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National School-Based Health Alliance Statement on COVID-19

Cross-posted from the national School-Based Health Alliance

The [national] School-Based Health Alliance is closely monitoring the impact of the COVID-19 pandemic on school-based health centers (SBHCs) across the nation. As this situation is rapidly evolving, we advise SBHCs to seek up to date operational and communications guidance from their sponsoring agency, school district and local public health authorities.

At the national level, the Alliance is monitoring guidance from our federal partners and ensuring the critical role of SBHCs are considered as federal legislation and regulatory guidance in response to this pandemic moves forward. We are also working closely with other national partner organizations to coordinate efforts to support access to school-based health care, both in the short and long term.

While the long term response to this pandemic will be complex and multi-pronged, one immediate policy priority on which we are focused is removing barriers (both payment and operational) to high quality telemedicine services for the tens of millions of students impacted by school closures across the country. As federal and state governments take the initial steps to loosen restrictions, we are focused on providing our field and other health and education partners with appropriate guidance and best practices.

Resources:

For regularly updated information on changes to telemedicine coverage policies due to COVID-19, please visit the Center for Connected Health Policy

For current guidance on COVID-19 for schools, workplaces and community locations, please visit the Centers for Disease Control and Prevention (CDC)

Changes to Medicaid billing for telehealth in response to COVID-19

The state has made changes to Apple Health (Medicaid) billing in response to COVID-19 and the increased need for telehealth services.  Check the Health Care Authority’s (HCA’s) Information on COVID-19 page for the most up-to-date information.

HCA has also obtained a limited number of Zoom licenses to distribute to providers needing access to a telemedicine platform, and the application process is now open. Read more here.

COVID-19 Updates for K-12 and Childcare Administrators

From Public Health–Seattle & King County:

Dear School and Childcare Administrators and Nurses,

Please find important COVID-19 updates for K-12 and childcare leadership on the Public Health Insider Blog.  These include:

Please subscribe to our Public Health Insider blog to receive regular updates about the local COVID-19 outbreak and response.

We are grateful for the extraordinarily difficult work you are each doing during this most challenging time.

Public Health – Seattle & King County

New COVID-19 Public Health Recommendations: How Do These Affect Schools?

Cross-posted from King County School Health.

Public Health – Seattle & King County is taking proactive steps to protect the health of our community by making recommendations that are meant to slow the spread of the novel coronavirus (COVID-19) in our community and reduce the number of people infected.

We understand these actions will have a tremendous impact on the lives of people in our community. Public Health is making these recommendations in consultation with Centers for Disease Control and Prevention (CDC) based on the best information we have to protect the public’s health. This is a critical moment in the growing outbreak of COVID-19 in King County when such measures can potentially impact the spread of the disease.


Dear School Superintendents, Administrators, and Nurses

Yesterday Public Health – Seattle & King County announced new recommendations to slow the spread of the novel coronavirus (COVID-19). Please find a summary on our blog, the Public Health Insider. While we recognize that these recommendations impact members of your communities in profound ways, at this time, we are not recommending closing schools. Health officials from Public Health – Seattle & King County and the Centers for Disease Control (CDC) weighed this decision very carefully. The available data about novel coronavirus cases has shown that children have not been high risk groups for serious illness from this virus.

We know that schools are doing the important work of educating our children, and we don’t want to disrupt that unless there are known novel coronavirus exposure risks. We also know that school closures have other impacts on working parents, and can be disruptive and costly for families.

We recognize that adults constitute a vital part of every school, and have different needs and vulnerabilities than children. With this and other considerations in mind, Public Health – Seattle & King County respects each school’s decisions about closures, postponement of activities, or other social distancing measures, as each school knows the needs of their community best.

We have tremendous appreciation for the work you are doing to communicate with families and staff, implement prevention measures, and prepare for local cases. We know that novel coronavirus has created enormous challenges and shifted your operations intensively.

Below, please find some questions and responses that we anticipate you, your staff, and the families you serve will have.

New Public Health COVID-19 Recommendations: How Do These Impact Schools?

Why is Public Health recommending that employers offer telecommute options but not recommending that childcare and K-12 schools close? 

Childcare and K-12 schools are unique settings for several reasons:

  • Most confirmed cases of novel coronavirus have occurred in adults. Serious illness in children has been uncommon. Information published about past outbreaks of other coronaviruses, like Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS), indicate that infection among children was relatively uncommon.
  • When schools closed during the H1N1 influenza pandemic, we learned that many children still gathered in group settings and still had exposure to one another.
  • We know that schools are doing the important work of educating our children. We don’t want to disrupt that unless there are known novel coronavirus exposure risks.
  • School closures have other significant impacts on working parents. Closures can be disruptive and costly for families. Identifying and paying for alternative childcare can be prohibitively expensive for families, and many students rely on schools for free and reduced meals and other vital resources.
  • Closing schools impacts the healthcare workforce. Many parents are healthcare workers and first responders. If large numbers of these professionals stay home to care for their children, our collective ability to respond to novel coronavirus as well as other more routine health threats will be diminished.

We know that school districts act with extra special caution in the interest of protecting children. Each school knows its community best and, ultimately, has the discretion and the support of Public Health to determine the approach for their community.

Is Public Health recommending that schools cancel school assemblies and other school events? 

At this time, we are not recommending the cancellation of school activities if the school remains open. We are continually evaluating our recommendations about school closures and activities as this situation changes. Schools may decide to cancel activities according to the needs of their communities.

