Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations




Scenarios for returning to in-person school

Schools should base decisions about when it is safe for students who develop symptoms  (in other words, those with a “yes” response in Section 1) to be around others and return to in-person school on the responses provided to Section 2 and COVID-19 viral test results, when available. Caregivers of symptomatic students should be encouraged to consult their children’s healthcare provider to determine when COVID-19 testing is appropriate.

Students in the following scenarios include those with a YES response to any part of Section 1:

Scenario 1: Symptomatic student with no increased risk of exposure to the virus that causes COVID-19 (in other words, NO to both parts of Section 2)

  • This student should stay home until his or her symptoms have improved according to existing school policies, typically, at least 24 hours after they no longer has a fever (temperature of 100.4 or higher) or signs of a fever (chills, feeling very warm, flushed appearance, or sweating) without the use of fever-reducing medicine (e.g., acetaminophen or ibuprofen).

Scenario 2: Symptomatic student who has had close contact (within 6 feet for a total of 15 minutes or more) with a person infected with COVID-19 (in other words, YES to Section 2A).

  • If the student receives a positive COVID-19 test result they should not attend school and should isolate until:
    • At least 10 days since symptoms first appeared AND
    • 24 hours with no fever without fever reducing medication AND
    • Other symptoms of COVID-19 are improving (see Isolate If You Are Sick for more information)
  • If the student receives a negative COVID-19 test result or are not tested they must still complete the full 14-day quarantine from the last contact with an infected person before returning to school because they can still develop COVID-19 for up to 14 days after being exposed. (See When to Quarantine for more information.)

Scenario 3: Symptomatic student with no known close contact with an infected person BUT attends a school with moderate risk of transmission or higher (in other words, NO to Section 2A but YES to Section 2B)

  • If the student receives a positive COVID-19 test result or if they are not tested, they should not attend school and should isolate until
    • At least 10 days since symptoms first appeared AND
    • 24 hours with no fever without fever reducing medication AND
    • Other symptoms of COVID-19 are improving (see Isolate If You Are Sick for more information)
  • If the student receives a negative test result, the symptoms are most likely from another infection. Because this student DOES NOT have a known close contact, they may return to school once symptoms have improved according to existing school policies such as those described in Scenario 1.

For each of these scenarios, after the appropriate isolation or quarantine period is complete, schools should not require a COVID-19 viral test result or doctor’s note for school return.

NOTE: The scenarios above describe return to school policies for students who have symptoms of possible infectious illness (i.e., YES response(s) in Section 1). Asymptomatic individuals who have had close contact with someone with COVID-19 should also quarantine for 14 days from the last contact with an infected person. See When to Quarantine for more information.

If the individual later develops symptoms, they will need to isolate for at least 10 days from the start of their symptoms and  meet the additional criteria described in CDC’s Isolate If You Are Sick guidance. As a result, some individuals may have a total quarantine plus isolation duration longer than 14 days.

Students Who Become Sick at School

Some students might develop symptoms of infectious illness while at school. Schools that identify symptomatic students during the school day should follow the steps of CDC’s “Student Becomes Sick” on what to do next. This includes notifying the student’s caregiver and recommending an evaluation by a healthcare provider and testing or initiating school-based testing, if available. Schools should work with students and their caregivers to base school exclusion and return decisions on the same criteria detailed for home-based screening above.

School Isolation Protocols

Additionally, when students develop symptoms of infectious illness, schools should take action to isolate them from other students and staff.

  • Students with any of the symptoms in Section 1 should follow their school’s current illness management policy to minimize transmission to others and allow for these symptoms to resolve (at least 24 hours without fever reducing medications or according to existing school illness policy).
  • Students who develop any of the symptoms in Section 1 while at school should be placed in an isolation area (ideally with a restroom) separate from staff and other students:
    • School nursing staff​ who interact with a student who becomes ill while at school should use  Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic when caring for sick people.
    • Students who are sick and not already wearing a mask should be provided one to wear unless the student has a contraindication to doing so. (See Considerations for Wearing Masks for more information.)
    • Students who are sick should go home or to a healthcare facility depending on how severe their symptoms are, and follow CDC guidance on for caring for yourself and others who are sick.
      • If a student has also answered YES to either question in Section 2 and the school needs to call an ambulance or bring a student to the hospital, the school should first alert the healthcare staff that the student might have been exposed to someone with COVID-19.
    • After the student leaves an isolation area, school staff should follow CDC’s Considerations for Cleaning and Disinfecting Your Facility.
      • Note: In developing plans for placing students with symptoms in an isolation area, schools should take care to ensure that students are isolated in a non-threatening manner, within the line of sight of adults, and for the shortest possible period. If more than one individual at a school becomes sick at the same time, ideally each person should be isolated separately to avoid unnecessary exposures in case one or more of those who are sick do not have COVID-19.

Additional resources regarding actions to take for students who become sick while at school are available at:

What to Do If a Student Becomes Sick at School or Reports a New COVID-19 Diagnosis Flowchart

Considerations If Schools Elect to Conduct Symptom Screening

Although CDC does not currently recommend that schools conduct symptom screening, for schools that choose to implement screening on-site, CDC offers the following:

  • Consider the scientific evidence previously outlined and weigh the risks and benefits to students, staff, and the larger community.
  • Consider how school policies regarding symptom screening can balance the resources required and feasibility of implementation and the risk of transmission in schools.
  • Consider ways to reduce the likelihood of excluding students who do not have COVID-19 from essential instructional and critical developmental experiences.

