COVID-19 FAQ

Topics

Budget
Cleaning, Sanitizing, Disinfecting
Close Contact; defining for exclusion and reporting
Cohorts
Communicable Disease Guidance
Exclusion
FERPA, Confidentiality
Hand Hygiene
Isolation
Logging Attendance and Reason for Absence
Logs, Tracking Tools
Masks, Face Coverings, PPE
Partnering with LPHAs
PE, Band, Choir
Planned Revision to Guidelines
Playground, Recess
School Nurse Needed Supports
Screening
Sports - Summer and After-School Programs
Staff Training and Nurse Role
Supplies
Vision and Dental Screening
Vulnerable Students and Staff

Budget

Any chance of hazard pay for staff at increased risk?
This is a district-level decision.

We're worried about budget...Do SSA funds do still exist?
Diminished but still some funding. Question sent to ODE for further info.

Updated 7/31/2020: During the July 28^th press conference, Governor Brown announced the state is releasing an additional $28 million to public schools.

Cleaning, Sanitizing, Disinfecting

What will the teacher need to do if they send a student to the office that ends up in the isolation room, for the class room. Do they close the class or disinfect the desk? … But what if someone has a cold, or just allergies while another has COVID in that isolated room?
Follow updated school protocols for cleaning, sanitizing, and disinfection of school spaces. Please be clear with all staff and students that being "in isolation" is NOT the same as being diagnosed with COVID-19. Per state law, the school should have an established process to keep an unwell student away from the rest of the student body. Isolation is emphasized in guidance but is not specific to the pandemic: any student who is sick should be "in isolation." If a student is diagnosed with COVID-19 after having been in the school, follow LPHA advice for contact tracing and follow-up for close contacts of that student.

Clarify frequency of cleaning; waiting before cleaning or use PPE during cleaning (Example comments: Please add guidance about cleaning isolation spaces: How often should we clean? If we use shower curtains or other barriers, do they need wiped down between students? ...Other comment: Has anyone heard how many times a day the student restrooms have to be cleaned during the day?...)

Updated 7/31/2020: The shortest response to this question is that surfaces and objects should be cleaned, sanitized, or disinfected after they have been in contact with a symptomatic individual, and between cohorts, and at least daily. Wording directly from guidance is provided below.

Required per RSSL version 3.0.1

p27 Section 1d Cohorting: Cleaning and wiping surfaces (e.g., desks, door handles, etc.) must be maintained between multiple student uses, even in the same cohort.

p36 Section 2c Technology: Update procedures for district-owned or school-owned devices to match cleaning requirements (see Section 2d).

p37 Section 2d School Specific Functions/Facility Features:

Hand-washing: All people on campus should be advised and encouraged to wash their hands frequently.

Equipment: Develop and use sanitizing protocols for all equipment used by more than one individual or purchase equipment for individual use.

p38 Section 2e Arrival/Dismissal: Ensure hand sanitizer dispensers are easily accessible near all entry doors and other high-traffic areas.

p39 Section 2g Playgrounds, Fields, Recess, Breaks, and Restrooms: [recommended not required] Prevent students and staff from touching bathroom door handles by keeping the door held open, where appropriate.

p41 Section 2j. Cleaning, Disinfection, and Ventilation – a few examples from this section:

• Clean, sanitize, and disinfect frequently touched surfaces (e.g. door handles, sink handles, drinking fountains, transport vehicles) and shared objects (e.g., toys, games, art supplies) between uses multiple times per day. Maintain clean and disinfected (CDC guidance) environments, including classrooms, cafeteria settings and restrooms.
• Apply disinfectants safely and correctly following labeling direction as specified by the manufacturer. Keep these products away from students.
• To reduce the risk of asthma, choose disinfectant products on the EPA List N with asthma-safer ingredients (e.g. hydrogen peroxide, citric acid, or lactic acid) and avoid products that mix these with asthma-causing ingredients like peroxyacetic acid, sodium hypochlorite (bleach), or quaternary ammonium compounds.
• Facilities should be cleaned and disinfected at least daily to prevent transmission of the virus from surfaces (see CDC’s guidance on disinfecting public spaces).

p44 Section 3b Response: If anyone who has been on campus is known to have been diagnosed with COVID-19, report the case to and consult with the LPHA regarding cleaning and possible classroom or program closure.

If area can't wait to be cleaned, would OHA recommend wearing medical grade mask, gloves, gown, or other PPE while cleaning?
This question refers to the fact that ODE Ready Schools guidance references CDC guidance which says "wait 24 hours" before cleaning certain areas like isolation rooms. Question sent to OHA for further info.

Updated 7/31/2020: CDC guidance considers likelihood viral particles are still airborne and either could be breathed in or could settle later and re-contaminate surfaces.

Are there any portable air cleaners that could help? .. I would like OHA to provide info on air purifiers-recommended or no?
Question sent to OHA for further info. Ventilation is emphasized but use of air filtration devices is not addressed in guidance as of version 1.5.8.

