● Please see updated guidance from WHO provided in Considerations for school-related public health measures in the context of COVID-19, which outlines considerations for a risk-based approach for school operations in the context of COVID-19 based on:

○ The level and intensity of the transmission at administrative levels lower than the national level.

○ Age-appropriate considerations for both physical distancing and the use of masks in the school setting.

○ Comprehensive, multi-layered measures to prevent introduction and spread of COVID-19 in educational settings.

● If there is NO community transmission of COVID-19, schools need to be ready if COVID-19 does appear in their communities. Strategies include:

○ Review, update, and implement emergency operations plans.

○ Develop information-sharing systems with partners.

○ Teach and reinforce hand hygiene which includes:

• Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Washing hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Intensify cleaning and disinfection efforts.

○ Monitor and plan for absenteeism.

○ Assess group gatherings and events. Follow current guidance about non-critical gatherings and events.

○ Require sick students and staff to stay home. Establish procedures for students and staff who are sick at school.

○ Create and test communications plans for use with the school community.

● If there is minimal to moderate community transmission of COVID-19, work with your local health officials to determine a set of strategies appropriate for your community’s situation. Continue using the preparedness strategies implemented for no community transmission, and consider the following physical distancing strategies:

○ Cancel field trips, assemblies, and other large gatherings.

○ Cancel or modify classes where students are likely to be in very close contact.

○ Increase the space between desks to at least 1 - 2 meters (3 - 6 feet).

○ Stagger arrival and/or dismissal times.

○ Reduce congestion in the health office.

○ Limit nonessential visitors.

○ Limit bringing in students from other schools for special programs (e.g., music, robotics, academic clubs).

○ Teach staff, students, and their families to maintain a safe distance 1 - 2 meters (3 - 6 feet) from each other in the school.

● Please see updated guidance from WHO provided in Considerations for school-related public health measures in the context of COVID-19, which outlines considerations for a risk-based approach for school operations in the context of COVID-19 based on:

○ The level and intensity of the transmission at administrative levels lower than the national level.

○ Age-appropriate considerations for both physical distancing and the use of masks in the school setting.

○ Comprehensive, multi-layered measures to prevent introduction and spread of COVID-19 in educational setting

● If there is substantial community transmission of COVID-19, you may need to consider extended school dismissals (e.g. dismissals for longer than 2 weeks).

○ This longer-term, and likely broader-reaching, dismissal strategy is intended to slow transmission rates of COVID-19 in the community.

○ During extended school dismissals, also cancel extracurricular group activities, school-based after school programs, and large events (e.g., assemblies, spirit nights, field trips, and sporting events).

○ Remember to implement strategies to ensure the continuity of education (e.g., distance learning) as well as meal programs and other essential services for students.

● The decision to close schools for in-person learning should be made together by local officials – including school administrators and public health officials — in a manner that is transparent for students, staff, parents, caregivers and guardians, and all community members.

● The decision to close schools for in-person learning should take into account a number of factors, such as:

○ Importance of in-person education to the social, emotional, and academic growth and well-being of students.

○ The level of community transmission.

○ Whether cases have been identified among students and staff.

• In most instances a single case of COVID-19 in a school would not warrant closing the entire school.

• Community spread and how much contact the person with COVID-19 had with others, as well as when such contact took place, need to be considered.

• These variables should also be considered when determining how long a school, or part of the school, stays closed.

• If the spread of COVID-19 within a school is higher than in the community, or if the school is the source of an outbreak, administrators should work with local health officials to determine if temporarily closing the school building is necessary.

• Students, teachers, and staff who test positive or had close contact with anyone who tested positive should be provided with guidance for when it is safe to discontinue self-isolation or end quarantine.

○ Other indicators that local public health officials are using to assess the status of COVID-19 in their area.

○ Whether student and staff cohorts have been implemented within the school, which would allow for the quarantining of affected cohorts rather than full school closure.

● Advise sick students, teachers and other staff to not come to school and avoid public places if they have symptoms or have been in close contact with a person with COVID-19.

○ Develop flexible attendance and sick leave policies that encourage students and staff to stay home when sick or when caring for sick family members.

○ Establish procedures if students or staff become unwell.

● Promote, demonstrate and schedule regular and frequent hand washing with soap and safe water for 20 seconds, or with alcohol-based hand sanitizer that is 60% ethanol, or 70% isopropanol alcohol.

○ Ensure soap and safe water is available at age-appropriate hand washing stations.

○ When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Place hand sanitizer that is 60% ethanol, or 70% isopropanol alcohol in restrooms/bathrooms, classrooms, halls, and near entrances and exits where possible.

● Promote physical distance of 1 - 2 meters (3 - 6 feet).

○ Stagger the beginning and end of the school day, limit class size, and consider implementing an alternating schedule and implementing cohorting.

○ Cancel assemblies, sports games and other events that create crowded conditions.

○ When possible, create space for children’s desks to be at least 1 - 2 meters (3 - 6 feet) apart.

○ Teach and model creating space and avoiding unnecessary touching.

○ Use physical guides, such as tape on floors or sidewalks, one-way routes in hallways, and signs on walls to help students, teachers, and staff remain at least 1 - 2 meters (3 - 6 feet) apart.

○ Wear a cloth face covering especially when other physical distancing measures are difficult to maintain.

● Promote and practice good hand and respiratory hygiene practices including:

○ Cover your mouth and nose with a bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately, and wash your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Washing your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol frequently throughout the day.

○ Avoiding touching eyes, nose, mouth, and cloth face covering.

● Teach and reinforce the use of masks or cloth face coverings for teachers, staff and students.

● Clean and disinfect school buildings, water and sanitation facilities, and classrooms at least once a day, particularly surfaces that are touched by many people (railings, lunch tables, sports equipment, door and window handles, toys, teaching and learning aids etc.).

○ Use sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfecting surfaces and 70% ethyl alcohol for disinfection of small items, and ensure appropriate equipment for cleaning staff. Please also refer to the guidance here.

○ Make a plan with teachers and staff, identifying obstacles and ways to overcome them.

○ Train staff and develop a routine schedule for cleaning and disinfecting.

○ Immediately clean surfaces and objects that are visibly soiled. Visibly dirty surfaces should be cleaned prior to disinfection.

○ If surfaces or objects are soiled with body fluids or blood, use gloves and other standard precautions to avoid coming into contact with the fluid. Remove the spill, and then clean and disinfect the surface.

○ Clean and disinfect shared objects frequently.

• Limit the use of shared objects that are difficult to clean or disinfect (e.g., gym or physical education equipment, art supplies, games) when possible.

• Keep each students' belongings separated from others'.

• Ensure adequate supplies to minimize sharing of high touch materials if possible.

● Provide water, sanitation and waste management facilities and follow environmental cleaning and decontamination procedures.

○ Ensure adequate, clean and separate toilets or latrines for girls and boys.

○ Ensure trash is removed daily and disposed of safely.

● Increase airflow and ventilation where climate allows (open windows, use air conditioning where available, etc.).

○ For more information on ventilation, see here.

● Know the latest facts:

○ Understand basic information about COVID-19, including its symptoms, complications, how it is transmitted and how to prevent transmission.

○ Stay informed about COVID-19 through reputable sources such as WHO, CDC, UNICEF, and national health ministry advisories.

○ Be aware of fake information/myths that may circulate by word-of-mouth or online. Check out the WHO myth buster web page.

● Provide increased education and training on these and other new protocols and procedures to support teachers, staff, and students to successfully implement them.

● Support coping and resilience by encouraging staff and students to:

○ Take breaks from watching, reading, or listening to news stories about COVID-19, including social media if they are feeling overwhelmed or distressed.

○ Eat healthy, exercise regularly, get adequate sleep, and find time to unwind.

○ Talk with people they trust about their concerns and how they are feeling.

● For additional information, see this section.

● Cohorting is a strategy that forms groups or “pods” of students, and sometimes teachers or staff, that stay together throughout the school day to minimize exposure for students, teachers, and staff across the school environment.

○ Cohorting can be done as part of a traditional model with all students attending school in-person, on a full-time basis, or as part of a hybrid school model (i.e., students attending in-person school on an alternating schedule).

• Cohorting may be implemented as one of a variety of mitigation strategies that schools can use to help minimize COVID-19 transmission.

○ Implementation of this strategy varies, depending on setting and resources.

• Schools may keep cohorts together in one classroom, and have teachers rotate between cohorts, or schools may assign student cohorts to specific days or weeks for in-person and online learning.

● Ideally, students and staff within a cohort would only have physical proximity with others in the same cohort. This practice may help prevent the spread of COVID-19 by:

○ Decreasing opportunities for exposure to or transmission of COVID-19.

○ Facilitating more efficient contact tracing in the event of a positive case.

○ Allowing for targeted testing, quarantine, and isolation of a single cohort instead of school-wide measures in the event of a positive case or cluster of cases.

○ Even with smaller groups, cohorts may not be truly independent of one another.

• Families may have children of different ages (i.e., siblings) who act as connections between cohorts within a school.

• Teachers, especially with specialized expertise, may also connect multiple cohorts within a school because their expertise is used/needed across cohorts.

• Use of cloth face coverings and distancing when possible are particularly important when teachers are moving amongst groups of students.

● Implementation of this strategy varies, depending on setting and resources.

● Cohorting refers to smaller groups of students, and sometimes teachers or staff, that stay together throughout the school day to minimize exposure for students, teachers, and staff across the school environment.

○ Research findings are limited on the optimal maximum or minimum cohort sizes to reduce the spread of COVID-19.

○ CDC modeling demonstrates that smaller cohort sizes are generally associated with less transmission in schools. Smaller cohorts means more limited contacts, but there is no specific threshold for optimal size.

○ Use of cloth face coverings and physical distancing when possible are particularly important when teachers are moving amongst groups of students.

● Cohorting is one strategy to help minimize COVID-19. Currently, the most effective way to reduce the spread of COVID-19 is using multiple mitigation strategies in combination.

○ To minimize the risk of COVID-19 transmission and maintain student health, schools should balance:

• Community transmission risk.

• Use of other mitigation strategies (e.g., limiting class sizes, use of cloth face coverings, proper hygiene, school cleaning).

• Students’ educational and emotional needs.

● An alternating schedule is when students rotate when they physically attend school. This is also sometimes called a hybrid schedule (mix of in-person and virtual school). For example:

○ Scheduling certain grades or classrooms to may attend school on Monday and Tuesday while other grades or classrooms may attend on Thursday and Friday. The school would be thoroughly cleaned on Wednesday.

OR

○ Rotating in-person attendance weekly with one group of students attending during a week, followed by a different group the next week in rotation.

● Preliminary modeling results suggest that – similar to cohorting – alternating schedules can help reduce contact between students and staff, and both alternating days and alternating weeks of in-person instruction have the potential to reduce in-school transmission of COVID-19 compared with daily in-person instruction.

