Schools create chart for guidance on potential COVID-19 cases that arise on campus.
‘Decision tree’ by health, education officials a guide
As schools begin welcoming students back to campus, they’re also looking at circumstances when they may need to send them home with coughs, fever or other symptoms that might signal a case of COVID-19.
To make those calls, school health officials are turning to a “decision tree” of COVID-19 symptoms that guides when students should be sent home, and how long they must wait before returning. The decision tree provides a step-by-step f low chart for handling COVID-19 cases on campus, and summarizes guidance from national, state and local public health authorities. It applies to all schools, both public and private, said Music Watson, communications chief for the County Office of Education, which wrote the guide in collaboration with San Diego County Public Health.
“It came about because there were so many different guidelines coming out from the state and the local health department, that we made the decision to create the decision tree so it would be easier to follow when you’re at a school and in the middle of a situation,” said Corinne McCarthy, a program specialist for school nursing with the County Office of Education.
Under normal circumstances, a runny nose or sore throat might simply warrant a trip to the school nurse, or perhaps a day or two out of school. But conditions are far from normal, and symptoms that typically accompany a common cold or allergies could indicate a more serious COVID-19 infection.
Because children may present with less severe symptoms than adults, school authorities must take even mild symptoms seriously to avoid transmission of the virus to teachers, staff or medically fragile students.
“We have known for some time that we will have to send students home more often, and for longer periods of time, than ever before,” McCarthy said. “It’s really difficult. I get calls every day. We have to err on caution now, and we send the student home.”
The symptom tree starts with a list of symptoms including fever, cough, shortness of breath, sore throat, vomiting and diarrhea, change to taste or smell and others that may indicate that the student has COVID-19. Even general maladies such as headache, muscle ache, loss of appetite or fatigue are on the list as possible red f lags. If a student or staff member shows any of those, school staff should put on personal protective equipment, and isolate the person until he or she can be sent home.
There is a caveat to that protocol; if the symptoms are consistent with a known chronic condition — such as asthma, allergies or migraines — school officials can disregard the symptoms and simply monitor the student. If not, however, they are advised to send the student home, and direct parents to contact the child’s health care provider.
If the doctor or nurse orders a COVID-19 test, a student who tests negative must provide proof of that result, and remain home for 72 hours after symptoms resolve. In cases where results come back positive, the student must remain home for at least 10 days after the onset of symptoms or the positive test. The student can return after that, provided that symptoms are improving, and there has been no fever for 24 hours without medication. Meanwhile, the school should notify close contacts of the student, and exclude those staff or students from campus for 14 days.
In the event of “presumed positive cases” without a COVID-19 test, the school is advised to follow the same protocol as it would for a positive test result, asking the student to quarantine for at least 10 days, and directing close contacts to quarantine for 14 days. If the health care provider believes the symptoms result from a chronic condition, and not COVID-19, families can provide a signed doctor’s note stating that and the student can return to school.
The “decision tree” chart aims to provide a streamlined scenario for possible COVID-19 cases, but the county office also wrote up guidelines to explain the steps in further detail.
“There are a thousand ‘what-ifs’ and it’s really hard to get to the essential decisions that need to be made,” said Bob Mueller, a program specialist for the county office. “The goal was to help decision makers at the school level know when they have to act, and when they don’t have to act.”
Because one of the first steps is directing the student and family to their health care provider, school officials will be prepared to help connect them to medical care if they don’t have it already, McCarthy said.
“Part of school nurses’ role is to get kids access to health care,” she said. “This would be an opportunity if they don’t have health care to help them, to get them enrolled in Medicare. And there’s community clinics. We know how to do that, and we will help them link up to a health care provider.”
Another issue may be the availability of testing for children. Existing testing guidelines have prioritized high-risk individuals and focused on adults, but the county is expanding testing of children, said Sarah Sweeney, a communications officer with the County of San Diego Health & Human Services Agency.
“The county is testing those 12 and older with plans to expand that to younger children beginning with those down to kindergarten ... and intends to expand to even younger children in the near future,” she said. “Additionally, the state’s testing sites test children of all ages.”
The county has also worked with Rady Children’s Hospital on a system that allows any doctors to refer pediatric patents to the hospital for testing, whether they are Rady-affiliated physicians or not.
With the possibility of weeks of quarantine for known or suspected COVID-19 patients, families must be aware of the possibility for disruption to school schedules. And schools must prepare to continue educating students during those absences. Individual schools may approach that differently, Mueller said, and there are no mandatory practices for instructing students on quarantine.
In some cases, Mueller said, students in isolation may be able to connect to their classes virtually in real time, seeing other students and asking questions of the teacher directly. In other scenarios, schools may ask the child’s teacher to set up individual tutoring sessions with the absent student, or hire a separate teacher to work with kids on quarantine.
He acknowledged it may be difficult for parents to accept extended school absences for apparently mild illnesses, but said the protocols are designed to protect both students and adults.
Although children comprise 22 percent of the U.S. population, data as of Aug. 3 suggest that they make up only 7.3 percent of all reported COVID-19 cases in the country, the CDC reported. Children are also hospitalized at much lower rates than adults, the CDC reported. However, some children, including Black and Hispanic youth, and those with pre-existing conditions, are at greater risk for severe illness. And researchers are still studying the role that children and teens play in community transmission of the virus, and don’t know how likely they are to spread it to vulnerable family members or other adults.
“This is really hard, because many children will have very mild symptoms, and in some cases be asymptomatic, and this is going to be very hard for everyone to understand that even mild symptoms require that 10day isolation period,” he said. “The only way that we can protect each other, our workforce, our grandparents and parents is that we take these precautions. It will be a challenge.”