Updated 7/31/2020: As of Version 3.0.1. Version 3.0.1 p 42 does state “Consider running ventilation systems continuously and changing the filters more frequently.”

Close Contact; defining for exclusion and reporting

I have a teacher whose husband is regularly exposed to COVID in a hospital setting. Is this something to refer to the health department?
Updated 7/31/2020: No. This question requires defining “exposure." Per guidance version 3.0.1, the definition of “Exposure: When an individual has close contact (less than 6 feet) for 15 minutes or longer with a contagious person with COVID-19.” Health care personnel in hospital settings are frequently excluded from the definition of “exposure” because they are wearing medical-grade PPE that significantly reduces exposure. Sick member of household would fit the definition – so, if the husband himself was sick, the teacher might need to quarantine. But if a person has only second-degree exposure like the teacher in this question, they are not required to quarantine. This question also requires understanding the difference between individuals who are “persons under investigation,” people in “quarantine,” people in “isolation,” or people who need to “monitor for symptoms.” See this OHA guidance doc.

Cohorts

Why are they asking staff to move around to each cohort that is a lot of exposure for those staff members. Why not have those staff members teach in a streaming way?
Updated 7/31/2020: Guidance does recommend the adult and students remain within a single stable group when possible. But also recognizes other needs. When there is need for staff to interact with multiple groups, then if staff move instead of students, this reduces students passing in the halls, or contaminating surfaces by using multiple rooms. Guidance version 3.0.1. requires all persons age 5 and up to wear face covering in the school building. Staff who interact with multiple cohorts could choose to wear more protection, such as medical-grade face mask and additional face shield, to reduce their own risk. Staff who provide “direct contact care and monitoring of staff/students displaying symptoms” (p.31) should wear medical-grade face masks and other PPE appropriate to the situation.ODE encourages schools to innovate to address needs.

Are they now allowing the whole school back and to transition between classes?
Updated 7/31/2020: Guidance now includes specific metrics for re-opening in person. Guidance could be read as "letting the whole school back" if the elements necessary to reduce exposure can be put into place, like physical distance, screening on entry, cleaning areas between use by different groups, etc. AND metrics are met.

See p19, section 0b, Metrics and Exceptions. State metrics must be met before all grades K-12 can return, with some exceptions. For example, even before state metrics are met, if county case rates are less than 30 per 100,000 for the past 3 weeks AND other measures are met, schools may consider in-person class options for grades K-3. In places where total school population is less than 100, and the school is in a remote or rural area, AND certain metrics are met, the whole school may return even before state metrics are met.

For any school, guidance version 3.0.1 p27 Section 1d clarifies that mixing of cohorts can be no greater than 100 individuals (for example, 5 cohorts of 20 people share spaces without cleaning between). If the school cannot prevent cross-contamination by multiple cohorts, this requirement would limit total persons on site to no more than 100.

Communicable Disease Guidance

When guidance is contradictory, which should we follow? Like fever exclusion for 24 hours or 72 hours. Our district uses OSBA policy, it has not been updated to align with ODE/OHA guidelines yet?
Local policy should not contradict state law / executive orders. Where guidance is based on emerging data, local policies may be more specific than state guidance, but should not contradict state-wide guidance.

Updated 7/31/2020: Guidance from state agencies takes precedence over guidance from other groups. Please note that specific requirements related to COVID-19 symptoms are updated most frequently in the ODE Ready Schools, Safe Learners guidance. If there is a contradiction between Ready Schools and other state guidance, the most recent update should be used.

Regarding fever exclusion, ODE is working to align this guidance across multiple documents; the 72-hour language remains in some documents but is outdated. Guidance version 3.0.1 is updated to align with CDC guidance, which states a minimum of 10 days exclusion for fever unless tested / cleared. In other words, guidance refers to 24-hours fever free AFTER being tested / cleared, or WITH at least 10 days since symptom onset.

When using the ODE/OHA communicable disease guidance in my plan, I am finding that I add things in between certain sections. Instead of re-creating the entire wheel, I am citing and adding my own policies. Is that acceptable?
Using the state-wide communicable disease guidance as a reference is appropriate. Local guidance may be more specific than state-wide guidance. It should not contradict state-wide guidance.

Updated 7/31/2020: Please note that specific requirements related to COVID-19 symptoms are updated most frequently in the ODE Ready Schools guidance. If there is a contradiction between Ready Schools and other state guidance, the most recent update should be used.

Will COVID be added to the list of the diseases toward the end of the document?
Yes, but not immediately. COVID-19 has been added to the list of excludable diseases on page 14. Would require state revision workgroup to add to the chart on pages 14-24 - that chart is based on CDC guidance lists, which do not yet include COVID-19.