● WHO provides Considerations for decision-makers and educators on how or when to reopen or close schools in the context of COVID-19 including:

○ Current understanding about COVID-19 transmission and severity in children.

○ Local situation and epidemiology of COVID-19 where the school(s) are located.

○ School setting and ability to maintain COVID-19 prevention and control measures including risk assessment guidance and key questions to consider in addressing:

• Policy

• Practice and infrastructure

• Behavioral aspects in the school environment

• Safety and security

• Hygiene and daily practices at school

• Physical distancing and tele-schooling

● The UNICEF Framework for Reopening Schools advises authorities to look at the benefits and risks across education, public health and socio-economic factors, in the local context, using the best available evidence.

○ This guide provides questions to help assess when, where and why to reopen schools, and a 15-point framework for how to reopen schools considering six dimensions: policy, financing, safe operations, learning, including the most marginalized, and well being and protection.

● CDC Considerations for Operating Schools during COVID-19 and Strategies for Protecting K-12 School Staff web pages provides supplemental information for ways schools can help protect students, teachers, administrators and staff to slow the spread of COVID-19. These include:

○ Guiding principles on risk.

○ Promoting behaviors that reduce spread.

○ Maintaining healthy environments.

○ Maintaining healthy operations.

○ Preparing for when somebody is sick.

● CDC Operational Considerations for Schools provides suggestions for mitigating risks for COVID-19 transmission in primary and secondary schools in low-resource, international settings.

○ Mitigation practices of physical distancing, hand hygiene, cleaning and disinfection, and respiratory hygiene are each addressed with detailed considerations for:

• Personal controls: Individuals’ behaviors to protect themselves and those around them.

• Administrative controls: processes and policies that keep people safe.

• Engineering controls: physical structures put in place to distance people from hazards.

● CDC also provides:

○ CDC Schools and Child Care Programs webpage that provides summary links to resources for school and program administrators to plan, prepare, and respond to COVID-19 in schools.

○ CDC Supplemental Guidance for Child Care Programs that remain open supplements the CDC Consideration for Operating Schools noted above.

○ CDC Toolkit for Childcare Programs and Summer Camps website includes a summary of guidance and planning documents, FAQ and links to graphic posters and fact sheets.

○ CDC provides guidance on what steps school health clinics may take immediately and strategies to prepare for community transmission of COVID-19.

○ CDC Interim Guidance for Administrators of US Institutions of Higher Education (IHE) aims to help Institutions of Higher Learning react quickly if a case is identified or if there is spread within the community. The guide also helps administrators plan for the continuity of teaching, learning and research if there is spread of COVID-19.

• International Exchange students should seek guidance from their IHE regarding policies impacting their health, studies, and visa status while abroad.

○ CDC Toolkit for Colleges and Universities website includes summary guidance, FAQ, and planning documents including situations unique to IHE such as living in shared housing and considerations for events and gatherings.

● The Global Education Cluster has developed the Safe Back to School: A Practitioner’s Guide to help program teams plan an integrated, participatory process for safe school reopening. This guide is divided into two sections:

○ Checklists for Integrated Safe Back-to-School Checklist for Program Staff: to ensure sectoral integration within the school reopening process and a School-Friendly Safe Back-to-School Checklist that provides topline actions for a head teacher or school committee to follow

○ Technical Annexes that provide detailed guidance and resources for specific activities mentioned in the checklists including:

• Participatory, inclusive back-to-school campaigns

• Absence Management Systems

• Annex 3 Enable teachers in the transition back to school

• MHPSS for children as schools reopen

• Participatory education and protection continuity planning

• Adaptations for camp settings

• Advocacy messages

● Early in the pandemic, UNICEF/WHO developed The Key Messages and Actions for COVID-19 Prevention and Control in Schools to provide actionable guidance for safe operations through the prevention, early detection and control of COVID-19 in schools and other educational facilities. This guide includes checklists for administrators, parents and teachers, and students.

● OpenSmartEDU.org is a free website designed to guide colleges and universities in planning operating strategies for both the near- and long-term amid the many challenges of COVID-19. This site includes:

○ COVID-19 Planning Guide for Higher Education

• Four central questions to determine readiness to resume on-campus instruction for each of the major COVID-19 alert levels.

• Comprehensive planning guides organized by leadership, cross-functional and functional work groups.

• Links to guidelines, resources, and media reports are provided to further supplement institutional planning.

○ COVID-19 Self-Assessment Calculator for Higher Education

• Excel spreadsheet designed to help IHE identify, understand and track risk and impact of major mitigation strategies.

○ University Response Tracker & Web Resources

• Access to the guide, the Risk Calculator, updated guidelines, resources, case studies, and media reports.

• University response tracker that can be searched by geography, name, enrollment, and institution type.

○ Higher Education Planning Tool (Smartsheet)

• Mirrors the COVID-19 Self-Assessment Calculator for Higher Education and provides institutions an online, sharable tool to assign work, develop timelines, and track critical issues related to reducing the risk of COVID-19 transmission on campus.

● The health, safety, and well-being of students, teachers, staff, and their families are the most important consideration in determining whether schools should reopen for in-person learning.

● Deciding to close, partially close or reopen schools should be guided by risk management to:

○ Maximize the educational and health benefit for students, teachers, staff, and the wider community, and

○ Help prevent a new outbreak of COVID-19 in the community as the local situation and epidemiology of COVID-19 may vary from one place to another within a country.

● Consider the following to assess the benefits and risks to children and staff in deciding to re-open schools or keep them open:

○ What is the intensity of transmission being reported in the area?

○ How quickly are local authorities able to respond to COVID-19 outbreaks in the area?

○ What is the level of coordination between the school and local health authorities?

○ How effective are remote learning strategies?

○ What are the impacts of closing/reopening on vulnerable and marginalized populations?

○ What is the school’s setting and ability to maintain COVID-19 prevention and control measures within it?

○ What is the range of public health measures being implemented outside of the school?

● The decision to open schools should include consideration of the following benefits:

○ Allowing students to complete their studies and continue to the next level.

○ Essential services, access to nutrition, child welfare, such as preventing violence against children.

○ Social and psychological well-being.

○ Access to reliable information on how to keep themselves and others safe.

○ Reducing the risk of non-return to school.

○ Benefit to society, such as allowing parents to work.

● Evidence from schools throughout the world suggests that reopening schools may be low risk in communities with low COVID-19 transmission rates.

● Computer simulations from Europe have suggested that schools reopening may further increase spread in communities where transmission is already high.

● As schools reopen, more will be learned about the feasibility and effectiveness of mitigation strategies such as wearing cloth face coverings and practicing physical distancing.

● Regardless of the level of community transmission, vigilance to practicing behaviors that prevent spread among everyone at school and taking other recommended actions to plan, prepare, and respond to COVID-19 will lower the risk of transmission than it might otherwise would be.

● Adults 60 years and older and people with underlying health conditions are at higher risk for severe disease and death.

● The decision to return to a teaching environment depends on the individual and should include consideration of: local disease trends, as well as the measures being put in place in schools to prevent further spread.

● Current evidence suggests that people with underlying conditions such as chronic respiratory illness, obesity, diabetes or cancer are at higher risk of developing severe disease and death than people without other health conditions. This also appears to be the case for children, but more information is still needed.

○ Current evidence suggests that the risk of severe disease for children is lower overall than for adults.

● Whether a child should go to school depends on:

○ Their health condition.

○ Current transmission of COVID-19 within their community.

○ Protective measures the school and community have in place to reduce the risk of COVID-19 transmission.

● Detection of people who may have COVID-19 in educational institutions and success of contact tracing.

● Implementation of and adherence to recommended public health measures in school settings.

● Information on school drop-out, disaggregated for sex, age, disability and socio-economic status.

● Effectiveness of remote education strategies.

● Effects of policies and measures on educational objectives and learning outcomes.

● Effects of policies and measures on the health and well-being of children, siblings, staff, parents and other family members.

● Based on what is learned from this monitoring, further modifications should be made to continue to provide children and staff with the safest environment possible.

● Create a local cross-sectional task force of local decision makers, education leaders, and representatives of school staff, families, local health officials, and other community members to support identifying mitigation strategies for your community, given your local context, to decrease community transmission levels now and throughout the fall.

● Update or develop school emergency and contingency plans in collaboration with your local health authority. Focus on the components or annexes of the plans that address infectious disease outbreaks.

○ Work with officials to guarantee schools are not used as shelters, treatment units, etc.

○ Consider cancelling any community events/meetings that usually take place on school premises, based on risk.

○ Ensure the plan emphasizes everyday preventive actions for students and staff.

● Establish procedures if students or staff become unwell.

○ Plan ahead with local health authorities, school health staff and update emergency contact lists.

○ Ensure a procedure for separating sick students and staff from those who are well – without creating stigma.

○ Ensure there is a process for informing parents and caregivers, and for consulting with health care providers or health authorities wherever possible.

○ Students or staff may need to be referred directly to a health facility, depending on the situation, or sent home.

○ Share procedures with staff, parents and students ahead of time.

● Develop plans for possible school closure (short or long term) depending on your local situation and in consultation with local health authorities.

● Promote information sharing.

○ Coordinate and follow guidelines from the national health and education authorities.

○ Share known information with staff, caregivers and students, providing updated information on the disease situation, including prevention and control efforts at school.

○ Designate a staff person to be responsible for responding to COVID-19 concerns (e.g. school nurse). All school staff and families should know who this person is and how to contact them.

○ Reinforce that caregivers should alert the school and health care authorities if someone in their home has been diagnosed with COVID-19 and keep their child at home.

○ Utilize parent-teacher committees and other mechanisms to promote information sharing.

○ Address children’s questions and concerns, including through the development of child-friendly materials such as posters which can be placed on notice boards, in restrooms, and other central locations.

● Adapt school policies where appropriate

○ Develop flexible attendance and sick leave policies that encourage students and staff to stay home when sick or when caring for sick family members.

○ Discourage the use of perfect attendance awards and incentives.

○ Identify critical job functions and positions, and plan for alternative coverage by cross training staff.

○ Plan for possible academic calendar changes, particularly in relation to breaks and exams.

○ CDC further recommends establishing procedures to ensure students and staff who show symptoms of COVID-19 at school or who arrive at school with these symptoms are sent home as soon as possible.

• Separate anyone that is sick from well students and staff until the sick person can be sent home.

• If a suspected sick student or staff member is confirmed to have COVID-19, immediately notify local health officials.

• Consider the potential need for an initial short-term dismissal (2-5 days) to allow time for the local health officials to gain a better understanding of the COVID-19 situation impacting the school and for custodial staff to clean and disinfect the affected facilities.

● Provide increased education and training on all new policies, protocols and procedures to support teachers, staff, and students successfully implement them.

● Monitor school attendance.

○ Implement school absenteeism monitoring systems to track student and staff absence and compare against usual absenteeism patterns at the school.

○ Alert local health authorities about large increases in student and staff absenteeism due to illnesses.

