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Page 1 of 3 COVID-19 Health Checks at Programs for Children and Youth Summer 2020 June 9, 2020 This document was developed by the San Francisco Department of Public Health (SFDPH) and will be posted at http://www.sfcdcp.org/covid19. This guidance will change as knowledge, community transmission, and availability of testing changes. AUDIENCE: Programs that screen children and youth arriving at their programs for symptoms of COVID-19. The information below is only for children enrolled in a program. It does not apply to personnel or volunteers who are under 18 years old. BACKGROUND: San Francisco Health Order requires child care programs, summer day camps, and other programs for children and youth to check children for fever and other symptoms of COVID-19 each day before allowing children into the program. This document lists the symptoms to ask about, defines what temperature is considered a fever, and sets out the conditions that must be met before a child can return to a program after symptoms of COVID-19. Prepare for COVID-19 health checks Check all children for COVID-19 symptoms and take their temperature before allowing them to enter the program. If the child was previously absent due to illness or was sent home sick, make sure they meet the required conditions to return to the program before starting the COVID-19 health check. For procedures on safely checking children for symptoms when they arrive, see “ Interim Guidance for Child Care Programs and Summer Day Camps” at https://www.sfcdcp.org/covid19/ under “Schools, Childcare, and Youth Programs” For guidance on safely checking temperatures, refer SFDPH “Interim Guidance: Measuring Temperatures when Screening for COVID-19 Symptoms” at https://sfcdcp.org/covid19/ under "Businesses and Employers" Symptom Check: What to Ask The symptom check has two parts, asking about symptoms and seeing if the child looks ill. 1. Ask the parent or guardian the following question: In the last 24 hours, has your child had any of these symptoms, new or different from what they usually have, and not explained by another reason? Fever or chills Cough Sore throat Shortness of breath or trouble breathing New loss of taste or smell Seems sick or like they are starting to get sick
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COVID-19 Health Checks at Programs for Children and Youth Summer 2020
June 9, 2020
This document was developed by the San Francisco Department of Public Health (SFDPH) and will be posted at http://www.sfcdcp.org/covid19. This guidance will change as knowledge, community transmission, and availability of testing changes. AUDIENCE: Programs that screen children and youth arriving at their programs for symptoms of COVID-19. The information below is only for children enrolled in a program. It does not apply to personnel or volunteers who are under 18 years old.
BACKGROUND: San Francisco Health Order requires child care programs, summer day camps, and other programs for children and youth to check children for fever and other symptoms of COVID-19 each day before allowing children into the program. This document lists the symptoms to ask about, defines what temperature is considered a fever, and sets out the conditions that must be met before a child can return to a program after symptoms of COVID-19.
Prepare for COVID-19 health checks
Check all children for COVID-19 symptoms and take their temperature before allowing them to enter the program. If the child was previously absent due to illness or was sent home sick, make sure they meet the required conditions to return to the program before starting the COVID-19 health check.
For procedures on safely checking children for symptoms when they arrive, see “Interim Guidance for Child Care Programs and Summer Day Camps” at https://www.sfcdcp.org/covid19/ under “Schools, Childcare, and Youth Programs” For guidance on safely checking temperatures, refer SFDPH “Interim Guidance: Measuring Temperatures when Screening for COVID-19 Symptoms” at https://sfcdcp.org/covid19/ under "Businesses and Employers"
Symptom Check: What to Ask
The symptom check has two parts, asking about symptoms and seeing if the child looks ill.
1. Ask the parent or guardian the following question:
In the last 24 hours, has your child had any of these symptoms, new or different from what they usually have, and not explained by another reason?
Fever or chills Cough Sore throat Shortness of breath or trouble breathing New loss of taste or smell Seems sick or like they are starting to get sick
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Programs may have parents answer the symptom question by e-mail, an app or online-form, or other form of communication before the child arrives that day. All responses must be sent on the day that the child is attending. Programs should still do a visual check when the child arrives.
2. Visual check The visual check has no specific requirements. It allows a program to send a child home if the child looks ill when they arrive, even if the parent says the child has no symptoms. Look at the child or youth for signs of illness like flushed cheeks, difficulty breathing, fatigue, or extreme fussiness. If the child is flushed or breathing rapidly from heat or exercise, give them time to cool down, then see if they still look ill.
If the parent or guardian answers “yes” to any symptom or the child looks ill, send the child home.
Temperature check: Definition of fever
When checking for fever at a program’s entrance with a “non-touch” thermometer, SFDPH defines a fever as a temperature of 100°F (37.8°C) or higher.
