COVID-19 Exclusion Guidelines 1. COVID-19 can be present without any symptoms, especially in children. To reduce any spread of disease, daily screenings will be performed on children and staff. 2. While screening may reduce some COVID-19 transmission in childcare, transmission may still occur because of asymptomatic, pre-symptomatic, and mildly symptomatic children and staff. 3. People with COVID-19 have had a wide range of reported symptoms – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure. Symptoms can include: a. Fever or chills (100.4 F or higher) (Infants < 4 months, 99.4 F or higher) b. Cough c. Shortness of breath or difficulty breathing d. Fatigue e. Muscle or body aches f. Headache g. New loss of taste or smell h. Sore throat i. Congestion or runny nose j. Nausea or vomiting k. Diarrhea 4. There is not a single symptom that is uniquely predictive of a COVID-19 diagnosis. A COVID-19 viral test is needed to confirm if someone has a current infection. 5. Many of the symptoms of COVID-19 are also common in other childhood illnesses like the common cold, the flu, or seasonal allergies. In children, fever has been the most frequently reported symptom. 6. Additionally, children and staff with chronic conditions like asthma or allergies may have symptoms like cough or nasal congestion without having any infection at all. 7. The table below illustrates some of the overlap between the symptoms of COVID-19 and other common illnesses.

Symptoms of Common Seasonal COVID-19 Strep Throat Cold Flu Asthma Allergies Fever or X X chills Cough X X X X Sore throat X X X X Shortness of X breath or difficulty breathing Fatigue X X X X Nausea or X X Vomiting Diarrhea X X

Updated 12/23/20 Congestion X X X or Runny Nose Muscle or X X X body aches

8. Children and staff who are sick with contagious illnesses should be excluded from childcare and work, but most illnesses do not require the same level or length of isolation that COVID-19 does. 9. Again, there are limitations in symptom screening due to the wide range of symptoms and the fact some people have no symptoms. Inappropriately excluding children from childcare may cause unintended harm as their absence is keeping them from essential educational and developmental experiences. In order to exclude children and staff based on symptoms of COVID-19, it is important to look to key symptoms.

COVID-19 Symptom Exclusions 1. The following symptoms may indicate a possible illness that places a risk for spreading illness to others, and may decrease a child's ability to learn: a. Fever (100.4F or higher) (Infants <4 months, 99.4F or higher) b. Sore Throat c. New uncontrolled cough that causes difficulty breathing (for those with chronic allergic/asthmatic cough, a change in their cough from baseline) d. Diarrhea, vomiting, or abdominal pain e. New onset of severe headache, especially with fever f. Loss of Taste or Smell 2. This second set of symptoms likely are tied to the first set, but when present alone, is less concerning for contagiousness. The risk for illness increases if the following symptoms occur WITH ANY OTHER SYMPTOM: a. Muscle aches or body aches b. Fatigue (difficulty or inability to initiate and/or maintain activity- i.e. feeling very tired and needing extra rest, more than just sleepiness) c. Nasal congestion or runny nose (above their baseline) 3. Children/Staff who develop the above symptoms (refer to flowchart) while at the program should have the following performed: a. Immediately separate the person from others until the person displaying symptoms can leave the facility (contact parent/emergency contact) b. Advise the employee or child’s parent or caregiver to inform the facility immediately if the person is diagnosed with COVID-19 c. If the child or employee tests positive for COVID-19, Reach Dane will contact the local public health department as soon as possible. 4. If a staff member or child has the above symptoms of COVID-19, they can return to the child-care facility if the following conditions are met (see table below): a. If they were tested and POSITIVE for COVID-19: i. The individual must isolate at home for at least 10 days since the first symptoms began AND be fever free without the use of fever-reducing medications for 24 hours AND with improvement in symptoms.

Updated 12/23/20 ii. Repeat testing is NOT recommended for making decisions about when people can return to work or school. iii. Siblings, household members, and other close contacts should follow the current CDC guidance. b. If they were tested and NEGATIVE for COVID-19: i. The individual must be fever free for 24 hours without the use of fever- reducing medications. ii. If diagnosed with another condition, the individual must complete the exclusion period for the diagnosed disease. c. If they did NOT have COVID-19 testing: i. The individual must remain home for at least 10 days since the first symptoms began AND be fever free without the use of fever-reducing medications for 24 hours AND with improvement of symptoms. ii. Siblings and household members do not need to be excluded. iii. If diagnosed with another condition that explains the symptoms, such as influenza or strep throat, follow guidance from the health care provider and exclusion period of the diagnosed disease.