● Implement targeted health education.

○ Integrate disease prevention and control in daily activities and lessons.

○ Ensure content is age-, gender-, ethnicity-, and disability-responsive and activities are built into existing subjects (See Section on specific considerations when speaking with children of different age-groups).

● Address mental health and psychosocial support needs.

○ Encourage children to discuss their questions and concerns.

○ Explain it is normal that they may experience different reactions and encourage them to talk to teachers if they have any questions or concerns.

○ Provide information in an honest, age-appropriate manner.

○ Guide students on how to support their peers and prevent exclusion and bullying.

○ Ensure teachers are aware of local resources for their own well-being.

○ Work with school health workers/social workers to identify and support students and staff who exhibit signs of distress.

● Support vulnerable populations.

○ Work with social service systems to ensure continuity of critical services that may take place in schools such as health screenings, feeding programs or therapies for children with special needs.

○ Consider the specific needs of children with disabilities, and how marginalized populations may be more acutely impacted by the illness or its secondary effects.

○ Examine any specific implications for girls that may increase their risk, such as responsibility for taking care of the sick at home, or exploitation when out of school.

● For childcare programs that have remained open throughout the COVID-19 pandemic, CDC further recommends screening children upon arrival (if possible). Childcare programs refers to home-based childcare, pre-kindergarten programs, public and private programs, and temporary childcare centers for essential service providers.

○ Persons who have a fever of 100.40 (38.00C) or above or other signs of illness should not be admitted to the facility.

○ Encourage parents to be on the alert for signs of illness in their children and to keep them home when they are sick.

○ There are several methods that facilities can use to protect their workers while conducting temperature screenings.

○ The most protective methods incorporate physical distancing (maintaining a distance of 1-2 meters (3-6 feet) from others) or physical barriers to eliminate or minimize exposures due to close contact to a child who has symptoms during screening.

• More detailed guidance on each method is available here.

• Alternatively, if barrier/physical controls cannot be implemented during the screening, personal protective equipment (PPE) can be used when within 1-2 meters (3-6 feet) feet of a child.

• Reliance on PPE alone is a less effective control and more difficult to implement, given PPE shortages and training requirements.

• If your staff does not have experience in using PPE, check to see if your facility has guidance on putting on PPE. Guidance for putting on and removing PPE is provided in this section.

○ When conducting temperature screening:

• Perform hand hygiene, which is to wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

  • • • Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled. Wash hands with soap and water when they are visibly soiled.

      • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

• Put on disposable gloves.

• Check the child’s temperature

• If screening via a barrier/partition, reach around the partition or through the window. Make sure your face stays behind the barrier at all times during the screening.

• If wearing PPE, after each screening, remove and discard PPE, and wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

• If performing a temperature check on multiple individuals, ensure that you use a clean pair of gloves for each child and that the thermometer has been thoroughly cleaned in between each check.

  • • • If you use disposable or non-contact (temporal) thermometers and do not have physical contact with an individual, you do not need to change gloves before the next check.

      • If you use non-contact thermometers, clean them with an alcohol wipe (or isopropyl alcohol on a cotton swab) between each client. You can reuse the same wipe as long as it remains wet.

● No. The number of reported children with COVID-19 infection who experience symptoms, the types of symptoms they experience, and the severity of those symptoms differs from adults.

● Based on the available evidence, CDC does not currently recommend universal (widespread) symptom screenings be conducted for students in K-12 schools.

● Parents or caregivers should be strongly encouraged to monitor their children for signs of infectious illness.

● Students who are sick should not attend school.

● CDC does not currently recommend that schools conduct universal in-person symptom screenings for staff (or students).

● Screening employees such as teachers is considered an optional strategy that administrators may use. Another option is to encourage staff to self-screen prior to coming onsite.

● Performing screening or health checks will not be completely effective because asymptomatic individuals or individuals with mild non-specific symptoms may not realize they are infected and may pass through screening.

● Screening and health checks are not a replacement for other protective measures such as physical distancing, frequent hand washing and wearing cloth face coverings or masks.

● For teachers, consider encouraging them to self-screen prior to coming onsite and not to attempt to enter the workplace if any of the following are present:

○ Symptoms of COVID-19.

○ Fever equal to or higher than 100.4oF.

○ Are under evaluation for COVID-19 (for example, waiting for the results of a viral test to confirm infection).

○ Have been diagnosed with COVID-19 and not yet cleared to discontinue isolation.

● If administrators do decide to implement in-person health checks for staff:

○ Conduct them safely and respectfully. Use physical distancing, 1 - 2 meters (3 - 6 feet) barrier or partition controls, or personal protective equipment (PPE) to protect the screener.

○ Complete the health checks in a way that helps maintain physical distancing guidelines, such as providing multiple screening entries into the building.

○ To prevent stigma and discrimination in the workplace, make employee health screenings as private as possible.

• Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of each individual’s medical status and history.

● For additional information on screening procedures see this section in Part 4.

● The following adaptations to transport to and from school should be implemented to limit unnecessary exposure of school or staff members (including bus drivers).

○ Promote and put in place respiratory and hand hygiene, physical distancing measures and use of cloth face covers or masks in transportation such as school buses, in accordance with local policy.

• Schools should consider having spare, clean cloth face coverings available to ensure all students wear cloth face coverings on the school bus.

• Schools may provide physical guides, such as signs and tape on the sidewalk, to ensure that students and school staff remain at least 1-2 meters (3-6 feet) apart while waiting for transportation.

○ Similar to frequently touched surfaces, buses should be cleaned and disinfected at least daily.

○ Provide tips for how to safely commute to and from school, including for public transportation.

○ Organize only one child per seat and ensure physical distancing of at least 1-2 meters (3-6 feet) between passengers in school buses, if possible. This may require more school buses per school.

• Drivers can create distance between children on school buses, including seating children one student per row facing forward and skipping rows between students. However, students who live in the same household may sit together if needed.

• Schools may consider alternative strategies to accommodate the reduced number of students in buses, such as staggered pick up and drop off times or additional bus routes.

○ If possible and safe, keep the windows of the buses, vans, and other vehicles open.

○ During dismissal, schools may provide physical guides, such as signs and tape on the sidewalk, to ensure that students and school staff remain at least 1-2 meters (3-6 feet) apart while waiting for transportation.

● Cloth face coverings are recommended to prevent transmission of COVID-19 in the general population in public areas, particularly where physical distancing (1 - 2 meters (3 - 6 feet)) is not possible, and in areas of community transmission. This may include school grounds.

○ Masks may help to protect others, because wearers may be infected and contagious before symptoms of illness appear.

○ The policy on wearing a mask or cloth face covering should be in line with national or local guidelines.

● Cloth face coverings may be challenging for students to wear in all-day settings for some students, teachers, and staff, including:

○ Younger students, such as those in early elementary school.

○ Students, teachers, and staff with severe asthma or other breathing difficulties.

○ Students, teachers, and staff with special educational or healthcare needs, including intellectual and developmental disabilities, mental health conditions, and sensory concerns or tactile sensitivity.

● Adaptations and alternatives should be considered such as clear face coverings for teachers and staff working with:

○ Students or staff who are deaf or hard of hearing.

○ Young students learning to read.

○ Students learning a second language.

○ Students with disabilities.

● Cloth face coverings should be worn by staff and students (particularly older students) as feasible, and are most essential in times when physical distancing is difficult.

○ Cloth face coverings should not be worn by:

• Children younger than 2 years old.

• Anyone who has trouble breathing.

• Anyone who is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance.

● Individuals should be frequently reminded not to touch the face covering and to wash their hands frequently.

○ Information should be provided to staff, students, and students’ families on proper use, removal, and washing cloth face coverings.

● It is important that anyone feeling unwell should stay at home and call their health provider.

● Include cloth face coverings on school supply lists and provide cloth face coverings as needed to students, teachers, staff, or visitors who do not have them available.

● Include clear face coverings on school supply lists for teachers and staff who regularly interact with students who are deaf or hard of hearing, students learning to read, students with disabilities, and those who rely on lip reading as a part of learning, such as students who are English Language Learners.

● Ensure that students and staff are aware of the correct use of cloth face coverings, including wearing cloth face coverings over the nose and mouth and securely around the face.

● Ensure that students, teachers and staff are aware that they should wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol before putting on a cloth face covering.

● Ensure that students, teachers, and staff are aware that they should not touch their cloth face coverings while wearing them and, if they do, they should wash their hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol before and afterward.

● Ensure that all students and staff are aware that cloth face coverings should not be worn if they are wet. A wet cloth face covering may make it difficult to breathe.

● Ensure that all students and staff are aware that they should never share or swap cloth face coverings.

● Students’ cloth face coverings should be clearly identified with their names or initials, to avoid confusion or swapping. Students’ face coverings may also be labeled to indicate top/bottom and front/back.

● Cloth face coverings should be stored in a space designated for each student that is separate from others when not being worn (e.g., in individually labeled containers or bags, personal lockers, or cubbies).

● Cloth face coverings should be washed after every day of use and/or before being used again, or if visibly soiled.

● Students and schools should consider having additional cloth face coverings available for students, teachers, and staff in case a back-up cloth face covering is needed during the day and to facilitate every day washing of cloth face coverings.

● Stigma, discrimination, or bullying may arise due to wearing or not wearing a cloth face covering. Schools should have a plan to prevent and address bullying.

● Not all families will agree with school policies about cloth face coverings. Schools should have a plan to address challenges that may arise and refer parents, caregivers, and guardians to guidance on cloth face coverings.

● For all students:

○ Encourage parents, caregivers, and guardians to practice wearing masks with students at home before the first day of school.

• If parents, caregivers, and guardians model appropriate use of cloth face coverings and help students get used to wearing them, students may be more comfortable using them.

○ Introduce students with sensory concerns/tactile sensitivities to cloth face coverings with a variety of materials, prints, and textures, and allow them to choose which mask is most comfortable.

○ Use behavioral techniques such as positive reinforcement to increase the likelihood that students will comply with guidance for cloth face covering and other prevention practices.

○ Encourage parents, caregivers, and guardians to include students in the selection of their cloth face covering and/or the material that is used to make it. This might increase a child’s acceptance of wearing the mask.

○ Display age appropriate posters and materials with visual cues that show the proper way to wear a cloth face covering in classrooms and hallways. Consider incorporating images of popular influencers promoting or modeling use of cloth face coverings masks.

○ Include reminders about cloth face coverings in daily announcements, school newspapers, and other materials. All communication should be in an appropriate format, literacy level, and language. Consider including how to properly use, take off, and wash masks/cloth face coverings in back-to-school communications educational materials.

● For Primary School Settings

○ Ensure that teachers and school staff are available to help students put on and adjust their cloth face coverings as needed and that teachers and staff wash their hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after doing so.

○ Play games or engage in other fun activities that teach students how to wear a mask/cloth face covering.

