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San Francisco Health Network

COVID-19 infections, symptoms, and exposures

Guidance for schools, childcares, and programs for children and youth

Last updated on November 18, 2021

 

On this page:

Quick reference for COVID‑19 infections, symptoms and exposures

Steps to take for confirmed COVID‑19 cases

When can children and youth return to their school or program?

Click below for translated versions of this page:

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

Scenario

Action

Communication

Child or staff has symptoms of COVID‑19

Send home if at school, with the parent handout on Returning to School after Symptoms (children) or Isolation and Quarantine Guidelines (all ages). Recommend testing.

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

Child or staff reports close contact* to COVID-19 and was not fully vaccinated for COVID-19

Send home if at school, with Home Quarantine Instructions for Children Under 18 (children) or Isolation and Quarantine Guidelines (all ages). Recommend testing.

Optional notification letter to staff and families that a staff member or child is quarantining for COVID‑19 exposure

Child or staff with confirmed COVID‑19

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

Notify the SFDPH Schools/Childcare 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

For fully vaccinated close contacts, recommend testing on day 5-7.

Send unvaccinated persons with known* close contact home to quarantine. Recommend testing.

Close contacts

All other staff and families

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

Schools may allow unvaccinated students to attend in-person classes during quarantine, if

  • The close contact occurred at school,
  • Both the exposed student and the infected person were fully masked (covering the mouth and nose) during the close contact, and
  • The student gets tested right away and again on or after day 5
  • Remains free of symptoms

See guidance on modified quarantine.

Close contacts

Send General Exposure Advisories to all other staff and families as above.

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 10 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 10 days after their test.

* 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.

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 1 hour entering if into CDPH's School and Shared Portal for Outbreak Tracking (SPOT) (preferred) or by emailing cases.schools@sfdph.org. An on-call public health professional will get back to you as soon as possible. Non-English-speaking sites may leave a voicemail at (628) 217-7499.
  4. Identify and notify people known to have close contact with the COVID-19 case, starting 2 days before they started having symptoms (or if they had no symptoms,  2 days before they tested positive). When informing people that they may have been exposed, do not disclose the identity of the person with COVID-19, as required by law.
  5. Use the List of Close Contacts template (Word document) to collect details of any close contacts
  6. and be prepared to submit list to SFDPH if requested.
  7. Communicate to your school community within one business day as indicated in the table above.
  8. 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 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,
    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).

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

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 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.

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 close contact/exposure

Scenario

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

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 on or after day 5 of quarantine.

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 as soon as possible after notification of exposure and once more on or after 5 days after exposure.
  • 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.

Quarantine exceptions and special situations

See the SFDPH Isolation and Quarantine guidance for the following exceptions to quarantine:

Staff Return to Work

See isolation and quarantine guidance.

For Schools and Programs:.

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 14 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 14 days.

 

Right away

PCR/NAAT or rapid antigen test

Modified quarantine to attend school

Right away, 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

Close contact 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

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

We currently do not know how well home tests can detect COVID-19 when the test is performed on a child by the child’s caregiver or by an individual on themselves.  If schools choose to accept home test results to return to school, SFDPH recommends that home testing be limited to symptomatic individuals when all the following are true: 

  1. The person’s symptoms* do not include loss-of-taste or smell.  
  2. The person has not had close contact with someone positive for COVID-19 in the past 14 days. 
  3. The person or caregiver is confident that they were able to thoroughly swab the nose, obtain a good sample and all test instructions were followed correctly.  
  4. Requiring a test at a clinic, school, or other test site would result in additional missed days from school.   

Schools should accept positive home test results in all situations.  Specifically, if a home test is performed and positive for COVID-19, SFDPH does not recommend repeat testing or confirmatory testing.  Moreover, even if follow up testing is done and negative, the individual will need proof of clinical evaluation and documented clearance from a medical provider to end isolation early. 

At this time, SFDPH does not recommend accepting home tests to end quarantine and home tests should not be used as part of a routine screening program for unvaccinated individuals. 

*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.

For more information about at-home self-testing see Interim Guidance for SARS-CoV-2 At-Home Self-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:

Centers for Disease Control (CDC)

Guidance for COVID-19 (searchable)

Vaccines for COVID-19

CA Dept of Public Health (CDPH)

Find All Guidance

Guidance for Fully Vaccinated People

Guidance for Testing

Guidance for Face Coverings

San Francisco

COVID-19 page at sf.gov

Outreach toolkit

Get Tested

Get Vaccinated