Is Public Health recommending cancellation of community events outside of school hours that involve family as spectators or participants, like school sports games and PTA meetings? 

Since adults are more at risk of serious illness from novel coronavirus, when possible, it’s a good idea for schools to practice social distancing by postponing unessential community events involving adults. In particular, we recommend that people over age 60, those with underlying health conditions like heart disease, lung disease, diabetes, or weakened immune systems stay home and away from large groups of people as much as possible. There is not much information about novel coronavirus in pregnancy, so we suggest pregnant women also take precautions recommended for other high-risk groups.

There is no exact number of people that constitutes a large gathering, but around fifty people can be used as a general guideline. Keep in mind that the close proximity of people is more of a concern than the number of people. Risk is reduced if there is little face-to-face interaction and people keep some physical space between them (6 feet is best, but at least an arm’s length).

My child is immune compromised or has an underlying health condition. Should they attend school? 

Individuals with underlying health issues should talk to their healthcare provider to develop a plan based on their specific health conditions. If you and your healthcare provider determine that your child should stay home, we encourage you to work with your school to set up a distance learning agreement, if possible. We strongly encourage schools to support students to stay on track with academic requirements while learning from home, and not to not penalize students who are unable to attend school or participate in distance learning.

What about administrators or teachers who are pregnant, over 60 years of age, or those who have preexisting health conditions? 

Staff in these higher vulnerability categories are encouraged to stay home and use leave benefits when possible. We encourage school districts to support staff in the higher risk categories to the greatest degree possible. We understand that absences may significantly affect the school’s capacity to continue normal operations, and we encourage schools to use their discretion when making choices about operations.

Under what circumstances would Public Health recommend school closures? 

At this time, Public Health would likely recommend a closure if someone with a novel coronavirus case spent time in a school and had contacts with other individuals in the school setting while ill. In this situation, Public Health will work with school leadership to consider the duration of the closure and to determine other steps that should be taken to limit spread.

If our school is closed because of a confirmed case, how long will the closure last?

The length of the closure will be determined based on multiple factors, including the number of cases and the number and types of exposure that other individuals in the school may have had, as well as the underlying health of the student population served. Public Health may recommend closure for anywhere from a few days up to a few weeks, depending on the circumstances.

Will Public Health notify our school if there is a confirmed case? 

Yes, if Public Health is aware of a case in a King County school, we will contact key school personnel, such as the school nurse, principal, or district leadership.

What should we do if a student or staff member becomes ill? 

Any person who exhibits flu-like symptoms (primarily fever, cough and shortness of breath) should not be at work or school. Sick individuals should stay home and away from others and contact their healthcare provider.  The healthcare provider can assess the individual’s risk and determine whether they should be tested for novel coronavirus.

Children are not at high risk for novel coronavirus, but many of them live with people who are. What can be done to protect more vulnerable household members?

We know that children are part of a larger family structure and community, and can’t isolate themselves from interacting with more vulnerable people. School districts may need to implement flexible policies for students who decide to stay home. We recognize that making policies like these is very complex and has many ramifications, and we respect the decisions made by each school district according to their community’s needs.

It’s unrealistic for most school staff to work from home. What else can our school do to protect students and staff from novel coronavirus?

Schools should take the precautions that are normally recommended to prevent the spread of viruses in schools. You can help students and staff reduce their risk for getting and spreading viral respiratory infections, including the flu and the common cold, by encouraging them to take simple steps which will also prevent novel coronavirus. These include:

  • Staying home when they are sick.
  • Frequent hand washing with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after they blow their nose. Help young children do the same. If hands are visibly dirty, use soap and water to clean hands.
  • If soap and water are not readily available, using an alcohol-based hand sanitizer with at least 60% alcohol.
  • Advising persons to avoid touching their eyes, nose, and mouth with unwashed hands.
  • Following the school’s routine cleaning and disinfection program. Emphasizing to clean and disinfect frequently touched objects and surfaces.
  • Covering coughs or sneezes with a tissue, then throwing the tissue in the trash and cleaning hands with soap and water or hand sanitizer (if soap and water are not readily available).
  • Urging students and staff to get a flu shot during the flu season.
  • Providing adequate supplies for good hygiene, including clean and functional handwashing stations, soap, paper towels, and alcohol‐based hand sanitizer.

Cleaning and Disinfecting Procedures

Routine cleaning will slow the spread of respiratory illness and will be effective against coronavirus. Schools should follow standard procedures for cleaning with third party certified “green” cleaners and disinfecting with an Environmental Protection Agency (EPA) registered disinfectant with a claim for human coronaviruses. Typically, this means daily sanitizing surfaces and objects that are touched often, such as bathrooms, water coolers, desks, countertops, doorknobs, computer keyboards, hands‐on learning items, faucet handles, phones and toys.

Disinfecting is the responsibility of school custodial staff. They are trained to use disinfectants in a safe and effective manner and to clean up potentially infectious materials and body fluid spills – blood, vomit, feces, and urine. Contact your custodian or school nurse if students are ill and your classroom needs cleaning and disinfection.

Clean the surface first to remove all organic matter. Custodial staff should follow the disinfectant manufacturer’s instructions for use including:

  • Using the proper concentration of disinfectant
  • Allowing the required wet contact time
  • Paying close attention to hazard warnings and instructions for using personal protective items such as gloves and eye protection
  • Using disinfectants in a sufficiently ventilated space

Schools and districts must have a Safety Data Sheet (SDS) for each chemical used in the school.

Where can I find more information about novel coronavirus?