Exclusion

Please clarify recommended length of exclusion if a person has a sick member of the household, and for fever without a test. (examples of similar comments: If we have symptomatic students who don't have a fever and refuse to get a test, how long do we keep them out of schools for? … Public health states isolate for 14 days if Covid is suspected? how does that work with schools? ... I've been working at our LPHA with case investigations and contact tracing and they and CDC are recommending isolating for 10 days if you're symptomatic but not tested. ... Johns Hopkins contact tracing course says 10 days if symptoms but no test. We had a child care staff who had fever and cough not test and they were told stay out for 10 days.)
Sent to OHA for further information and clarification.

Updated 7/31/2020: Guidance version 3.0.1 now uses CDC’s updated recommendation. Full text below. Short version: primary COVID-19 symptoms warrant exclusion a minimum of 10 days unless tested and cleared. After tested/cleared OR after 10 days have passed, all persons must ALSO have been fever-free at least 24 hours.

See page 34 for the most comprehensive list.

Staff and students who are ill must stay home from school and must be sent home if they become ill at school, particularly if they have COVID-19 symptoms.

• Symptomatic staff or students should be evaluated and seek COVID-19 testing from their regular physician or through the local public health authority.
• If they have a positive COVID-19 viral (PCR) test result, the person should remain home for at least 10 days after illness onset and 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.
• If they have a negative COVID-19 viral test (and if they have multiple tests, all tests are negative), they should remain home until 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.
• If a clear alternative diagnosis is identified as the cause of the person’s illness (e.g., a positive strep throat test), 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 physician note is required to return to school, to ensure that the person is not contagious.
• If they do not undergo COVID-19 testing, the person should remain at home for 10 days and until 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.

FERPA, Confidentiality

We are concerned about violating confidentiality laws. I feel like that line seems more blurred now. ... Some school admin seem to think the allowance for sharing info with LPHA also applies to sharing with parent. ODE and OHA need to emphasize this. We need clearer guidance in terms of communicating to other parents. Worried that parents will tell the school there is a case and someone will "immediately" report.
Updated 7/31/2020: Sent to OHA and ODE for further clarification in guidance. As of Version 3.0.1 p28, Section 1e requires schools to "Develop protocols for communicating immediately with staff, families, and the community when a new case(s) of COVID-19 is diagnosed in students or staff members, including a description of how the school or district is responding."

Those protocols should be clear in how information is worded, to ensure personally identifiable information is protected. Both FERPA and Oregon public health law [ORS 333-019-0010] state that during health emergency, the school MAY release of personally-identifiable information to the HEALTH AUTHORITY to protect public health. So the school could share cohort logs and contact info for contact tracing WITH THE LOCAL PUBLIC HEALTH AUTHORITY. There is no such allowance for public release of information; national and state laws do NOT allow release of personally-identifiable information to the school community, without permission from the parent/guardian or eligible student (over age 18).

Two examples of letters-to-community are posted for schools. One is found under “Tools you can use” on the main ODE COVID-19 Resources page. The other is found within the Influenza Outbreak Toolkit, on the OHA Influenza page.

Hand Hygiene

Is there a certain percent of alcohol in hand sanitizer that is allowed at schools with children?
Guidance recommends using hand sanitizer with 60% or greater alcohol content. This recommendation is consistent for all age groups. Protocols for providing hand sanitizer should consider recognized risks in the population, such as ensuring adult supervision as needed.

Isolation

What will the teacher need to do if they send a student to the office that ends up in the isolation room, for the class room. Do they close the class or disinfect the desk? … But what if someone has a cold, or just allergies while another has COVID in that isolated room?
Follow updated school protocols for cleaning, sanitizing, and disinfecting school spaces. Please be clear with all staff and students that being "in isolation" is NOT the same as being diagnosed with COVID-19. Isolation is emphasized in guidance but is NOT new to the pandemic: per state law, the school should have space so that any student who is sick can be isolated from the rest of the student body. If a student is diagnosed with COVID-19 within 14 days of being school, follow LPHA advice for contact tracing and follow-up for close contacts of that student.

How can we find space for "isolation room"? Our schools are old; we don't have room.
Consider using spaces opened up due to physical distancing requirement, such as teacher's lounge or direct therapy rooms; conference rooms. Consider adding ventilation and physical barriers in existing spaces.

What is required for an isolation space? … Do we need an isolation room per sick child? OR can you group children with similar symptoms into one isolation room?
Updated 7/31/2020: See Section 1i. Measures noted throughout guidance for the entire school setting are also required for isolation space:

• physical distancing and/or physical barriers between individuals;
• adequate ventilation;
• face covering by all individuals age 5 and up;
• face mask - medical grade - and other PPE as needed worn by the person providing care -- changed between contact with individuals;
• hand hygiene (readily-available soap and water - ideally, sink and bathroom - or minimum 60% hand sanitizer) before and after contact, and whenever PPE is put on or removed
• Guidance section 2f recommends "Furniture: Consider removing upholstered furniture and soft seating and replace with surfaces that can be wiped down and cleaned easily." 
• Guidance also requires supervision and monitoring of the student in isolation, and measures to reduce stigma, fear, or anxiety (don't label the space "dirty").