Close Contact Exposure Close contact is defined as being within 6 feet of an infected person for a prolonged period (15 minutes or more) starting from 2 days before illness onset. The 15 minutes does not need to be continuous (e.g., 3, 5-minute periods would count) and wearing a cloth face covering does not completely remove the exposure risk when in close contact. Quarantine means you should stay home from school, work, and other activities and get tested as soon as possible if you develop symptoms. If positive, follow isolation guidance for people who test positive; if negative, continue quarantining as based on guidance set by the CDC. 1. If a staff member or child has the above symptoms of COVID-19 and was a close contact of someone with COVID-19, they can return to the child-care facility if the following conditions are met (see table below): a. If an individual thinks they have COVID-19, they should stay home until at least 10 days since symptoms first appeared AND at least 24 hours with no fever without fever-reducing medication AND symptoms have improved. i. If symptoms worsen, they should contact their healthcare provider to determine if they should be tested for COVID-19 or go to a community testing site. b. If they are tested and NEGATIVE for COVID-19: i. The individual must quarantine, and it is safest to quarantine for 14 days. The quarantine starts after the last contact with the COVID-19 positive person. If the exposure is to a household member and the case cannot properly isolate away from others at home, the last date of contact may be the last day of isolation for the case. ii. The individual must also be fever free for 24 hours without the use of fever-reducing medications AND if diagnosed with another condition, they must complete the exclusion period for the diagnosed disease. c. If they are tested and POSITIVE for COVID-19:

Updated 12/23/20 i. The individual must isolate at home for at least 10 days since the first symptoms began AND be fever free without the use of fever-reducing medications for 24 hours AND with improvement in symptoms. ii. Repeat testing is NOT recommended for making decisions about when people can return to work or school. iii. Siblings, household members, and other close contacts should also follow CDC guidance to determine quarantine length. 2. If a staff member or child believes they had close contact with someone with COVID-19 but are not currently sick, they can return to the child-care facility if the following conditions are met (3 options set by the CDC): a. They should monitor their health for fever, cough, and shortness of breath during the 14 days after the last day they were in close contact with the sick person. b. Quarantine for 10 days after your last exposure. No test is required to end quarantine. Monitor yourself for symptoms until 14 days after your last exposure. c. Quarantine and get tested for COVID-19 6 or 7 days after last exposure. If your test is negative, you could end quarantine after 7 days of quarantine. You must have your negative test result before ending quarantine and the test cannot be before day 6. Monitor yourself for symptoms until 14 days after your last exposure.

Positive COVID-19 Test (See table below) 1. If an enrolled child or employee tests positive for COVID-19, Dane County Public Health Department and the Dept of Children and Families will be contacted. Reach Dane will follow their guidance for next steps. a. Staff and children who showed symptoms may return when meeting these guidelines: i. At least 10 days since symptoms first appeared ii. At least 24 hours with no fever without fever-reducing medication iii. Symptoms have improved b. Staff and children who showed no symptoms, but tested positive, may return when meeting these guidelines: i. 10 days have passed since the test 2. The program will post and notify families of any confirmed staff or child cases of COVID-19 3. If COVID-19 is confirmed in a child or staff member: a. Close off areas used by the person who is sick. b. Open outside doors and windows to increase air circulation in the areas. c. Wait up to 24 hours or as long as possible before you clean or disinfect to allow respiratory droplets to settle before cleaning and disinfecting. d. Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas. e. If more than 7 days have passed since the person who is sick visited or used the facility, additional cleaning and disinfection is not necessary. f. Continue routine cleaning and disinfection. 4. If COVID-19 is confirmed in a child or staff member and the person was on-site and was in close contact with others while contagious, the classroom (and possibly the site) will

Updated 12/23/20 close for 14 days since the last contact with the positive person.

Negative COVID-19 Test 1. If the person was in close contact with a positive case and tested negative, see section Close Contact Exposure - Number 2 for guidance on when to return to normal activities. 2. If the person was NOT in close contact with a positive case, has symptoms, and tested negative, follow Reach Dane’s normal exclusion guidelines for returning to work/school. See normal exclusion guidelines listed below.

