JANUARY 25, 2021 · 2021. 1. 25. · 2 DRAFTJANUARY 25, 2021 6. Many overnight camps with...

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DRAFT JANUARY 25, 2021

NH Safeguarding Guidance for Overnight Camps

The State of New Hampshire recommends the Resident/Overnight Camp industry establish measures to protect consumers (campers) and employees. The following guidance is built upon recommendations from the Universal Guidelines for All New Hampshire Employers and Employees, the CDC Considerations for Youth and Summer Camps and additional resources created by Environmental Health & Engineering, an independent multidisciplinary consulting company in public health, workplace safety, research and data analytics which has been retained by ACA and YMCA- USA to provide educational resources and guidance for camps to function as effective public health partners in the current COVID-19 environment. This guidance was developed through the formation of an independent expert panel, which included members of the American Academy of Pediatrics, the Association of Camp Nursing and the Harvard School of Public Health, in dialogue with the CDC.

• Review and follow the updated NH Universal Guideline • Review and follow the NH day and overnight camp guidance. • Review and consider CDC considerations for youth and summer camps.

Considerations: 1. Children have and continue to experience considerable disruption to their growth,

learning and socio-emotional well-being during this pandemic. As such, it is critical to prioritize every effort to open programs serving these purposes.

2. Camp age children and young adult staff continue to represent the lowest-risk segment of the population for COVID-19 complications and health care utilization.

3. Data from the 2020 camp season overwhelmingly supports summer camps across the country operated safely, with either no COVID cases or a very limited spread of cases that were managed effectively and safely to mitigate transmission. Cases of outbreaks reflected breakdowns in systems of infection control. 1, 2, 3

4. Similarly, growing data has demonstrated that schools can remain open provided they strictly implement strategies of infection control.4

5. The diligent use of multiple non-pharmaceutical interventions (NPIs), specifically facial coverings, physical distancing and outdoor programming, allowed camps to prevent transmission and quickly identify and isolate cases to mitigate spread.1

a. Additional NPIs unique to overnight camps are use of low-risk pre-camp behaviors, use of testing, daily health screenings, use of cohorts for sleeping/eating groups (where facial covering is not possible), hand/respiratory hygiene, cleaning & disinfecting and rapid response protocols for identification, isolation and quarantine.

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Deleted: Many Residential Camps, with acceptable modifications, can quarantine, functioning as a ‘single family home’ and ‘shelter-in-place’ together for the duration of the camp session regardless of camp size.

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6. Many overnight camps with acceptable modifications can function to a ‘single family home’ and have the ability to quarantine on-site (if and when required) regardless of camp size. Thus, travel and group gathering restrictions must be considered in the context of overnight summer camps ability to self-isolate.

7. The diversity of camp size, duration, built environment and programming requires public health overarching guidelines to prevent and mitigate spread (specifically group and cohort size limits) but that allow for implementation & interpretation in a variety of settings. Without such flexibility, many camps will need to consider their ability to open and/or apply for additional waivers to allow opening.

1. Blaisdell LL, Cohn W, Pavell JR, Rubin DS, Vergales JE. Preventing and Mitigating SARS-

CoV-2 Transmission — Four Overnight Camps, Maine, June–August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1216–1220.

2. Szablewski CM, Chang KT, Brown MM, et al. SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1023–1025

3. Pray IW, Gibbons-Burgener SN, Rosenberg AZ, et al. COVID-19 Outbreak at an Overnight Summer School Retreat ― Wisconsin, July–August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1600–1604.

4. Schools and the Path to Zero: Strategies for Pandemic Resilience in the Face of High Community Spread https://globalepidemics.org/2020/12/18/schools-and-the-path-to-zero-strategies-for-pandemic-resilience-in-the-face-of-high-community-spread/?fbclid=IwAR19APskUJOg5upRXwE7A9u-qmh9x4a00HSDCpf5NEFqrOYUCX3h8-zfZdg

Preparation Requirements

1. Work with camp health staff to develop a COVID-19 specific Communicable Disease Plan which specifies a plan and process for:

1. The implementation of guidance outlined in this document, the NH Universal Guidelines, CDC Considerations for Youth and Summer Camps.