○ Consider using some art materials or other creative outlets to help students understand why cloth face coverings help reduce the spread of COVID-19.

○ Share social stories about cloth face coverings with students so they know what to expect at school. A social story is similar to a simple picture book that teaches students what to expect in social settings.

○ Use behavioral techniques, such as positive reinforcement, to increase the likelihood that students will comply with guidance for cloth face coverings and masks.

● For Lower Secondary School Settings

○ Show short videos or incorporate short lessons (less than 10 minutes) that teach students how to wear a mask/cloth face covering. Consider including videos with celebrities, musicians, athletes or other influencers popular among this age group.

○ Follow videos with verbal instructions that demonstrate the correct ways to wear cloth face coverings and masks.

○ Engage the class in discussions about why cloth face coverings and masks help reduce the spread of COVID-19.

○ Incorporate a lesson into the science curriculum on how respiratory droplets spread infectious disease.

○ Create a school competition for the best health communication strategy to highlight the importance of wearing a mask to middle school students.

● For Upper Secondary School Settings

○ Show videos or incorporate lessons that teach students how to wear a cloth face covering and mask, including the correct and incorrect ways to wear them. Consider including videos with celebrities, musicians, athletes, or other influencers popular among this age group.

○ Ask students to write a short paper on the science behind the use of cloth face coverings and masks as a form of source control.

○ Create a school competition for the best health communication strategy to highlight the importance of wearing cloth face coverings and masks to high school students.

● For Students with Special Healthcare Needs

○ Ask parents, caregivers, and guardians to practice wearing cloth face coverings at home before the student returns to school.

○ Share social stories about cloth face coverings masks with students so they know what to expect at school. A social story is similar to a simple picture book that teaches students about what to expect in social settings.

○ Introduce students with sensory concerns or tactile sensitivities to cloth face coverings with a variety of materials, prints, and textures, and allow them to choose which covering is most comfortable.

○ Use behavioral techniques such as positive reinforcement to increase the likelihood that students will comply with mask guidance and other prevention practices.

● Ventilation is an important factor in preventing the virus that causes COVID-19 from spreading indoors.

● Steps to improve ventilation should consider:

○ Local environmental conditions (temperature/humidity).

○ Ongoing community transmission in the area.

○ Consultation with a heating, ventilation and air conditioning (HVAC) professional (as appropriate).

● WHO and CDC recommend people who manage public spaces and buildings improve indoor ventilation by:

○ Using natural ventilation, opening windows if possible and safe to do so.

○ For mechanical systems, increasing the percentage of outdoor air, using economizer modes of HVAC operations and potentially as high as 100%.

• Before increasing outdoor air percentage, verify compatibility with HVAC system capabilities for both temperature and humidity control as well as compatibility with outdoor/indoor air quality considerations.

○ Increasing total airflow supply to occupied spaces, whenever feasible.

○ Disabling demand-control ventilation controls that reduce air supply based on temperature or occupancy.

○ Improving central air filtration:

• Increase air filtration to as high as possible without significantly diminishing design airflow.

• Inspect filter housing and racks to ensure appropriate filter fit and check for ways to minimize filter bypass.

• Check filters to ensure they are within service life and appropriately installed.

○ Consider running the HVAC system at maximum outside airflow for 2 hours before and after spaces are occupied, in accordance with manufacturer recommendations.

○ Generating clean-to-less-clean air movements by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers and adjusting zone supply and exhaust flow rates to establish measurable pressure differentials.

• Have staff work in “clean” ventilation zones that do not include higher-risk areas such as visitor reception or exercise facilities (if open).

○ Ensuring exhaust fans in restroom facilities are functional and operating at full capacity when the building is occupied.

○ Inspecting and maintaining local exhaust ventilation in areas such as restrooms, kitchens, cooking areas, etc.

● Clean, natural ventilation should be used inside buildings where possible, without re-circulating the air.

○ When weather conditions allow, increase fresh outdoor air by opening windows and doors.

• Do not open windows and doors if doing so poses a safety or health risk (e.g., risk of falling, triggering asthma symptoms) to children and staff using the school.

○ Consider outdoor classes where circumstances allow.

○ Use fans to increase the effectiveness of open windows.

• Position fans securely and carefully in/near windows so as not to induce potentially contaminated airflow directly from one person over another (strategic window fan placement in exhaust mode can help draw fresh air into the room via other open windows and doors without generating strong room air currents).

○ Decrease occupancy in areas where outdoor ventilation cannot be increased.

● If air re-circulation is necessary, filters and duct systems should be cleaned regularly and routinely changed according to the manufacturer’s instructions.

● Heating and cooling systems should be well maintained.

● More information on improving ventilation is available in this section.

● Maintain existing cleaning and hygiene practices for outdoor areas and routinely clean high touch surfaces made of plastic or metal, such as grab bars and railings, if practical.

○ Outdoor areas generally require normal routine cleaning and do not require disinfection.

○ Spraying disinfectant on outdoor playgrounds is not an efficient use of disinfectant supplies and has not been proven to reduce the risk of COVID-19 to the public.

○ Cleaning and disinfection of wooden surfaces (e.g., play structures, benches, tables) or groundcovers (e.g., mulch, sand) is not recommended.

● Additional information on cleaning and disinfecting outdoor spaces is also available here.

● CDC provides interim guidance for K-12 School Administrators (supporting Interim Considerations for Institutions of Higher Education Administrators) to use COVID-19 testing as one component of a comprehensive strategy that also includes:

○ Promoting behaviors that reduce spread.

○ Maintaining healthy environments.

○ Maintaining healthy operations.

○ Preparing for when someone gets sick.

● Schools should work with local health authorities on whether and how best to implement any testing strategy.

○ Implementation should be guided by what is feasible, practical, and acceptable and be tailored to the needs of each community.

● Screening, testing, and contact tracing help to slow and stop the spread of transmission of COVID-19, and should be implemented following local laws and regulations.

○ Because of the potential for asymptomatic and pre-symptomatic transmission of the virus, it is important that contacts of students or staff with COVID-19 be quickly identified and tested.

○ Viral testing is recommended for all close contacts of persons with diagnosed COVID-19 or individuals with signs or symptoms of COVID-19.

○ School administrators should work with local health officials to inform those who have had close contact with a person diagnosed with COVID-19 to stay home and self-monitor for symptoms.

○ Healthcare providers or health officials will determine when viral testing of asymptomatic students or staff for COVID-19 is appropriate.

● CDC does not recommend universal testing of all students and staff.

○ Universal COVID-19 testing of all students and staff in school settings has not been systematically studied. It is not known if testing in school settings provides any additional reduction in person-to-person transmission of the COVID-19.

● While schools play a role in screening staff and students, school staff are not expected to directly administer COVID-19 tests.

○ In some instances, school-based healthcare providers (e.g., school nurses, physicians) with the resources and training may conduct COVID-19 testing in their capacity as healthcare providers.

● Staff, students and their families should be linked to testing opportunities in the community.

● Building on the guidance above, CDC recommends the following additional considerations for child care programs that remain open during the COVID-19 pandemic:

○ Implement physical distancing of 1 - 2 meters (3 - 6 feet) strategies, for example:

• If possible, child care classes should include the same group each day, and the same child care providers should remain with the same group each day.

  • • • Consider creating a separate classroom or group for the children of healthcare workers and other first responders.

      • If your program is unable to create a separate classroom, consider serving only the children of healthcare workers and first responders.

      • Keep each group of children in a separate room.

• Consider whether to change or stop daily group activities that may promote transmission.

  • • • Limit the mixing of children, such as staggering playground times and keeping groups separate for special activities such as art, music, and exercising.

• If possible, at nap time, ensure that children’s naptime mats (or cribs) are spaced out as much as possible, ideally physical distance of 1 - 2 meters (3 - 6 feet). Consider placing children head to toe in order to further reduce the potential for viral spread.

• Consider staggering arrival and drop off times and/or have child care providers come outside the facility to pick up the children as they arrive.

  • • • Your plan for curbside drop off and pick up should limit direct contact between parents and staff members and adhere to physical distancing recommendations.

• If possible, arrange for administrative staff to telework from their homes.

○ Intensify cleaning and disinfection efforts.

• Hand hygiene stations should be set up at the entrance of the facility, so that children can clean their hands before they enter.

  • • • Wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

      • Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

      • Wash hands with soap and water when they are visibly soiled. When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands.

• If these are not available, use clean cloth towels and replace them frequently.

• If possible, place sign-in stations outside, and provide sanitary wipes for cleaning pens between each use.

○ Modify drop off and pick up procedures.

• Consider staggering arrival and drop off times and plan to limit direct contact with parents as much as possible.

• Have child care providers greet children outside as they arrive.

• Designate a parent to be the drop off/pick up volunteer to walk all children to their classroom, and at the end of the day, walk all children back to their cars.

• Ideally, the same parent or designated person should drop off and pick up the child every day.

• If possible, older people such as grandparents or those with serious underlying medical conditions should not pick up children, because they are more at risk for severe illness from COVID-19.

• Infants could be transported in their car seats. Store car seats out of children’s reach.

○ Implement screening procedures upon arrival.

○ Maintain an adequate ratio of staff to children to ensure safety.

• Plan ahead and recruit those with child care experience to ensure you have a roster of substitute caregivers who can fill in if your staff members are sick or stay home to care for sick family members.

○ When feasible, staff members and older children should wear cloth face coverings within the facility.

• Cloth face coverings should not be put on babies and children under age two because of the danger of suffocation.

● CDC provides guidance for school nutrition professionals and volunteers, who are working in meal preparation and/or distribution at a school/school district site or other public settings.

● Potential sources of exposure include:

○ Close contact with co-workers, students, and families with COVID-19.

○ Touching your nose, mouth, or eyes after touching contaminated surfaces.

○ Handling items that others infected with COVID-19 have touched.

● Currently there is no evidence to support transmission of COVID-19 spread through food.

● CDC makes the following recommendations:

○ Notify your supervisor and stay home if you are having symptoms.

• Follow guidance on steps to take if you are sick.

• You should not return to work until the criteria to discontinue home isolation are met, in consultation with healthcare providers and state and local health departments.

○ Notify your supervisor if you are well but have a sick family member at home with COVID-19.

○ Wear a cloth face covering in public settings where other physical distancing measures 1 - 2 meters (3 - 6 feet) are difficult to maintain, especially in areas of significant community-based transmission.

○ Clean and disinfect frequently touched surfaces such as kitchen countertops, cafeteria and service tables, door handles, carts, and trays, throughout the day.

○ Practice proper hand hygiene, which is to wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Wash hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

• With appropriate hand hygiene, gloves are not necessary for workers who are not involved in food preparation.

○ Key times to wash hands include:

• Before and after work shifts.

• Before and after work breaks.

• After using the restroom.

• Before eating or preparing food.

• Before putting on and after taking off disposable gloves when preparing food.