Normal Exclusion Guidelines There are only 3 reasons to exclude an ill child from a child-care setting: 1. The illness prevents the child from participating comfortably in the program’s activities. 2. The illness requires the caregiver to provide more care than the caregiver can provide without compromising the care of the other children. 3. The child has a specific condition that is likely to expose others to a communicable and/or reportable disease, including the COVID-19 virus (see COVID-19 Exclusions below). a. State of WI child-care regulations identifies certain diseases that are reportable to LHD and give permission to child-care centers to send a child home for the purpose of diagnosis and treatment of suspected communicable disease or any condition that has potential to affect the health of other students or staff. Each site should post the WI Communicable Diseases Chart, May 2014.

** Contact PNP/RN or Health Manager immediately. PNP/RN or Health Manager will provide Communicable Disease Exposure Notice for the classroom to post and send home with families and contact Public Health if necessary.

A. If a child or staff member is diagnosed with a communicable disease, the specific Communicable Disease Exposure Notice should be posted and sent home to all families whose children may have been exposed. The site is to contact a PNP/RN or the Health Manager immediately if a child has a diagnosed communicable disease. 1. Communicable Disease Exposure Notices are stored on the Reach Dane Shared Drive in the Communicable Disease Exposure Notices folder and on the Reach Dane website on the staff intranet. B. The length of time to exclude varies with each disease; check with PNP/RN, Health Manager or the WI Communicable Disease Chart, May 2014 to determine when child may return to child-care. C. For suspected communicable disease, children should go home as soon as possible, but not to exceed one hour after the communicable disease is suspected. Send the child home with a Health Visit Follow-up Report (#503). Complete the top half of the form listing the symptoms observed while in care. The bottom half of the form must be completed by a health care provider before the child may return to child-care. The site is to contact a

Updated 12/23/20 PNP/RN or the Health Manager immediately if a child has a suspected communicable disease.

Exclusion Guidelines A child is excluded from child-care and should be seen by their primary care provider for: 1. Persistent Abdominal Pain

2. Blood in stools, not explained by hard stools

3. Diarrhea - Exclude for 24 hours after last episode of diarrhea. a) Diarrhea is defined as more watery, less formed, more frequent stools not associated with a diet change or medication i. 3-5-year olds: two or more large watery stools in 8 hours or one loose uncontrolled stool for which preschooler cannot make it to the toilet in time. ii. Infants/toddlers: two or more large watery stools in a diaper or two large stools that cannot be contained in a snug fitting diaper. b) A child with diarrhea may remain in child-care if he/she has no other symptoms and has a letter from a health care provider stating the child should not be excluded from child-care (consider new foods, teething, medications, etc.) If diarrhea is caused by a chronic condition contact a PNP/RN or the Health Manager. c) For diarrhea caused by E Coli or Shigella infection the child may not return to child- care until the diarrhea resolves and the test results of 2 stool cultures performed by a health provider or public health are negative. 4. Fever with other signs of illness such as sore throat, rash, vomiting, diarrhea, earache, behavior change, etc. - Exclude until 24 hours fever-free without the use of fever reducing medicine. **See COVID fever restrictions. Reach Dane will follow those guidelines until further notice. a) Fever is defined as temperature of 100.5 degrees either under the arm or by mouth (3- 5 yr. olds). Do not add a degree when reporting the temperature.

5. A fever of 99.0 degrees axillary (with or without other sign of illness) in infant younger than 4 months of age a) Exception - Infant with fever is behaving normally on the day after an immunization is given and has no other symptoms. **Follow COVID restrictions until further notice.

6. Rapidly rising fever (with or without other sign of illness) – Temperature > 100.5 degrees and rising rapidly within 15 minutes

7. Vomiting - Exclude for 24 hours after last episode of vomiting a) Defined as vomiting 2 or more times in 24 hours unless determined to be caused by non-infectious condition and child remains adequately hydrated. With infants, not just

Updated 12/23/20 spitting up. Child should not be excluded if vomiting is suspected due to teething, stressful situations, or introduction to new foods.

8. Child appears to be severely ill: Lethargic, uncontrolled coughing, inexplicable irritability or crying, difficulty breathing, or other unusual signs

Updated 12/23/20 A child or staff member is feeling sick. Do they have the following symptoms?