2. The implementation of NPIs in the camp setting including: Low-risk pre-camp behaviors, testing, health screening, facial coverings, physical distancing, hygiene, cohort/pods for groups sleeping and/or eating together, cleaning and disinfection and management of camp entry/exit.

3. Early identification, isolation and testing of symptomatic individuals and Quarantine and increased surveillance of individuals with prolonged exposure(s).

4. Health Staff Guidelines: 1. Strongly encourage camps to work with a medical provider (e.g.

M.D./D.O., or APRN) to assist in developing camps COVID-19 Plan, manage symptomatic or confirmed COVID-19 positive staff or campers and order/interpret COVID-19 tests.

2. Create plans for travel to camp that minimize exposures to the degree possible. Camps should ideally consider direct to camp transportation or the use of

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chartered direct ground transport and/or direct travel from airports. When using airtravel, camps must instruct attendees on data supporting safest practice while traveling.5,6,7

3. Regardless of travel method to camp, plan for all staff and campers will comply with current NH travel and quarantine restrictions as outlined per NH Universal Guidelines. As camp is the ‘family home’ to staff and campers, they may quarantine on camp premises. Camps must note the role of testing and vaccination status within quarantine guidelines. Camp medical staff do not need to arrive and stay on camp prior to the start of camp due essential worker status.

1. Camps will not allow any person with symptoms of COVID-19 or an identified risk for COVID-19 exposure into the camp.

Employee & Camper Protection During Camp Program 1. Prevention.

a. Prearrival Procedures: i. Staff should arrive at camp prior to the camp program having

participated in low-risk pre-camp behaviors and in sufficient time to complete current NH travel and quarantine restrictions per NH Universal Guidelines. Staff should be separated into cohorts (see below) and during this time should practice physical distancing & face coverings when this is not practicable. They should dine in their cohort. Staff should be screened daily for COVID-19 and be tested prior to camp and camper arrival (see Screening and Diagnostic Testing for COVID-19).

ii. Campers and their families should be asked to participate in low-risk pre-camp behaviors for up to 10 days prior to traveling to camp. Campers should be screened daily for COVID-19 during this time. Campers should be tested prior to camp arrival (see Testing below).

iii. Camps must not allow staff or campers who are symptomatic for COVID-19 to travel to camp. Campers and staff identified on the day of travel to be ill will be required to be tested and if positive isolate for 10 days prior to attending camp.

b. Arrival Procedures: Establish arrival procedures to minimize visitor entry into camp and to screen for COVID-19 in staff and campers upon camp arrival.

c. Health Surveillance: Screen all individuals on camp premises daily for COVID-19 symptoms and maintain a log of health screenings. If screening is positive, see section entitled Health Center, COVID-19 and COVID-19 Illness Management below.

d. Face Coverings: i. Camps must teach and reinforce the use of facial coverings for all

campers and staff. Times when facial coverings are not possible


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(e.g. sleeping, swimming, dining and showering) campers and staff should either a) be in their designated cohort (see Physical Distancing & Cohorting) or b) be physically distant by a minimum on 6 feet from non-cohort members and c) consider outdoor programming and indoor ventilation.

ii. Staff not residing full time on property, Vendor Deliveries and Visitors: facial coverings will be worn at all times by all others on camp premises.

e. Hygiene: i. Teach and reinforce washing/sanitizing hands and covering coughs

and sneezes among children and staff. ii. Have adequate supplies to support healthy hygiene behaviors,

including soap and water, hand sanitizer with at least 60 percent alcohol for staff and older children who can safely use hand sanitizer, tissues, and no-touch trash cans.

iii. Use hand hygiene before and after activities, use of bathroom, dining and at other times throughout the day.

