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San Francisco Health Network

COVID-19 infections, symptoms, and exposures—Guidance for schools*

Last updated on January 26, 2022

* NOTE: Although childcare and non-TK-12 youth programs may find the steps to take for confirmed COVID‑19 cases useful for their settings, this page applies only to TK-12 Schools. Childcare and non-TK-12 youth programs should follow isolation and quarantine guidance for the general public.

Summary of changes since January 1, 2022:

Updated to reflect shortened quarantine period to 5 days with a negative test on or after day 5 and addition of "group tracing" approach to school-based exposures.

On this page:

Quick reference for COVID‑19 infections, symptoms and exposures

Steps to take for confirmed COVID‑19 cases

Notifying your school community of a positive case

When can children and youth return to their school?

Quick reference: What to do for COVID‑19 infections, symptoms, or exposures

Scenario

Action

Child has symptoms of COVID‑19

Send home if at school, with the parent handout on Returning to School after Symptoms.

Recommend testing.

If rapid antigen testing is available on-site, the child may remain if their test is negative.

Child with confirmed COVID‑19

Send infected child home, if at school, with Isolation and Quarantine Guidelines

Notify the SFDPH Schools COVID‑19 Response team at cases.schools@sfdph.org or (628) 217-7499. Follow step-by-step instructions below in Steps to take for a confirmed COVID‑19 case.

Follow steps for contact tracing and notification of contacts using either an individual tracing approach or group-tracing approach.

Child reports Close Contact  to COVID-19 outside of school setting and was not fully vaccinated for COVID-19

Send child home, if at school, with Home Quarantine Instructions for Children Under 18.

Recommend testing on or after 5 days from last close contact.

Steps to take for confirmed COVID‑19 cases

  1. Use the Exposure and Investigation Tool (Word document) to collect the important details about the case BEFORE contacting the Schools/Childcare Response Team.
  2. If you can, obtain a copy of the lab report and attach it to the Exposure and Investigation Tool. If your school or program does not have the test result yet, please note the test results are pending. Send the lab report to the Schools/Childcare Response Team when you receive it.
  3. Report the case within 24 hours entering if into CDPH's School and Shared Portal for Outbreak Tracking (SPOT) (preferred) or by emailing cases.schools@sfdph.org. Non-English-speaking sites may leave a voicemail at (628) 217-7499.
    Identify and notify people as required by the tracing approach (individual or group). When informing people that they may have been exposed, do not disclose the identity of the person with COVID-19, as required by law.
  4. Communicate to your school community within one business day as indicated in the table below.
  5. Notifying your school community of a positive case

    Event

    Who

    Notification Template

    Case at school (no known Close Contact to COVID‑19)

    Families and staff

    Exposure at school
    (Group Tracing Approach)

    Families of students who were exposed and staff

    Close contact at school
    (Individual Tracing Approach)

    Families of children who had known‡ close contact and staff

    Close contact outside of program (optional)

    Families of children who had confirmed close contact and staff

    Definition of close contact in schools, childcares, and programs for children and youth

    Close Contact is being within 6 feet of an infected person for a total of 15 minutes or more in 24 hours, even if both people were wearing masks. An infected person can spread COVID‑19 starting 2 days before they have symptoms or test positive for COVID‑19. They stay contagious for at least 5 days after their symptoms started, even if their symptoms began after their positive test. People who test positive and never have symptoms are contagious until 5 days after their test.

    Known Close Contact. In schools, childcares and programs for children, it may be difficult to know who has had close contact. People should be considered close contacts when the program is reasonably sure that they spent at least 15 minutes within 6 feet of the infected person during the course of a day. People are not considered close contacts simply because they were in the same group or class. If the program cannot determine this or does not know, the person should not be considered a close contact.

    SFDPH has developed the following Word documents that can be used for notification:

Notification Template (Word docx)

Translations

Close Contact Advisory — Children and Youth under 18

  Español  |   中文  |   Pilipino  |   Tiếng Việt  |   Русский  |   العربية   

Close Contact Advisory — Adult

  Español  |   中文  |   Pilipino  |   Tiếng Việt  |   Русский  |   العربية 

TK-12 Schools Only: Modified Quarantine Advisory

General Exposure Advisory — Children and Youth under 18

  Español  |   中文  |   Pilipino  |   Tiếng Việt  |   Русский  |   العربية

General Exposure Advisory — Adult

  Español  |   中文  |   Pilipino

Notification that a Student or Staff Member is in Quarantine for COVID‑19 Exposure