• After touching objects with bare hands which have been handled by other staff, customers or visitors, such as tables, trays, carts, racks, dishes, cups, utensils, bags, coolers, totes, and trash.

• After blowing your nose, coughing, or sneezing.

• After putting on, touching, or removing cloth face coverings.

○ Avoid contact with body fluids.

○ Do not touch your eyes, nose, or mouth.

○ Use tissues when you cough, sneeze, or touch your face. Throw used tissues in the trash, and then wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

● In addition to having nutrition services staff continue to follow recommended food safety practices for preparing and serving food schools should:

○ Avoid offering any self-serve food or drink options, such as hot and cold food bars, salad or condiment bars, and drink stations.

○ Serve individually plated or pre-packaged meals, while ensuring the safety of children with allergies.

○ As feasible, schools should have students and staff eat meals in classrooms, while maintaining physical distancing as much as possible, instead of in a communal dining hall or cafeteria.

• If communal dining halls or cafeterias are used, schools should encourage physical distancing in food service lines and at tables while eating.

○ Students and staff should wash their hands with with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after eating.

○ Schools should clean and disinfect food line areas, tables, and chairs between uses.

○ Schools should encourage students and staff not to share food or utensils and use disposable food service items (e.g., utensils, trays). If use of disposable items is not possible, ensure that all non-disposable food service items and equipment are handled by staff with gloves and washed with dish soap and hot water or in a dishwasher.

○ Individuals should wash their hands with with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol removing their gloves or after directly handling used food service items.

○ Lastly, if food is offered at any event, schools may consider:

• Having pre-packaged boxes or bags for each attendee instead of a buffet or family-style meal.

• Providing tissues and no-touch or foot pedal disposal receptacles for use by students, staff, and food service volunteers.

• If possible, installing touchless payment methods. If touchless payment is not possible, providing hand sanitizer to students and staff for use right after handling money, cards, or keypads.

● Children and young people should understand basic, age-appropriate information about COVID-19, including its symptoms, risks, how it is transmitted and how to prevent transmission.

○ Keep them informed about COVID-19 with information from reputable sources such as WHO, UNICEF, CDC and national health ministry advisories.

○ Be aware of stories or myths that may circulate by word-of-mouth or online.

● When talking to preschool aged children:

○ Focus on good health behaviors such as:

• Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze . Then dispose of the used tissue immediately and wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol or 70% isopropanol.

○ Sing a song while washing hands with soap to practice the recommended 20 second duration.

• Children can “practice” washing their hands with hand rub (sanitizer).

○ Develop a way to track hand washing and reward for frequent/timely hand washing.

○ Use puppets or dolls to demonstrate symptoms (sneezing, coughing, fever) and what to do if they feel sick (i.e. their head hurts, their stomach hurts, they feel hot or extra tired) and how to comfort someone who is sick (cultivating empathy and safe caring behaviors).

● Help children understand and practice the importance of keeping a physical distance of 1 - 2 meters (3 - 6 feet) from their friends by asking them to sit further apart from one another and practice stretching their arms out or ‘flapping their wings’ to make sure they have enough space to not touch each other.

● When talking to primary school aged children:

○ Make sure to listen to children’s concerns and answer their questions in an age-appropriate manner; don’t overwhelm them with too much information.

• Encourage them to express and communicate their feelings.

• Discuss the different reactions they may experience and explain that these are normal reactions to an abnormal situation.

○ Emphasize that children can do a lot to keep themselves and others safe.

• Introduce the concept of physical distancing (standing further away from friends, avoiding large crowds, not touching people if you don’t need to, etc.)

• Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze (respiratory hygiene). Then dispose of the used tissue immediately and wash your hands. Supply tissues and closed bins to dispose of them in. Proper hand hygiene is:

  • • Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

    • Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

    • Washing hands with soap and water when they are visibly soiled.

    • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Help children understand the basic concepts of disease prevention and control. Use exercises that demonstrate how germs can spread.

• For example, by putting colored water in a spray bottle and spraying over a piece of white paper. Observe how far the droplets travel.

○ Demonstrate why it is important to wash hands for 20 seconds with soap and water.

• Put a small amount of glitter in students’ hands and have them wash them with just water, notice how much glitter remains, then have them wash for 20 seconds with soap and water.

○ Have students analyze scenarios to identify high risk behaviors and suggest modifying behaviors.

• For example, a teacher comes to school with a cold. He sneezes and covers it with his hand. He shakes hands with a colleague. He wipes his hands after with a handkerchief then goes to class to teach. What did the teacher do that was risky? What should he have done instead?

● When talking to lower secondary school aged children:

○ Make sure to listen to students’ concerns and answer their questions.

○ Emphasize that students can do a lot to keep themselves and others safe.

• Introduce the concept of physical distancing.

• Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze (respiratory hygiene). Then dispose of the used tissue immediately and wash your hands. Supply tissues and closed bins to dispose of them in. Proper hand hygiene is:

  • • Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

    • Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

    • Washing hands with soap and water when they are visibly soiled.

    • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Encourage students to prevent and address stigma.

○ Discuss the different reactions they may experience and explain these are normal reactions to an abnormal situation.

• • • • • • • • Encourage them to express and communicate their feelings.

○ Build students’ agency and have them promote facts about public health.

• Have students make their own Public Service Announcements through school announcements and posters.

○ Incorporate relevant health education into other subjects.

• Science can cover the study of viruses, disease transmission and the importance of vaccinations.

• Social studies can focus on the history of pandemics and evolution of policies on public health and safety.

• Media literacy lessons can empower students to be critical thinkers and makers, effective communicators and active citizens.

● When talking to upper secondary school aged children:

○ Make sure to listen to students’ concerns and answer their questions.

○ Emphasize that students can do a lot to keep themselves and others safe.

○ Introduce the concept of physical distancing.

○ Emphasize the importance of covering your mouth and nose with your bent elbow or tissue when you cough or sneeze (respiratory hygiene). Then disposing of the used tissue immediately and washing your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Washing hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Encourage students to prevent and address stigma.

• Discuss the different reactions they may experience and explain these are normal reactions to an abnormal situation.

• Encourage them to express and communicate their feelings.

○ Incorporate relevant health education into other subjects.

• Science courses can cover the study of viruses, disease transmission and the importance of vaccinations.

• Social studies can focus on the history of pandemics and their secondary effects and investigate how public policies can promote tolerance and social cohesion.

○ Have students make their own Public Service Announcements via social media, radio or even local television broadcasting.

• Media literacy lessons can empower students to be critical thinkers and makers, effective communicators and active citizens.

● Information for adolescents is available in this section.

● Practice and reinforce everyday prevention actions such as:

○ Frequently washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

○ Reinforcing physical distancing (1 - 2 meters (3 - 6 feet)) measures including but not limited to:

• Modifying classes where students are likely to be in very close contact.

• Increasing space between desks.

• Allowing students to eat meals in the classroom.

○ Practice respiratory hygiene, including:

• Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then disposing of the used tissue immediately, and washing your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Wear a cloth face covering when physical distancing is not possible or when recommended by your local health authority.

• In areas where there is widespread transmission, all adults/teachers under the age of 60 and who are in general good health should wear cloth face coverings.

• Adults/teachers aged 60 or over, or who have any underlying health conditions such as heart disease, diabetes or lung cancer, should wear a medical mask because of their higher risk of getting seriously ill from COVID-19.

○ Clean and disinfect frequently touched surfaces.

• Immediately clean surfaces and objects that are visibly soiled. Visibly dirty surfaces should be cleaned prior to disinfection.

• If surfaces or objects are soiled with body fluids or blood, use gloves and other standard precautions to avoid coming into contact with the fluid. Remove the spill, and then clean and disinfect the surface.

○ Limit the use of shared objects, particularly those that are difficult to clean.

• Keep each students’ belongings separated from others’.

• Ensure adequate supplies to minimize sharing of high touch materials if possible.

○ Improve ventilation in your classroom by opening windows and doors, when possible.

○ Monitor your health daily and be alert to symptoms of COVID-19.

● Plan to stay home if you have symptoms of COVID-19 like fever, cough, or shortness of breath.

● Encourage parents to keep students at home if they’re sick.

● Know the latest facts.

○ Understand basic information about COVID-19, including its symptoms, risks, how it is transmitted and how to prevent transmission.

○ Stay informed about COVID-19 through reputable sources such as CDC, UNICEF , WHO and national health ministry advisories.

○ Be aware of false information or myths that may circulate by word-of-mouth or online.

● Recognize the symptoms of COVID-19 in your child.

○ Seek medical advice by first calling your health facility/provider and then take your child in, if advised.

○ Remember that symptoms of COVID-19 such as cough or fever can be similar to those of the flu, or the common cold, which are a lot more common.

○ Information related to children with underlying medical conditions can be found in this section.

● If your child is sick, keep them home from school and notify the school of your child’s absence and symptoms.

○ Provide reading and assignments so that students can continue learning while at home.

● Explain to your child what is happening in simple words and reassure them that they are safe.

○ Remain calm. Remember that children will react to both what you say and how you say it. They will pick up cues from the conversations you have with them and with others.

○ Let children know they can come to you when they have questions.

○ Avoid language that might blame others and lead to stigma.

○ Provide truthful and factual information that is appropriate for the age and developmental level of the child.

• Talk to children about how some stories on COVID-19 on the Internet and social media may be based on rumors and inaccurate information.

• Children may misinterpret what they hear and can be frightened about something they do not understand.

● Keep children in school when healthy.

○ If your child isn’t displaying any symptoms such as a fever or cough it’s best to keep them in school – unless a public health advisory or other relevant warning or official advice has been issued affecting your child’s school.

● Teach, model and practice good and frequent hand hygiene for school and elsewhere.

○ Step 1: Wet hands with safe running water.

○ Step 2: Apply enough soap to cover wet hands.

○ Step 3: Scrub all surfaces of the hands – including backs of hands, between fingers and under nails – for at least 20 seconds.

○ Step 4: Rinse thoroughly with running water.

○ Step 5: When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ If soap and water are not readily available, use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Wash hands with soap and water when they are visibly dirty or soiled.

● Support children to practice respiratory hygiene by:

○ Covering their mouth and nose with their bent elbow or tissue when they cough or sneeze. Then dispose of the used tissue immediately, and wash their hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Not touching their eyes, mouths or noses if they haven’t properly washed their hands.

● Help your children with physical distancing.

○ Explain to your children that they have an important job of keeping themselves and their community healthy by temporarily physically. distancing from others.

○ Show them extra positive attention when they make an effort to practice safe physical distancing from others.

○ Guidance on how to keep your family healthy in crowded living areas is provided in this section.

● Teach and practice the use of masks or cloth face coverings for your children.

○ Additional information is available in masks in schools is available in this section.

● Maintain the quality of air in your home. When possible, open windows and doors for ventilation. See Part 2 for more information on ventilation in the home.

● Ensure that safe drinking water is available and toilets or latrines are clean and available at home.

● Ensure waste is safely collected, stored and disposed.

