Pitkin County Public Health is providing this guidance to all schools and early childcare centers. The goal of this guidance is to help provide a roadmap for schools and childcare centers to use in their efforts to navigate the current Covid-19 landscape as well as to clearly define roles and responsibilities. This guidance is in line with the current CDC and CDPHE school guidance. 

The motivation behind this guidance is to incorporate Covid-19 response into standard surveillance and mitigation strategies for schools and to build a more robust response to all year-to-year respiratory illnesses. While Covid-19 is the motivating respiratory illness, these tools and benchmarks are equally helpful in helping reduce general disease burden due to respiratory illnesses within school settings.

Each school may pick and choose from many of the below recommendations and develop enforcement policies which fit their capacity.  Public Health will assist with providing mitigation strategies and resources in outbreak scenarios.

Please Note: While most mitigation strategies are short term and implemented by choice in response to outbreak scenarios, isolation of positive cases regardless of vaccination status is still required per CDPHE and CDC guidelines. Isolation must be enforced by local public health and school districts. Re-testing cannot be used in lieu of isolation for individuals who have tested positive for Covid-19.

General School Recommendations

• If staff or students are sick, the best way to reduce transmission is to go home and seek a PCR test
  • If staff or students can’t go home, wear a mask!

• Staying Up to Date on Vaccinations!
  • Up to Date means having received all vaccines that you are eligible for including all childhood Immunizations and the Flu
    • The first positive Polio case in 43 years occurred in New York on August 10th, 2022 and there is evidence of community transmission, likely amongst unvaccinated individuals
  • Many individuals are eligible for booster doses of an mRNA Covid-19 vaccine
    • You can schedule your appointment with your medical provider or at a Pitkin County Public Health Vaccination Clinic
  • Reformulations of Covid-19 vaccines are set to be released in September
    • Public health will notify schools and childcare centers when reformulation occurs
    • Primary care providers are also a source of information regarding vaccinations 

• Monitoring and Communication
  • Schools and childcare providers should continue to notify families of possible exposures in order for each family to make the best decisions on their own personal mitigation and risk reduction efforts possible. 

• Ventilation and Filtration: Increasing airflow and removing virus from the air
  • Ventilation:
    • Open cross facing doors and windows
    • Hold classes/meetings outdoors when possible
    • Gatherings should occur in larger than needed spaces 
  • Filtration
    • Portable Air Filters with HEPA certified filters
    • HVAC system filter upgrade to HEPA approved filters
    • Masking with well fitting N95 or KN95 mask
      • Masking by teachers helps greatly reduce the number of staff out due to respiratory illness
      • Masking is particularly helpful for those at high risk of severe infection
  • Testing
    • Encouraging PCR testing for individuals after exposure or when symptoms develop
      • See community testing sites available in Pitkin County 
    • Utilizing proactive universal testing before school events
      • Overnight trips, indoor sporting events, school dances etc.
      • School Point of Care ‘Bulk’ Binax Order Form
    • Providing Free At-Home Antigen tests to symptomatic individuals to use to end isolation to return to work/school
      • School At Home Covid-19 Test Form

• Quarantine and Isolation
  • Quarantine: Individuals who are exposed to Covid-19 are no longer required to quarantine per CDC recommendations
    • During an Outbreak scenario quarantine may be reinstated as a mitigation strategy or for unvaccinated individuals
  • Isolation: All individuals who are positive for Covid-19 must isolate for at least 5 days. On day 6, if there is no fever and symptoms are improving, individuals may return to work/school and wear a medical grade mask until day 10. If individuals are unable or unwilling to wear a medical grade mask, isolation must continue through day 10. 
    • Using an antigen test on Day 6 in order to determine if an individual is contagious before ending isolation is highly recommended. Do NOT use a PCR test for this purpose. If two antigen tests taken 48 hrs apart come back negative individuals can remove their mask before 10 days.

Note on Monkeypox (MPX) for Schools

Currently there have been no confirmed cases of MPX in Pitkin County. However, due to the potential for widespread transmission should MPX be identified in a school setting all nurses should be on alert for any pox like illness. 

Any students presenting with unexplained skin rash should be sent home with recommendation to seek testing from a physician. Public health should be notified of any pox like illness in a school population. If MPX is confirmed within a school setting, public health will work with the school and parents to organize a post-exposure prophylactic vaccination clinic with the Jynneos vaccine.

