COVID-19 Isolation and Exposure Guidance for Children and Staff in K-12 settings

  • Last updated - 11/7/22

    Guidance for children and staff in certain settings

    Overview

    Effective August 15, 2022, children and staff in child care, K-12, out-of-school time (OST) and recreational camp settings should follow the below guidance.1 

    • A rapid antigen test, such as a self-test, is preferred to a PCR test in most situations.
    • To count days for isolation, Day 0 is the first day of symptoms OR the day the day positive test was taken, whichever is earlier.  
    • Contact tracing is no longer recommended or required in these settings, but schools or programs must continue to work with their Local Board of Health in the case of outbreaks.
    • The Commonwealth is not recommending universal mask requirements, surveillance testing of asymptomatic individuals, contact tracing, or test-to-stay testing in schools. While masks are not required or recommended in these settings except for in school health offices, any individual who wishes to continue to mask, including those who face higher risk from COVID-19, should be supported in that choice.  For those who need or choose to mask, masking is never required in these settings while the individual is eating, drinking, sleeping or outside.
    • All individuals are encouraged to stay up-to-date with vaccination as vaccines remain the best way to help protect yourself and others.

    Isolation and exposure guidance and protocols

    Guidance for Children and Staff in Child Care, K-12, OST, and Recreational Camp Settings:

    • Quarantine is no longer required nor recommended for children or staff in these settings, regardless of vaccination status or where the exposure occurred. All exposed individuals may continue to attend programming as long as they remain asymptomatic. Those who can mask should do so until Day 10, and it is recommended that they test on Day 6 of exposure. If symptoms develop, follow the guidance for symptomatic individuals, below.
    • Children and staff who test positive must isolate for at least 5 days. If they are asymptomatic or symptoms are resolving and they have been fever free without the use of fever-reducing medicine for 24 hours, they may return to programming after Day 5 and should wear a high-quality mask through Day 10:
      • If the individual is able to mask, they must do so through Day 10.
        • If the individual has a negative test on Day 5 or later, they do not need to mask.
        • If the individual is unable to mask, they may return to programming with a negative test on Day 5 or later.
    • Symptomatic individuals can remain in their school or program if they have mild symptoms, are tested immediately onsite, and that test is negative. Best practice would also include wearing a mask, if possible, until symptoms are fully resolved. For symptomatic individuals, DPH recommends a second test within 48 hours if the initial test is negative.
      • If the symptomatic individual cannot be tested immediately, they should be sent home and allowed to return to their program or school if symptoms remain mild and they test negative, or they have been fever-free for 24 hours without the use of fever-reducing medication and their symptoms are resolving, or if a medical professional makes an alternative diagnosis. A negative test is strongly recommended for return.  

    Note: At this time, the US Food and Drug Administration (FDA) has not approved or authorized any at-home rapid antigen test for use in children under 2 years of age. However, at-home rapid antigen tests may be used off-label in children under 2 years of age for purposes of post-exposure, isolation, and symptomatic testing. It is recommended that parents or guardians deciding to test children under 2 years of age administer the at-home rapid antigen test themselves.

    COVID-19 symptoms

    COVID-19 Symptoms for Child Care, K-12, OST, and Recreational Camps
    • Fever (100.0° Fahrenheit or higher), chills, or shaking chills
    • Difficulty breathing or shortness of breath
    • New loss of taste or smell
    • Muscle aches or body aches
    • Cough (not due to other known cause, such as chronic cough)
    • Sore throat, when in combination with other symptoms
    • Nausea, vomiting, when in combination with other symptoms
    • Headache, when in combination with other symptoms
    • 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

Section 1: Key Definitions

  • This section outlines the list of COVID-19 symptoms, provides the definition of a close contact, and outlines situations where close contacts are exempt from COVID-19 testing and quarantine response protocols including isolation, quarantine, and Test and Stay.