● Encourage your children to ask questions and express their feelings with you and their teachers. Remember that your child may have different reactions to stress; be patient and understanding.

● Help children cope with the stress.

○ Children may respond to stress in different ways. Common responses include:

• Unhealthy eating or sleeping habits

• Returning to behaviors they have outgrown (for example toileting accidents or bedwetting)

• Excessive crying, anger or being afraid to be left alone in younger children

• Excessive worry or sadness

• Irritability and "acting out" behaviors in teens

• Poor school performance or avoiding school

• Difficulties with attention and concentration

• Avoidance of activities enjoyed in the past

• Use of alcohol, tobacco or other drugs

• Unexplained headaches, stomach pain or other body pain

○ Respond to children’s reactions in a supportive way and explain to them that they are normal reactions to an abnormal situation.

• • • • • • • • Additional information on children with special needs is available in this section.

○ Listen to their concerns and take time to comfort them and give them affection, reassure them they’re safe and praise them frequently.

○ If possible, create opportunities for children to play and relax.

• Keep regular routines and schedules as much as possible, especially before they go to sleep, or help create new ones in a new environment.

○ Provide age-appropriate facts about what has happened, explain what is going on and give them clear examples on what they can do to help protect themselves and others from infection. Share information about what could happen in a reassuring way.

• For example, if your child is feeling sick and staying at home or the hospital, you could say, “You have to stay at home/at the hospital because it is safer for you and your friends. I know it is hard (maybe scary or even boring) at times, but we need to follow the rules to keep ourselves and others safe. Things will go back to normal soon.”

● Prevent stigma by using facts and reminding children to be considerate of one another.

● Coordinate with the school to receive information and ask how you can support school safety efforts (though parent-teacher committees, etc.).

● Be prepared if your child’s school or childcare facility is temporarily dismissed.

○ Talk with your employer about sick leave and telework options in case you need to stay home with your child.

○ Consider planning for alternate childcare arrangements.

● If your school or childcare program is dismissed:

○ Keep track of school dismissal updates.

○ Talk to your school about options for digital and distance learning.

○ Discourage children and teens from gathering in other public places while school is dismissed to help slow the spread of COVID-19 in the community.

○ Seek guidance from your school administrator to determine when students and staff should return to schools.

● Be willing to talk. They will already have heard something. Silence and secrets do not protect our children. Honesty and openness do. Think about how much they will understand. You know them best.

○ Be open and listen.

• Allow your child to talk freely. Ask them open questions and find out how much they already know.

• Let children know they can come to you when they have questions.

○ Be honest.

• Always answer their questions truthfully. Think about how old your child is and how much they can understand.

○ Be supportive.

• Your child may be scared or confused. Give them space to share how they are feeling and let them know you are there for them.

○ Remain calm.

• Remember that children will react to both what you say and how you say it. They will pick up cues from the conversations you have with them and with others.

○ Know that it is OK not to know the answers.

• It is fine to say “We don’t know, but we are working on it; or we don’t know, but we think.” Use this as an opportunity to learn something new with your child.

○ Promote heroes not bullies.

• Avoid language that might blame others and lead to stigma.

• Explain that COVID-19 has nothing to do with the way someone looks, where they are from, or what language they speak.

• Tell your child that we can be compassionate to people who are sick and those who are caring for them.

• Look for stories of people who are working to stop the outbreak and are caring for sick people.

○ Promote facts

• There are a lot of stories going around. Some may not be true. Be sure to use trustworthy sources for information like your national health authority or WHO, or UNICEF.

• Talk to children about how some stories on COVID-19 on the Internet and social media may be based on rumors and inaccurate information.

• Children may misinterpret what they hear and can be frightened about something they do not understand.

○ End on a good note.

• Check to see if your child is okay. Remind them that you care and that they can talk to you anytime. Then do something fun together.

○ Using your own words to best relate to your child, consider using some of these conversation starters:

• COVID-19 is a new disease, which can be confusing. Do you have any questions about it? If I don’t know the answer, I can try to find it or maybe we could search for it together.

• People can be angry, sad, or worried when something bad happens. Those feelings can make you feel confused or uncomfortable. Tell me what you have been feeling since the changes started.

• What worries you most about COVID-19?

• Have you been feeling nervous about going back to school because of COVID-19?

• Wearing masks and staying at a distance from others is not something we were used to doing. How do you feel about those things?

• When our minds are stuck on bad things, it can be really hard to focus on other things. Have you ever felt this way? What kinds of things does your mind get stuck on?

• Is there anything that you are looking forward to, for when we can connect in-person more safely and return to more normal activities—like a vacation, movie, graduation or playing on a sports team? Tell me about what that might look like.

● School shutdown is also a chance to develop better relationships with our children and teenagers.

● One-on-one time is free and fun. It makes children feel loved and secure, and shows them that they are important.

○ Set aside time to spend with each child.

• It can be for just 20 minutes, or longer. It can be at the same time each day so children or teenagers can look forward to it.

○ Ask your child what they would like to do.

• Choosing builds their self confidence. If they want to do something that isn’t OK with physical distancing, then this is a chance to talk with them about this.

• Listen to them, look at them. Give them your full attention. Have fun.

• Switch off the phone and TV.

● Ideas with your baby/toddler.

○ Copy their facial expression and sounds.

○ Sing songs, make music with pots and spoons.

○ Stack cups or blocks.

○ Tell a story, read a book or share pictures.

● Ideas with your young child.

○ Read a book or look at pictures.

○ Make drawings with crayons or pencils.

○ Dance to music or sing songs!

○ Do a chore together – make cleaning and cooking a game.

○ Help with school work.

● Ideas with your teenager.

○ Talk about something they like: sports, music, celebrities, friends.

○ Cook a favorite meal together.

○ Exercise together to their favorite music.

● It may be challenging at times to feel positive when our kids or teenagers are around us all day long. We often end up saying “Stop doing that!” But children are much more likely to do what we ask if we give them positive instructions and lots of praise for what they do right.

○ Say the behaviour you want to see.

• Use positive words when telling your child what to do; like "Please put your clothes away" (instead of "Don’t make a mess").

○ When children misbehave:

• Stop it before it starts. When they start to get restless, you can distract with something interesting or fun: “Come, let’s play a game together.”

• Give your child a choice to follow your instruction before giving them a consequence you are sure you can follow through.

○ Speak in a calm voice.

• It’s all in the delivery. Shouting at your child will just make you and them more stressed and angrier. Get your child’s attention by using their name.

• Give yourself a 10-second pause. Breathe in and out slowly five times. Then try to respond in a calmer way.

○ Praise your child when they are behaving well

• Try praising your child or teenager for something they have done well. They may not show it, but you’ll see them doing that good thing again. It will also reassure them that you notice and care.

• One-on-One time, praise for being good, and consistent routines will reduce difficult behaviour.

• Give your children and teens simple jobs with responsibilities. Just make sure it is something they are able to do. And praise them when they do it.

○ Get real.

• Can your child actually do what you are asking them? It is very hard for a child to keep quiet inside for a whole day but maybe they can keep quiet for 15 minutes while you are on a call.

○ Help your teen stay connected.

• Teens especially need to be able to communicate with their friends. Help your teen connect through social media and other safe distancing ways. This is something you can do together, too.

• Information for adolescents and teens is available in this section.

● COVID-19 has changed our familiar daily work, home and school routines. This is hard for children, teenagers and for you. Making new routines can help.

○ Create a flexible but consistent daily routine.

• Make a schedule for you and your children that has time for structured activities as well as free time. This can help children feel more secure and better behaved.

• Children or teenagers can help plan the routine for the day – like making a school timetable. Children will follow this better if they help to make it.

• Include exercise in each day - this helps with stress and kids with lots of energy at home.

○ Teach your child about keeping safe distances.

• • • • • • • • If it is OK in your country, get children outside.

              • You can also write letters and draw pictures to share with people. Put them up outside your home for others to see!

              • You can reassure your child by talking about how you are keeping safe.

              • Listen to their suggestions and take them seriously.

○ Make hand washing and hygiene fun.

• • • • • • • • Make a 20-second song for washing hands. Add actions!

              • Give children points and praise for regular hand washing.

              • Make a game to see how few times we can touch our faces with a reward for the least number of touches (you can count for each other).

              • Hand hygiene includes:

● Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

● Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

● Washing hands with soap and water when they are visibly soiled.

● When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

• Respiratory hygiene includes:

● Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately, and washing your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Model the behavior for your child.

• • • • • • • • If you practice keeping safe distances and hygiene yourself, and treat others with compassion, especially those who are sick or vulnerable – your children and teenagers will learn from you.

○ At the end of each day, take a minute to think about the day. Tell your child about one positive or fun thing they did. Praise yourself for what you did well today.

● Children and teens are now spending a lot more time online. Being connected helps them reduce the impact of COVID-19 and encourages them to continue with their lives…but it also presents risks and dangers.

○ Online risks include:

• Adults targeting children for sexual purposes on social media, gaming, and messaging platforms.

• Harmful content – violence, misogyny, xenophobia, inciting suicide and self-harm, misinformation, etc.

• Teens sharing personal information and sexual photos or videos of themselves.

• Cyberbullying from peers and strangers.

● Tech fixes to protect your children online include:

○ Setting up parental controls.

○ Turning on SafeSearch on your browser.

○ Setting up strict privacy settings on online apps and games.

○ Covering webcams when not in use.

● Create healthy and safe online habits by:

○ Involving your child or teen in creating family tech agreements about healthy device use.

○ Creating device-free spaces and times in your house (eating, sleeping, and playing, schoolwork).

○ Helping your children learn how to keep personal information private, especially from strangers – some people are not who they say they are.

○ Reminding your children that what goes online stays online (messages, photos, and videos).

● Spend time with your child or teen online:

○ Explore websites, social media, games, and apps together.

○ Talk to your teen on how to report inappropriate content (see below).

○ Common Sense Media has great advice for apps, games and entertainment for different ages.

● Keep your children safe with open communication:

○ Tell your children that if they experience something online that makes them feel upset, uncomfortable, or scared, they can talk to you and you will not get mad or punish them.

○ Be alert to signs of distress. Notice if your child is being withdrawn, upset, secretive, or obsessed with online activities.

○ Create trusting relationships and open communication through positive support and encouragement.

○ Note that every child is unique and may use different ways to communicate.

○ Take time to adjust your message for your child's needs. For example, children with learning disabilities, may require information in simple format

● Millions are stressed about money because of COVID-19. It can make us feel exhausted, angry, and distracted. Children or teenagers asking for things can cause arguments. But we can do things that help cope with financial stress.

○ Involve children and teens in making a family budget.

• Making a budget together helps children understand that we all need to make hard decisions in difficult times.

• It also helps families to have enough at the end of the month and borrow less.

○ What do we spend now?

• Get a piece of paper (or old newspaper or a cardboard box) and a pen.

• Draw pictures of all the things that you and your family spend money on each month.