Definitions:

• Case: Any case that has been confirmed via any test (PCR, At-Home or Bulk Binax). Could be identified by public health from CEDRS, by a school nurse, self report to nurse or public health by family, or during an outbreak testing setting

• Outbreak: May be identified by Pitkin County Public health or by the School
  • Within a Classroom (or similar) setting: 3 or more cases within a 5 day period within a classroom or other cohort (sports, event etc) without familial exposure.
  • With a School: 5% Absenteeism over larger population w/ 10 or more Cases within 7 days

Mitigation Strategies:

Once an outbreak is identified the affected school and Pitkin County Public Health will work together to come up with a feasible mitigation strategy. This will be done by taking into account the scale of the outbreak and the schools capacity to institute mitigation measures.

Less Intensive Mitigation Efforts	Case Investigation	While routine case investigation wouldn’t occur for most cases, in an outbreak setting Pitkin County Public Health could reinstate in order to reduce transmission or to confirm an outbreak.
	Notifications	Notify impacted populations of outbreak and current mitigation strategy. Encourage PCR testing for impacted individuals While PCR testing is the most effective at diagnosing Covid-19; students could be sent home with At-Home tests provided by the school
	Universal Testing	Ideally 2x per week for 2 weeks; could be tailored to meet the need of any given outbreak based on outcomes from first round of testingAgain, while PCR testing is the best diagnostic tool, At-Home tests could be used
	Short Term Universal Masking	Impacted populations should wear a medical grade mask for a set amount of time
	Quarantine	While universal Quarantine is no longer recommended, in settings with high risk exposure it may be recommended to reduce transmission. Unvaccinated or under vaccinated (not up to date) individuals should quarantine during any outbreak scenario
More Intensive Mitigation Efforts	Short Term Closures	This would only be recommended in the instance that no other mitigation efforts were working and there continued to be increased cases.

Outbreak Example:

Step 1: Identification

• School receives one anecdotal covid positive report from a parent for a 5th grader. Within the same classroom there are already 2 students out with Covid-19 and are still isolating at home.
  • Action: School has identified a classroom outbreak via a combination of anecdotal cases and confirmed PCR tests. School nurse reaches out to Pitkin County Public Health to report a possible outbreak.

Step 2: Case Investigation

• Pitkin County Public Health will reinstate case investigation to help determine if school was the source of exposure
  • Action: School provides PH with contact for anecdotal cases and public health performs case investigation interviews for all associated cases
  • Outcome: Public health determines all 3 cases are linked and none had external or familial exposure. School is the most likely transmission source. Public Health submits outbreak report to CDPHE.

Step 3: Set Mitigation Strategies if no cases have familial exposure

• School and Public Health meet to set a mitigation strategy utilizing a mixture of the above efforts. Any strategy set must be reasonable to be enforced by the school.
  • Action: School and public health determine that notifying families of classmates and requesting symptom monitoring and students sent home with At-Home tests and asked to take one before returning to school and one at day 5 after notification.
  • Outcome: One test was positive, student isolated at home, symptom monitoring continues over the weekend

Step 4: Outbreak Continues

• Over the weekend 7 more cases within the grade were identified and the school is seeing a higher rate of absenteeism for the middle school on Monday and Tuesday.
  • Action: School reports high rate of absenteeism with no other explanation (ie no holiday or something similar) and PH notes higher case counts outside of initial classroom through case investigations. 
  • Outcome: Further response is needed to contain spread and reduce transmission.

Step 5: Continue CI/CT and expand Mitigation Efforts

• Public health continues to investigate cases and school broadens notifications to families of impacted population. The 5th grade does not mix with other grades so outbreak is likely limited to single grade. Further mitigation measures are deemed necessary, including universal testing for entire impacted population and universal masking within the school for 14 days.
  • Action: Pitkin County public health facilitates universal testing resources. The first testing date to be in 2 days with CDPHE response team. School institutes mandatory masking for impacted population immediately.
  • Outcome: Universal testing comes back with 5 new cases. It is determined to do a 2nd universal testing effort in 5 days.

Step 6: Continue CI/CT and 2nd Universal Testing effort

• Public Health determines CI/CT for all cases and school continues enforcement of universal masking. 2nd universal testing effort turns up 1 new case.
  • Action: Universal masking to be completed until day 14. Public Health to continue to monitor for potential associated cases and will check in with school regarding any new cases and will check in after masking ends.
  • Outcome: 1 new case comes through public health but determined that it was due to community exposure. 

Step 7: Masking Ends Outbreak End Check-in 

• Public health and school meet to debrief outbreak response, what worked and what didn’t. Determine if any other mitigation efforts are needed.
  • Action: Meeting/phone call, both continue to monitor for potential associated cases for 7 days.
  • Outcome: No new associated cases, outbreak resolved.