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COVID-19 infections, symptoms, and exposures—Guidance for schools, childcare and programs for children and youth

Last updated on April 11, 2022

Summary of changes since March 22, 2022:

Updated to eliminate quarantine requirement for children after exposure to COVID-19, regardless of location or type of exposure or vaccination status.

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?

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 instructions for isolation.

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 exposure to COVID-19 outside of school setting

If asymptomatic, child may continue to attend school or program

Strongly recommend wearing a well-fitting mask for 10 days

Recommend testing 3-5 days from exposure

Steps to take for confirmed COVID‑19 cases

  1. 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.
  2. Identify and notify people as required by the group tracing approach. When informing people that they may have been exposed, do not disclose the identity of the person with COVID-19, as required by law.
  3. Communicate to your school community within one business day as indicated in the table below.
  4. Notifying your school community of a positive case

    Event

    Who

    Notification Template

    Exposure at school
    (Group Tracing Approach)

    Families of students who were exposed and staff

    Case at school (no exposure to COVID‑19)

    Families and staff

    Exposure: defined as having spent more than a cumulative total of 15 minutes (within a 24-hour time period) in a shared indoor airspace (e.g., classroom) with someone with COVID-19 during their period of infectiousness.

    SFDPH has developed the following Word documents that can be used for notification. Note, close contact and quarantine advisory letters remain available for reference until June 30, 2022, but will not be updated.

Notification Template (Word docx)

Translations

Group Tracing Exposure Letter

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

General Exposure Advisory

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

Standard Quarantine Close Contact Advisory — Children and Youth under 18

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

Standard Quarantine Close Contact Advisory — Adult

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

TK-12 Schools Only: Modified Quarantine Advisory

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

Scenario

Criteria to return to school

If child tests negative

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

Symptoms of 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 with exposure outside of school setting

Children who are exposed to COVID-19, regardless of the type or location of exposure or their vaccination status are allowed to return to school as long as they are asymptomatic.  It is strongly recommended they continue to wear a well-fitting mask for 10 days, if not already doing so.  It is recommended that they test 3-5 days after exposure.  See CDPH guidance.

 

Children with exposure in a TK-12 school setting

SFDPH urges schools to prioritize keeping asymptomatic children in school while continuing to isolate symptomatic children and positive cases.

SFDPH strongly recommends utilizing a Group Tracing Approach over individual tracing for rapid notification of families whenever possible, but especially when it is difficult to reliably determine close contacts and universal indoor masking measures are not in place.

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.  Schools may also choose to implement a group tracing approach for school-based exposures per CDPH guidance.

Testing is recommended and not required to implement group tracing.  Moreover, if testing resources are limited, it is reasonable to prioritize allocation of testing for:

Tier 1: Students who become symptomatic after exposure, regardless of vaccination status

Tier 2: Asymptomatic students who are not fully vaccinated for COVID-19

Tier 3: Asymptomatic students who are fully vaccinated for COVID-19

In addition, in the event of wide-scale and/or repeated exposures, once weekly testing may be considered 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.

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

 

Right away

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

Rapid antigen test preferred if positive for COVID in the last 90 days.

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

Exposure in Group Tracing Approach and no symptoms

Between 3-5 days after exposure

PCR/NAAT or rapid antigen test

Rapid antigen test preferred if positive for COVID in the last 90 days.

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:

  • 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.
  • Use a digital (app-based) platform for test verification, which often includes scanning barcodes; these are available for certain brands of self-tests.

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