covid doh guidance for schools

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

COVID DOH Guidance for Schools

October 2, 2020

LIVING IN

A

COVID WORLD


INTRODUCTIONS• Dr. Tom Massaro, Chief Medical & School Health Officer NMDOH

• Dr. Chris Novak, DOH/PHD Medical Director

• Regional Health Officers: Dr. Marciniak (SW & Acting SE Regions), Dr. Miranda Durham (Metro, NW), Dr. Ogren (NE)

• PED Representative

• NM School Nurse Association – Lisa Crawford

• OSAH: Jim Farmer, Director; Susan Acosta, State School Health Consultant; Shayna Klassen, Behavioral Health Consultant; Victoria Waugh-Reed, Suicide Prevention Coordinator

• Regional School Mental Health Advocates: Twila Bencenti-Fundark & Regina Bejarano

• Regional School Health Advocates: Jennifer Downey, Leslie Berry, Barbara Lynn Wheeler, Maricelda Pisana, & Crista Pierce


COVID AND SCHOOLSDefinitions

Scenarios/Decision TreesMental Health AspectsQuestions & Answers


Definitions:Confirmed case: A person who has tested positive for COVID-19 by laboratory testing*

* Confirmatory laboratory tests include Polymerase Chain Reaction (PCR) or antigen testing

from a respiratory specimen. Note that a positive serology, IgM or IgG is not considered a confirmatory test.

COVID-like Symptoms: Fever, chills, cough, shortness of breath or difficulty

breathing, fatigue, muscle or body aches, headache, new loss of smell or taste, sore

throat, congestion or runny nose, nausea or vomiting, diarrhea

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

Corona Safe Practice (CSP)

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

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


• Infectious period: Time during which an infected person is contagious and most likely to spread disease to others. If a student, staff or volunteer was at school during their infectious period, all of their close contacts must be identified and quarantined.

Definitions Continued: Infectious Period


Infectious Period - Symptomatic

• For a confirmed symptomatic COVID-19 case, the infectious period starts 2 days prior to the illness onset date and continues for 10 days* after illness onset. *as long as they have been fever free for at least 24 hours and symptoms have resolved or improved.

• For a confirmed symptomatic COVID-19 case with severe illness or severe immunosuppression, the infectious period starts 2 days prior to illness onset date and is extended to 20 days after illness onset date.


• Asymptomatic confirmed case: A person who has tested positive for COVID-19 by laboratory testing but did not experience any symptoms of illness (listed above) within 10 days of the test.

For a confirmed asymptomatic COVID-19 case, the infectious

period starts 2 days prior to the specimen collection date and

continues for 10 days after.

If a confirmed asymptomatic COVID-19 case has severe

immunosuppression, at least 20 days should have passed since

the date of first positive specimen collected.

Infectious Period - Asymptomatic


Infectious Period – Severe Illness• Severe illness: Severe illness is indicated by hospitalization in an intensive

care unit with or without mechanical ventilation.

• Severe immunosuppression: Severe immunosuppression includesbeing on chemotherapy for cancer, untreated HIV infection with CD4T lymphocyte count <200, combined primary immunodeficiencydisorder, and receipt of prednisone >20 mg/day for more than 14days.

• Other factors, such as advanced age, diabetes mellitus, or end-stagerenal disease, may pose a much lower degree of immunocompromiseand not clearly affect decisions about duration of isolation.


Definitions Continued:

Isolation: Isolation keeps someone who is sick or tested positive for COVID-19 without symptoms away from others, by staying home from school, work and other activities while infectious.

• Isolation should last at least 10 days after the onset of symptoms, and until you are fever-free for 24 hours without the use of fever-reducing medications and have experienced improvement of symptoms.

• For people who never had symptoms, the isolation period is 10 days after the date their first positive test was collected.

• If someone has a severe illness or severe immunosuppression, the isolation period should be extended to 20 days.

• A negative test is not recommended to determine when to end the isolation period. When in doubt, the New Mexico Department of Health should be consulted.


• Quarantine: Quarantine keeps someone who was in close contact with someone who has COVID-19 away from others.