When using a conventional thermometer at home, a fever is a temperature 100.4oF (38°C) or higher
This is because “No-touch” (infrared) thermometers tend to read slightly lower, especially when used outside.
Programs may choose to have parents take their child’s temperature at home and inform the program of the temperature. Programs may allow parents to inform them by email, using an on-line form, or using some other form of communication.
If the child has a fever, as defined above, send them home.
Requirements for a child to return to a childcare, summer day camp or other program after symptoms of COVID-19
If the child gets tested, they can return after A negative COVID-19 test and 3 days with no fever, without taking medicines to lower a fever, like acetaminophen (Tylenol) or
ibuprofen (Advil, Motrin), and 3 days since symptoms have improved. The symptoms do not have to be completely better. The parent or guardian must show documentation of the child’s negative test, for example, a copy of the test result or a message from the clinic or test site that the test was negative. This may be in electronic form. A separate doctor’s note is not needed.
This is usually the fastest way for a child to return.
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If the child is not tested, they can return after
10 days have passed since symptoms first appeared and 3 days since symptoms improved and 3 days with no fever, without taking medicines to lower a fever, like acetaminophen (Tylenol) or
ibuprofen (Advil or Motrin).
A note from the clinic or doctor’s note is not needed.
Exceptions: Doctor’s Note or Clinic Note If a parent has a note from a doctor or clinic saying that the child may return sooner, the program should accept the note, even if the parent says the child was not tested for COVID-19. The note may be an email, electronic message or part of an after-visit summary. This should not be common.
Sometimes a child’s symptoms are clearly due to another cause, such as strep throat or hand-foot-and-mouth disease. In this situation, the provider may clear a child to return to camp or childcare. This does not mean that the child does not have COVID-19. Many children with COVID-19 do not have any symptoms. It only means that a definitive cause other than COVID-19 was found for the symptoms that kept the child out of the program.
What to do when a child must be sent home
Tell the parent or guardian that child cannot attend the program that day.
Instruct them to contact their regular doctor or clinic.
Give them the parent handout on COVID-19 health screens. The parent handout lists the conditions required for the child to return to the program and also has instructions on how to get tested.
Remind the parent that the child should stay at home until they meet the conditions to return to the program.
Frequently Asked Questions
What if this parent is unsure whether to answer “Yes” to the symptom question?
Ask the parent to focus on whether the symptom is NEW, DIFFERENT from their child’s usual illness, or UNEXPLAINED. Encourage the parent to trust their intuition. Here are an example.
The child has asthma. They often cough with exercise or allergies. o They have their usual cough NO, this is not new or different. o Their cough is worse than usual or sounds different than usual YES
What if a parent says they can’t get a test for the child?
Ask if they have already called these three places: o Their child’s regular doctor or clinic (preferred) o SFDPH New Patient Appointment Call Center for COVID-19 at 415-682-1740 if uninsured o Mission Neighborhood Health Center at 415-552-3870 x2217
Call the SFDPH Schools and Childcare Hub if the parent still couldn’t get a test o (415)-554-2830 Press 1 for COVID-19, then press 6 for Schools o [email protected]
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Sample COVID-19 Health Check Sheet for Children and Youth
Before starting
Check if the child was absent or sent home because they were sick. If they were, make sure they meet the conditions required to return to the program before you start the COVID-19 health screen.
Step 1: Ask and look for symptoms
Ask the parent or guardian, “In the last 24 hours, has your child had any of these symptoms that are new or different from what they usually have, and not explained by another reason?”
Fever or chills Cough Sore throat Shortness of breath or trouble breathing New loss of taste or smell Seems sick or like they are starting to get sick
YES/NO
Look at the child. Do they look ill? Look for signs like for flushed cheeks, trouble breathing, fatigue, or extreme fussiness. If the child is flushed or breathing hard from exercise, wait for them to cool down.
Child looks ill YES/NO
IF YES to any symptom or child looks ill SEND HOME (see instructions below) IF NO to all symptoms and child looks well GO TO STEP 2.
Step 2: Take the temperature
Ask the child to come forward. Take their temperature. Keep your face behind the partition.
Temperature 100.0°F or higher) YES/NO
IF YES, temperature is 100.0°F or higher SEND HOME (see instructions below). IF NO Say, “Thank you, your child can come in now.” Tell the child, “Please wash your hands now.”
Send home
Say, “I am sorry, your child cannot come today, your child may be sick. Please call your child’s doctor or clinic for advice. Here is information on when your child can come back to our program, and how your child can get tested for COVID-19.”
Give the parent a copy of “For Parents and Guardians: COVID-19 Health Checks at Childcares and Summer Day Camps.”
Document that the child was sent home because of fever or symptoms.
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