From OSNA colleagues: Also consider the need for students to walk from "clean" space to "isolation" space through public spaces; needing isolation spaces near exits if possible for pick-up; other measures to reduce exposure while student is symptomatic.

What about plans if a parent doesn't pick up a sick child?
This is a district-level decision.

Can isolated students be required to wear face covering?...Many of the isolation spaces are not near the office. So students will have to walk there. Should students be encouraged to wear masks when walking to that room?
See sections 1h and 1i. Face covering for symptomatic individuals is recommended in current guidance "if it can be done safely."

Updated 7/31/2020: Guidance version 3.0.1. requires all persons age 5 and up to wear face covering in the school building. Staff who interact with multiple cohorts could choose to wear more protection, such as medical-grade face mask and additional face shield, to reduce their own risk. Staff who provide “direct contact care and monitoring of staff/students displaying symptoms” (p.31) should wear medical-grade face masks and other PPE appropriate to the situation.

How often should we clean isolation space? If we use shower curtains or other barriers, do they need wiped down between students?
Updated 7/31/2020: The briefest summary of guidance is to clean after contact with a symptomatic individual, and at least daily. Guidance section 1d requires "Cleaning and wiping surfaces (e.g., desks, door handles, etc.) must be maintained between multiple student uses, even in the same cohort." Guidance section 2j recommends "Clean, sanitize, and disinfect frequently touched surfaces (e.g., playground equipment, door handles, sink handles, drinking fountains, transport vehicles) and shared objects (e.g., toys, games, art supplies) between uses multiple times per day. Maintain clean and disinfected (CDC guidance) environments, including classrooms, cafeteria settings, restrooms, and playgrounds." Guidance section 2f recommends "Furniture: Consider removing upholstered furniture and soft seating and replace with surfaces that can be wiped down and cleaned easily." 

What about video monitoring of the isolation room? … Can video baby monitors be used as a surveillance method of isolation? We have very limited staff.
Consider both safety and confidentiality. If "very limited staff" are monitoring, the video is not increasing safety. Consider district privacy policies before video recording students.

Do schools need more than one isolation space? … What if screening on arrival leads to 5-10 students "isolated" at once?
Guidance emphasizes taking measures to reduce exposure; decisions about size, location, and number of isolation spaces for a given school should reflect consideration of those required measures.

Can the school nurse [or other health staff] serve the student in isolation at the same time as healthy? Even if they properly remove PPE for the healthy visit, and then put PPE back on to return to the isolated student?
Guidance talks about having designated staff to supervise. Not explicit, but could be read as requiring a separate individual. For nurse specifically, appropriate PPE for sick care is emphasized, along with removing and *disposing* of PPE after care -- so, similar to other health care settings, using appropriate hygiene between every "patient" is emphasized.

We're worried about stigma and the impact on mental health when these isolation measures are implemented.
Guidance recommends taking measures to reduce fear, anxiety, and stigma related to isolation. Remember that isolation is not a diagnosis; it is recognition that someone is sick, and needs extra care. Take measures such as considering signage - labeling "Care space" instead of "Dirty room" etc. explain the use of PPE, "something we do to take care of one another, something I do with everyone."

One of my principals was concerned about Isolation vs restraint - How do we choose the staff that will be in the isolation room and what risk are we putting them in? What if a student does not want to isolate until a parent picks them up, can we force them for the safety of everyone else in the cohort? What if a student does not have a parent to pick them up, can we send symptomatic students home by bus?
Sent to ODE for clarification

We need more detail about isolation recommendations. What are acceptable barriers to be used in the isolation space? Can it be divided off by a screen? hospital curtains? shower curtains? ...hanging curtains, screens, plastic walls, specific recommendations? Masks and 3 feet apart? Is it still 35 sq feet if masked?
Sent to OHA for clarification

Updated 7/31/2020: Guidance version 3.0.1 requires 35sq feet AND face covering for all individuals age 5 and up.

Logging Attendance and Reason for Absence

How often are attendance logs required? I thought it was just twice a week.
Attendance is required every day or every class, per normal school protocols. For online learning, check-in is required twice a week, not the same as attendance. The check-in has requirements that involved a good bit of two-way communication. See page 19 and 20 of the guidance.

Guidance says we're supposed record how many are out with symptoms. How can we gather data about why students are absent?

Example shared at OSNA Q&A -  If kids are sent up from class, log reason for visit and track symptoms without exposing identifiable information. Changing the outgoing attendance message to ask for more specific symptoms will help to say whether kids are staying home due to fever or something less serious.

Updated 7/31/2020: Note that Section 1i (Isolation Measures) states schools are required to “Record and monitor the students and staff being isolated or sent home for the LPHA review.” This means systems are needed to track 1) students absent because of specific symptoms, and 2) students or staff present – and then sent home - with specific symptoms. If your school didn’t already have a health-room log, now is a good time to create one.

Basic information that helps with COVID-19 response can ALSO support better school nurse data collections the way NASN recommends. For example, the required school record would need to note specific symptoms, as well as who saw the student (nurse, UAP, etc), and could include what happened next (send back to class, sent home, 911 call). 

