business may have specific steps for operators to take, but operators should avoid actions potentially creating violent situations.

Questions?

If you have further questions regarding workplace safety, please call 1-800-4 BE SAFE ( 1-800-423-7233).

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Washington State Department of Labor & Industries

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Coronavirus (COVID-19) Common Questions Regarding Worker Face Covering and Mask Requirements

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These common questions and answers are to help with implementation of Governor Jay Inslee's orders and L&I regulatory policy related to COVID-19 and the use of face coverings, masks and respirators. This information is being updated as new questions come in.

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For Administrators

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Centers for Disease Control and Prevention

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Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

Preparing K-12 School Administrators for a Safe Return to School in Fall 2020

Schools are an important part of the infrastructure of communities and play a critical role in supporting the whole child, not just their academic achievement.

This guidance is intended to aid school administrators as they consider how to protect the health, safety, and wellbeing of students, teachers, other school staff, their families, and communities and prepare for educating students this fall.

This guidance is for K-12 school administrators who are preparing for students, teachers, and staff to return to school in fall 2020. School administrators are individuals who oversee the daily operations of K-12 schools, and may include school district superintendents, school principals, and assistant principals.
It is critical that all administrators:

Engage and encourage everyone in the school and the community to practice preventive behaviors. These are the most important actions that will support schools' safe reopening and will help them stay open.

Implement multiple SARS-CoV-2 mitigation strategies (e.g., social distancing, masks, hand hygiene, and use of cohorting).

Communicate, educate, and reinforce appropriate hygiene and social distancing practices in ways that are developmentally appropriate for students, teachers, and staff.

Integrate SARS-CoV-2 mitigation strategies into co-curricular and extracurricular activities (e.g., limiting or cancelling participation in activities where social distancing is not feasible).

Maintain healthy environments (e.g., cleaning and disinfecting frequently touched surfaces).

Make decisions that take into account the level of community transmission.

Repurpose unused or underutilized school (or community) spaces to increase classroom space and facilitate social distancing, including outside spaces, where feasible.

Develop a proactive plan for when a student or staff member tests positive for COVID-19.

Develop a plan with state and local health department to conduct case tracing in the event of a positive case.

Educate parents and caregivers on the importance of monitoring for and responding to the symptoms of COVID-19 at home.

Develop ongoing channels of communication with state and local health departments to stay updated on COVID-19 transmission and response in your local area.

The guidance described in this document is based on the best available evidence at this time. This guidance is meant to supplement-not replace-any state, local, territorial, or tribal health and safety laws, rules, and regulations with which schools must comply.

Key considerations for school administrators

COVID-19 transmission rates in the immediate community and in the communities in which students, teachers, and staff live

Approaches to cohorting that fit the needs of your school/district and community (e.g., keeping students in class pods, staggering when students return to school facility, having the same teacher stay with the same group of students)
Can unused or underutilized school spaces, including outdoor spaces, be repurposed to increase classroom space and facilitate social distancing?

Concurrently implementing multiple strategies in school to prevent the spread of COVID-19 (e.g., social distancing, masks, hand hygiene, and use of cohorting)

Best practices for your school and community to communicate, educate, and reinforce personal protective behaviors to prevent the spread of COVID-19 in school and in the community

Integrating strategies to reduce COVID-19 transmission into co-curricular and extracurricular activities (e.g., limiting participation in activities where social distancing is not feasible)

Planning and preparing for when someone gets sick

Working with state and local health authorities to develop a plan to conduct contact tracing in the event of a positive case

Communicating appropriately to families about home-based symptom screening

Critical role of schools

This guidance is intended, first and foremost, to protect the health, safety and wellbeing of students, teachers, other school staff, their families, and communities.

Schools are an important part of the infrastructure of communities, as they provide safe, supportive learning environments for students, employ teachers and other staff, and enable parents, guardians, and caregivers to work. Schools also provide critical services that help to mitigate health disparities, such as school meal programs, and social, physical, behavioral, and mental health services. School closure disrupts the delivery of these critical services to children and families, and places additional economic and psychological stress on families, which can increase the risk for family conflict and violence.

The unique and critical role that schools play makes them a priority for opening and remaining open, enabling students to receive both academic instruction and support as well as critical services. In order to prioritize opening schools safely and helping them to remain open, communities should consider adopting actions to mitigate community transmission. CDC's Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission has strategies for community mitigation to reduce or prevent the spread of COVID-19, which in turn will help schools to open and stay open safely. Recognizing the importance of providing safe, in-person learning, communities may also wish to help schools by examining whether additional public or private space, including outdoor spaces, that is currently underutilized might be safely repurposed for school and instructional purposes.

Returning to school in fall 2020 poses new challenges for schools, including implementing mitigation measures (e.g., social distancing, cleaning and disinfection, hand hygiene, use of masks), addressing social, emotional, and mental health needs of students, addressing potential learning loss, and preparing for the probability of COVID-19 cases within the broader school community.

This guidance provides information about:

What is currently known about COVID-19 among school-aged children

The importance of going back to school safely

What is currently known about SARS-CoV-2 (the virus that causes COVID-19) transmission in schools and its impact on community transmission

The ways administrators for kindergarten through grade 12 (K-12) schools can plan and prepare for in-person instruction and minimize the impact of potential closures

What is known about the signs and symptoms, burden, and transmission of SARS-CoV-2 among children?

Signs and symptoms

Common COVID-19 symptoms among children include fever, headache, sore throat, cough, fatigue, nausea/vomiting, and diarrhea. However, many children and adults infected with the virus that causes COVID-19 are asymptomatic (meaning they have no signs or symptoms of illness).

Impact of COVID-19 on children

Early reports suggest the number of COVID-19 cases among children may vary by age and other factors. Adolescents aged 10-17 may be more likely to become infected with SARS-CoV-2 than children younger than age 10, but adolescents do not appear to be at higher risk of developing severe illness. There are currently a higher proportion of COVID-19 cases among Hispanic/Latino children as compared to non-Hispanic white children. Children and adults with certain underlying medical conditions are at increased risk of severe illness from COVID-19. Severe illness means that they may require hospitalization, intensive care, or a ventilator to help them breathe, or may even die. Children with intellectual and developmental disabilities are more likely to have comorbid medical conditions (e.g., diseases of the respiratory system; endocrine, nutritional and metabolic diseases; and diseases of the circulatory system) that may put them at increased risk for severe illness from COVID-19. Although rare, some children have developed multisystem inflammatory syndrome (MIS-C) after exposure to SARS-CoV-2. As of May 20, 2020, the majority of children hospitalized with MIS-C had recovered.

Data on SARS-CoV-2 transmission among children are limited. Evidence from other countries suggests that the majority of children with COVID-19 were infected by a family member. For example, the first pediatric patients in South Korea and Vietnam were most likely from contact with an adult family member. Published reports from contact tracing of students with COVID-19 in schools from France, Australia, and Ireland suggest that students are not as likely to transmit the virus to other students compared to household contacts. However, more research is needed on SARS-CoV-2 transmission between children and household members.

