Principle 4: Screening and Triage

Screen for symptoms of COVID-19 daily, instruct staff and students to stay home if any symptoms are present, and create space within the school for children and staff to isolate before going home if they develop symptoms during the school day.

4.1 Create a daily symptom screening process

Likely Implementation Level DISTRICT, SCHOOL

Status

Priority Level

NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).

Key Recommendations for Consideration

  • Provide a checklist for use at home and school to review symptoms each morning and in a suspected case.

  • Assess if any materials require translation / interpretation.

  • Incorporate the resource into your communication plans.

  • Ask parents and caregivers to screen their children each morning.

  • Require students and staff to stay home when sick, even without a doctor’s note.

  • Specify that a positive response to screening questions (e.g. indicating a student should not come to school) will lead to remote learning services and how these will be rapidly implemented.

  • Remind families of the testing resource referral list (see Principle 3.1).

Starting Point Tools

The symptom checklist should at least include the following items. If staff or students have any of these symptoms, they should stay home and get a test for active COVID-19 infection prior to returning to school.

  • Fever (100.4° Fahrenheit or higher), chills, or shaking chills

  • Cough (not due to other known cause, such as chronic cough)

  • Difficulty breathing or shortness of breath

  • New loss of taste or smell

  • Sore throat

  • Headache when in combination with other symptoms

  • Muscle aches or body aches

  • Nausea, vomiting, or diarrhea

  • Fatigue, when in combination with other symptoms

  • Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms

  • New rash, especially on the toes or fingers

  • Exposure to someone recently diagnosed with COVID-19

Considerations and Questions for Team Decision-Making and Reflection

  • Do you have a language translation / interpretation service you can use?

  • Consider tracking symptom information from families, perhaps in your existing system for child and staff sick-day policy.

  • Who is responsible for reviewing this daily screening information, and where/when do they do so (for both staff and students)?

  • How can we ensure that screening tools can be equitably accessed by all students, families, and staff (e.g. availability of thermometers, access to web-based forms)?

  • How will we protect the privacy of students, families, and staff?

Other Resources

Country/District Examples

Ideas

  • Have signs with screening checklists at entrances of school buildings.

  • Develop an online form that staff can fill out as part of a self-screening process.

Guidelines

4.2 Develop a school plan for what to do when a suspected COVID-19 cases

Likely Implementation Level SCHOOL

Status

Priority Level

NOTE: Update your school's or district's status and priority level in your progress tracker (link at the bottom of the homepage).

Key Recommendations for Consideration

  • Designate an isolation space for suspected cases and protocol for interactions with that individual that reduce exposure.

  • Develop a protocol for sanitation of the isolation room.

  • Ensure the isolation room has adequate ventilation that does not leak contaminated air into other spaces.

  • Ensure there is sufficient PPE for staff who will interact with the suspected case.

  • Determine what information will be provided to the students’ parent(s)/caregiver(s), when, and whether by phone or other means.

  • Develop strategies for reducing anxiety and traumatic responses, such as training staff and students on calming practices (meditation, breathing, journaling, etc.), incorporating soothing materials into isolation rooms (easy-to-disinfect manipulatives such as fidget tools, music, dimmed lights, etc.), and classroom debriefs that allow students to express feelings in response to incidents.

  • Identify supports for staff mental health and anxiety, including referrals to counseling, check-ins, and staff debriefing of traumatic events.

Starting Point Tools

Workflow:

  1. Case suspected based on agreed upon set of symptoms.

  2. Student sent to / escorted by nurse or other designated staff trained to respond and placed in isolation room.

  3. Student is provided with a medical mask and isolated.

  4. Close off areas visited by the COVID-19-positive individual until cleaned and disinfected, including classrooms, bathrooms, buses, and extracurricular facilities. The area can be used 12 hours after cleaning/disinfecting has occurred.

  5. Nurse (wearing N95 mask along with a face shield, gloves, and gown) does an assessment of symptoms.

  6. If a case is suspected, call parent/caregiver to pick up student.

  7. Student remains isolated until picked up.

      • If a staff member remains with the child, the staff member should wear a surgical mask and remain 6 feet apart. Refer to Principle 7 of this guide for more information on masks and PPE.

  8. Provide information on quarantine, testing, and isolation to parent/caregiver when they arrive.

  9. After student leaves, nurse (or other designated person) conducts thorough cleaning and disinfection of isolation space.

  10. While awaiting test results, student should stay in isolation at home.


Parabola Project: Positive COVID-19 Case of Staff or Student Tool

Example state-level tool: Massachusetts protocols for responding to COVID-19 scenarios in school, on the bus, or in community settings

Considerations and Questions for Team Decision-Making and Reflection

  • Given school space, and the recommendation that people who are suspected to be infected cannot under any circumstances be isolated together, how many people can the school isolate at a time?

  • Who will escort the student to the nurse’s office and make sure they feel safe?

  • What information on quarantine, testing, and isolation can be provided?

  • How much detail does the school nurse need on protocols for PPE (e.g. when to change gloves provided by CDC)?

  • If students and/or staff need to be quarantined, how can they continue their learning or duties virtually?

  • What support does your nursing staff need to carry out these responsibilities?

Other Resources

Country/District Examples

Guidelines