Logs, Tracking Tools

What are the data collection tools that exist? We don't have a good one at our district.
Examples shared at OSNA Q&A - logs of cohorts already exist via course and class rosters. [Our county's] nurses have been working with our public health department prior to COVID on establishing data collection and tracking documents to be used when any outbreak begins to trend (influenza, norovirus, etc.). Tools already exist on OHA website as well under Outbreak Toolkits. Oregon School Nurses' Association is working on centralizing and creating some examples. Other responses: we are looking at options for teachers / classroom tracking, sign in/out for bathroom etc as a log to review who might have been there at the same time. Our group talked about considering scanners for middle/high school students. Student ID's would be able to scanned if they moved throughout the building. [Later conversations suggest this is overkill. We need to track the cohort groups exposed, not the minute-to-minute movement of individual students.] Elementary was harder. Curious if there is an app or using Google forms for parents to answer questions. We talked about how important it would be if we can be as standardized as possible. Standardized signs, arrows, forms... I believe that some of the SIS (e.g. Synergy) are looking into ways they can support this work. ... Before school was closed, we were working with tech on tracking through Synergy (though we never got to try it).

I would love an algorithm for looking for symptoms as well as what they need to do. I'm hoping someone that is good at that can share that with everyone.
Updated 7/31/2020: Tools that might be modified exist on OHA website under Outbreak Toolkits. For what to screen for, see page 15 Section 1f: primary symptoms that warrant exclusion include, "cough, fever or chills, shortness of breath, or difficulty breathing." Also "Note that muscle pain, headache, sore throat, new loss of taste or smell, diarrhea, nausea, vomiting, nasal congestion, and runny nose are also symptoms often associated with COVID-19." Diarrhea and vomiting are excludable for other reasons.

For "what they need to do," the OHA/ODE Communicable Disease letter to families lists symptoms of all communicable diseases and how long to stay home. It must be updated to reflect longer exclusions for the top 3 COVID-19 symptoms (fever, cough, and shortness of breath or difficulty breathing).

Otherwise, length of exclusion is outlined on page 34: Staff and students who are ill must stay home from school and must be sent home if they become ill at school, particularly if they have COVID-19 symptoms.

• Symptomatic staff or students should be evaluated and seek COVID-19 testing from their regular physician or through the local public health authority.
• If they have a positive COVID-19 viral (PCR) test result, the person should remain home for at least 10 days after illness onset and 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.
• If they have a negative COVID-19 viral test (and if they have multiple tests, all tests are negative), they should remain home until 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.
• If a clear alternative diagnosis is identified as the cause of the person’s illness (e.g., a positive strep throat test), 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 physician note is required to return to school, to ensure that the person is not contagious.
• If they do not undergo COVID-19 testing, the person should remain at home for 10 days and until 24 hours after fever is gone, without use of fever reducing medicine, and other symptoms are improving.

I don't know who is going to do the contact tracing for our school, once we collect all the contact tracing logs.
Local public health is responsible for this, not school personnel. School collects data. LPHA conducts contact tracing.

Updated 7/31/2020: A contact person at our LPHA said it would violate HIPAA for the LPHA to help us determine when students can return to school. Can you share the specific reference to the law and the rational?

Sent to ODE and OHA for clarification. Remember that OSNA members are not lawyers but when reading section 2 and section 6 of Division 19 together, that law appears to require the LPHA to share information necessary to support school decision-makers. This is from Oregon public health law OAR 333-019-0010:

(2) To protect the public health, an individual who attends or works at a school or child care facility, or who works at a health care facility or food service facility may not attend or work at a school or facility while in a communicable stage of a restrictable disease, unless otherwise authorized to do so under these rules.

(6) If a local health officer receives a request from a school administrator to determine whether an exclusion is appropriate under this rule, the local health officer, in consultation as needed with the Authority, may consider the following non-exclusive factors in making the determination: …

Masks, Face Covering, PPE

Question about face shields for our staff that can’t wear a mask. Are face shields that can be cleaned appropriate? (Also concerned about masks for staff with our hearing-impaired students). … Consideration of face covering vs face shield, do we have students who lip read?
Updated 7/31/2020: Guidance version 3.0.1 requires face covering for all individuals age 5 and up. Section 1h, page 30, permits the use of face shields in some cases. Consider the evidence and the risk for specific cases. Face shields can reduce large droplet spread, but allow airflow around edges (may not be as effective as face masks for extended time in closed rooms). Note that guidance requires medical-grade mask for direct care of symptomatic individuals. Includes face shields as an option as an alternative to face covering, and makes them required for staff providing articulation therapy (speech).

See NASN’s Facemask Considerations guidance for more detail.