What is known about how schools have reopened and the impact on SARS-CoV-2 transmission?

Internationally, schools have responded to COVID-19 using a variety of approaches. For example, China, Denmark, Norway, Singapore, and Taiwan all required temperature checks at school entry. Most countries have changed the way they operate to reduce class sizes, increase physical distance between students, and keeping students in defined groups to reduce contacts (i.e., cohorting). Furthermore, many countries have staggered attendance, start and stop times, and created alternating shifts to enable social distancing. In some places this means that only certain students have returned to schools, either by grade range or need. For example, Denmark was the first European country to reopen schools. Denmark staggered students' reentry in waves (e.g., one group started school first, followed by another group at a later date), with limited class sizes and using other social distancing measures. Younger students (under age 12) returned first based on their lower health risk and need for more supervision than older students. Class sizes were reduced to allow physical distancing. In Taiwan, students returned to school with mandatory temperature checks and use of face masks. Rather than national school closures, Taiwan relied on local decision-making to determine if classroom or school closures were needed, based on infection rates.

It is important to consider community transmission risk as schools reopen. Evidence from schools internationally suggests that school re-openings are safe in communities with low SARS-CoV-2 transmission rates. Computer simulations from Europe have suggested that school re-openings may further increase transmission risk in communities where transmission is already high. More research and evaluation is needed on the implementation of mitigation strategies (e.g., social distancing, masks, hand hygiene, and use of cohorting) used in schools to determine which strategies are the most effective. Such research would improve understanding of the impact of mitigation strategies on the risk of SARS-CoV-2 transmission in schools, and ongoing monitoring and surveillance of transmission in schools could help with timely outbreak detection and prevent wider spread.

Why is it important to open schools for in-person instruction?

While opening schools - like opening any building or facility-does pose a risk for the spread of COVID-19, there are many reasons why opening schools in the fall of 2020 for in-person instruction is important.

Schools play a critical role in the wellbeing of communities

Schools are a fundamental part of the infrastructure of communities. Schools provide safe and supportive environments, structure, and routines for children, as well as other needed support services to children and families. Schools play a vital role in the economic health of communities by employing teachers and other staff and helping parents, guardians, and caregivers work.

Schools provide critical instruction and academic support

Schools provide critical instruction and academic support that benefit students and communities in both the short- and long-term. The main role and priorities of K-12 educational institutions are to provide age-appropriate instruction and support students' academic development. Reopening schools will provide in-person instruction for students, facilitate increased communication between teachers and students, and provide students with critical academic services, including school-based tutoring, special education, and other specialized learning supports.

In-person instruction may be particularly beneficial for students with additional learning needs. Children with disabilities may not have access through virtual means to the specialized instruction, related services or additional supports required by their Individualized Education Programs (IEPs) or 504 Plans. Students may also not have access through virtual means to quality English Language Learning (ELL).

When schools are closed to in-person instruction, disparities in educational outcomes could become wider, as some families may not have capacity to fully participate in distance learning (e.g., computer and internet access issues, lack of parent, guardian, or caregiver support because of work schedules) and may rely on school-based services that support their child's academic success. The persistent achievement gaps that already existed prior to COVID-19 closures, such as disparities across income levels and racial and ethnic groups, could worsen and cause long-term effects on children's educational outcomes, health, and the economic wellbeing of families and communities. While concern over higher rates of COVID-19 among certain racial/ethnic groups may amplify consideration of closing a school that educates primarily racial minority students, there should also be consideration that these may also be the schools most heavily relied upon for students to receive other services and support, like nutrition and support services.

Schools play a critical role in supporting the whole child, not just the academic achievement of students

Social and emotional health of students can be enhanced through schools

Mental health of students can be fostered through school supports and services

Schools are an important venue for students to receive emotional and psychological support from friends, teachers, and other staff members. Lengthy school building closures can leave some students feeling isolated from important friendships and support from other caring adults. Schools also provide critical psychological, mental and behavioral health (e.g., psychological counselling, mental and behavioral assessment) services to children who may not have access to these services outside of school. School closures have limited the availability of these services. Furthermore, isolation and uncertainty about the COVID-19 pandemic can create feelings of hopelessness and anxiety while removing important sources of social support. Some students may have experienced trauma through the loss of a loved one from COVID-19. Increases in anxiety and depression may occur when students do not have the structure and routine that being in school brings to their daily lives. Finally, having opportunities to be physically active through recess and physical education can help improve students' feelings of anxiety and sadness. These physical activities should be provided regularly to students in a safe and supportive environment that includes physical distancing and strategies to reduce close contact between students.

Continuity of other special services is important for student success

Students who rely on key services, such as school food programs, special education and related services (e.g., speech and social work services, occupational therapy), and after school programs are put at greater risk for poor health and educational outcomes when school buildings are closed and they are unable to access such school health programs and services. During periods of school building closures, students had limited access to many of these critical services, potentially widening educational and health disparities and inequities.

How can K-12 schools prepare for going back to in-person instruction?

Expect cases of COVID-19 in communities

International experiences have demonstrated that even when a school carefully coordinates, plans, and prepares, cases may still occur within the community and schools. Expecting and planning for the occurrence of cases of COVID-19 in communities can help everyone be prepared for when a case or multiple cases are identified.

Coordinate, plan, and prepare

Administrators should coordinate with local public health officials to stay informed about the status of COVID-19 transmission in their community. Additionally, planning and preparing are essential steps administrators can take to safely reopen schools:

CDC's Considerations for Schools provides detailed recommendations for schools to plan and prepare to reduce the spread of COVID-19, establish healthy environments and maintain healthy operations. This guidance includes information about implementation of mitigation strategies, such as physical distancing within buses, classrooms and other areas of the school, healthy hygiene habits, cleaning and disinfection, use of masks, staggering student schedules, and planning for staff and teacher absences (e.g., back-up staffing plans).

One important strategy that administrators can consider is cohorting (or "pods"), where a group of students (and sometimes teachers) stay together throughout the school day to minimize exposure for students, teachers, and staff across the school environment. At the elementary school level, it may be easier to keep the same class together for most of the school day. In middle and high school settings, cohorting of students and teachers may be more challenging. However, strategies such as creating block schedules or keeping students separated by grade can help to keep smaller groups of students together and limit mixing. Strategies that keep smaller groups of students together can also help limit the impact of COVID-19 cases when they do occur in a school. If a student, teacher, or staff member tests positive for SARS-CoV-2, those in close contact should follow CDC quarantine guidance. This helps prevent a disruption to the rest of the school and community by limiting the exposure. Schools should have systems in place to support continuity or learning for students who need to stay home for either isolation or quarantine. This includes access to online learning, school meals, and other services. The same holds for students with additional needs, including children with a disability, that makes it difficult to adhere to mitigation strategies.

Prepare for potential COVID-19 cases and increased school community transmission

Schools should be prepared for COVID-19 cases and exposure to occur in their facilities. Collaborating with local health officials will continue to be important once students are back to school, as they can provide regular updates about the status of COVID-19 in the community and help support and maintain the health and wellbeing of students, teachers, and staff. Having a plan in place for maintaining academic instruction and ensuring students have access to special services is also critical.