f. Testing: Screening, Diagnostic and Surveillance testing is a part, and notably, not the sole mitigation method to the creation of a healthy summer, especially in light of potential false negative and false positive results, even with the use of RT-PCR. Camps must develop a testing plan in their COVID-19 Communicable Disease Plan acknowledging availability and affordability is not universal to all camps. The number and type of available tests and criteria for their use are continuing to evolve due to the rapid reviews being conducted by the U.S. Food and Drug Administration (FDA) under their Emergency Use Authorization (EUA) program and developments in testing technology. Selection of testing type must consider variable test performance, who should be tested and when testing should occur and medical consultation with camp health staff is recommended given the complexity and changing nature of recommendations. (See Field Guide for Camps, Chapter 13.). Camps should establish relationships with testing facilities prior to camp. The strictest and most diligent NPIs must be in place after arrival of campers or staff while awaiting testing and testing results.

i. Screening Testing: 1. RT-PCR based testing is recognized as the gold standard by

both federal and state public health authorities and should be used in the camp testing protocol.

2. Tests must be scheduled with sufficient turnaround time to allow for results to be assessed prior to travel (note that some test results can be delayed by several days).

3. Campers and staff should be tested within 72 hours to 7 days prior to arrival at camp, where available. Low-risk behaviors must be ensured after testing and prior to camp.

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4. Testing of campers and staff on the first day of arrival should be considered, especially if attendees were unable to adhere to low-risk behaviors prior to camp (e.g. college students arriving directly from campus to camp or children of essential workers). If day one testing is not performed, all attendees should be considered as potentially infected until the results of the subsequent test on day 5 and strict multi-layered NPIs must be used.

5. 5 days after arrival at camp, campers and staff should be re-tested to capture potential travel-related exposures. Testing prior to this time may yield false negative results.8

ii. Diagnostic Testing: 1. Camps should establish relationships with testing facilities to

be prepared to conduct testing when campers or staff display symptoms or are in contact with a confirmed or suspected case.

2. Camps should use tests other than RT-PCR with caution and medical advice.

iii. Surveillance Screening: Camps may consider ongoing surveillance testing of camp attendees subject to testing costs and availability.

iv. Test Reporting: Records must be kept of all testing and test results. Results must be kept confidential in compliance with state and federal HIPAA regulations. Positive cases must be immediately isolated. If there is a confirmed case of COVID-19, the camp must contact the Bureau of Infection Disease Control (BIDC) immediately at 603-271-4496 (available 24/7).

g. Education and Communication. i. Camps must train all staff and campers on the camps COVID-19

Communicable Disease Guidelines, including their role in compliance with prevention guidelines.

ii. Post signs on how to stop the spread of COVID-19, properly wash hands, promote everyday protective measures, and properly wear a face covering.

iii. Teach use of cloth face coverings among staff working outside their cabin or programming cohorts when physical distancing is not possible. Staff should be frequently reminded not to touch the face covering and to wash their hands frequently. Information must be provided to all staff on proper use, removal, and disposal or washing of cloth face coverings.

iv. Provide educational materials in advance to parents and guardians for sharing with children prior to camp and reinforce awareness at staff and camper orientation and periodically thereafter for all throughout the camp experience.

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2. Physical Distancing & Cohorting. The congregant living in the camp setting requires particular considerations for how to manage interactions and activities of daily living within camp attendees to minimize and prevent spread of infectious disease. Camps should use consistent sleeping groups (also called “household”, “family”, “pod” or “bunk”) and/or ‘cohorts’ made of a small collection of sleeping groups.

i. Camp administrators should identify sleeping groups of campers and counselors that remain consistent over the camp program.

ii. The use of cohorts allows size of sleeping groups to be flexible as long as cohorts remain separate from other cohorts through facial covering and physical distancing. Cohorts should be as small as practicable.

iii. When within a cohort, staff and campers act as a ‘family unit’ and are not required to wear cloth face coverings or physically distance.

iv. Physical distancing between cohorts is most important in settings where facial coverings cannot be worn such as dining facilities and swimming areas.

v. Consider limiting large gatherings, events, and extracurricular activities to those that can maintain social distancing, facial covering and support proper hand hygiene, Outdoor fields can be used for large gatherings with the use of facial covering and at least 6 feet maintained between cohorts. Manage communal use spaces, shared facilities, and playgrounds to avoid large gatherings of mixed cohorts.

