Additional Strategies that May Be Used to Minimize Infectious Disease Transmission in Schools during Times of Elevated Illness Activity

When there is a higher level of illness in the school community, schools can add other strategies to their regular activities in addition to increasing everyday actions like hand washing and ventilation. Which strategies, and how many, are added can be based on considerations such as local factors (for example, elevated absenteeism in your area, community preferences) and the virus or other pathogen that is circulating.

Additional strategies include:

• Masking and respiratory protection
• Increasing distance and cohorting
• Illness monitoring
• Testing
• Managing exposure

Masking and Respiratory Protection

Correctly and consistently wearing a mask can help lower the risk of respiratory virus transmission. When worn by a person with an infection, masks reduce the spread of the virus to others. Masks can also help protect wearers from breathing in infectious particles from people around them. Different masks offer different levels of protection. Wearing the most protective mask you can comfortably wear for extended periods of time that fits well (completely covering the nose and mouth) is the most effective option. Cloth masks generally offer lower levels of protection to wearers, surgical/disposable masks usually offer more protection, international filtering facepiece respirators (like KN95 respirators) offer even more, and the most protective respirators are NIOSH Approved® filtering facepiece respirators (like N95® respirators).

During times when respiratory disease spread and absence is high, an outbreak is occurring, or there is an epidemic or pandemic/public health emergency, and where consistent with local laws, indoor mask wearing is an option schools may choose as part of their response. Wearing a mask may help protect those most at risk for severe illness from respiratory disease (e.g., children with asthma or cystic fibrosis) and decrease spread of illness in the school setting by helping to minimize infectious particles in the environment. Some students and staff may elect to wear masks at additional times, even when disease burden is not high, due to personal health circumstances or preference. Schools should support anyone who chooses to wear a mask or respirator regardless of illness- spread levels. Mask wearing can be included into existing programming (e.g., antibullying programming). Schools should also support students or staff who might have difficulty wearing masks, or need clear masks.

Increasing Distance and Cohorting

Physical distancing is a way to increase space between people in settings where there is commonly close contact with one another, such as schools. The closer you are to a greater number of people, the more likely you are to be exposed to infectious illnesses. There is no single number that defines a “safe” distance, since spread of viruses can depend on many factors. Often in the school setting, space is limited, making achieving distancing in a classroom difficult. Schools can consider outdoor activities when feasible to allow greater distancing, as respiratory illnesses are less likely to spread during outdoor activities. If weather permits and it is safe to move activities outside, schools can increase the number of classes or group activities done outside during times of elevated illness activity.

When space is limited, schools can use cohorting as a strategy to minimize disease spread. Cohorting involves creating groups of students that are separated from other groups. Each group of students is kept together with the same peers and staff throughout the school day to reduce the risk for illness or limit spread throughout the school. Students with immunocompromising conditions or other underlying medical conditions or disabilities that increase risk for getting very sick should not be placed into separate classrooms or otherwise segregated from other students, as this could limit engagement in learning activities. Schools can develop cohorting plans in advance, to ensure that they are available for use promptly when needed.

Illness Monitoring

Schools, with support from health departments, can provide parents and caregivers with instructions on how to monitor students for illness or when to have a child stay home. This may be especially important in cases where new or emerging pathogens are causing illness. This can include a standardized symptom list that parents need to consider prior to students arriving at school. Procedures for allowing return to the school setting (based on the infectious disease of concern) should also be outlined. Schools should communicate procedures to parents and caregivers and include clearly defined reasons for school exclusion in these instances.

Testing

Screening tests identify people with an infection who do not have symptoms or known or suspected exposures so that steps can be taken to prevent further spread of the disease. During an outbreak or a pandemic, and when disease-specific tests are available, a testing program may be implemented to help prevent spread of disease. Currently, rapid tests are available for influenza and COVID-19. Schools can work with their local health department to help determine when and how to implement screening tests and when there are reporting requirements for specific infection types.

Schools should consider the characteristics of different test types (including accessibility, accuracy, turnaround time, cost, and practicality) to determine which best suits their needs as well as public health guidance for the particular pathogen.

Schools should conduct testing in a way that ensures the ability to maintain confidentiality of results and protect privacy in accordance with applicable laws and regulations, which may include the Family Educational Rights and Privacy Act (FERPA). Schools should address obtaining appropriate consent to testing consistent with applicable law.

Schools can provide information about the appropriate use of testing within home settings, and can communicate with families the importance of following pertinent public health guidance for anyone who tests positive, including information about when to contact a healthcare provider for additional management. For individuals who have symptoms consistent with the circulating illness, schools can identify local facilities and healthcare providers for referral to testing and management. This resource can be shared with students, families, and staff if they do not have a primary care physician capable of testing and treating the pathogen. For some individuals, diagnostic testing for certain respiratory illnesses, like influenza and COVID-19, may be important especially if they are at increased risk for severe disease and could benefit from treatment.

Managing Exposure

Schools can proactively identify spaces to separate sick students from well students while waiting for them to leave school. Ideally, such a space will allow for staff to monitor the sick student, have a door that separates the space, and have increased air circulation. It is important that staff who are monitoring students use appropriate PPE and other precautions.

Schools can notify caregivers of exposures to certain communicable diseases (e.g., tuberculosis, measles, or new/emerging pathogens). Schools may also be required to notify state or local health departments for some diseases. The local health department will work with schools and caregivers to conduct contact tracing and identify contacts who may require notification.