• If someone has close contact with a confirmed case of COVID-19, they should stay home from school, work and other activities for 14 days after their last exposure due to the incubation period being 2-14 days.

• The exposed contact should be tested for the virus that causes COVID-19 no sooner than 3 days following the last exposure to a confirmed case and ideally between 7-10 days.

• If the close contact has a positive result, isolation should be implemented as described above



Close Contact: Someone who:

• Has an exposure of 3 minutes or longer within 6 feet of a confirmed COVID-19 case during the case’s infectious period with or without a mask or cloth-face covering.

• OR -- Was in the same class or cohort as a confirmed COVID-19case.

• The Cohort includes classroom and buses.



• Cohorting: The practice of keeping groups of students, and staff if possible, together over the course of the school day. The goal of cohorting is to limit exposures to only those within the same cohort. This practice may help reduce the spread of COVID-19 by:

• Limiting exposure to an individual with COVID-19 to one particular cohort and not posing a broad risk to the rest of the school

• Reducing contact with shared surfaces

• Facilitating more efficient contact tracing in the event of a positive case

• Allowing for targeted quarantine, testing and/or isolation of a single cohort, instead of school-wide measures in the event of positive case or cluster of cases



Guidance from ERD on Chronic Conditions:

1.Should students or staff be tested every time they have a runny nose?

• Students or school staff with mild non-specific COVID-19 symptoms, such as headache, runny

nose, diarrhea, myalgias, etc., should be tested initially for COVID-19 and be sent home to initiate

isolation until the results come back. A negative test result will discontinue the isolation and the

student or staff should be allowed to return to school provided that their symptoms do not interfere

with their ability to work at school.

• The individual should then be monitored for changes in symptoms, if they experience no significant

changes, then they should not be required to be tested again.

• Some level of conservative caution is required with an illness that often presents with mild non-

specific symptoms. However, school staff, ideally a school nurse, in consultation with the New

Mexico Department of Health’s School Health Advocates, should be able to make judgment calls

based on severity of symptoms, chronicity of symptoms, and changes from baseline.


Guidance from ERD on Chronic Conditions Continued:

2. What if the symptoms are chronic?

• Students or school staff with chronic allergic rhinitis, or chronic asthma or other chronic,

non-infectious respiratory symptoms should consult their primary care provider (PCP), if

their PCP agrees the current symptoms do not differ from the patient’s baseline, then, the

individual being evaluated is not required to be tested for COVID-19.

• If the individual has a change in symptoms from their baseline as assessed either by the

person themselves (if staff), a parent/guardian or school nurse (if student) or a physician,

then that individual should be tested for COVID-19 and be placed in isolation until the

results come back. A negative result will discontinue the isolation.


3. What if a student or staff has been tested in the past, how

old will a negative test be good for?

• Students or staff that have tested negative for COVID-19 in the

past two weeks, should NOT be tested again in the presence of

chronic symptoms that have not changed in a meaningful way

during that interval. If those symptoms were to change from their

baseline, then they should be tested and begin home isolation.

Guidance from ERD on Chronic Conditions Continued:


➢ Each scenario is an example of a possible situation that involves a school and their

response to a COVID-19 illness.

➢ Exposure Scenarios: Refers to a student or staff member exposed to a person with

a confirmed case of COVID-19.

➢ Becomes Ill Scenarios: Refers to a student or staff member who becomes ill with

COVID-19 either after no contact with a person with COVID-19 symptoms or after

close contact with a person with COVID-19 symptoms.

➢ Tests Positive Scenarios: Refers to one or more student or staff member having a

positive COVID-19 test, including the action necessary if in the same or different

cohorts.

➢ Tests Negative Scenarios: Refers to an ill student or staff member who has a

negative COVID-19 test.

➢ Does Not Get Tested Scenarios: Refers to a student or staff member who does not

get tested in response to specific events.

About Scenarios:


General Quarantine Protocol


Quarantine OR Isolate

• A. People who have tested positive for COVID-19 should isolate.

• B. Any person who has been in close contact with a person with positive

COVID-19 should quarantine.