3. Sleeping & Bathroom Facilities. a. Windows or other openings for ventilation in sleeping areas/cabins must

remain open as much as possible to increase ventilation. b. Consider bed arrangement within the cohort to maximize distanced

between beds. For example, 6 feet distance from head-to-head of campers and/or staff.

c. Stagger use of bathroom facility by cohort. If this is not possible, reinforce spacing by closing stalls/sinks and enforcing facial covering at all times in bathrooms.

4. Programming. a. Camps must train all staff on the camps COVID-19 Communicable

Disease Guidelines, including their role in compliance with prevention guidelines.

b. Staff should consider how to alter programmatic activities to reflect current recommendations for cohorting, physical distancing, facial coverings and maximize outdoor programming.

c. When physical distancing is not possible in programming and staff or campers are outside of their cohort, face coverings should be used.

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d. Wilderness Activities: Camps with overnight wilderness trips will ensure that trip groups are consistent with their camp cohort. Face Coverings should be used in travel to and from trips, including while in vehicles.

5. Migration In and Out of Camp. Camp administrators should restrict arrival to and departure from camp to the greatest extent possible.

a. Camps should consider having campers and staff with direct camper contact (for example, bunk counselors, activity and program leaders) remain on campgrounds for the duration of the camp session with exceptions to outside medical or other essential visits.

b. Camps should create protocols for leaving and returning to camp when necessary including wearing facial coverings at all applicable times, physically distancing (in vehicle and from others), hand hygiene and minimizing duration of interactions with others from outside the camp community.

c. Staff Time Off: Camps must train staff on protocols for staff days off that minimize exposure from non-camp participants at all times. Camps should consider on premises days off or approved locations away from non-camp participants. Staff should not visit retail establishments, including bars and restaurants. Facial covering and physical distancing must be used if non-camp participant interaction cannot be avoided.

d. Visitors: Restrict nonessential visitors, visiting programming, volunteers and activities with non-camp groups, including socials and intercamp games.

e. Parent Visiting Weekend: Visitors, including parents, will be minimized to every extent possible, including consideration of elimination of parent visiting days. If a visit by a parent or other visitor becomes essential to camp, face coverings and social distancing are to be used and interactions with the larger camp community will be minimized.

f. Field trips: Small cohort groups may consider day travel to nearby recreational areas where interfacing with the external community is not expected. For example, taking campers for equestrian sessions, transporting cyclists to go mountain biking or campers traveling offsite for a canoe trip.

6. Dining & Large Group Facilities. Particular attention should be paid to dining facilities as the potential risk of infectious spread increases when facial coveringss cannot be worn during eating and larger groups are brought together.

a. Camps are strongly advised to have campers and staff eat by cohort. Cohort tables should be maximally distanced from other cohort tables with a minimum of 6 feet between backs of chairs.

b. Camps are strongly advised to de-densify dining areas with use of tents, shelters and pavilions if necessary.

c. Camps should consider ingress and egress protocols for dining facilities to minimize inter-cohort interactions.




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d. Facial coverings should be worn at all times during meals, and only removed when campers and staff are seated at their tables.

e. Meal service should be performed to minimize exposures. i. Buffet lines must be managed to maintain distance between non-

cohort attendees. ii. Avoid self-service processes including salad bars.

f. Important attention should be paid to hand hygiene prior to dining, after touching any shared item and after dining. Sufficient hand hygiene is preferred to single-use items but consider individually wrapped high touch shared items like condiments.

g. Develop appropriate cleaning and disinfecting protocols. 7. Transportation. Camp directors are encouraged to arrange for camper and staff

travel that minimizes exposures outside the camp community. This could include direct to/from camp transportation or the use of chartered direct ground transport and/or direct travel from airports. These guidelines are based upon the assumption that Camps are conducting pre-arrival screening prior to boarding buses to overnight camp.

a. Campers and staff should follow best practices for travel as outlined by the CDC (see also Preparation).

b. Consider drop off/pick up protocols that limit direct contact with families, parents should be ready to separate from their camper son after drop off and avoid families entering camp grounds and mixing with staff and other campers during this time.