- Fever (100.4F or higher) (Infants <4mo, 99.4F or higher)

- Sore Throat

- New uncontrolled cough that causes difficulty breathing (for those with chronic asthma or allergic cough, a change in their cough from baseline)

- Diarrhea

- Vomiting

- Abdominal pain

- New onset of SEVERE headache (especially with YES fever) IMMEDIATELY separate child from others, call parent to pick up. (OR - Loss of taste or smell SEND HOME STAFF)

Advise parent to notify us if the child is diagnosed with COVID-19. NO (OR staff should notify HR)

The child or staff member must Does they have at least TWO of the following not return to childcare for at least symptoms? 10 days (see guidelines in chart - Muscle aches or body aches below on when they can return YES based on the situation). - Nasal congestion or runny nose (above their baseline)

- Fatigue (difficulty or inability to initiate and/or maintain activity- i.e. feeling extremely tired and needing frequent rest, more than just sleepiness)

NO

- Check the standard exclusion policy for further guidance and follow - If otherwise OK, allow child/staff to remain at childcare center COVID-19: WHEN A STUDENT, OR FACULTY/STAFF MEMBER CAN RETURN TO SCHOOL Purpose: The purpose of this document is to assist school health care staff and public health officials in determining if a student, or faculty/staff member needs to be excluded from the facility for COVID-19 quarantine or isolation. The chart uses three criteria to determine this: close contact, symptoms, and COVID-19 test status.

How to use: The first step is to determine if the individual was a close contact to a COVID-19 case based on the definition below and then selecting the appropriate chart on the next page. The second step is to determine if the individual is showing symptoms of COVID-19 (symptomatic) or not. Finally determine if they were tested for COVID-19 and the result of the test. Key definitions are provided below: Isolation means keeping sick people away from healthy ones. This usually means that the sick person rests in their own bedroom or area of your home and stays away from others. This includes staying home from school.

Quarantine means separating people who were around someone who was sick, just in case they get sick. Since people who were around other sick people are more likely to get sick themselves, quarantine prevents them from accidentally spreading the virus to other people even before they realize they are sick. Usually people who are in quarantine stay at home and avoid going out or being around other people. This includes staying home from school. You can develop COVID-19 anytime during the 14 days after your last close contact with someone who has COVID-19. In order to prevent spreading COVID-19 to others, you must quarantine, which means you must stay home from work, school, and other activities. When quarantining, you should always: Monitor your symptoms for 14 days after your last exposure to COVID-19 and stay home from school, work, and other activities and get tested as soon as possible if you develop symptoms. If positive, follow isolation guidance for people who test positive; if negative, continue quarantining.

It is safest if you quarantine for 14 days after your last exposure. No test is required to end quarantine. You do have other options for quarantine. These options are to:  Quarantine for 10 days after your last exposure. No test is required to end quarantine. Monitor yourself for symptoms until 14 days after your last exposure.  Quarantine and get tested for COVID-19 6 or 7 days after last exposure. If your test is negative, you could end quarantine after 7 days of quarantine. You must have your negative test result before ending quarantine and the test cannot be before day 6. Monitor yourself for symptoms until 14 days after your last exposure.

Close contact: An individual is considered a close contact if any of following is true:  Were within 6 feet of a positive person for more than 15 minutes total in a day.  Had physical contact with the person.  Had direct contact with the respiratory secretions of the person (i.e., from coughing, sneezing, contact with dirty tissue, shared drinking glass, food, or other personal items).  Lives with or stayed overnight for at least one night in a household with the person.

These close contact criteria apply regardless of mask use, face shields, or physical barriers, such as Plexiglas or plastic barriers. The only exception is if a health care worker in a school setting is wearing the proper personal protective equipment. When an individual’s symptom, contact, or test status changes, their quarantine or isolation requirements should be reassessed.

SYMPTOMS Symptoms are considered consistent with COVID-19 when one of the symptoms marked with a (^) or two of the other symptoms are present above baseline for that individual. Cough^ Shortness of breath or difficulty breathing^ New loss of taste or smell^ Congestion or runny nose Fever or chills Nausea or vomiting Diarrhea Headache Fatigue Muscle or body aches Sore throat

Updated December 17, 2020 at 3:30pm publichealthmdc.com/coronavirus Individual is NOT a known close contact to a COVID-19 case: Individual Symptomatic No Symptoms Not tested  The individual must remain home for at least 10 days since the first symptoms began AND be fever free May attend school. for COVID- without the use of fever-reducing medications for 24 hours AND with improvement of symptoms. 19  Siblings and household members do not need to be excluded (different from DHS guidance).  If diagnosed with another condition that explains the symptoms, such as influenza or strep throat, follow guidance from the health care provider and exclusion period of the diagnosed disease as listed on the Wisconsin Childhood Communicable Diseases Wall Chart