    COVID-19 symptoms

    Below is the full list of symptoms for which caregivers should monitor their children, and staff should monitor themselves.1

    At this time, based on the advice of public health officials and medical experts, DESE and DPH are revising the symptoms list to align with DPH statewide guidance. While previous guidance provided a differentiated symptoms list for vaccinated and unvaccinated individuals, the new symptoms list below applies to all individuals, regardless of vaccination status. Individuals who experience any symptoms on the list below should follow the testing and quarantine response protocol for symptomatic individuals (Protocol C) as outlined in Section 2 of this document. Please note that, consistent with the DPH Public Health Advisory Regarding COVID-19 Testing, these protocols have been adjusted to recommend, but not require, a COVID-19 test to return to school.

    COVID-19 symptoms list:

    • Fever (100.0° Fahrenheit or higher), chills, or shaking chills
    • Difficulty breathing or shortness of breath
    • New loss of taste or smell
    • Muscle aches or body aches
    • Cough (not due to other known cause, such as chronic cough)
    • Sore throat, when in combination with other symptoms
    • Nausea, vomiting, or diarrhea when in combination with other symptoms
    • Headache when in combination with other symptoms
    • 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

    Definition of a close contact

    Close contacts are defined as individuals who have been within 6 feet of a COVID-19 positive individual while indoors, for at least 15 minutes during a 24-hour period.2 3 Please note that the at-risk exposure time begins 48 hours prior to symptom onset (or time of positive test if asymptomatic) and continues until the time the COVID-19 positive individual is isolated.

    In general, close contacts should follow the testing and quarantine response protocols in Section 2 of this document. However, certain close contacts are exempted from testing and quarantine response protocols as noted below.

    Close contacts who are exempt from testing and quarantine response protocols

    The following close contacts are exempt from testing and quarantine response protocols:

    • Asymptomatic, fully vaccinated4 close contacts: Individuals who are asymptomatic and fully vaccinated are exempt from testing and quarantine response protocols.
    • Classroom close contacts: An individual who is exposed to a COVID-19 positive individual in the classroom while both individuals were masked, so long as the individuals were spaced at least 3 feet apart, is exempt from testing and quarantine response protocols.
    • Bus close contacts: Individuals on buses must be masked according to federal requirements. As such, individuals who are masked on buses when windows are open are exempt from testing and quarantine response protocols.
    • Close contacts who have had COVID-19 within the past 90 days: An individual who has been previously diagnosed with COVID-19 and then becomes a close contact of someone with COVID-19 is exempt from testing and quarantine response protocols if:
      • The exposure occurred within 90 days of the onset of their own illness AND
      • The exposed individual is recovered and remains without COVID-19 symptoms.

Section 2: Recommended testing and quarantine response protocols

  • This section outlines testing and quarantine response protocols for individuals – students and staff – who test positive for COVID-19, close contacts who are not exempt from testing and quarantine response protocols, and symptomatic individuals. Each scenario outlines the duration of any recommended quarantine or isolation, the conditions to be met in order for the individual to return to school, and any additional considerations.

    Overview of Protocol Categories:

    • Protocol A: For individuals who test positive for COVID-19
    • Protocol B: Protocol for asymptomatic close contacts 
    • Protocol C: Protocol for symptomatic individual

    Protocol A: For individuals who test positive for COVID-19

    Protocol A for individuals who test positive 
    • Duration: Self-isolation for COVID-19 positive cases is a minimum of 5 days after symptom onset or after positive PCR or antigen test, if asymptomatic.
    • Return to school: After 5 days5 and once they have: 
      • Been without fever for 24 hours (and without taking fever-reducing medications)
      • Experienced improvement in other symptoms.
      • Following the 5-day isolation period, individuals must mask for 5 additional days when around others, other than when eating, drinking, or outside.
    • Note: Return to school should be based on time and symptom resolution. Testing during isolation to return to school is not required.

    Protocol B: Protocol for asymptomatic close contacts 

    Protocol B* (New Version) for Districts and Schools that Selected the New Testing Option to Provide At-home Rapid Antigen Tests

    Updated testing guidance from DESE and DPH recommend that districts select the new option within the statewide testing program to offer weekly rapid at-home antigen tests to students and staff and discontinue contact tracing and Test and Stay programs. As such, for districts selecting this new option, individuals will no longer be identified as close contacts by school health professionals.