CDC’s guidance as of July 2020: Face Shields: It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles. CDC does not recommend use of face shields for normal everyday activities or as a substitute for masks. Some people may choose to use a face shield when sustained close contact with other people is expected. If face shields are used without a mask, they should wrap around the sides of the wearer’s face and extend to below the chin. Disposable face shields should only be worn for a single use. Reusable face shields should be cleaned and disinfected after each use. Plastic face shields for newborns and infants are NOT recommended.

Could student with cough use a face shield? Like a chronic cough from asthma or allergies?
Updated 7/31/2020: Not directly addressed; sent to OHA for clarification. Uncontrolled cough may warrant referral to PCP. Guidance requires face covering for symptomatic individuals, if it can be worn safely. Guidance recommends face covering for all students all individuals age 5 and up. Students cannot be denied education for failure to wear a face covering. Sent to ODE, request clarification whether students can be denied IN PERSON education if unable / unwilling to wear a face covering (considering ADA, FAPE, etc).

Who gets to use PPE in your schools? What about nurses in a medical fragile classroom where a child drools a lot. Gowns?...My school custodian staff and vulnerable staff want access to N95.
Guidance recommends consulting the nurse about appropriate use of PPE. Consider risk specific to work environment. Guidance and evidence emphasize the importance of hygiene and physical distance in addition to PPE. Educate to ensure PPE is used appropriately. Examples: Educate about the need for N95s to be fitted to work properly. (Comment: "I have partnered with out hospital to do the fit test on staff IF we get access to N95's"). Educate that after contact with symptomatic individual, all used PPE should be removed - masks, gloves, and other PPE - and should be discarded (single-use), or appropriately disinfected (e.g. face shields) prior to re-use.

Does a medical grade mask mean an N95?
Updated 7/31/2020: "Medical grade" is not defined further in this iteration of guidance. There are differences in use and fit-testing for different types of medical-grade mask. Guidance recommends consulting a nurse or medical provider to ensure correct use for specific procedures or settings. See NASN’s Facemask Considerations guidance for more detail.

What about re-usable PPE supplies?
Example shared at OSNA Q&A - [At one district] nurses are employed by Legacy and we are contracted to the schools. We are planning on getting a 'set' of 95's and gowns that will be 'recycled' and returned to us weekly. I thought this was great as it would cut down on the PPE that we need.

Partnering with LPHAs

About LPHAs, I was wondering who the school goes to for questions. ... Do they know their role? Who is the liaison for their guidance?
This will vary by LPHA. Usually there is a Communicable Disease Lead. Check LPHA contacts for more information

We need better communication between LPHAs. We often find that local public health departments within a particular region (where families may be working, going to school, and recreating in several different counties each day) are not routinely communicating well with one another to truly facilitate accurate and timely contact tracing. There needs to be clear protocols and contacts identified, to whom schools can refer to when they have a family reportable or restrictable illnesses. ... Other comment: I feel our public health, who is my employer, has been dragging their feet in regards to helping the schools.
Noted and communicated to OHA. 

PE, Band, Choir

In the Ready Schools document on page 40 list PE is in the high risk for disease. Does this mean we are not permitted to do these activities?
No. The list of high-risk activities does not require the school to cancel but emphasizes that the school should ensure updated process to reduce risk of disease. Using evidence to guide practice, consider for example that physical activity can boost the immune system, increase alertness and attention, while music instruction can accelerate math skills while improving social connection and boosting mood. Comments from OSNA members: “We are trying to get creative about ways to continue things like band or choir; music theory in classroom, wide open outdoor space.”

Updated 7/31/2020: Guidance version 3.01. Section 2, p34 states “Some activities and areas will have a higher risk for spread (e.g., band, choir, science labs, locker rooms). When engaging in these activities within the school setting, schools will need to consider additional physical distancing or conduct the activities outside (where feasible). Additionally, schools should consider sharing explicit risk statements for instructional activities requiring additional considerations (see section 5f).”

What is OHA preparing about higher-risk activities like choir? Our schools are waiting for guidance from OHA about how to safely do band, choir, and other classes listed as high-risk.
OHA previously deferred guidance to ODE; request for clarification.

Updated 7/31/2020: Guidance version 3.01. Section 2, p34 states “Some activities and areas will have a higher risk for spread (e.g., band, choir, science labs, locker rooms). When engaging in these activities within the school setting, schools will need to consider additional physical distancing or conduct the activities outside (where feasible). Additionally, schools should consider sharing explicit risk statements for instructional activities requiring additional considerations (see section 5f).”

Guidance version 3.0.1 p.63 Section 5f Instructional and Extra-Curricular Activities Requiring Additional Considerations states, “For any course, learning experience, or school activity that involves hands-on, physical interaction or physical activity, districts and schools must carefully consider Public Health Protocols (see section 1) and Facilities and School Operations (see section 2). To the extent possible, modifications to the learning experience, course, or physical space should be made. See program specific requirements and recommendations in the links below.”

Planned Revisions to Guidance

How can they already anticipate the “major” plan changes on specific dates, when it is a living document? Are they just assuming there will be major changes at those times?
ODE is planning for there to be community feedback that will warrant the updates.