Making decisions about school operations

Administrators should make decisions in collaboration with local health officials based on a number of factors, including the level of community transmission, whether cases are identified among students, teachers, or staff, what other indicators local public health officials are using to assess the status of COVID-19, and whether student, teacher, and staff cohorts are being implemented within the school.

What is the level of community transmission?

There are specific strategies schools can implement based on the level of community transmission reported by local health officials:

If there is no to minimal community transmission, reinforcing everyday preventive actions, ensuring proper ventilation within school facilities, including buses, and maintaining cleaning and disinfection practices remain important. These actions can help minimize potential exposure. Schools should also monitor absenteeism among teachers, staff, and students to identify trends and determine if absences are due to COVID-19, symptoms that led to quarantine, concerns about being in the school environment and personal health and safety, or positive test results. Anyone who tests positive for COVID-19 should stay home and self-isolate for the timeframe recommended by public health officials. Anyone who has had close contact with someone who has tested positive or is symptomatic for COVID-19 should stay home until receiving a negative result, or stay home and monitor for symptoms.

If there is minimal to moderate community transmission, schools should follow the actions listed above, and continue implementing mitigation strategies such as social distancing, use of masks, reinforcing everyday preventive actions, and maintaining cleaning and disinfection. This also can include ensuring that student and staff groupings/cohorts are as static as possible and that mixing groups of students and staff is limited.

If there is substantial, controlled transmission, significant mitigation strategies are necessary. These include following all the actions listed above and also ensuring that student and staff groupings/cohorts are as static as possible with limited mixing of student and staff groups, field trips and large gatherings and events are canceled, and communal spaces (e.g., cafeterias, media centers) are closed.

If there is substantial, uncontrolled transmission, schools should work closely with local health officials to make decisions on whether to maintain school operations. The health, safety, and wellbeing of students, teachers, staff and their families is the most important consideration in determining whether school closure is a necessary step. Communities can support schools staying open by implementing strategies that decrease a community's level of transmission. However, if community transmission levels cannot be decreased, school closure is an important consideration. Plans for virtual learning should be in place in the event of a school closure.

Did a student or staff member test positive for SARS-CoV-2?
If someone within the school community (e.g., student, teacher, staff) tested positive for SARS-CoV-2, assessing the level of risk is important to determine if, when, and for how long part or all of a school should be closed. K-12 administrators can also refer to CDC's Interim Considerations for K-12 for School Administrators for SARS-CoV-2 Testing, which provides additional information about viral diagnostic testing. A single case of COVID-19 in a school would not likely warrant closing the entire school, especially if levels of community transmission are not high. The levels of community transmission described above and the extent of close contacts of the individual who tested positive for SARS-CoV-2 should all be considered before closing. These variables should also be considered when determining how long a school, or part of the school, stays closed. If the transmission of the virus within a school is higher than that of the community, or if the school is the source of an outbreak, administrators should work collaboratively with local health officials to determine if temporary school closure is necessary. Students, teachers, and staff who test positive or had close contact of the individual who tested positive should be provided with guidance for when it is safe to discontinue self-isolation or end quarantine.

What other indicators are local public health officials using to assess the status of COVID-19? Local health officials can help inform decisions related to school operations by examining public health indicatorspdf icon that are used to determine level of community transmission and disease severity levels. For example, indicators such as healthcare capacity (e.g., staffing, ICU bed occupancy), changes in newly identified COVID-19 cases, and percentage of people testing positive for SARS-CoV-2 infections in the community might be useful to determine whether to maintain or modify school operations. These indicators are set by state, local, tribal, and territorial health and healthcare officials, and should be shared with schools for decision making.

Is a cohort approach used within the school? The level of student and staff mixing within the school should also be considered. If students are kept in cohorts to minimize mixing of students, exposure to an individual with COVID-19 may be limited to one particular cohort and not pose a broad risk to the rest of the school. Cohorts that have been in close contact with someone with COVID-19 can switch to virtual learning and stay home in accordance with CDC's guidelines for quarantine and self-isolation, and the school may remain open.

Communicate with families, staff, and other partners

When preparing to go back to school, regular communication should be used to update students, families, teachers, and staff about academic standards, meal program services, and access to other school-based essential services that students and families rely on.

Regular communication with families, staff, and other partners should include:

Updates about the status of COVID-19 in the school and community

Notification when there are COVID-19 cases in the school (when communicating about the health status of students, schools should take care to avoid disclosing personally identifiable information and should follow all applicable privacy requirements, including those of the Family Educational Rights and Privacy Act)

Explanation of what parents, students, teachers, and staff can expect when returning to school; in particular, communicating about:

Actions being taken to prevent SARS-Cov-2 transmission in buses, school buildings and facilities

Actions that families and households can take to help prevent the spread of COVID-19

Actions families can take to manage anxiety about COVID-19

Decisions about operational status, potential use of virtual learning if COVID-19 cases are identified among students, teachers, or staff, and

Guidance on caring for someone who is sick and for parents, guardians, and caregivers who are sick

Guidance on how to reduce stigma. Fear and anxiety about a disease can lead to social stigma, which is negative attitudes and beliefs toward people, places, or things

Families and students who had to make alternative arrangements with community providers to receive services (e.g., physical or occupational therapy, speech therapy, mental health services) during periods of school closures may need additional support and communication to establish a transition plan upon returning to school. Additionally, some families may have experienced significant hardship that now increases the number of students who need or qualify for some services, such as school meal programs. Schools can take actions to identify, support, and communicate with families who need to initiate new services as schools prepare to open. Administrators can work with community partners to plan for additional school-based services and programs during the transition back to normal schedules in anticipation of an increased need for mental health services.

Cohorting (sometimes called podding) is a new term for a strategy that schools may use to limit contact between students and staff as part of their efforts to limit transmission of SARS-CoV-2 (the virus that causes COVID-19). These strategies work by keeping groups of students - and sometimes staff - together over the course of a pre-determined period of time. Ideally, the students and staff within a cohort will only have physical proximity with others in the same cohort. This practice may help prevent the spread of COVID-19 by limiting cross-over of students and teachers to the extent possible, thus:

Decreasing opportunities for exposure or transmission of SARS-CoV-2

Reducing contact with shared surfaces

Facilitating more efficient contact tracing in the event of a positive case

Allowing for targeted testing, quarantine, and/or isolation of a single cohort instead of school-wide measures in the event of a positive case or cluster of cases

Cohorting strategies are common practice in many elementary schools across the United States. Many elementary school students have the same teacher and classmates during the entire school year. Implementation of this strategy varies, depending on setting and resources. For example:

Schools may keep cohorts together in one classroom, and have teachers rotate between rooms.

Schools may alternate cohorts by days or weeks, with cohorts assigned to specific days or weeks.

Schools may adopt a hybrid approach, with some cohorts assigned to in-person learning and others assigned to online learning.