    However, individuals may still be identified as close contacts outside of school settings (e.g. as a close contact of someone who tests positive for COVID-19 in their household). In these cases:

    •  While in school settings (including for sports and extracurriculars), asymptomatic vaccinated6 individuals remain exempt from testing and quarantine protocols. If an asymptomatic, vaccinated individual is identified as a close contact outside of school, they may return to school. Individuals should closely monitor for symptoms and follow Protocol C if they experience symptoms listed in Section 1.
    • Unvaccinated individuals who are identified as close contacts outside of school settings should stay home and follow Protocol B* below prior to returning to school:

    Protocol B* (New Version): Protocol for asymptomatic, unvaccinated individuals identified as close contacts outside of school settings

    • Duration: Quarantine is at least 5 days from the date of exposure
    • Return to School: After 5 days, returning on day 6, provided that they:
      • Remain asymptomatic,
      • Adhere to strict mask use, other than when eating, drinking, or outside, and conduct active monitoring for symptoms through day 10; and,
      • Self-isolate if symptoms develop.
    • Note: If an individual has symptoms at the time they are designated as a close contact or within the 5 days following initial exposure, they should follow the protocol for symptomatic individuals (Protocol C). If an individual tests positive at any time, they follow the protocol for individuals who test positive for COVID-19 (Protocol A). For all those exposed, best practice would also include a viral test (antigen or PCR) for COVID-19 at day 5 after exposure. An antigen test may be self-administered and does not need to be proctored or performed by a healthcare professional.

    Protocol B (Legacy Version) for Districts and Schools Choosing to Maintain Contact Tracing and Test and Stay

    Only schools and districts that choose to maintain contact tracing and the Test and Stay program should follow the guidelines in Protocol B (Legacy Version) below. Please recall that all asymptomatic, fully vaccinated individuals are exempt from close contact testing and quarantine response protocols and therefore do not need to follow Protocol B. However, fully vaccinated individuals are expected to monitor for symptoms, stay home and get tested if they experience symptoms, in alignment with Protocol C.

    Protocol B (Legacy Version) for asymptomatic close contacts who are not exempt from testing and quarantine response protocols

    Districts who choose to maintain contact tracing and are participating in the statewide COVID-19 testing program or another similar testing program are encouraged to utilize the Test and Stay (B-1) protocol option to minimize the amount of time individuals are out of school. This testing and quarantine response protocol has been shown to be generally equivalent to quarantine for school-based contacts, and a safe alternative to at-home isolation.7 Individuals who are part of the Test and Stay protocol may be eligible to participate in school sports and extracurricular activities, provided that they are in compliance with the applicable protocol. For events and sports that take place on non-school days, testing will still be required on those days to participate. As part of Test and Stay, quarantine is still strongly recommended for individuals outside of school settings.

    Protocol B-1 (Recommended): Test and Stay

    • Duration of Test and Stay: 5 days from the date of exposure
    • Return to School: Close contacts can remain in school and do not have to quarantine, as long as they:
      • Are asymptomatic
      • Wear masks in school at all times, other than when eating, drinking, or outside. When these individuals cannot be masked (i.e., when eating or drinking) they should maintain 3 feet of distance from other individuals to the extent feasible.
      • Take a rapid antigen test (e.g., BinaxNOW) on each school day and receive a negative result. When the 5 days from date of exposure includes weekends or holidays, individuals should quarantine on weekends, and if they remain asymptomatic, upon return to school be tested immediately. If the individual remains negative, they can stay in school.
      • Conduct active monitoring for symptoms through day 10, and self-isolate at home if symptoms develop.
    • Note: If an individual has symptoms at the time they are designated as a close contact or develops symptoms during the Test and Stay period or the 10 days following initial exposure, they should follow the protocol for symptomatic individuals (Protocol C). If an individual tests positive at any time, they should follow the protocol for individuals who test positive for COVID-19 (Protocol A).