Tested and  The individual must be fever free for 24 hours without the use of fever-reducing medications May attend school. negative for  If diagnosed with another condition, the individual must complete the exclusion period for the COVID-19 diagnosed disease as listed on the Wisconsin Childhood Communicable Diseases Wall Chart. An alternative diagnosis is not required. Tested and  The individual must isolate at home for at least 10 days since the first symptoms began AND be fever free  Must isolate at home for 10 days after positive for without the use of fever-reducing medications for 24 hours AND with improvement in symptoms. Repeat the day the sample was collected. COVID-19 testing is NOT recommended for making decisions about when people can return to work or school.  Siblings, household members, and  Siblings, household members, and other close contacts should follow the close contact chart below. other close contacts should follow the close contact chart below.

Individual IS a known close contact to a COVID-19 case:

Individual Symptomatic No Symptoms Not tested  The individual must quarantine. The quarantine starts after the last contact with the COVID-19 positive person. It is Must quarantine (see first page) from the for COVID- safest if the individual quarantines for 14 days (see first page for other quarantine options). If the exposure is to a date of last exposure before returning to 19 household member and the case cannot properly isolate away from others at home, the last date of contact may school or day care. If the exposure is to a be the last day of isolation for the case. household member and the case cannot  The individual must also remain home for at least 10 days since the first symptoms began AND be fever free properly isolate away from others at home, without the use of fever-reducing medications for 24 hours AND with improvement of symptoms. the last date of contact may be the last day  The criteria in both of the above bullets must be met before returning to school. of isolation for the case.  Siblings and household members do not need to be excluded (different from DHS guidance). Tested and  The individual must quarantine. The quarantine starts after the last contact with the COVID-19 positive person. It is Must quarantine (see first page) from the negative for safest if the individual quarantines for 14 days (see first page for other quarantine options). If the exposure is to a date of last exposure before returning to COVID-19 household member and the case cannot properly isolate away from others at home, the last date of contact may school or day care. If the exposure is to a be the last day of isolation for the case. household member and the case cannot  The individual must also be fever free for 24 hours without the use of fever-reducing medications AND if properly isolate away from others at home, diagnosed with another condition, they must complete the exclusion period for the diagnosed disease as listed the last date of contact may be the last day on the Wisconsin Childhood Communicable Diseases Wall Chart. An alternative diagnosis is not required. of isolation for the case.  The criteria in both of the above bullets must be met before returning school. Tested and  The individual must isolate at home for at least 10 days since the first symptoms began AND be fever free Must isolate at home for 10 days from the positive for without the use of fever-reducing medications for 24 hours AND with improvement in symptoms. Repeat day the sample was collected. Siblings and COVID-19 testing is NOT recommended for making decisions about when people can return to work or school. household members and other close  Siblings, household members, and other close contacts should also follow this chart to determine contacts should also follow this chart to quarantine length. determine quarantine length.

Updated December 17, 2020 at 3:30pm publichealthmdc.com/coronavirus Was the person a close contact to a someone with a positive COVID-19 test? COVID-19: WHEN A CHILD/YOUTH OR STAFF MEMBER CAN RETURN TO Yes No SCHOOL OR CHILD CARE Do they have symptoms? Do they have symptoms? Updated December 14, 2020

No Yes No Yes Was their COVID-19 test Have they been tested for Was their COVID-19 test Have they been tested for positive? COVID-19? positive? COVID-19?

No, not tested Yes, negative test Yes, positive Yes, positive test Yes, positive Yes, positive test Were they given another Were they given another Isolate* Isolate* Isolate* Isolate* diagnosis? diagnosis?

Yes, other diagnosis Yes, other diagnosis No, negative Yes, negative test No, negative Follow guidelines for Follow guidelines for Quarantine** Quarantine** May attend school diagnosis diagnosis

No, no other diagnosis Not tested No, not tested Not tested No, no other diagnosis May attend school when Quarantine** Isolate* and quarantine** May attend school Isolate* symptoms meet other return to school criteria

*Isolate: Individual should not attend/work at school until it has been at least 10 days since symptom onset, they have been fever-free for 24 hours (without the use of fever reducing medications), and their other symptoms are improving **Quarantine: Individual should not attend/work at school until quarantine is complete, following their last exposure to a person who was infectious. See page 1 for quarantine options. When calculating isolation and quarantine, the date of symptom onset/positive lab test (for asymptomatic) or last date of exposure to an infectious person is day 0. For example, individuals may return to school on day 11 (isolation).