Evidence of the impact of cohorting on spread of COVID-19 is limited. Some evidence from other viral disease outbreaks and school reopenings in international settings suggests that cohorting may be an important tool for mitigating COVID-19 spread. However, it is essential to note that those studies were conducted in very different contexts, in communities with lower transmission levels.

1. Capaldi, D. M., Knoble, N. B., Shortt, J. W., & Kim, H. K. (2012). A systematic review of risk factors for intimate partner violence. Partner abuse, 3(2), 231-280

2. Intimate Partner Violence and Child Abuse Considerations During COVID-19pdf icon . Substance Abuse and Mental Health Services Administration . 2020.

3. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.

4. CDC COVID Data Tracker. Accessed on July 6, 2020.

5. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.

6. CDC COVID Data Tracker. Accessed on July 21, 2020.

7. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.

8. CDC COVID Data Tracker. Accessed on July 6, 2020.

9. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.

10. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.

11. Turk, M. A., Landes, S. D., Formica, M. K., & Goss, K. D. (2020). Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis. Disability and Health Journal, 100942.

12. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MB, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, Singh AR. Multisystem Inflammatory Syndrome in US Children and Adolescents [published online ahead of print June 29, 2020]. New Eng J Med. DOI: 10.1056/NEJMoa2021680

13. Rajmil L. Role of children in the transmission of the COVID-19 pandemic: a rapid scoping review. BMJ Paediatr Open. 2020;4:e000722.

14. Park JY, Han MS, Park KU, Kim JY, Choi EH. First pediatric case of Coronavirus Disease 2019 in Korea. J Korean Med Sci. 2020;35:e124.

15. Le HT, Nguyen LV, Tran DM, Do HT, Tran HT, Le YT, Phan PH. The first infant case of COVID-19 acquired from a secondary transmission in Vietnam. Lancet Child Adolesc Health. 2020;4:405-6.

16. Danis K, Epaulard O, Bénet T, Gaymard A, Campoy S, Botelho-Nevers E, et al. Cluster of Coronavirus Disease 2019 (COVID-19) in the French Alps, 2020. Clin Infect Dis.2020; ciaa424,

17. National Centre for Immunisation Research and Surveillance (NCIRS). COVID-19 in schools - the experience in NSW. Sydney,Australia: NCIRSpdf icon ; 2020.

18. Laura H, Geraldine C, Ciara K, David K, Geraldine M. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill. 2020;25:pii=2000903.

19. Melnick, H., & Darling-Hammond, L. (with Leung, M., Yun, C., Schachner, A., Plasencia, S., & Ondrasek, N.). (2020). Reopening schools in the context of COVID-19: Health and safety guidelines from other countries (policy brief). Palo Alto, CA: Learning Policy Institute.

20. Sheikh A, Sheikh A, Sheikh Z, Dhami S. Reopening schools after the COVID-19 lockdown. J Glob Health. 2020 Jun;10(1):010376.

21. Melnick, H., & Darling-Hammond, L. (with Leung, M., Yun, C., Schachner, A., Plasencia, S., & Ondrasek, N.). (2020). Reopening schools in the context of COVID-19: Health and safety guidelines from other countries (policy brief). Palo Alto, CA: Learning Policy Institute.

22. Guthrie BL, Tordoff DM, Meisner J, Tolentino L et al., Summary of School Re-Opening Models and Implementation Approaches During the COVID 19pdf icon Pandemic [Accessed July 13, 2020].

23. Melnick, H., & Darling-Hammond, L. (with Leung, M., Yun, C., Schachner, A., Plasencia, S., & Ondrasek, N.). (2020). Reopening schools in the context of COVID-19: Health and safety guidelines from other countries (policy brief). Palo Alto, CA: Learning Policy Institute.

24. Melnick, H., & Darling-Hammond, L. (with Leung, M., Yun, C., Schachner, A., Plasencia, S., & Ondrasek, N.). (2020). Reopening schools in the context of COVID-19: Health and safety guidelines from other countries (policy brief). Palo Alto, CA: Learning Policy Institute.

25. Reopening schools in Denmark did not worsen outbreak, data shows. (2020, May 28). Retrieved July 3, 2020.

26. Estrin, D. (2020, June 3). After Reopening Schools, Israel Orders Them To Shut If COVID-19 Cases Are Discovered. Retrieved July 3, 2020.

27. Spells A. and Jones CK. Texas coronavirus cases top 1,300 from child care facilities alone. CNN. Published 2020. Accessed July 8, 2020.

28. School openings across globe suggest ways to keep coronavirus at bay, despite outbreaks. Science. Retrieved July 10, 2020.

29. Stage HB, Shingleton J, Ghosh S, Scarabel F, Pellis L, Finnie T. Shut and re-open: the role of schools in the spread of COVID-19 in Europe. arXiv preprint arXiv:2006.14158. Retrieved 2020 Jun 25.

30. Dorn E, Hancock B, Sarakatsannis J, Viruleg E. COVID-19 and student learning in the United States: the hurt could last a lifetime. Retrieved July 4, 2020.

31. Fitzpatrick, B. R., Berends, M., Ferrare, J. J., & Waddington, R. J. (2020). Virtual Illusion: Comparing Student Achievement and Teacher and Classroom Characteristics in Online and Brick-and-Mortar Charter Schools. Educational Researcher, 49(3), 161-175.

32. Fitzpatrick, B. R., Berends, M., Ferrare, J. J., & Waddington, R. J. (2020). Virtual Illusion: Comparing Student Achievement and Teacher and Classroom Characteristics in Online and Brick-and-Mortar Charter Schools. Educational Researcher, 49(3), 161-175.

33. Petretto DR, Masala I, Masala C. Special educational needs, distance learning, inclusion and COVID-19. Education Sciences, 10, 2020;154. doi:10.3390/educsci10060154

34. Granados A, Parker C, Boney L. How is COVID-19 affecting ESL students?. EducationNC. Published 2020. Accessed July 13, 2020.

35. Dorn E, Hancock B, Sarakatsannis J, Viruleg E. COVID-19 and student learning in the United States: the hurt could last a lifetime. Retrieved July 4, 2020.

36. U.S. Department of Education, Office of Elementary and Secondary Education, Consolidated State Performance Report, 2017-18. See Digest of Education Statistics 2019.

37. Fitzpatrick, B. R., Berends, M., Ferrare, J. J., & Waddington, R. J. (2020). Virtual Illusion: Comparing Student Achievement and Teacher and Classroom Characteristics in Online and Brick-and-Mortar Charter Schools. Educational Researcher, 49(3), 161-175.

38. Fitzpatrick, B. R., Berends, M., Ferrare, J. J., & Waddington, R. J. (2020). Virtual Illusion: Comparing Student Achievement and Teacher and Classroom Characteristics in Online and Brick-and-Mortar Charter Schools. Educational Researcher, 49(3), 161-175.