Playground, Recess

Do we need to keep school playgrounds closed if our county isn't opening playgrounds and parks yet?
No. School playgrounds are not treated the same as public playgrounds. Guidance recommends school playgrounds remain closed TO THE PUBLIC until local phase permits opening. But within the school community, guidance recommends using outdoor spaces; hand washing or hand sanitizer before and after use of shared equipment; and cleaning playground equipment between student cohort groups. Using evidence to guide practice, note that being outside and being active support both physical and emotional health, and can boost alertness and improve learning. Also note that viral transmission via contaminated surfaces is less common than via airborne particles; and that airborne transmission is less likely in outdoor spaces.

School Nurse Needed Supports

What support do school nurses need?
OSNA and the SSNC continue to collaborate to meet needs – including this COVID-19 Toolkit and online gatherings, with more planned for August and throughout the school year – please keep emailing and calling so we know “what support school nurses need.”

Comments shared at OSNA Q&A - Access to reassurance and help. Tool box on web page with power point with Covid info and quiz. Tool box where resources can be shared. Looking forward to the next meeting and more templates. Guidance language addressed the need to collaborate with school nursing; might still need to help admin see how nursing needs to be involved.)

Screening

Bus drivers and screening: It is my understanding that the bus driver performs the first “passive” screening. However, they are responsible for driving the student to the school regardless. If the bus driver is still to bring the student, would it be easier to just have staff screen at the school entries? Or is the bus driver expected to do more than just passively screen? For example, mask the student, check temperature, etc.
Sent to ODE for clarification. Per guidance, the requirement is for a system or process to be established. Specifics can be tailored to the local setting. Common question has been, are bus drivers declining entry to those who "screen positive"? How do we address this locally with a process that is protective and feasible?

What does guidance say about screening on arrival?
Updated 7/31/2020: Guidance version 3.1.0 says

• Section 1f p29 “Screen all students and staff for symptoms on entry to bus/school every day. This can be done visually and/or with confirmation from a parent/caregiver/guardian. Staff members can self-screen and attest to their own health. Anyone displaying or reporting the primary symptoms of concern must be isolated (see section 1i) and sent home as soon as possible.”
• Section 1g: “Screen all visitors/volunteers for symptoms upon every entry. Restrict from school property any visitor known to have been exposed to COVID-19 within the preceding 14 calendar days.”
• Section 2e p38: “Assign students or cohorts to an entrance; assign staff member(s) to conduct visual screenings (see section 1f). Ensure accurate sign-in/sign-out protocols to help facilitate contact tracing by the LPHA. Sign-in procedures are not a replacement for entrance and screening requirements. Students entering school after arrival times must be screened for the primary symptoms of concern.”
  

Are we not supposed to do temp checks on everyone anymore? Why did this change from when schools closed?
Current guidance DOES require screening on arrival for every student, but does NOT require mass temp checks of all persons on entry. Two rationales: 1. Temp checks on children serve less benefit than temp checks on adults (studies show children are less likely to have fever compared to adults), while simultaneously increasing risk of exposure during screening. 2. Following available evidence, emphasis shifts to screening in ways that do not increase risk of exposure; screening children for contact with individuals who have been ill; and recognizing that asymptomatic individuals can be contagious and therefore taking all recommended measures to reduce transmission once on site (hygiene, physical distance, etc).

What does "screening on arrival" look like in what people are thinking?
Depending on age and maturity, the school's plan for screening may include questions about symptoms, questions about contact with individuals who are sick, a parent note verifying no symptoms and no sick contacts, and/or screening visually for signs of illness such as observing for cough. Parents will need to be accountable; having a page which parents sign that states they understand when kids need to stay home could be part of the parent participation for "screening on arrival."

I'm worried that ʺvisual screeningʺ could lead to discrimination. We need a more specific details/algorithm for ʺvisual screeningʺ what that means and what next steps would be.
Sent to OHA and ODE and continuing discussion in OSNA. Screening algorithms should be as specific as possible. Training of staff doing screening should include implicit bias. Don't screen for socioeconomic or cultural details like dirty clothes or stoic expressions, but for specific symptoms. Teachers who know students best can look for obvious changes, like the kid who normally is really hyper sitting with head down. If it's not a really clear symptom, nurse is needed to assess beyond the screening tool.

Updated 7/31/2020: Guidance version 3.0.1 section 1h p29 recommends “All staff who do screenings should receive implicit bias training. Student screening should not consider appearance (ie. clothing, hair), personality (shy, etc.), ability, cleanliness, etc.” and p79 recommends, “Offer opportunities for professional learning on creating an inclusive, caring, and supportive school culture with particular attention to discussing strategies to address anti-Asian discrimination and bias against students/staff who have had COVID-19.”

