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COVID-19 Child Care Settings Webinar Middlesex and London Region August 10, 2020
Welcome Presenter: Dr. Alex Summers Associate Medical Officer of Health Middlesex-London Health Unit @alexsummers4 Mary Lou Albanese Manager, COVID-19 Program
Surveillance Report As of August 2 nd , 2020: • Over 18.2 million COVID-19 cases and over 693,000 deaths have been reported worldwide. • 39 537 cases of this illness confirmed in Ontario, including 2778 deaths • Local:
Child Care Centre Guidance Healthunit.com
Safe Healthy Children https://www.healthunit.com/ uploads/safe-healthy- children-a-health-and-safety- manual-for-childcare- providers.pdf
COVID-19 symptoms: Common symptoms of COVID-19 include: • Fever (temperature of 37.8 °C or greater) • New or worsening cough • Shortness of breath (dyspnea) Other symptoms of COVID-19 can include: • Sore throat • Difficulty swallowing • New olfactory or taste disorder(s) • Nausea/vomiting, diarrhea, abdominal pain • Runny nose, or nasal congestion – in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.
Atypical COVID-19 symptoms • Unexplained • Croup • Conjunctivitis fatigue/malaise/myalgias • Delirium (acutely altered • Multisystem inflammatory mental status and vasculitis in children • Presentation may include inattention) persistent fever, abdominal • Unexplained or increased pain, conjunctivitis, number of falls gastrointestinal symptoms • Acute functional decline (nausea, vomiting and • Exacerbation of chronic diarrhea) conditions • Chills • Headaches
Screening • Staff and children to be screened daily before entry • CCC to complete parent and child’s temperature check at the beginning of the day • Report from parent is not sufficient and end of day temperature checks not necessary • If the parent has a fever, the child should not attend the centre. The parent should self-isolate at home and get tested. If not getting tested, the child is to be excluded from daycare for 14 days • During business hours all people entering the centre need to be screened by CCC staff. A record must be kept.
Screening • Central screening for more than one program is allowable as long as centre can ensure physical distancing • Screeners need to wear a mask and eye protection when screening children – a non-medical mask is sufficient • Screeners can remove their mask once screening is completed. • If two metres physical distancing can’t be maintained within your cohort your mask should stay on. • Paper copies of daily screening to be kept for a minimum of 2 weeks.
What to do if a child shows COVID-19 symptoms: • Child would fail the screening prior to entering the centre • Not to be admitted to centre • Sent home to self-isolate and recommended to get tested • Instruct parent of ill child to wear a mask and monitor themselves for symptoms • Becomes ill with COVID-19 symptoms during course of the day, e.g. fever, watery diarrhea and/or vomiting, call parents immediately and recommend going for testing
Illness and Exclusion STAFF • Staff who fail the screen should be sent home to self- isolate and recommended to get tested • Individuals that test negative for COVID must be excluded until 24 hours after their symptoms resolve. • Individuals identified as a close contact of a confirmed case must be excluded for 14 days after their last exposure • Individuals that test positive for COVID must be excluded for 14 days after symptom onset and remain excluded until cleared by MLHU
Illness and Exclusion Algorithm
Illness and Exclusion CHILDREN • A child is to be sent home as soon as COVID- symptoms arise or as directed by the CCC’s policy. • When a child is sent home, the other children and staff in the cohort should monitor for symptoms. Siblings of the ill child are to be sent home too. • If a parent is ill, the child must be excluded from the centre. • Children with a runny nose, in the absence of an underlying reason, should be excluded and referred for testing. If an underlying reason exists (allergies, etc.) the child does not need to be excluded
Illness and Exclusion CHILDREN • Children that test negative for COVID must be excluded until 24 hours after their symptoms resolve. • Parents are not required to notify the CCC of their COVID- 19 test results • Children identified as a close contact of a confirmed case must be excluded for 14 days after their last exposure • Children that test positive for COVID must be excluded for 14 days after symptom onset and remain excluded until clearance by MLHU staff.
Illness and Exclusion • Staff and/or children are ill and not tested must be excluded for 14 days from symptom onset and be symptom free for 24 hours before they can return • If there is a COVID positive staff member, only close contacts will be required to quarantine or self- isolate. It’s important for staff to physically distance from other staff members to prevent exposure. • If enteric outbreak is declared at the centre, exclusions for children with enteric symptoms will be extended to 48-72 hours after symptoms resolve.
Illness and Exclusion Algorithm
Cleaning and Disinfection • Outside play equipment should be disinfected between cohorts • Sand and water tables are not able to be cleaned properly, therefore play in these should be suspended • Health Canada has a list of disinfectants to use against COVID-19 • If using a fogging system, routine manual cleaning and surface disinfection is still required
Cleaning and Disinfection • Disinfection of personal belongings aren’t required but should be stored in designated areas within a cohort. • Soiled personal belongings should be bagged and sent home with the parent at the end of the day.
Staffing • Face masks (medical or non-medical) are to be worn by all staff members when physical distancing is not possible • If staff is not able to wear a mask, centre operators are encouraged to find alternate work for staff members • Staff can leave the building on their break, but should complete proper hand hygiene upon re-entry. No re- screening is required • Staff encouraged to limit their locations of work as much as possible • Documentation must be maintained to show which staff members were working with a particular cohort of children
Staffing • Resource consultants should continue with virtual visits where possible. If they must visit multiple cohorts they should wear a mask, maintain physical distance, and practice frequent hand hygiene. • Cohorts should access the washroom separately, hand washing must be performed and supervised by staff members, frequently touched surfaces should be cleaned and disinfected at least twice a day or when soiled. Maintain a cleaning and disinfection log.
Masking • All staff are required to wear a mask if they cannot maintain two metres physical distance from either the children or other staff. • A face shield is not a replacement for a mask • ASTM Level 1 certification masks are acceptable for use by screeners and when caring for symptomatic children
Food Service • Meal services must ensure that there is no self-service or sharing of food or utensils between children • Each child is to be served on an individual plate • Staff members who distribute food should use utensils when serving • There are no changes to food handling or cleaning and sanitizing requirements in the kitchen • Outside food should only be brought in the centre when necessary. Clear procedure on storage, handling, and serving of these foods are required.
Reporting • CCC are not required to report all symptomatic staff and children to MLHU • MLHU is notified of all COVID-19 positive cases and will follow-up as necessary with CCCs
Other FAQs • Transportation can be offered if children are screened prior to boarding and children are limited to the same cohort. A different cohort can use the same vehicle after it has been disinfected. If a child must be held or carried during loading, a gown or blanket over the staff member’s clothing must be changed between children • You can sing outside while keeping two metres distance • Maximum number of children is 15 per cohort • The health unit will not report testing results to the CCC due to confidentiality. Parents are encouraged to communicate with the centre
Other FAQs • Workplaces can order PPE through: https://covid- 19.ontario.ca/workplace-ppe-supplier-directory • Questions related to symptomatic staff members or children, or for questions about screening and testing, etc. call MLHU 519-663-5317 and ask for the Outbreak and Facilities Team between 9a.m. and 6 p.m. Monday to Friday • Questions related to policies, procedures, infection prevention, and control call MLHU and ask for Infectious Disease Team
COVID-19 Briefing Webinars • The MLHU will be hosting weekly briefing webinars for community stakeholders • Held on Tuesdays at 12:30 p.m. to 1:00 p.m. • Please send your questions to covid@mlhu.on.ca
Contacting MLHU • Call 519-663-5317 • Monday to Friday 9:00 a.m. – 6:00 p.m. – For telephone calls and email communication with COVID investigators • www.healthunit.com
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