39. Collaborative for Academic, Social, and Emotional Learning (CASEL). What is SEL? Website. Accessed July 4, 2020.

40. Loades et al. Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J Am Acad Child Adolesc Psych. 2020; preprint.

41. Basch C. Healthier students are better learners: high-quality, strategically planned, and effectively coordinated school health programs must be a fundamental mission of schools to help close the achievement gap. J Sch Health. 2011;81:650-662.

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Important update: Healthcare facilities CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more Preparing K-12 School Administrators for a Safe Return to School in Fall 2020 Schools are an important part of the infrastructure of communities and play a critical role in supporting the whole child, not just their academic achievement.

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This product design and specifications are being provided by the University of Wisconsin-Madison College of Engineering as a free service to the community during this public health emergency.
Regulatory Notice
This product has not been cleared for medical use by the U.S. Food and Drug Administration. The product should only be used during the declared COVID-19 public health emergency if FDA cleared or approved products are unavailable. This product has not been evaluated for the prevention of specific diseases or infections, the filtering of surgical smoke or plumes, the filtering of specific amounts of viruses or bacteria, or the killing or reduction of the amount of viruses, bacteria or fungi. Not recommended for use in a surgical setting where exposure to liquid, bodily or other hazardous fluids may be expected or for use in a clinical setting where infection risk level through inhalation exposure is high. Not recommended for use in the presence of a high intensity heat source or flammable gas. [This product is intended for one-time use by a single user.]
Liability Notice
By using this product, the end user assumes all risks associated with its use, including the voiding of manufacturers' warranties of devices with which the product is used, and agrees to hold harmless and waive any claims against the Board of Regents of the University of Wisconsin System, its officers, employees and agents, and other persons or companies which may have contributed to the design and specifications. EXCEPT WHERE SPECIFICALLY PROHIBITED BY LAW, NO WARRANTIES OF ANY KIND ARE OFFERED FOR THE PRODUCT DESIGN AND SPECIFICATIONS, INCLUDING WARRANTIES OF NON-INFRINGEMENT AND FITNESS FOR A PARTICULAR PURPOSE.
Intellectual Property License
Individuals and organizations are free to use, copy, and share this design and specifications, including for commercial manufacture, without payment of any fees or charges, and for the duration of the declared COVID-19 public health emergency only, but may not assert ownership in the design and specifications, ownership of which belongs to the Board of Regents of the University of Wisconsin System and/or the individuals who created the design.
Notice to Manufacturers
Individuals or organizations that manufacture products utilizing this design and specifications are responsible for any federal or state regulatory requirements that apply to the manufacture of products intended for medical use, and are responsible for informing health care providers to which the product is supplied that they are responsible for decisions regarding appropriate personal protective equipment for their personnel. The distribution or sale of products manufactured using this design and specifications must include the Regulatory Notice and the Liability Notice as set forth above displayed prominently on packaging and marketing materials, as well as any information required by the FDA or other governmental authorities.

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THE OPEN SOURCE DESIGN FOR THE BADGER SHIELD+ HAS BEEN POSTED HERE*** Informational Badger Shield+ video below:As seen in UW Health's Daily Update article: UW Health and UW-Madison College of Engineering Develop Clear Face Shields:Midwest Prototyping (Not UW Madison) is currently taking orders for the Badger Shield+(no air assist yet): These links will take you...

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Washington State Department of Labor & Industries

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Face shields alone do not prevent the spread of COVID 19 and do not meet the face covering requirement. Employees with a medical or disability issue, who are requesting accommodation, must provide their employer with an accommodation statement from their medical professional specifying that a face covering or mask should not be worn due to their present health condition. Employers cannot just allow the employee to work without a mask with no other mitigations or accommodations.

Employers should assess any negative impacts that face coverings might have on employees with disabilities and make accommodations per the Americans with Disabilities Act (ADA). For example, workers communicating with people who are deaf or hard of hearing may need to temporarily unmask while staying at least 6 feet away or behind a physical barrier or wear an approved face shield closed with fabric around the contour of the face and neck in order to allow for lip reading.

Click to edit this placeholder text.

Las caretas de protección transparentes, no detienen el contagio del COVID-19 y no cumplen con los requisitos de las mascarillas ni los cubre bocas de tela.Los trabajadores con problemas médicos o de discapacidad que impiden el uso de mascarillas deben proporcionar a su empleador la declaración de acomodación de su doctor de que no deben usar cubre bocas o mascarillas debido a su condición. Cuando se comuniquen con personas sordas o con problemas de audición, los trabajadores pueden quitarse las mascarillas para ayudar en la lectura de las señales faciales y la lectura de los labios mientras aseguran la distancia de al menos 6 pies (2 metros) o una barrera física entre ellos o una careta aprobada de protección transparente, sellada, con tela alrededor del contorno de la cara y el cuello.

Posteriormente, el empleador debe evaluar sus necesidades y hacer los ajustes apropiados a las reglas de trabajo para acomodar al trabajador. En general, se debe seguir los procesos de acomodación de la Ley de Estadounidenses con Discapacidades (Americans with Disability Act, ADA), particularmente cuando una solución no es obvia o puede afectar a otros trabajadores. Los ajustes a las reglas y al lugar de trabajo pueden ser necesarios para garantizar un lugar de trabajo seguro y saludable para todos los trabajadores.Click to edit this placeholder text.

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What if a worker can't wear a mask? / ¿Qué hago si un trabajador no puede usar el cubre boca?:

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Face shields alone do not prevent the spread of COVID 19 and do not meet the face covering requirement. Employees with a medical or disability issue, who are requesting accommodation, must provide their employer with an accommodation statement from their medical professional specifying that a face covering or mask should not be worn due to their present health condition.

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L & I : Which Mask for Which Task?

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Federal Funding

Elementary and Secondary School Emergency Relief (ESSER) Fund

The Elementary and Secondary School Emergency Relief (ESSER) fund, created through the CARES Act, will grant Washington state $216 million, of which $195 million will be provided to school districts as sub-award using the Title I allocation methodology.

Posted June 25, 2020: Final ESSER allocation amounts are available by district. In the spreadsheet, please see the second tab ("Final ESSER June 22") for the final allocation amounts.

Posted June 25, 2020 is a detailed questions and answers (Q&A) document for school districts about the distribution of ESSER funds, allowable uses, requirements, and more. As districts receive their portion of ESSER funds, OSPI has four priorities that we expect districts will make priorities in their work, as well.

Coronavirus Aid, Relief, and Economic Security (CARES) Act

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Pub. L. No. 116-136 was signed into law on March 27, 2020. The CARES Act provides substantial relief to students and educators who have been profoundly affected by the novel coronavirus disease (COVID-19). CARES Act funding for nationwide distribution to school districts was set at $13.5 billion.

In addition to providing funding, the CARES Act authorized the U.S. Department of Education to provide flexibility through waivers of specific requirements in K-12 education funding and programs in the Elementary and Secondary Education Act (ESEA) of 1965. More information about these waivers is available in OSPI Bulletin 032-20, published April 15, 2020.