• C. Anyone who has been in close contact with someone who was exposed

to COVID-19 does not need to quarantine.

This framework will need to be applied within an ever-changing context.


Scenario 1a. How to handle an EXPOSURE to COVID-19Scenario 1a. A healthy student or staff member has been exposed to a person with

confirmed COVID-19 within their household

SCHOOL

Send individual home (if not homealready). Testing no early than 3 days from exposure. Preferably test 7-10 days since date of exposure.

Record the date school became aware and excluded the

individual.

EXPOSED PERSON

Quarantine at home for 14 days after date of last exposure to the COVID-

19 positive contact. If additional household members become ill with COVID-19, or if the exposed person

cannot avoid continued close contact, the length of quarantine may

be >14 days.

If exposed person becomes ill during quarantine, see

Scenario 2B

Siblings should also quarantine at home for 14 days after date of last exposure to the COVID-19 positive

contact. If additional household members become ill with COVID-19,

or if the exposed person cannot avoid continued close contact, the length of

quarantine may be >14 days.

If exposed sibling becomes ill during quarantine, see

Scenario 2B

HOUSEHOLD MEMBERS

Including siblings (if ill person is a student)


Scenario 1b. How to handle an EXPOSURE to COVID-19Scenario 1b. A healthy student or staff member has been exposed to a person with

confirmed COVID-19 outside of their household

SCHOOL

Record the date school became aware and excluded the

individual.

EXPOSED PERSON

Quarantine at home for 14 days after date of last

exposure to the COVID-19 positive contact.

If exposed person becomes ill during quarantine, see

Scenario 2B

HOUSEHOLD MEMBERS


If siblings were not exposed tothe person with confirmed

COVID-19: they may continue school attendance as long as

exposed sibling remainshealthy.

CSP: Exposed member minimize contact with others in house

Send individual home (if not homealready). Testing no early than 3 days from exposure. Preferably test 7-10 days since date of exposure.


Scenario 2a. How to handle a COVID-19-LIKE SymptomsScenario 2A. A student or staff member becomes illwith COVID-19-like symptoms*.

Ill person has no known COVID-19 contacts in past 14 days

SCHOOL

Send student or staff home.

Record the date school became aware

and excluded the individual.

Symptomaticperson

Seek testing from healthcare provider

If individual does not have a provider and needs assistance finding a testing site www.cvnmhealth.org or

COVID Hotline 855-600-3453.

If the ill person has a negative COVID-19 viral

test, see Scenario 3A

If the ill person does not get

tested for COVID-19, see

Scenario 4A

If the ill person has a positive COVID-19 viral

test, see Scenario 5A

HOUSEHOLD MEMBERS


All healthy siblings may continue school

attendance while ill student is evaluated for

COVID-19 infection.

http://www.cvnmhealth.org


Scenario 2b. How to handle a COVID-19 illnessScenario 2b. Student or staffmember becomes illwith COVID-19 symptoms*. Ill person was in close

contact with someone with has COVID-19 in past 14 days

If the ill person

does not get

tested see

Scenario 4b

If the ill person

has a positive

test see

Scenario 5b

Record the date

school became

aware & excluded

the individual

Send student or staff home since they are a close contact of a confirmed COVID-19case.

Seek testing from healthcare provider. If individual does not have a provider and needs assistance finding a testing site www.cvnmhealth.org or COVID Hotline 855-600-3453.

If the ill person

has a negative

test see

Scenario 3b

All healthy siblings should be

able to attend school until

the sibling has a confirmed

positive result.

CSP: family members should

minimize exposure to ill

person

SCHOOLSymptomatic HOUSEHOLD

MEMBERS


http://www.cvnmhealth.org/


Scenario 3a. How to handle a Negative COVID-19 testScenario 3a. An illstudent or staffmember has a negative COVID-19 test. Ill person

has no known COVID-19 contacts in past 14 days

SCHOOL

Send individual home (if not

home already).

Symptomatic

Isolate at home until 24 hours after feveris resolved, without use of fever-reducingmedicine, and symptoms are improving.

