MEMO: Niagara Specific Guidance for COVID-19 in the School and Childcare Settings

TO: Health Care Professionals in the Niagara region

FROM: Pandemic Response Division, Niagara Region Public Health

REFERENCE: Niagara Specific Guidance for COVID-19 in the School and Childcare Settings

DATE: Sept. 9, 2021

With the August 26, 2021 update to the Ministry of Health/Ministry of Education screening tools and guidance for school and childcare settings, primary care may receive questions from patients regarding testing and returning to schools or childcare settings.

This memo summarizes key advice for keeping schools and childcare settings safe from COVID-19 and mirrors provincial guidance. However, in some cases, Niagara Region Public Health is recommending additional or more extensive measures given local learnings from the 2020-2021 school year.

PUBLIC HEALTH MEASURES

Vaccination is the best line of defense for preventing COVID-19 in the school or childcare setting. Niagara Region Public Health recommends all eligible individuals be vaccinated against COVID-19.

VACCINE EXEMPTIONS

Adults

For more information on COVID-19 Vaccine Contraindications and Medical Exemptions please review Niagara Region’s memo released Aug. 27, 2021.
For information on a workplace vaccination policy, please refer patients to their organizational policy or ministry directly. These types of policies have been made at the discretion of each individual employer.
For more information, read Ontario Makes COVID-19 Vaccination Policies Mandatory for High-Risk Settings

ACTIVE SCREENING

Physicians may be contacted by patients for COVID-19 assessment, following a failure of a screening tool.

If a child fails the Ministry of Health School and Childcare Screening Tool, they must self-isolate at home immediately and either:

Contact their health care provider for a medical assessment OR
Contact the Niagara Health COVID-19 Assessment Centre to book an appointment for testing, this can be done on-line or by calling 905-378-4647 ext. 42819.

SYMPTOMS POST VACCINATION

If an individual develops any of the following new and mild symptoms within forty-eight hours of receiving the COVID-19 vaccine, they may continue to attend school or childcare as long as they wear a medical grade mask:

Headache
Fatigue
Muscle Ache
Joint pain

Any other symptoms of COVID-19 (e.g. cough, shortness of breath, loss of taste or smell), even if they are mild, are to self-isolate immediately and get tested. If the individual has a fever or symptoms longer than forty-eight hours, the individual must isolate immediately and get tested.

TESTING AND RETURN TO SCHOOL

Symptomatic students who test negative for COVID-19, or receive an alternate diagnosis by a health care provider, can return to school when:

They have been free of fever for over twenty-four hours and
They have been free of vomiting or diarrhea for forty-eight hours and
Other symptoms have mostly improved for at least twenty-four hours and
They have not been directed to self-isolate and
Have had no contact to a confirmed cased of COVID-19

Note: If symptoms compatible with COVID-19 are persisting or worsening, the symptomatic individual is to continue to stay home from school/work. A repeat COVID-19 test should be considered. If a health care provider has advised that the symptom(s) are related to a chronic or pre-existing condition (e.g., allergies, post-nasal drip, migraines, asthma) the child can return to school/childcare once they feel well enough, without waiting for symptoms to go away.

If the child is not assessed by a health care provider, and testing for COVID-19 was declined for any reason, the child is to self-isolate for ten days from symptom onset (away from household members when possible).

Note: If self-isolation away from household members is not possible, unvaccinated household members are to self-isolate as well for the duration of the child illness, and then for an additional ten days from last exposure to the symptomatic child. If household members become symptomatic, they should consult their health care provider and/or go for testing.

Niagara Region Public Health will follow up with all cases who test positive and will provide recommendations as per provincial guidance and/or local decision making based on our risk assessment

Medical notes or proof of negative tests should not be required for staff or students to return to school.

SIBLINGS AND OTHER HOUSEHOLD MEMBERS LIVING WITH A SYMPTOMATIC CHILD

If a test is recommended by a health care provider for the symptomatic child, or a decision is made to get tested at an assessment centre, all household members who are not fully immunized with two doses of vaccine are to self-isolate, until the test results are back. If the test result is negative, household members can leave self-isolation.
Asymptomatic fully vaccinated household members are not required to self-isolate and may attend work/school/childcare
If a health care provider advises that a test for COVID-19 is not needed, household members can leave self-isolation.

SIBLINGS OF AN ISOLATING COHORT

Siblings who are not contacts, but are household members of an isolating cohort, may continue to attend school as long as they remain symptom-free and the isolating family member remains symptom-free.

REPORTING COVID-19 CASES

Confirmed PCR tests, probable cases and positive rapid molecular tests are required to be reported through our portal: Reporting Confirmed COVID-19 Cases or Positive Rapid Test Results - Niagara Region, Ontario. See Case Definition – Coronavirus Disease (COVID-19) for full details. Reporting through our portal is the preferred method for timely follow up from Public Health, however alternatively cases can be reported through our COVID-19 Primary Care Info-Line at 905-688-8248, press 7, then press 1 for physicians.

Positive rapid antigen test results are also recommended to be reported to public health. For individuals who are known contacts of a positive COVID-19 case (symptomatic or asymptomatic), negative antigen results should be confirmed through a PCR test.

See Point-of-Care Testing Use Case Guidance and Considerations for Antigen Point-of-Care Testing for further details.

HIGH RISK CONTACTS OF CASES

High risk contacts of a case are to isolate for ten days, unless they are fully vaccinated or if they were previously positive within the past ninety days and recovered.

Testing at day seven is recommended to all high risk contacts regardless of vaccination status. If your patient develops symptoms, testing is recommended immediately. If testing is declined, isolation is extended for an additional ten days (total of twenty days), to those who are not fully vaccinated. In certain situations, Niagara Region Public Health may recommend immediate testing of contacts.

For more information visit our website or contact the COVID-19 Primary Care Info-Line Monday to Friday from 8:30 a.m. – 4:15 p.m. at 905-688-8248, press 7, then press 1 for physicians.