Accounting for COVID-Related Expenditures

Posted July 1, 2020:The COVID-related expenditure tool is now available. In preparation for submitting their initial claim for CARES Act funding disbursement, districts should follow the directions in the tool and submit their COVID-related expenditures since March 2020.

The COVID-19 situation is considered a subsequent event for accounting purposes, which needs to be disclosed in the notes to the 2018-19 financial statements for school district audit reports that are being issued now. A subsequent event is a significant event that occurs after fiscal year end, but before the financial statements have been issued. The financial impacts may not be known at this time, but there are significant operational impacts and schools are operating in an environment that is vastly different than just a few months ago. OSPI has created a template for the note required to be added to the financial statement.

In addition, OSPI has prepared accounting guidelines to provide a framework through which districts can identify COVID-related expenditures. The guidelines also include a preview of the data reporting template for those expenditures. These expenditures will be reported through a supplemental reporting tool and will not be separately identified in each school district's financial statement (F-196) this fall.

State Apportionment

Posted June 25, 2020: OSPI is crafting guidance on how to quantify and report student FTE through a continuous learning or hybrid learning model for the 2020-21 school year. When the guidance is finalized, it will be posted to this section of the webpage.

Basic Education Funding Sources

Published May 4, 2020 is a high-level overview of the state budget with respect to basic education versus non-basic education funding sources. This document is for discussion purposes only, and is not intended to be legally binding. Questions on the included categories or characterizations should be directed to T.J. Kelly, Chief Financial Officer, at thomas.kelly@k12.wa.us or 360-725-6301.

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Novel Coronavirus (COVID-19) Guidance & Resources

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OSPI is committed to providing ongoing guidance and resources as we experience this unprecedented situation together. The most current guidance and resources are provided below.

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COVID-19 Health Services Recovery Plan-FINAL 

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Centers for Disease Control and Prevention

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Back to School Planning: Checklists to Guide Parents, Guardians, and Caregivers

For many families, back to school planning will look different this year than it has in previous years. Your school will have new policies in place to prevent the spread of COVID-19. You may also be starting the school year with virtual learning components. Whatever the situation, these checklists are intended to help parents, guardians, and caregivers, plan and prepare for the upcoming school year.

Some of the changes in schools' classroom attendance or structure may include:

Cohorts: Dividing students and teachers into distinct groups that stay together throughout an entire school day during in-person classroom instruction. Schools may allow minimal or no interaction between cohorts (also sometimes referred to as pods).

Hybrid: A mix of virtual learning and in-class learning. Hybrid options can apply a cohort approach to the in-class education provided.

Virtual/at-home only: Students and teachers engage in virtual-only classes, activities, and events.

Planning for In-Person Classes

Going back to school this fall will require schools and families to work together even more than before. Schools will be making changes to their policies and operations with several goals: supporting learning; providing important services, such as school meals, extended daycare, extracurricular activities, and social services; and limiting the transmission of SARS-CoV-2, the virus that causes COVID-19. Teachers and staff can teach and encourage preventive behaviors at school. Likewise, it will be important for families to emphasize and model healthy behaviors at home and to talk to your children about changes to expect this school year. Even if your child will attend school in-person, it is important to prepare for the possibility of virtual learning if school closes or if your child becomes exposed to COVID-19 and needs to stay home.

CDC has created a checklist to help with back to school planning for school year (SY) 2020-2021. If your school uses a hybrid model, you may want to review both the in-person and virtual/at-home learning checklists.

Cloth Face Coverings
If your school is requiring or encouraging the use of , think about the following actions. Consider asking what steps your school will take to minimize the potential for students to be singled out or teased for wearing or not wearing a mask. Appropriate and consistent use of face coverings may be challenging for some children. Wearing cloth face coverings should be a priority when it is difficult for students to stay 6 feet apart from each other (e.g., during carpool drop off or pick up, when entering the building or standing in line at school, or while on the bus).

Cloth face coverings should not be worn by:

Children younger than 2 years old

Anyone who has trouble breathing

Anyone who is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance

Mental Health & Social-Emotional Wellbeing Considerations:
Since the school experience will be very different from before with desks far apart from each other, teachers maintaining physical distance, and the possibility of staying in the classroom for lunch, it is unlike anything your child is used to. Before school is in session, you may want to talk to your child and explain that all these steps are being taken to keep everyone safe and healthy. The list below provides actions and considerations regarding your child's mental health and emotional well-being as they transition back to in-person school. CDC's Stress and Coping During the COVID-19 Pandemic provides additional resources for you and your family. In addition, if your child seems to need mental health or behavioral services (e.g., social skills training, counseling), you may want to ask your school administrator for more information on these services.

Planning for Virtual or At-home Learning

Virtual learning may be a choice or part of a child's Individualized Education Program (IEP) or Section 504 Plan for some children and families, and it may be necessary if your child has certain underlying health conditions or is immunocompromised. In a hybrid model, learning may occur virtually during part of the week and occur in-person for the rest. Or, the school year may start with virtual learning but switch to in-person learning for the remainder or certain times of the school year. Going back to school virtually may pose additional challenges with staying connected to peers, since students may have less frequent or no in-person interactions to each other. You may want to talk to school staff to learn more about what they are doing to support connection among students, interactive learning with feedback, building resilience, and social-emotional wellbeing for students who will not be onsite. In addition, if your child receives speech, occupational, or physical therapy or other related services from the school, ask your school how these services will continue during virtual at-home learning. Likewise, if your child receives mental health or behavioral services (e.g., social skills training, counseling), ask your school how these services will continue during virtual at-home learning.

Setting up for Virtual or At-Home Learning

Things to consider as you get ready for virtual or at-home learning.

Planning for Virtual or At-Home Learning

Here are some things to look for when reviewing your school's plan for virtual or at-home learning. Some of these action items and points to consider might warrant additional conversations with your school administrators or healthcare provider.

Mental Health and Social-Emotional Wellbeing Considerations:
Since the school experience will be very different from before with desks far apart from each other, teachers maintaining physical distance, and the possibility of staying in the classroom for lunch, it is unlike anything your child is used to. Before school is in session, you may want to talk to your child and explain that all these steps are being taken to keep everyone safe and healthy. The list below provides actions and considerations regarding your child's mental health and social-emotional wellbeing, as they transition to virtual or at-home learning. CDC's Stress and Coping During the COVID-19 Pandemic provides some additional resources for you and your family.

Resources to Navigate Stress and Uncertainty

Below are governmental and non-governmental resources that can help parents, guardians, and caregivers navigate stress and uncertainty and to build resilience for you and your children heading into the school year.

Exit Notification/Disclaimer Policy

Links with this icon (external icon) indicate that you are leaving a CDC Web site. The link may lead to a non-federal site, but it provides additional information that is consistent with the intended purpose of a federal site. The Department of Health and Human Services (HHS) cannot attest to the accuracy of a non-federal site. Linking to a non-federal site does not constitute an endorsement by HHS or any of its employees of the sponsors or the information and products presented on the site. You will be subject to the destination site's privacy policy when you follow the link.