    Protocol B-2: Traditional protocol (if school does not have access to rapid daily testing or family or adult individual chooses not to participate in Test and Stay)

    • Duration: Quarantine is at least 5 days from the date of exposure
    • Return to School: After 5 days, returning on day 6, provided that they:
      • Remain asymptomatic;
      • Adhere to strict mask use, other than when eating, drinking, or outside, and conduct active monitoring for symptoms through day 10; and,
      • Self-isolate if symptoms develop.
    • Note: If an individual has symptoms at the time they are designated as a close contact or within the 5 days following initial exposure, they follow the protocol for symptomatic individuals (Protocol C). If an individual tests positive at any time, they follow the protocol for individuals who test positive for COVID-19 (Protocol A). For all those exposed, best practice would also include an antigen or PCR test for COVID-19 at day 5 after exposure. An antigen test may be self-administered and does not need to be proctored or performed by a healthcare professional.

    Protocol C: Protocol for symptomatic individuals

    Protocol C applies to vaccinated and unvaccinated individuals who experience the COVID-19 symptoms listed in Section 1 and who have not tested positive for COVID-19.

    Protocol C for symptomatic individuals: Return to school post-symptoms with optional test8
    • Duration: Dependent on symptom resolution
    • Return to School: Individuals may return to school after they: 
      • Have improvement in symptoms 
      • Have been without fever for at least 24 hours without the use of fever-reducing medications.
      • It is also recommended that individuals receive a negative PCR or antigen test result for COVID-19. An antigen test may be self-administered and does not need to be proctored or performed by a healthcare professional. Note: So long as the individual is not a close contact, if a medical professional makes an alternative diagnosis for the COVID-19-like symptoms, the individual may use this recommendation (e.g., for influenza or strep pharyngitis) in lieu of a PCR test or antigen test.
    • Please note: If an individual has mild symptoms, the individual may be considered for testing using BinaxNOW, if available.
      • If the result if positive, they should be sent home and follow Protocol A.
      • If the result is negative, they should remain in school.
      • If the minimal symptom(s) persist, the individual may be re-tested within the subsequent 3 days. If symptoms worsen, the individual should seek medical care and be evaluated for the need for PCR testing.

Section 3: Routine COVID pooled testing protocols

  • Routine COVID pooled testing involves combining several test samples together and then testing the group sample with a PCR test for detection of COVID-19. Testing for all consenting students and staff members will typically take place once per week.

    Unvaccinated district and school staff and students who submit consent forms are strongly encouraged to participate in voluntary routine COVID pooled testing. This includes contracted staff such as bus drivers. Vaccinated staff and students may also participate in pooled testing if they submit consent forms; however, this is not recommended. An individual who has tested positive for COVID-19 in the past 90 days should not participate in pooled testing.

    Protocol for routine COVID pooled testing

    If the routine group pooled testing result is negative, then:

    •  All individuals within that group are presumed negative and should remain in school.

    If the routine group pooled testing result is positive, then:

    • All individuals within that group should be retested individually by rapid antigen (e.g. BinaxNOW) or PCR test.
    • If asymptomatic, members of the group should return to school until and unless an individual is identified as positive. Individuals in the group should wear masks until the positive individual is identified.
    • Symptomatic members of the group should stay home and follow Protocol C.

Notes

    1. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

    2. Note: To be a close contact, the 15 minutes must occur within a 24-hour period. Multiple brief or transitory interactions (less than a minute) throughout the day are unlikely to result in 15 minutes of cumulative contact and do not meet the definition of close contact.

    3. CDC definition of Close Contact. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html.

    4. At this time, fully vaccinated is defined as two-weeks following the completion of the Pfizer or Moderna series or two-weeks following a single dose of Johnson & Johnson’s Janssen vaccine.

    5. If an individual tests positive as part of a group pooled test, the 5-day period begins the day the group pooled test returned a positive result.

    6. At this time, fully vaccinated is defined as two-weeks following the completion of the Pfizer or Moderna series or two-weeks following a single dose of Johnson & Johnson’s Janssen vaccine.

    7. Bernadette C Young, David W Eyre, Saroj Kendrick, Chris White, Sylvester Smith, et. al. “A cluster randomized trial of the impact of a policy of daily testing for contacts of COVID-19 cases on attendance and COVID-19 transmission in English secondary schools and colleges.” (July 2021). medRxiv. Available at: https:/www.medrxiv.org/content/10.1101/2021.07.23.21260992v1

    8. Please note that, consistent with the DPH Public Health Advisory Regarding COVID-19 Testing, these protocols have been adjusted to recommend, but not require, a COVID-19 test to return to school.