• Write next to each picture how much each thing costs.

• Add up how much money you have each month to spend.

○ Talk about needs and wants.

• Needs: Which things are important or must have for your family to survive? (like food, soap to wash hands, needs for family members with an illness or disability)

• Wants: Which things are nice to have but not essential?

• Discuss with your children what things you could try to spend less on.

○ Build your own budget.

• Find a bag of stones or anything with lots of pieces. This is your money for the month.

• As a family, decide what you will spend on what, and put the stones on your picture.

• If you can save even a tiny amount for the future, or for another emergency – it is great!

○ Find out if there is help you can get.

• Your government may be giving money, or food parcels to families during COVID-19.

• Ask about whether places in your community are giving support.

● Adolescents may be missing school, friends and their social life. It is important to provide them with extra support as well as the space to express themselves independently.

○ Spend time with your teen.

• Plan creative ways to communicate with friends and family (e.g. writing messages or drawing pictures).

• Cook a favourite meal together.

• Exercise together to their favourite music.

• Talk about something they like: sports, music, celebrities, friends.

○ Talk about COVID-19.

• Involve them in fact-finding and listen to their questions.

• Task them with exploring a topic and reporting back to the family from a radio programme, a newspaper article or the internet.

○ Share responsibilities.

• Teens appreciate having extra responsibilities. Allow them to choose a special job that helps out.

• Create a time during the day where everyone shares one thing that they enjoyed.

• Share responsibilities equally amongst women and men and girls and boys.

○ Make routines.

• Involve your teen in creating daily schedules.

• Set goals and rewards together.

• Make sure your teen has time to relax along with structured time for chores and schoolwork.

○ Deal with difficult behaviour.

• Talk through the effects of challenging behaviour.

• Explore alternatives with your teen and let them make suggestions.

• Decide together on clear and fair rules and boundaries.

• Praise your teen when they behave well and follow guidelines.

○ Promote kindness and compassion.

• Model kindness and compassion for those who are sick and those who are caring for the sick.

• Share how your teen can make a difference like standing up for someone facing discrimination or helping a neighbor with food deliveries if they live alone.

○ Help your teen manage stress.

• Teens will get stressed too - sometimes from different things than you.

• Allow them to express how they feel and accept their feelings.

• Try to listen to your teen and see things from their perspective.

• Do relaxing and fun activities together.

○ Keep your teen safe online.

• Involve your teen in creating family tech agreements about healthy device use.

• Help your teen learn how to keep personal information private, especially from strangers.

• Remind your teen that they can talk to you whenever they experience something upsetting online.

○ Information for adolescents and teens is provided in this section.

● Children and adolescents can be infected and spread COVID-19.

● COVID-19 is reported much less frequently in children than in adults.

● The burden of severe disease is in adults, however, children can develop serious illness.

● Studies to date show minimal spread among children under ten years.

● Infection occurs more often in teenagers than in younger children.

● Children and adults should follow the same guidance on self isolation if there is a risk they have been exposed or are showing symptoms.

● There are reports of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Children with MIS-C can have problems with their heart and other organs and should receive medical attention.

● Children with MIS-C have symptoms like persistent fever with a variety of signs and symptoms including multi-organ involvement and elevated inflammatory markers. Common symptoms include but are not limited to:

○ Irritability or decreased activity

○ Abdominal pain without another explanation

○ Diarrhea

○ Vomiting

○ Rash

○ Conjunctivitis (pink or red eyes)

○ Poor feeding

○ Red, cracked lips or red, bumpy tongue

○ Swollen hands and feet

● Not all children have the same symptoms, and symptoms may appear weeks after a child is infected with COVID-19.

○ It is possible that children and caretakers did not know that the child was infected with COVID-19.

● For children with high fever and symptoms, care takers should call their doctor. If the child is seriously ill, or showing any of these emergency signs, seek emergency care immediately.

○ Trouble breathing

○ Pain or pressure in the chest that does not go away

○ New confusion

○ Inability to wake or stay awake

○ Bluish lips or face

○ Severe abdominal pain

● MIS-C is not contagious, but it is possible that the child has COVID-19 or another infection that may be contagious.

● Most children who become ill with MIS-C will need to be treated in the hospital. Some will need to be treated in the pediatric intensive care unit (ICU).

○ Doctors may provide supportive care for symptoms (medicine and/or fluids to make your child feel better) and may use various medicines to treat inflammation.

○ Tests may include blood tests, chest x-rays, heart ultrasound, and abdominal ultrasound.

● Parents or caregivers who have concerns about their child’s health, including concerns about COVID-19 or MIS-C, should call a pediatrician or other healthcare provider immediately.

● Healthcare providers can follow recommendations from their national or local health authority to keep children and their parents or caregivers safe if an in-person visit is needed.

● What we don’t know about MIS-C at this point includes:

○ Why some children have gotten sick with MIS-C and others have not.

○ If children with certain health conditions are more likely to get MIS-C.

● If your child shows symptoms of COVID-19, seek medical care, and follow the instructions from the health care provider.

○ As with other respiratory infections like the flu, keep your child well rested at home while symptomatic, and avoid going to public places, to prevent spread to others.

● When possible, keep your child in class.

● If classes are suspended, follow the guidance of your local and national authorities on how to ensure your children can continue with their education.

○ Ensure appropriate supervision for children who are out of school, to allow for continued education and to protect them from COVID-19, and other potential threats when left unsupervised.

● If your child is staying at home because of school closures, continue teaching him or her good hand and respiratory hygiene practices.

○ Hand hygiene includes:

• Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Washing hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Respiratory hygiene includes:

• Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then disposeing of the used tissue immediately, and washing your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

● CDC provides a School Decision-Making Tool for parents, caregivers and guardians to help weigh the risks and benefits of available educational options in deciding whether to send their child(ren) back to school. It is organized to provide parents and caregivers with:

○ Information on COVID-19 and why safely reopening schools is important.

○ Tools to:

• Help you assess your child’s and your family’s risk of COVID-19.

• Consider factors that will help you make a choice, if offered, of instructional format (e.g. virtual, in person, or a hybrid option).

• Prepare for the school year, regardless of format.

● CDC also provides Back-To-School Planning Tools for parents, caregivers and guardians to help prepare and plan for some of the changes they may find when their children return to school.

● An important guiding principle to remember is that the more people children interact with, and the longer that interaction, the higher the risk of COVID-19 spread.

● While children may be spending time with other people as they return to daycare or school settings, it is important to remember that exposure to additional children and adults outside of daycare or school should be managed to decrease risk.

● For playdates, the risk of COVID-19 increases as follows:

○ Lowest risk: No in-person playdates. Children connect virtually (via phone calls and video chats).

○ Medium risk: Infrequent playdates with the same family or friend who is also practicing everyday preventive behaviors. Children maintain a distance of 1-2 meters (3-6 feet) from each other during the playdate. Playdates should be held outdoors, if possible. Indoor spaces are more risky than outdoor space where it might be harder to keep children apart and there is less ventilation.

○ Highest Risk: Frequent indoor playdates with multiple friends or families who are not practicing everyday preventive behaviors. Children do not maintain a distance of 1-2 meters (3-6 feet) from each other.

● While school is out, children should not have in-person playdates with children from other households.

○ Remember, if children meet outside of school in groups, it can put everyone at risk.

● If children are playing outside their own homes, it is essential that they remain 1-2 meters (3-6 feet) from anyone who is not in their own household.

● To help children maintain social connections while physical distancing, help your children have supervised phone calls or video chats with their friends.

● Make sure children practice everyday preventive behaviors, including hand hygiene which includes:

○ Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

○ Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

○ Washing hands with soap and water when they are visibly soiled.

○ When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

● Revise spring break plans if they include non-essential travel.

● Additional information on keeping you family safe in crowded conditions is in this section.

● Stay in touch with your child’s school.

○ Many schools are offering lessons online (virtual learning).

○ Review assignments from the school, and help your child establish a reasonable pace for completing the work.

○ You may need to assist your child with turning on devices, reading instructions, and typing answers.

○ Communicate challenges to your school. If you face technology or connectivity issues, or if your child is having a hard time completing assignments, let the school know.

● Create a schedule and routine for learning at home, but remain flexible.

○ Have consistent bedtimes, and get up at the same time, Monday through Friday.

○ Structure the day for learning, free time, healthy meals and snacks, and physical activity.

○ Allow flexibility in the schedule—it’s okay to adapt based on your day.

● Consider the needs and adjustment required for your child’s age group.

○ The transition to being at home will be different for preschoolers, K-5, middle school students, and high school students. Talk to your child about expectations and how they are adjusting to being at home versus at school.

○ Consider ways your child can stay connected with their friends without spending time in person.

● Look for ways to make learning fun.

○ Have hands-on activities, like puzzles, painting, drawing, and making things.

○ Independent play can also be used in place of structured learning. Encourage children to build a fort from sheets or practice counting by stacking blocks.

○ Practice handwriting and grammar by writing letters to family members. This is a great way to connect and limit face-to-face contact.

○ Start a journal with your child to document this time and discuss the shared experience.

○ Use audiobooks or see if your local library is hosting virtual or live-streamed reading events.

● Watch your child for any signs of illness.

○ If you see any sign of illness consistent with symptoms of COVID-19, particularly fever, cough, or shortness of breath, call your healthcare provider and keep your child at home and away from others as much as possible. Follow guidance on “What to do if you have symptoms."

● Watch for signs of stress in your child.

○ Some common changes to watch for include excessive worry or sadness, unhealthy eating or sleeping habits, and difficulty with attention and concentration.

● Take time to talk with your child or teen about the COVID-19 outbreak.

○ Answer questions and share facts about COVID-19 in a way that your child or teen can understand. Resources include:

• Helping Children Cope with Emergencies

• Talking with Children About COVID-19

• Stop the Spread of Rumors factsheet

• WHO visual tools and myth busters

● Teach and reinforce everyday preventive actions.

○ Parents and caretakers play an important role in teaching children to wash their hands.

○ Explain that hand hygiene can keep them healthy and stop the virus from spreading to others. Hand hygiene includes:

• Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Washing hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Be a good role model—if you wash your hands often, they’re more likely to do the same.

○ Make hand washing fun.

● Help your child stay active.

○ Encourage your child to play outdoors—it’s great for physical and mental health. Take a walk with your child or go on a bike ride.

○ Use indoor activity breaks (stretch breaks, dance breaks) throughout the day to help your child stay healthy and focused.

● Help your child stay socially connected.

○ Reach out to friends and family via phone or video chats.

○ Write cards or letters to family members they may not be able to visit.

○ Some schools and non-profit organizations, such as the Collaborative for Academic, Social, and Emotional Learning and The Yale Center for Emotional Intelligence, have resources for social and emotional learning. Check to see if your school has tips and guidelines to help support social and emotional needs of your child.

○ While school’s out, limit time with older adults, including relatives, and people with chronic medical conditions.