  Español  |   中文  |   Pilipino  |   Русский  |   العربية

Outdoor Exposure Advisory Sample Letter Youth

When children and youth can return to school after COVID‑19 infection, symptoms or exposure

Children who test positive or are diagnosed with COVID‑19

Scenario

Criteria to return to school

Tested positive or clinically diagnosed with COVID‑19, and had symptoms

  • 5 days have passed since symptoms began, even if symptoms began after the positive test AND
  • Symptoms are getting better, AND
  • No fever for 24 hours, without taking medicines for fever like acetaminophen (Tylenol), ibuprofen (Motrin, Advil) or naproxen (Aleve).
  • AND
  • A negative test collected on or after Day 5. (If the child is not retested, they must stay home for 10 days after the start of symptoms and may return after the above three bullets are also true.)

Tested positive, but never had symptoms

  • 5 days have passed since their positive test was collected (not 5 days after the result was received) and
  • A negative test collected on or after Day 5.
    OR
  • If the child is not retested, they may return 10 days after their original positive test was collected.

Children with symptoms of COVID‑19

Fully vaccinated for COVID‑19, or unvaccinated without known exposure to COVID‑19

Note: For unvaccinated children with close contact, see "Children not fully vaccinated for COVID‑19 with close contact".

Scenario

Criteria to return to school

If child tests negative

If the child is not tested
A doctor's note is not needed.

Symptoms but no known Close Contact to COVID‑19

A negative test, collected after symptoms started.

  • 10 days have passed since symptoms began, and
  • Symptoms are getting better, and
  • No fever for 24 hours, without taking medicine for fever.

Doctor's Note or Clinic Note

If a child or youth has COVID‑19 symptoms and has a note from a doctor or clinic saying that they can return, the school or program should accept the note, even if the child was not tested. The note may be an email, electronic message or part of an after-visit summary.

Sometimes a child's symptoms are clearly due to another cause, such as strep throat or hand-foot-and-mouth disease. Other times, the symptoms are due to a chronic medical condition, like a cough in a child with known asthma. In these situations, the health care provider may clear a child to return to their school or program. This does not mean that the child does not have COVID‑19. Many children with COVID‑19 do not have any symptoms. It only means that a definitive cause other than COVID‑19 was found for their symptoms.

Children not fully vaccinated for COVID‑19 with a close contact outside of a TK-12 school setting (e.g. at home or after school)

Please note table correction made on Jan 25 to second column of second row and to footnote.

Scenario

Criteria to return to school
Note: When counting days use the day of last close contact as day 0.

A child can return to school after:

If the child is not tested
A doctor's note is not needed.

Close contact but no symptoms

  • A negative test, collected on or after day 5 of quarantine and
  • No symptoms after last close contact.

No symptoms for 10 days after the last close contact.

Close contact and symptoms

  • 5 days after the last close contact and
  • A negative test, collected after symptoms began.

If not tested after symptoms began,

  • 10 days have passed since the last close contact, and
  • 10 days have passed since symptoms began, and
  • Symptoms are getting better, and
  • No fever in the last 24 hours, without taking medicine for fever.

If the child has ongoing close contact with the person with COVID‑19 (for example, a parent), the child must quarantine for 5-10 days after the person with COVID‑19 is no longer infectious. For example, a child quarantining for 10 days after the last close contact would have to stay home for a total of 20 days after the person with COVID‑19 first developed symptoms, or if asymptomatic, had a positive test.

Children with exposure in a TK-12 school setting

Schools may follow either an individual tracing approach OR group tracing approach.

Individual Tracing Approach

    • Determine close contacts
    • Close contacts who are not fully vaccinated must quarantine for at least 5-10 days. Schools may choose to allow these students to continue to attend school during quarantine by following modified quarantine procedure.

Modified Quarantine also known as “Test to stay”

Students who are unvaccinated or not fully vaccinated for COVID-19 and have Close Contact in a supervised school setting can leave quarantine to attend school if both the student and the infected person were wearing face masks consistently and correctly at the time. They can also ride school buses and public transportation to go to and from school.
This “test to stay” or "modified quarantine" applies only to students who were exposed to COVID‑19 at school, because of the low risk of transmission between students in school classrooms. It does not apply to students who were exposed to COVID‑19 at home, outside of school, or during extracurricular activities like school sports.
To attend school during quarantine, the student must:

  • Get tested for COVID19 twice: once as soon as feasible after notification of exposure and once more on or after day 5 from last date of known Close Contact. Students do not need to be taken out of class for the first test.
  • Remain free of any COVID‑19 symptoms during this time.
  • Wear a face mask in school, except to eat

Students must quarantine except to attend school. During modified quarantine, students must not participate in activities outside of school or extracurricular activities at school, including sports. They also must not play wind instruments in class. Quarantine can end on day 5 if a test collected on or after day 5 is negative (The last Close Contact is day 0).
For more information, see CDC “Test to stay”,   CDPH schools guidance and CDPH Schools Q and A.