Before conducting screenings or sharing personally identifiable information on students concerning COVID-19 with public health authorities or other officials, consider federal, state, and local requirements, including provisions in the Family Educational Rights and Privacy Act (FERPA).  Some of the factors schools may weigh include:

Feasibility

  • If symptom screening is implemented by the school, are there enough staff who are sufficiently trained in screening procedures as well as in putting on and taking off personal protective equipment (PPE)?
  • How will results of screening be verified?
  • Is proper equipment (e.g., thermometers, PPE) available in sufficient quantities?
  • How will proper cleaning and disinfection of the screening area and equipment be ensured?
  • Will processes be in place to ensure screeners and students maintain safe distance during screening?
  • What protections will be included for staff who are at increased risk of severe COVID-19?
  • What testing strategies will be implemented by the school so that students with positive symptom screenings can be further evaluated? (See Considerations for Testing in K-12 Schools.)

Harm mitigation

  • What strategies are needed to reduce the harms to students and their families when students are excluded from school, such as students who rely on school meals or impact on parental ability to work, when screening falsely identifies their chronic symptoms as symptoms of COVID-19?
  • How will students with chronic conditions or special health care needs be accommodated to minimize the risk of symptom screening falsely identifying chronic symptoms as symptoms of COVID-19?
  • How will stigma be reduced for students who screen positive for having symptoms of COVID-19, regardless of whether they have COVID-19?
  • What is the emotional impact of daily screening on young children and how can fear of new mitigation protocols, such as adults wearing PPE, be reduced?
  • How will ill students be afforded the opportunity to make up any missed classwork without penalty to reduce mental or physical anxieties about missed academic opportunities when screening falsely identifies their chronic symptoms as symptoms of COVID-19?

Level of community transmission in the area where the school is located

  • If there is minimal COVID-19 transmission in the community, symptom screening will be more likely to identify people with symptoms who have something other than COVID-19. Symptom screening in this scenario will be more likely to identify other illnesses or conditions, not COVID-19, including certain chronic symptoms, some of which may not require staying home.
  • When there is more community transmission, the likelihood that individuals with symptoms actually have COVID-19 is higher. Therefore, symptom screening may be more helpful when COVID-19 transmission in the community is high.

Recommendations of local public health authorities

  • Regardless of factors above, schools should ensure that their policies follow the recommendations of local public health officials and are consistent with Federal, state, and local laws, including FERPA.
  • Schools that choose to conduct symptoms screening should contact their local health departments with questions regarding practices and implementation.
  • Additionally, schools should continue to monitor compliance with the immunizations required for in-person school attendance.

Note: Symptom screening is intended to reduce transmission from a potentially infected person to others. It is not designed to assess the severity of illness in the person with infection, the person’s risk of developing serious illness, or the person’s need to seek medical care. CDC has a COVID-19 self-checker to help caregivers of children with symptoms of COVID-19 assess whether they should contact their child’s healthcare provider available at Coronavirus Self-Checker.

References

[1] Poline J, Gaschignard J, Leblanc C, Madhi F, Foucaud E, Nattes E, Faye A, Bonacorsi S, Mariani P, Varon E, Smati-Lafarge M. “Systematic SARS-CoV-2 screening at hospital admission in children: a French prospective multicenter study.” Clinical Infectious Diseases (2020).

[2] Davies, N.G., Klepac, P., Liu, Y. et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med (2020). https://doi.org/10.1038/s41591-020-0962-9external icon

[3] Assaker, Rita, Anne-Emmanuelle Colas, Florence Julien-Marsollier, Béatrice Bruneau, Lucile Marsac, Bruno Greff, Nathalie Tri, Charlotte Fait, Christopher Brasher, and Souhayl Dahmani. “Presenting symptoms of COVID-19 in children: a meta-analysis of published studies.” BJA: British Journal of Anaesthesia (2020). https://www.sciencedirect.com/science/article/pii/S0007091220304086?via%3Dihubexternal icon

[4] Dong, Yuanyuan, Xi Mo, Yabin Hu, Xin Qi, Fan Jiang, Zhongyi Jiang, and Shilu Tong. “Epidemiology of COVID-19 among children in China.” Pediatrics 145, no. 6 (2020). https://pediatrics.aappublications.org/content/145/6/e20200702external icon

[5] Assaker, Rita, et al. “Presenting symptoms of COVID-19 in children: a meta-analysis of published studies.” BJA: British Journal of Anaesthesia (2020).

[6] Clemency, Brian M., Renoj Varughese, Danielle K. Scheafer, Brian Ludwig, Jacob V. Welch, Robert F. McCormack, Changxing Ma, Nan Nan, Theresa Giambra, and Thomas Raab. “Symptom Criteria for COVID‐19 Testing of Heath Care Workers.” Academic Emergency Medicine 27, no. 6 (2020): 469-474.

[7] Roland, Lauren T., Jose G. Gurrola, Patricia A. Loftus, Steven W. Cheung, and Jolie L. Chang. “Smell and taste symptom‐based predictive model for COVID‐19 diagnosis.” In International Forum of Allergy & Rhinology. 2020.

[8] Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2externalexternal icon.

[9]Assaker, Rita, et al. “Presenting symptoms of COVID-19 in children: a meta-analysis of published studies.” BJA: British Journal of Anaesthesia (2020).

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