8. Cleaning, Disinfection & Limited Sharing of Items. Summer camps have existing strong cleaning & disinfection protocols and these protocols should be enhanced with COVID-19 specific guidance to include:

a. Clean and disinfect frequently touched surfaces at least daily (for example playground equipment, door handles, sink handles, etc.) and shared objects (for example, toys, games, art supplies) between uses.

b. Clean and disinfect vans and buses; refer to guidance for bus transit operators. Camp vehicles should be cleaned and sanitized/disinfected between uses.

c. Ensure safe and correct application of disinfectants per the manufacturers’ instructions for use (IFU) by trained staff. Keep products away from children.

d. Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible by opening screened windows and doors, using fans, or other methods. Do not open windows and doors if they pose a safety or health risk (e.g., temperature, inclement weather, insects, and allowing pollens in or exacerbating asthma symptoms) to children at the facility.

e. Take steps to ensure that all potable water systems and terminal fixtures (for example, sinks and bottle filling stations) are sanitized daily. Provide


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disposable cups for water fountains and refillable water jugs. Avoid use of water bubblers without disposable cups.

f. Ensure potable and process water plumbing systems are appropriately readied prior to camp in accord with CDC and local health department guidance to minimize the risk of diseases associated with waterborne pathogens.

9. Health Center, COVID-19 and COVID-19 Illness Management. a. Health Center:

i. Standard and Transmission-Based Precautions: 1. Standard Precautions: Camp Health Center staff will

standard precautions including hand hygiene, use of PPE whenever expectation of a possible exposure to infectious material, use respiratory/cough etiquette, proper handling, cleaning and disinfecting of care equipment, instrument and environment, handle laundry carefully, follow safe injection practices and ensuring safety in handling of needles.

2. Transmission-Based Precautions: Contact, Droplet and Airborne precautions will be utilized as appropriate for suspected and confirmed COVID cases. See CDC Guidance.

3. See: What Healthcare Personnel Should Know About Caring for Patients with Confirmed or Possible COVID-19 Infection.

ii. Medication Administration should be done in a manner physically distant from other health related activities in the health center.

iii. Consider triaging illness and injury in a way that keeps campers and staff with suspected COVID-19 symptoms physically distant and removed from evaluation and treatment of non-COVID-19 medical issues.

iv. Health Logs will be maintained for record keeping and identification of patterns of illness.

v. Establish relationships with local public health authorities, medical providers and emergency services.

vi. COVID-19 is a reportable disease. In the event of a confirmed case by viral PCR testing, camp administration will notify health officials as required, staff, and families in accord camps Communicable Disease Plan while maintaining confidentiality as required by the Americans with Disabilities Act (ADA).

b. Camper and Staff with Suspected COVID-19 Symptoms: i. When a camper or staff is identified with suspected COVID-19

symptoms, this person will be isolated, and contacts quarantined from camp activities until COVID-19 status can be determined. Therefore, camps must develop testing protocols and locations for isolation and quarantine of staff, volunteers, or campers if needed.






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1. Isolation is for people who have tested positive for COVID-19, or who have suspected symptoms of COVID-19. In the camp setting, this means sleeping, eating, bathing and living in a separate area.

2. Quarantine is for people with prolonged contact to someone diagnosed with or suspected of having COVID-19.

a. Prolonged contact is defined at this time as less than 6 feet for greater than 10 minutes with or without facial coverings.

b. Contact tracing should be done in camp to identify and quarantine individuals with prolonged contact to the presumed case. Camp health staff must work to identify in as confidential a manner as possible who else in the camp community may meet that definition.

c. Quarantine locations should ideally involve a private room with a private bathroom in a location separate from others, ideally with a private entrance. Whole groups/cabins meet exposure criteria may quarantine together (dedicated bathrooms and eating facilities).

ii. Camps must establish RT-PCR testing ability for campers and staff that develop symptoms consistent with COVID-19 and be prepared to promptly test suspected cases after isolation.

c. Camper and Staff with Confirmed COVID-19 i. Camp must establish policies and protocols for the management of

COVID-19 cases. Many camps are well-prepared to manage the isolation and quarantine of COVID-19 cases within the camp premises, however, camps may decide that positive cases will be leave camp by private transportation.

ii. Symptomatic cases should have increased monitoring to ensure stability in health. Camps must have a detailed plan for how to transport a symptomatic person to the local hospital in the event the person needs medical attention. Transportation should involve a mechanism for avoiding exposing individuals to COVID-19 (e.g., consider utilizing local emergency medical services).

iii. Per CDC guidance, isolation of confirmed cases is 10 days from the date of symptom onset and/or positive test result.