● Older adults and people who have serious underlying medical conditions are at highest risk of getting sick from COVID-19.

○ If others in your home are at particularly high risk for severe illness from COVID-19, consider extra precautions to separate your child from those people.

○ If you are unable to stay home with your child during school dismissals, carefully consider who might be best positioned to provide childcare.

○ If someone at higher risk for COVID-19 will be providing care (an older adult, such as a grandparent or someone with a serious underlying medical condition), limit your children’s contact with other people.

○ Consider postponing visits or trips to see older family members and grandparents. Connect virtually or by writing letters and sending via mail.

● It depends. As a parent or coach, follow the guidance of your local health authority and know the risk of COVID-19 transmission in your community.

● Understand the risks involved and limit your child’s risk:

○ Lowest risk: performing skill-building drills or conditioning at home, alone or with family members.

○ Increasing risk: team-based practice.

○ More risk: within-team competition.

○ Even more risk: full competition between teams from the same local geographic area.

○ Highest risk: full competition between teams from different geographic areas.

● Your child/player should:

○ Stay home if sick.

○ Bring their own equipment if possible.

○ Reduce physical closeness and practice physical distancing keeping 1-2 meters (3- 6 feet) of space between players when possible.

○ Wash their hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after practices, games, and sharing equipment.

○ Avoid physical contact, like high fives, handshakes, fist bumps, and hugs.

○ Cover their mouth and nose with their bent elbow or tissue when they cough or sneeze. Then dispose of the used tissue immediately, and wash their hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Avoid spitting.

○ Avoid sharing towels, clothing, or any items used to wipe their face or hands.

○ Keep their belongings separated from others, like their gym bag and equipment, when not in use.

○ Tell a coach or staff member if they don’t feel well.

● Parents, coaches and spectators should:

○ Allow players to focus on building individual skills, like batting, dribbling, kicking, and strength training.

○ Limit full contact between players to game days (avoid during practice).

○ Increase space between players in the practice areas, including on the sideline, dugout, and bench.

○ Encourage players to bring their own equipment, like gloves, balls, and helmets (if possible).

○ Clean and disinfect shared items between use.

○ Limit travel outside of your area.

○ Identify small groups and keep them together.

○ Limit nonessential visitors, spectators, and volunteers.

○ Coaches, parents, fans, officials, and sports staff should wear a cloth face covering.

• Don’t touch your cloth face covering. If you do, wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Parents, coaches, and sports administrators should decide if the kids need to wear cloth face coverings.

○ It’s most important to wear a cloth face covering when it’s hard to keep at least a 1-2 meter (3-6 feet) distance between people.

○ CDC Youth Sports Programs FAQ website provides additional information.

● In addition to the information above, UNICEF and WHO provide graphics addressing the following topics:

○ General parenting in the time of COVID-19

• • • 1. 1. 1. • • Talking about COVID-19

                 • Parenting tips to add structure

                 • Learning through play

                 • Keep calm and manage stress

                 • Keeping it positive

                 • One-on-one time

                 • When we get angry

                 • Family harmony at home

                 • When children misbehave

○ Parenting specific child groups/ages

• • • • • • • • Tips for children with disabilities

              • Parenting a new baby

              • Tips for parenting teens

○ Parenting specific situations

• • • • • • • • Keeping children safe online

              • Parenting in crowded homes and communities

              • Family budgeting in times of financial stress

● CDC provides COVID-19 Parental Resource Kits to help support parents, caregivers, and other adults serving children and young people in recognizing children and young people’s social, emotional, and mental health challenges and helping to ensure their well-being. These include:

○ Early childhood (0-5 years)

○ Childhood (6-12 years)

○ Adolescents (13-17 years) and

○ Young adulthood (18-24 years)

● CDC also provides a Toolkit for People 15 to 21 webpage including a summary of links designed for youth and young adults to keep them healthy as they venture out during the COVID-19 pandemic.

● Yes. Infected people in all age groups – including adolescents – can transmit the virus to other people, even if you have mild symptoms or do not feel ill.

○ The virus is spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs, sneezes, sings or speaks.

○ These droplets can spread through the air or land on objects and surfaces. People can then become infected by coming in contact with these droplets, and then touching their eyes, nose or mouth.

● If you have minor symptoms, such as a slight cough or a mild fever, there is generally no need to seek medical care.

○ Stay at home, self-isolate and monitor your symptoms. Follow guidance on self-isolation.

● Avoiding contact with others and avoiding visits to medical facilities will allow health facilities to operate more effectively and help protect you and others from possible COVID-19 and other viruses.

● Seek medical care if your health gets worse, or if there is no one in your family that can take care of you at home. It is important that you follow the procedures put in place by your country.

○ Ask a family member or another trusted adult how you can find out what these procedures are where you live.

● Seek medical care, if members of your family get seriously ill.

○ If possible, either you or an adult should phone the local or national COVID-19 emergency number for advice on where and how you could get care.

○ If your family member is confirmed as having COVID-19, you must be prepared that you and other known contacts will need to monitor your symptoms, and continue to self-quarantine for 14 days, even if you feel healthy.

● It is important to continue care and medication for chronic and other conditions, such as asthma, diabetes, HIV infection and TB, and attend recommended check-ups.

● WHO recommends that all vaccination in schools and mass campaigns should be postponed during the COVID-19 pandemic.

● It is important you get the vaccines you are supposed to get, even if they have to be delayed due to the COVID-19 pandemic.

● Vaccines provided to adolescents have sufficiently flexible schedules to make sure you can get the vaccine in time when vaccination services start again.

○ For example, the HPV vaccine that requires two doses can be started any time between 9 and 14 years of age and the interval between the two doses can be longer.

○ The minimum interval between doses is 6 months, but it can be 12 or 15 months and, if necessary, even longer. It is most important that you receive the second dose at some point in time to be fully protected.

● Decisions to continue routine vaccination services are made by each country.

○ Ask a family member or another trusted adult how you can get information about vaccination services where you live.

● Staying at home is difficult and can get boring, but it is still really important that you reduce your chances of being infected or spreading COVID-19 by:

○ Keeping 1 - 2 meters (3 - 6 feet) from other people, and avoiding crowded places.

○ Wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

• Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Wash hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

● You might become infected, or you could spread it to others and be responsible for them getting really ill or even dying.

● You have the power to make choices that could save lives and together young people can play an important part in fighting COVID-19.

● It may help reduce your boredom to do something you enjoy.

○ This could be reading a book, playing games or listening to music.

○ Try to stay connected with friends and family every day either by communicating with them by phone or internet if you can, or, if you live close to them and the local rules allow you to, by talking in-person while keeping your distance.

● You may be feeling loss or distress over the changes in your life during this time. Take steps to manage your stress.

● Explain to your friends why it is important to protect themselves and others by washing their hands (hand hygiene), avoiding touching their face, always coughing or sneezing into their elbow, sleeve, or a tissue (respiratory hygiene), and cooperating with physical distancing measures and movement restrictions.

○ Hand hygiene includes:

• Washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Using an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Washing hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Respiratory hygiene includes:

• Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then disposing of the used tissue immediately, and washing your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ We don’t know when the pandemic will end, but we know it depends on every individual’s contribution in helping stop the transmission.

• The sacrifices you have made by not seeing your friends and by stopping going to school and other activities are your contributions to fighting the pandemic.

• By putting societies and economies on hold, we have:

  • • Reduced the ability of the virus to spread through our communities, helping to limit some of the short-term impacts of the virus.

    • Given ourselves time to take what we have learned about COVID-19 and create solutions to help us get back to a more familiar way of living.

● You can share ideas for fun virtual activities that your friends can participate in and encourage them to do them together with you or with other friends. This way you are giving them alternatives rather than just telling them to stay at home.

○ Remember that you do not have control over other peoples’ actions so do not get into an argument or a fight to try to change their minds.

● Yes. You can still play sports that are in line with physical distancing measures and movement restrictions that are in place in your country.

○ Set up a regular routine to practice activities or sports that do not require close contact with others every day for 1 hour. You can:

• Do individual sports, like jogging, walking, dancing or yoga.

• Set up playground games indoors, such as jump rope and hop-scotch.

• Play with your brothers and sisters.

• Practice strength training activities using improvised weights like bottles full of water or sand.

○ If you have access to the internet, you can also join in online active games or fitness classes, or set up your own online physical exercises with your friends or classmates.

○ Find an activity that is fun, can be done within the restrictions that are in place in your country, and makes you feel good.

● If you play sports with others, the following are important:

○ Stay home if you are sick.

○ Bring your own equipment if possible.

○ Reduce physical closeness and practice physical distancing keeping 1-2 meters (3- 6 feet) of space between players when possible.

○ Wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after practices, games, and sharing equipment.

○ Avoid physical contact, like high fives, handshakes, fist bumps, and hugs.

○ Cover your mouth and nose with their bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately, and wash your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Avoid spitting.

○ Avoid sharing towels, clothing, or any items used to wipe your face or hands.

○ Keep your belongings separated from others, like your gym bag and equipment, when not in use.

○ Tell a coach or staff member if you don’t feel well.

● CDC Youth Sports Programs FAQ website provides additional information.

● In situations like a pandemic it is very normal to feel anxious and powerless, and that is ok. Here are a few suggestions on things that could help you proactively manage your anxiety:

○ Don’t ignore your feelings, especially if you don’t feel well. When your life is disrupted, it is normal to have many different feelings: worry, frustration, sadness, stress, anger, anxiety - this can happen to everyone.

○ Draw on skills and strategies you have used in the past that have helped you to manage life challenges, and skills to help you manage your emotions. Here are a few examples:

• Keep a diary.

• Express your feelings through art, like writing a poem, drawing, dancing, or playing music.

• Talk about your feelings and concerns with someone you trust.

• Try some breathing exercises. You may find guided breathing exercises online if you have access to the internet.

○ Do something active every day. Any exercise will help, as it reduces levels of the body's stress hormones, which can help your body and mind relax.

• Exercise also produces a “feel good hormone” called endorphins which can help to improve your mood.

• Try taking a walk, running, or any physical activity outdoors while keeping a distance from others. For those who are unable to leave the house, you could open the window for fresh air and do some indoor exercises to stay active.

○ Don’t use smoking, eating, alcohol or other drugs to deal with your emotions.

○ Stay connected with friends and family either by communicating with them by phone or internet if you can.

• If you live close to them and the local rules allow you to, you could also talk to them in person while keeping your distance.

○ Keep a daily routine as much as possible. Try to go to bed and wake up at the same time every day, making sure you get enough sleep.

○ Plan ahead and try to have a balance of activities such as keeping up with schoolwork, physical exercise, connecting with friends and family, doing things you enjoy, and eating regular meals.

○ Talk to a health worker or counsellor if you, or someone you care about:

• Feel overwhelmed with emotions like sadness, fears and worries.

• Feel like stress gets in the way of your daily routines.

• Feel like you want to harm yourself or others.