Last Updated July 23, 2020

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Communities, Schools, Workplaces, & Events

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Back to School Planning: Checklists to Guide Parents, Guardians, and Caregivers For many families, back to school planning will look different this year than it has in previous years. Your school will have new policies in place to prevent the spread of COVID-19. You may also be starting the school year with virtual learning components.

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Centers for Disease Control and Prevention

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CDC suggests that all school reopening plans address adherence to behaviors that prevent the spread of COVID-19. When used consistently and correctly, important mitigation strategies, cloth face coverings are important to help slow the spread of COVID-19. Other important mitigation strategies include social distancing, washing hands, and regular cleaning and disinfecting frequently touched surfaces in schools and buses. CDC provides considerations for wearing cloth face coverings and recommends that people wear cloth face coverings in public settings and when around people who live outside of their household. The use of cloth face coverings is especially important when social distancing is difficult to maintain.

Cloth face coverings are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the cloth face covering coughs, sneezes, talks, or raises their voice. Cloth face coverings are an example of source control. Several studies ¹⁻¹³ have documented asymptomatic and pre-symptomatic SARS-CoV-2 transmission; meaning that people with COVID-19 who never develop symptoms (asymptomatic) and those who are not yet showing symptoms (pre-symptomatic) can still transmit the virus to other people. Cloth face coverings are meant to protect other people in case the wearer is unknowingly infected. Cloth face coverings are not personal protective equipment, such as surgical masks or respirators.

The use of cloth face coverings in educational settings may present challenges, particularly for younger students and students with special healthcare or educational needs. This document provides guidance to help school administrators decide how to best implement the wearing of cloth face coverings ― in their school settings and facilities, including but not limited to buses and other shared transportation.

Education and promotion of positive and supportive relationships should remain the primary focus of school administrators, teachers, and staff. This guidance provides K-12 school administrators with strategies to encourage students to wear face coverings, consistent with CDC guidance, while maintaining a positive learning environment.

General Considerations

COVID-19 can be spread to others even if you do not feel sick. A cloth face covering helps prevent a person who is sick from spreading the virus to others. Appropriate and consistent use of cloth face coverings is most important when students, teachers, and staff are indoors and when social distancing of at least 6 feet is difficult to implement or maintain.

Cloth face coverings should not be placed on:

Children younger than 2 years old.

Anyone who has trouble breathing or is unconscious.

Anyone who is incapacitated or otherwise unable to remove the cloth face covering without assistance.

Appropriate and consistent use of cloth face coverings may be challenging for some students, teachers, and staff, including:

Younger students, such as those in early elementary school.

Students, teachers, and staff with severe asthma or other breathing difficulties.

Students, teachers, and staff with special educational or healthcare needs, including intellectual and developmental disabilities, mental health conditions, and sensory concerns or tactile sensitivity.

While cloth face coverings are strongly encouraged to reduce the spread of COVID-19, CDC recognizes there are specific instances when wearing a cloth face covering may not be feasible. In these instances,

parents, guardians, caregivers, teachers, and school administrators should consider adaptations and alternatives whenever possible. They may need to consult with healthcare providers for advice about wearing cloth face coverings.

Consider use of clear face coverings that cover the nose and wrap securely around the face by some teachers and staff. Clear face coverings should be determined not to cause any breathing difficulties or over heating for the wearer. Teachers and staff who may consider using clear face coverings include;

Those who interact with students or staff who are deaf or hard of hearing, per the Individuals with Disabilities Education Actexternal icon

Teachers of young students learning to read

Teachers of students in English as a second language classes

Teachers of students with disabilities

Clear face coverings are not face shields. CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings because of a lack of evidence of their effectiveness for source control.

Unintended Consequences

Practical Recommendations

Include cloth face coverings on school supply lists and provide cloth face coverings as needed to students, teachers, staff, or visitors who do not have them available.

Include clear face coverings on school supply lists for teachers and staff who regularly interact with students who are deaf or hard of hearing, students learning to read, students with disabilities, and those who rely on lip reading as a part of learning, such as students who are English Language Learners.

Ensure that students and staff are aware of the correct use of cloth face coverings, including wearing cloth face coverings over the nose and mouth and securely around the face.

Ensure that students, teachers and staff are aware that they should wash or sanitize their hands (using a hand sanitizer that contains at least 60% alcohol) before putting on a cloth face covering.

Ensure that students, teachers, and staff are aware that they should not touch their cloth face coverings while wearing them and, if they do, they should wash their hands before and after with soap and water or sanitize hands (using a hand sanitizer that contains at least 60% alcohol).

Ensure teachers and staff are aware that they should wash or sanitize hands (using a hand sanitizer that contains at least 60% alcohol) before and after helping a student put on or adjust a cloth face covering.

Ensure that all students and staff are aware that cloth face coverings should not be worn if they are wet. A wet cloth face covering may make it difficult to breathe.

Ensure that all students and staff are aware that they should never share or swap cloth face coverings.

Students' cloth face coverings should be clearly identified with their names or initials, to avoid confusion or swapping. Students' face coverings may also be labeled to indicate top/bottom and front/back.

Cloth face coverings should be stored in a space designated for each student that is separate from others when not being worn (e.g., in individually labeled containers or bags, personal lockers, or cubbies).

Cloth face coverings should be washed after every day of use and/or before being used again, or if visibly soiled.

Students and schools should consider having additional cloth face coverings available for students, teachers, and staff in case a back-up cloth face covering is needed during the day and to facilitate every day washing of cloth face coverings.

Additional Considerations for the Use of Cloth Face Coverings among K-12 Students

CDC recommends that people, including teachers, staff, and students, wear cloth face coverings in public settings as able when around people who live outside of their household, especially when other social distancing measures are difficult to maintain.

The following table contains examples of some, but not all, situations schools might encounter.
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Possible Student Scenario

Cloth face coverings recommended

Cloth face coverings may be considered

Additional considerations

Students are seated less than 6 feet apart while riding a bus or carpooling

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Cloth face coverings should always be worn by bus and carpool drivers as able*

Students are less than 6 feet apart while entering or exiting school (e.g., carpool drop off/pick up) or while transitioning to/from other activities

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Students are seated at least 6 feet apart in the classroom

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Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Students are seated less than 6 feet apart in the classroom, or are engaging in learning stations or circle time that require close contact

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Schools may consider keeping students in "cohorts." Cohorts are groups of students that do not mix with other cohorts/groups of students throughout the school day.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Students are less than 6 feet apart while transitioning between classes or to other activities during the school day

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Schools may consider staggering classroom transition times and allow only one-way pathways/hallways.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Students are at recess or in physical education class.

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Vigorous exercise in a confined space (e.g., indoors) may contribute to transmission of COVID-19 and should be limited.

Social distancing helps protect students at recess or in physical education class.

Consider conducting activities in an area with greater ventilation or air exchange (e.g., outdoors).

See CDC's guidance on youth sports for more information.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Students are in band, choir, or music class.

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When students are not singing or playing an instrument that requires the use of their mouth, they should wear a cloth face covering in music class (unless class is outdoors and distance can be maintained).