1. During time of isolation, cases should have separate sleeping, eating, bathing and programming areas and be monitored regularly by health staff.

iv. Per CDC guidance, quarantine duration for those with close exposure to a positive case is 10 days.

1. During time of quarantine due to exposure to a case, the quarantine group should not participate in the general camp program. Quarantine locations should ideally involve a

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private room with a private bathroom in a location separate from others, ideally with a private entrance.

2. Whole groups/cabins meet exposure criteria may quarantine together (dedicated bathrooms and eating facilities), but if additional cases are identified within the group, the group would be under a rolling quarantine extending the need to quarantine for longer than 10 days.

3. Testing of quarantined individuals should be considered with guidance from local public health and medical authorities.

v. Clean and disinfect areas used by ill campers and staff per CDC recommendations. Communication with State & Local Public Health Authorities. COVID-19 is a reportable disease. In the event of a confirmed case by viral PCR testing, camp administration will notify health officials as required, staff, and families in accord camps Communicable Disease Plan while maintaining confidentiality as required by the Americans with Disabilities Act (ADA).

10. Communication with State & Local Public Health Authorities. COVID-19 is a reportable disease. In the event of a confirmed case by viral PCR testing, camp administration will notify health officials as required, staff, and families in accord camps Communicable Disease Plan while maintaining confidentiality as required by the Americans with Disabilities Act (ADA).

11. High-Risk Populations and Vaccination. Vulnerable or high-risk populations require special consideration for camping programs.

d. Camps cannot be presumed COVID-free, and thus camp directors should advise staff members and campers’ parents to consult with their primary care providers to determine if camp is a reasonably safe option for them.

e. Families of campers with high-risk individuals residing in their homes must consider COVID-19 exposure risks if they send their child to camp and determine if it is safe.

f. The role of vaccination, while uncertain at this time, will be evaluated as highly desirable for high-risk population in the congregant setting of overnight camps.

5 Harvard T.H. Chan School of Public Health. Assessment of risks of SAR-CoV-2

transmission during air travel and non-pharmaceutical interventions to reduce risk. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf

6 Silcott D et al. TRANSCOM/AMC Commercial Aircraft Cabin Aerosol Dispersion Tests. https://www.ustranscom.mil/cmd/docs/TRANSCOM%20Report%20Final.pdf

7 Domestic Travel During COVID-19, US CDC. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

8 Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests

.

12


by Time Since Exposure. Ann Intern Med. 2020 Aug 18;173(4):262-267. doi: 10.7326/M20-1495. Epub 2020 May 13. PMID: 32422057; PMCID: PMC7240870.

Moved up [9]: Camp directors are encouraged to arrange for camper and staff travel that minimizes exposures outside the camp community.


Formatted: Line spacing: single

Deleted: Thiscouldinclude:charterbuses,direct-to-camp/direct-to-hometransportation.

Moved up [10]: These guidelines are based upon the assumption that Camps are conducting pre-arrival screening prior to boarding buses to overnight camp.


Deleted: Airtraveltocampsfromcampersorstaffarenotpermitted.¶Createsocialdistancebetweenchildrenontransportvansandbuseswherepossible.Usefacemasks,ifunabletomaintainsocialdistancing.¶Campadministratorsshouldbeawareoftheinfectionpotentialofcampersandstafftravelingfromhighinfectiontransmissionareasandareadvisedtoconsiderlimitstoparticipantsfromtheseareasand/orinaccordwiththeStateandlocalagencyrequirementsforregional,interstate,andinternationaltravel.Ifallowed,stafffromtheseareasmustquarantineinsmallgroups(

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