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San Francisco Health Network

Returning to School After COVID-19

Last updated September 2, 2021

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

Children who test positive or are diagnosed with COVID‑19

Scenario

Criteria to return to school or program
A doctor's note or negative test is not needed to return.

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

  • 10 days have passed since symptoms began, 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).

Tested positive, but never had symptoms

10 days have passed since their positive test was collected
(not 10 days after the result was received)

Children with symptoms of COVID‑19, without known close contact

Scenario

Criteria to return to school or program

If child tests negative
Must show proof of the negative test

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.

Children not fully vaccinated for COVID‑19 with close contact/exposure

Scenario

Criteria to return to school or program

If child tests negative
Must show proof of the negative test

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

Close contact but no symptoms

  • No symptoms for 7 days after the last* close contact and
  • A negative test, collected at least 5 days after the last close contact.

No symptoms for 10 days after the last* close contact.

TK-12 schools only:
Close contact at school while both the student and the infected person were masked.

Student may leave home to attend school during quarantine if they

  • Get tested twice a week.
  • Remain free of symptoms
  • Wear a face mask at school.

Close contact and symptoms

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

If not tested after symptoms began,

  • 14 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 7-14 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.

Exceptions

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 an itchy, runny nose in a child with known allergies. 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.

COVID‑19 Vaccination

Children and youth who have been fully vaccinated for COVID‑19 do not have to quarantine after close contact to COVID‑19. See isolation and quarantine guidance for fully vaccinated people.

COVID‑19 in the last 3 months

If a child or youth has had COVID‑19 within the last 3 months, they do not have to quarantine after close contact to COVID‑19, as long as they do not have any symptoms of COVID‑19. If they have symptoms of COVID‑19, they should stay at home until they can consult with their doctor about whether they need to be tested or continue to stay at home. The school or program can require a doctor’s note in this situation.  See isolation and quarantine guidance for people with recent COVID‑19.

Elementary, middle, and high school students with close contact at school (modified quarantine)

If a student has close contact at a school, but both the student and the infected person wore masks over their nose and mouth during the exposure, the student may attend school during quarantine, with restrictions. See modified quarantine guidance for TK-12 students.

Outdoor exposures in schools, childcares and other supervised programs

Children with close contact to COVID‑19 while outdoors in a school or other supervised program for children and youth generally do not have to quarantine. See isolation and quarantine for outdoor exposures in schools, childcares, and other programs for children and youth.

Staff Return to Work

See isolation and quarantine guidance.

For Schools: Summary of Testing Scenarios

Scenario

When to test

Type of Test

Where to test

Symptoms of COVID‑19

Right away

Molecular (ie PCR, NAAT, LAMP) only or
Rapid antigen with confirmatory molecular test if antigen test is negative

Negative molecular test needed to return to school early.

School, clinic or test site.

Accept positive results from home tests

Modified quarantine to attend school

Right away, then twice a week (3 days apart)

Rapid antigen or molecular

Close contact and no symptoms

On day 6 after the close contact (The day of the close contact is day 0.​)

Molecular (preferred) or antigen

When can we do a rapid antigen test?

Rapid antigen tests provide results in 15 minutes. But rapid antigen tests can sometimes miss infections, especially in people who don’t have symptoms.

Schools can use rapid antigen tests twice a week for students who have no symptoms, for example, for modified quarantine. Testing twice a week instead makes up for the decreased sensitivity of the antigen test compared to the PCR test.

To help detect infections early, schools can also use rapid antigen tests for students who develop symptoms at school. If the antigen test is negative, the student still needs a PCR test to make sure they are not infected.

When can schools and programs accept a COVID‑19 test done at home?

Schools and programs should only accept positive results from home tests. If the test is negative, the child still needs a PCR test sent from a school, clinic or testing site to make sure they are not infected.

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