Healthy siblings may

continue school attendance

HOUSEHOLD MEMBERS



Scenario 3b. How to handle a Negative COVID-19 testScenario 3b. An ill student or staff member has a negative COVID-19 test. Ill person

was in close contact with someone with has COVID-19 in past 14 days

Symptomatic Person

Because of recent close contact ill person must quarantine for 14 days from date of last exposure to known COVID positive case

SCHOOL

.Send student/staff home, if

not already isolated.

Quarantine for 14 dayssince last known date of exposure


Scenario 4a. How to handle a person who does not get testedScenario 4a. An ill student or staff member does not get tested for COVID-19.

Symptomatic person has no known COVID-19 contacts in past 14 days

If person has respiratory

symptoms, isolate at home

for 10 days and until 24

hours after fever has

resolved without the use of

antipyretics and other

symptoms are improving

If no alternative diagnosis is identified as the cause of the person’s illness, the ill person should isolate at home for 10 days and until 24 hours after fever is resolved, without use of fever-reducing medicine, and other symptoms are improving.

Symptomatic Person

If a clear alternative non-respiratory diagnosis is identified by a healthcare provider as the cause of the person’s illness (e.g., a positive urine culture in a febrile child), then usual disease-specific return-to-school guidance should be followed and person should be fever-free for 24 hours, without use of fever-reducing medicine.

A healthcare provider note is required for return to school before 10 days of isolation, ensuring that the person is no longer contagious.

SCHOOL

Send individual home (if not

home already).


Scenario 4b. How to handle a person who does not get testedScenario4b.An illstudentorstaffmemberdoesnotget tested for COVID-19. Ill person was inclose contact with someone who had COVID-19 in past 14 days.

SCHOOL

Send individual home (if not home already).

Should quarantine for 14 days since last known

exposure to positive case

If no alternative diagnosis is identified by a

healthcare provider as the cause of the person’s illness, the ill person

should quarantine for 14 days since last known

exposure to positive case

If an alternative respiratorydiagnosis is identified by ahealthcare provider as thecause of the person’s illness(e.g., positive influenza test),

COVID-19 is still not ruled out. Co-infection is possible.

The ill person should quarantine for 14 days since

last known exposure to positive.

Symptomatic Person


Scenario 5. How to handle a Positive COVID testScenario 5. One student or staff member has a positive COVID-19 viral test

SCHOOL

Send student/staff home, if not already isolated.

Designatedstaff contact NM PED at 505-476-5825 or email [email protected]

Must notify within 4 hours! Notify the NM Department of Environmental Services only when staff members are positive. The link for the form:https://nmgov.force.com/rapidresponse/s/

Close classroom for 24 hours and then disinfect

Develop Close Contact Line List and enter into Salesforce

School to notify individuals listed on LineList to quarantine 14 days after last exposure to confirmed case

Time Based Method:

Isolate 10 days from

positive test as long

as symptoms do not

develop may return

after the 10 days

Asymptomatic Symptomatic

Symptom Based Method:

Isolate for 10 days from onset

of symptoms & Until 24 hours

after fever resolves without

antipyretics & other symptoms

improved

A negative COVID-19 test is not

needed for return to work/school.

Repeat testing not recommended

https://nmgov.force.com/rapidresponse/s/


Scenario 5 Continued. How to handle a Positive COVID testScenario 5. One student or staff member has a positive COVID-19 viral test

EXPOSED PERSON

Refer to

Scenario 1

Close Contact is anyone within 6 feet of positive case with or without a mask for 3 minutes or

greater.

HOUSEHOLD MEMBERS

All healthy siblings must quarantine at

home. Refer to Scenario 1a


Scenario 6. How to handle Multiple Positive COVID casesScenario 6. Two or more people within same cohort have a positive COVID-19

viral test within 14 days

A negative COVID-19 test

is not needed for return to

work/school. Repeat

testing not recommended

Time Based Method:


collection of

specimen as long as

symptoms do not

develop may return

after the 10 days

AsymptomaticSymptomatic

Symptom Based

Method:

Isolate for 10 days from

onset of symptoms &

Until 24 hours after

fever resolves without

antipyretics & other

symptoms improved

SCHOOL


Designatedstaff contact NM PED at 505-476-5825 or email [email protected]

Must notify within 4 hours! Notify the NM Department of Environmental Services only when staff members are positive. The link for the form:https://nmgov.force.com/rapidresponse/s/

Close classroom for 24 hours and then disinfect


School to notify individuals listed on LineList to quarantine 14 days after last exposure to confirmed case



EXPOSED PERSON

Refer to

Scenario 1

Close Contact is anyone within 6 feet of positive case with or without a mask for 3 minutes or

greater.