Social distancing helps protect students in music class.

While students are singing or playing an instrument, use visual cues to keep them at least 6 feet apart. If it's safe and weather permits, consider moving class outdoors where air circulation is better than indoors and maintain at least 6 feet distance between students.

Students are at least 6 feet apart during mealtimes in a common area.

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Cloth face coverings are recommended when transitioning to and from mealtimes if outside of the classroom.

Schools may be able to stagger mealtimes to ensure 6 feet distance between students in a cafeteria or lunchroom.

Schools can serve meals in classrooms if students are able to maintain 6 feet of distance between one another in the classroom.

Consider allowing students to eat meals outside, if weather permits.

Students participating in an assembly or event that requires close contact.

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Large assemblies of students should be discontinued, unless necessary.

When necessary, consider having the assemblies outdoors, plan for social distancing, and encourage use of cloth face coverings according to CDC guidance.

Cloth face coverings should be worn by teachers and staff at all times* and are especially important at times when social distancing is difficult to maintain.

Student has severe asthma or breathing problems.

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Cloth face coverings should NOT be worn by children under the age of 2 or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance.

Administrators and/or teachers should consult with parents, caregivers, or guardians about strategies to protect these students and those around them.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Student is deaf or hard of hearing, or relies on lip reading to communicate.

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Clear face coverings may be considered for teachers or staff who interact with students who are deaf and hard of hearing.

Face shields are not considered clear face coverings.

It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles. CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings. Some people may choose to use a face shield when sustained close contact with other people is expected. If face shields are used without a mask, they should wrap around the sides of the wearer's face and extend to below the chin.

Student has a disability, childhood mental health conditions, sensory concern/tactile sensitivity.

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Administrators and/or teachers should consult with parents, caregivers, or guardians about strategies to protect these students and those around them.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Student is receiving one-on-one services or instruction.

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Students and service providers should wear a face covering as much as possible during service delivery.*

Administrators and/or teachers should consult with parents, caregivers, or guardians about strategies to protect these students and those around them.

Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading.

Cloth face coverings should be worn by teachers and staff at all times* and are especially important at times when social distancing is difficult to maintain.

Students and service providers may need additional protective equipment depending on the individual characteristics of the student. See CDC's Guidance for Direct Service Providers for additional information.

* CDC recognizes that wearing cloth face coverings may not be possible in every situation or for some people. In some situations, wearing a cloth face covering may exacerbate a physical or mental health condition, lead to a medical emergency, or introduce significant safety concerns. Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading if it is not possible to wear one. Learn more.

Strategies to Support Students' Wearing Cloth Face Coverings in Schools

All Students

Encourage parents, caregivers, and guardians to practice wearing cloth face coverings with students at home before the first day of school. If parents, caregivers, and guardians model appropriate use of face coverings and help students get used to wearing them, students may be more comfortable using them.

Introduce students with sensory concerns/tactile sensitivities to face coverings with a variety of materials, prints, and textures, and allow them to choose which face covering is most comfortable.

Use behavioral techniques such as positive reinforcement to increase the likelihood that students will comply with face covering guidance and other prevention practices.

Encourage parents, caregivers, and guardians to include students in the selection of their cloth face covering and/or the material that is used to make it. This might increase a child's acceptance of wearing the cloth face covering.

Display age appropriate posters and materials with visual cues that show the proper way to wear a face covering in classrooms and hallways. Consider incorporating images of popular influencers promoting or modeling use of cloth face coverings.

Include reminders about face coverings in daily announcements, school newspapers, and other All communication should be in an appropriate format, literacy level, and language. Consider including how to properly use, take off, and wash cloth face coverings in back-to-school communications educational materials.

Elementary School Settings

Ensure that teachers and school staff are available to help students put on and adjust face coverings as needed and that teachers and staff wash or sanitize their hands with hand sanitizer that includes at least 60% alcohol before and after doing so.

Play games or engage in other fun activities that teach students how to wear a face covering.

Consider using some art materials or other creative outlets to help students understand why face coverings help reduce the spread of COVID-19.

Share social stories about face coverings with students so they know what to expect at school. A social story is similar to a simple picture book that teaches students what to expect in social settings.

Use behavioral techniques, such as positive reinforcement, to increase the likelihood that students will comply with face covering guidance.

Middle School Settings

Show short videos or incorporate short lessons (less than 10 minutes) that teach students how to wear a face covering. Consider including videos with celebrities, musicians, athletes or other influencers popular among this age group.

Follow videos with verbal instructions that demonstrate the correct ways to wear a face covering.

Engage the class in discussions about why face coverings help reduce the spread of COVID-19.

Incorporate a lesson into the science curriculum on how respiratory droplets spread infectious disease.

Create a school competition for the best health communication strategy to highlight the importance of wearing a cloth face covering to middle school students.

High School Settings

Show videos or incorporate lessons that teach students how to wear a face covering, including the correct and incorrect ways to wear a face covering. Consider including videos with celebrities, musicians, athletes, or other influencers popular among this age group.

Ask students to write a short paper on the science behind the use of cloth face coverings as a form of source control.

Create a school competition for the best health communication strategy to highlight the importance of wearing cloth face coverings to high school students.

Students with Special Healthcare Needs

Ask parents, caregivers, and guardians to practice wearing face coverings at home before the student returns to school.

Share social stories about face coverings with students so they know what to expect at school. A social story is similar to a simple picture book that teaches students about what to expect in social settings.

Introduce students with sensory concerns or tactile sensitivities to face coverings with a variety of materials, prints, and textures, and allow them to choose which face covering is most comfortable.

Use behavioral techniques such as positive reinforcement to increase the likelihood that students will comply with face covering guidance and other prevention practices.

References

1. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Students. N Engl J Med 2020;382:1663-5.

2. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23.

3. Wang Y, Liu Y, Liu L, Wang X, Luo N, Ling L. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China. J Infect Dis

4. Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis 2020;20:410-1.

5. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14):1406-1407.

6. Kam KQ, Yung CF, Cui L, et al. A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load. Clin Infect Dis

7. McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility - King County, Washington, February 27-March 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:339-42.

8. Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:377-81.

9. Roxby AC, Greninger AL, Hatfield KM, et al. Detection of SARS-CoV-2 Among Residents and Staff Members of an Independent and Assisted Living Community for Older Adults - Seattle, Washington, 2020. MMWR Morb Mortal Wkly Rep 2020;69:416-8.

10. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill 2020;25.

11. Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med 2020;382:1278-80.

12. Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 - Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:411-5.

13. Tong ZD, Tang A, Li KF, et al. Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis 2020;26:1052-4.

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Communities, Schools, Workplaces, & Events

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CDC suggests that all school reopening plans address adherence to behaviors that prevent the spread of COVID-19. When used consistently and correctly, important mitigation strategies, cloth face coverings are important to help slow the spread of COVID-19. Other important mitigation strategies include social distancing, washing hands, and regular cleaning and disinfecting frequently touched surfaces in schools and buses.