Sports - Summer and After-School Programs

We have been starting sports practices, are they also just supposed to be visual screenings or anything extra?
Updated 7/31/2020: School programs should follow written state guidance. ODE has guidelines for summer programs. However, Ready Schools, Safe Learners guidance for the 2020-2021 school year was effective upon release – if any portions contradict, schools should reach out to ODE to clarify which is most appropriate for their setting. Note that other organizations also provide guidance but it may not follow state guidelines. For example, OSAA has a form for activities. It required temp check, but they ask for no fever in previous 4 to 8 hours -- that's not what we're supposed to be doing per current guidance. Guidance version 3.0.1 states a minimum 10 day exclusion unless tested and cleared, AND whether tested or not must be fever-free at least 24 hours.

Staff Training and Nurse Role

How are school nurses planning to support staff training? What trainings do you think are needed?
Comments shared at OSNA Q&A - [We need to do everything from] Covid training to routine Fall trainings.... PPE use, First aid (in addition to supplying classrooms with basic first aid supplies) , COVID s/sx adult/children, why we are doing the screening we are doing, all health protocols and workflows that are developed regarding guidance. Helpful to have LPHA approval in these trainings....how infection is spread and stopped, handwashing, face covering/mask use, gloves, how to properly use a thermometer, symptoms recognition and response, space and distancing, when must they be trained (before starting schools)...We discussed the establishment of using ONE online accessible training for staff in regards to donning and removing PPE. As well as ONE training tool for screening/algorithm tool....We need to train how to screen especially if we are talking about "visually." A nurse should train an assigned person at the school make sure they know the difference between screening and what needs a licensed assessment. We need a consistent training program of these individuals....We are looking to existing resources like W.H.O. videos. ...Considering doing a brief video each morning with teachers to start the day focused on safe and supportive practices. Hoping for a consistent training for all nurses in the state especially for the part-time or "only one in the district" nurses. ... My hope would be that if have clear (simple as possible) tools and training, and if the process we setup is streamline, we can reduce their anxiety (and ours!)...[Nurses at our district] already recorded trainings on safety practices (e.g. handwashing, how to wear and wash a mask) and the new policies/forms like screening logs for emergency childcare and summer school, but we anticipate having to modify these for August meetings as people return to school...Use tools for education and training already available such as safe schools, CDC posters. Teaching with families to include an acknowledgment of understanding. Partnering with risk management for training.

What resources can nurses and schools access?
Comments shared at OSNA Q&A - Make sure that whatever you choose aligns with state guidelines before using it. … OSNA collecting or developing examples is a good idea and it will help continuity across our state... PublicSchoolWorks has the following available for COVID training: How to clean and disinfect your school; how to protect yourself and others. ...Utilize trainings that are already in use (safeschools) to reach every single staff member. ...It would be helpful if OSNA, in collaboration with the guidelines, to develop frameworks or training modules that we can use/edit.

For regular trainings, will zoom training for med admin qualify as in-person training?
Yes. ODE has clarified that currently the "in-person" component can be met with live-stream interactive training done in a remote format. Colleagues recommend having at least 2 facilitators so you can monitor engagement and chat box during presentations, recognizing the difficulty in assessing understanding when not doing trainings/education in person.

For training-for-anticipated-emergency, can we train staff via Zoom or online training?
Not recommended, but OHA has stated remote formats for these trainings be considered by the trainer if 1) there is a need for this format to ensure safety in the community and 2) the trainer can still verify competency of those being trained. Colleagues have given examples of only training the staff they know have done it before and are able to demonstrate competency well - only training the nurses themselves remotely - only doing information portions online and then doing the skills check-off in person - having multiple facilitators for the online component to monitor engagement and chat boxes. These are examples, not state recommendations.

Supplies

One concern is availability of the equipment we will need (PPE, hand sanitizer...)
Refer to Supplies Described in ODE Guidance within this COVID-19 Toolkit; examples come directly from wording in ODE guidance.

I'd like to hear nurse thoughts about thermometers; what kind, how to pay for expensive supply, reliability inside and outside weather etc.
Invited nurses to share examples in OSNA discussion group. See also NASN discussion lists.

Vision and Dental Screening

Will our community health screeners be considered non-essential volunteers? No screening this year?
Sent to OHA for clarification.

Vulnerable Students and Staff

What about our medically fragile students? Can we require MD notes that they are ok to be at school as medically fragile students?
Requiring an MD note suggests excluding if no note. Could cross the line into excluding by disability, against ADA. Ensure updated plans but work with admin, LPHA, and district legal if looking at broad exclusion based on a diagnosis rather than exposure.

What about families that keep their enrolled children home to protect an immune compromised family member to reduce exposure?
Updated 7/31/2020: Guidance emphasizes supporting students and staff who are at increased risk. Guidance version 3.01. Section 5 beginning on page 50 givesg details about attendance requirements for remote learning. Districts have to design attendance policies to account for students who do not attend in-person due to student or family risks. Comment: We discussed including staff worries or anxiety plus encourage staff to speak to their PCP if they are concerned about their health risk.

We need more guidelines, what to tell our high-risk students and staff. How might we modify care plans, accommodations, recommendations if a person is in a high-risk category…?
Sent to OHA for clarification.