Group Tracing Approach

The framework outlined for the group tracing approach allows for a quicker and broader response to cases identified in school settings, accomplishable through prompt notification, testing, and isolation protocols.  This strategy also allows for schools to provide safe in-person instruction without undertaking intense contact tracing to identify individual students within a specified radius of someone infected.  This approach relies more heavily on widespread testing of individuals, regardless of vaccination status, to limit spread.  Schools may also choose to implement a group tracing approach for school-based exposures per CDPH guidance.

In addition, in the event of wide-scale and/or repeated exposures, as we have been experiencing during the current Omicron surge, once weekly testing may be implemented in lieu of traditional exposure notification and contact tracing. This approach makes sense when frequent exposures are occurring in school and outside of school, where exposures are not or cannot be communicated in a timely way.

Quarantine exceptions and special situations

  • Fully vaccinated for COVID‑19: if a child is fully vaccinated for COVID-19, meaning 2 weeks have passed since their second dose of the Pfizer or Moderna vaccine for COVID-19, then they do not need to quarantine after close contact. It is recommended they monitor for symptoms and test 5-7 days after close contact even if asymptomatic.
  • COVID-19 in the last 3 months: if a child had confirmed COVID-19 in the last 90 days (e.g. they had a positive viral test or they were diagnosed by a medical provider), then they do not need to quarantine after close contact. It is recommended they monitor for symptoms and test if they become symptomatic, preferably with an antigen test.

Staff Return to Work

See isolation and quarantine guidance.

For Schools:

What types of tests to accept and when to test:

Scenario

When to test

Type of Test

Symptoms of COVID-19 AND close contact to COVID-19 in the last 10 days.

 

Right away

PCR/other nucleic acid amplification test (NAAT) or
rapid antigen test.

Symptoms of COVID-19 and without close contact to COVID-19 in the last 10 days.

 

Right away

PCR/NAAT or rapid antigen test

Modified quarantine to attend school

As soon as feasible after notification, then on or after day 5 from date of last close contact.

The day of the last close contact is day 0.

PCR/NAAT or rapid antigen test

COVID-19 positive and in isolation, to return to school before 10 days.

On or after day 5.

Rapid antigen test preferred, PCR/NAAT acceptable

Close contact in quarantine and no symptoms

On or after day 5 from date of last close contact. 

Can also consider getting tested right away as well. 

PCR/NAAT or rapid antigen test

Exposure in group tracing approach and no symptoms

Between 3-5 days after exposure

PCR/NAAT or rapid antigen test

Considerations for COVID 19 tests done at home

Schools may now accept home test results to end isolation and quarantine. Home tests yield best results when a person is symptomatic, a good sample swab has been collected and test kit instructions are followed completely. If there is any uncertainty that the swab sample was collected correctly, it is a good idea to get a test done at a clinic or testing site by a professional. Regardless of the test result, if symptoms include fever, a child or staff person must stay out of school until they are fever free for at least 24 hours without the use of medications for fever.

Most home tests come with straightforward print and video instructions. SFDPH has also created a resource with tips for testing children.
The following are best practices for schools to verify the results of home tests:

  • Use a digital (app-based) platform for test verification, which often includes scanning barcodes; these are available for certain brands of self-tests.
  • Write the name and date on the test card results and send a picture of the card to the requesting entity.
  • Create an attestation form and require signature declaring that the test specimen was obtained from the individual represented on the form, include the date the specimen was collected, and that the test was processed according to the instructions provided.

If a home test is positive for COVID-19, SFDPH does not recommend confirmatory testing.  Children and staff with a positive home test should follow isolation guidance and only retest on or after day 5.

For more information about at-home self-testing see Interim Guidance for SARS-CoV-2 At-Home Self-Testing and CDPH guidance on home testing.

More information on school testing

CDPH K-12 school-based COVID‑19 testing strategies

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

Other COVID-19 Resources:

CDC

    Searchable Guidance

    Vaccines

CDPH

    Find All Guidance

    Isolation and Quarantine

    Testing

    Face Coverings

San Francisco

    COVID-19 page at sf.gov

    Outreach toolkit

    Get Tested

    Get Vaccinated