HOUSEHOLD MEMBERS

All healthy siblings must quarantine at

home. Refer to Scenario 1a

Scenario 6. How to handle Multiple Positive COVID casesScenario 6. Two or more people within same cohort have a positive COVID-19 viral

test within 14 days


Scenario 7. How to handle Multiple Positive COVID casesScenario 7. Two or more people within DIFFERENT COHORTS have a positive

COVID-19 viral test within 14 days

SCHOOL


Close the rooms/wings & work with PED on specifics

Must notify within 4 hours! Notify the NM Department of Environmental Services only when staff members are positive. The link for the form:


School to notify individuals listed on Line List to quarantine 14 days after last exposure to confirmed case

Time Based Method:


positive test as long

as symptoms do not

develop may return

after the 10 days

Asymptomatic Symptomatic

Isolate for 10 days

from onset of

symptoms & Until 24

hours after fever

resolves without

antipyretics & other

symptoms improvedDesignated staff contact NM PED at 505-476-5825 or email [email protected]

EXPOSED PERSON

Refer to

Scenario 1

Close Contact is anyone within 6 feet of positive case with or

without a mask for 3 minutes or

greater.

NMDOH does not

recommended repeat

testing.




SHA Contact Information:

• Susan Acosta, RN State Consultant [email protected] 505-490-2763

• Jennifer Downey, RN NE Region [email protected] 505-469-3010

• Crista Pierce, RN SW Region [email protected] 575-339-4380

• Leslie Berry, RN NW Region [email protected] 505-490-7948

• Maricelda Pisana, RN SE Region [email protected] 575-528-8863

• Barbara Lynn Wheeler, RN Metro Region [email protected] 505-467-9292

mailto:[email protected]







Behavioral Health ResourcesSNAC

The Office Of School and Adolescent Health

Behavioral Health Team


Who is OSAH?The Office of School and Adolescent Health (OSAH) strives to educate and provide resources to educational staff, health and behavioral health professionals, and community members who serve schools and adolescents.

We aim to provide resources, training, and technical assistance to develop and enhance a sustainable behavioral health system for schools and youth-serving organizations.

We promote the use of evidence-based practices to improve the health, wellness, and resilience of students and adolescents.


Evidence Based Practices

The National Alliance on Mental Illness defines

evidence-based practices (EBPs),

as treatments that have been researched academically or scientifically, been proven effective,

and replicated by more than one investigation or study.


Meet your OSAH Behavioral Health Team…

[email protected] Region School Mental Health Advocate (SMHA)

[email protected]

SE Region School Mental Health Advocate (SMHA)[email protected]

Statewide Behavioral Health [email protected]

Statewide Youth Suicide Prevention Coordinator

*** If you do not have a designated SMHA in your Region, please reach out to the Statewide Behavioral Health Consultant***






Subscribe to the OSAH Brief for resources, training bulletins, regional updates, and more


https://mhttcnetwork.org/

https://mhttcnetwork.org/


Resources• Behavioral Health Guidance Document- PED/DOH

• Mental Health Resources for K-12 Educators during Covid-19

• Fostering Resilience: Responding to the Needs of School-Aged Children

• Covid-19 Effect on Child Mental Health

• Back to School after Covid 19- Supporting Staff and Student Mental Health

• 99 Coping Skills

• NM Covid-19 Coping Poster

• Psychological First Aid School Provider Self Care checklist


Please reach out to your regional or statewide OSAH BH team member!

THANK YOUfor your time, passion,

& commitment

[email protected] [email protected] Behavioral Health Consultant Statewide Youth Suicide Prevention Coordinator



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