State of California—Health and Human Services Agency
California Department of Public Health
RELATED MATERIALS: Safe Schools for All Hub | CDPH Shots for School | When and Why to Wear a Mask | Considerations when a Child has Symptoms of Illness in Child Care or School | CDSS Provider Information Notice (PIN 23-18-CCLD)
FROM: California Department of Public Health (CDPH), with consultation from California Department of Social Services (CDSS) and California Department of Education (CDE)
Updates as of October 2, 2023:
- Includes adding reference to Considerations when a Child has Symptoms of Illness in Child Care or School.
This guidance is intended to support safe, in-person learning and care in K–12 schools, child care, and related settings by mitigating the spread of communicable diseases.
The guidance builds upon a multi-layer strategy used to manage COVID-19 and serves as a general prevention framework to reduce the spread of multiple types of infections, including COVID-19, influenza, respiratory syncytial virus (RSV), and norovirus. Strategies are guided by the principle that safe, in-person learning, and care are critical to the well-being and development of children.
This guidance provides considerations for various settings where children spend time, including but not limited to the following:
- Licensed child care centers and family child care homes
- Licensed-exempt child care providers
- Early childhood education sites, including preschools
- K–12 schools (public and private)
- Before/after-school programs
- Summer school/intersession programs
For ease of reference, these settings are collectively referred to as “schools and child care” throughout this document.
Additionally, many of the strategies used to reduce transmission of infections can also protect against harmful enviromental effects. California school administrators and child care providers should consider the approaches described below as potential methods to protect children and staff from allergens, pollutants, wildfire smoke, and other external causes of illness and disease.
The guidance is based on best available scientific and epidemiological knowledge. It is subject to change.
1. This guidance provides general recommendations, and the provided references are not intended to be comprehensive. It does not replace or revise existing laws or requirements that apply to schools and child care. Information about certain relevant requirements may be found throughout this guidance and other relevant requirements may also exist.
2. CDPH supports the authority of local health departments, local educational agencies, and California Department of Social Services (CDSS) to maintain or establish additional guidance, including required actions, for facilities in their respective jurisdictions. Licensed child care providers may continue to maintain or establish additional guidance for their licensed facility, so long as the guidance does not conflict with licensing laws.
3. In workplaces, employers are subject to the Cal/OSHA COVID-19 Prevention Non-Emergency Regulations, and in some workplaces the Cal/OSHA Aerosol Transmissible Diseases Standard (PDF).
4. Local health departments or state agencies may implement additional requirements that go beyond this statewide guidance based on local circumstances. If there are differing requirements between the most current CDPH, Community Care Licensing (CCL), Cal/OSHA, and local health department guidance or health orders, providers should follow the strictest requirements.
5. When applying this guidance, confer with local health officials and consider the factors listed below. An assessment of the complete situation, rather than any one single factor, is recommended.
- Vaccination coverage in the community and among children, teachers, and staff;
- Local disease outbreaks or transmission patterns;
- Facility-specific indoor air quality;
- Availability and accessibility of resources, including masks and tests;
- Availability and capacity of school and child care;
- Population served, with attention to individuals at high risk for severe disease and immunocompromised populations;
- Community input, including from children, families, and staff; and
- Socioeconomic, cultural and linguistic barriers that may disproportionately impact populations and that increase the risk of infection, limit access to health care services and reduce the adoption of recommendations.
6. It is recommended that school administrators and child care providers communicate their health and safety strategies to children, parents, and staff, utilizing multiple strategies including parent communications and on-site reminders. Communication should be appropriate to the languages and literacy levels of community members.
7. This document updates and replaces the following guidance documents:
- COVID-19 Guidance for Child Care Providers and Programs.
- COVID-19 Public Health Guidance for K–12 Schools to Support Safe In-Person Learning, 2022–2023 School Year.
- Preliminary Testing Framework for K–12 Schools for the 2022–2023 School Year, pursuant to California Education Code section 32096.
Staying Up to Date on Vaccinations
Vaccinations (also referred to as “immunizations”) can help protect against certain diseases by working with the body’s natural defenses to safely build immunity to disease. Vaccinations protect the person who receives the vaccination. In addition, if many people are vaccinated, this may reduce the burden of disease in communities and protect individuals who are not vaccinated and individuals who may not develop a strong immune response from vaccination.
- Encourage children, families, and staff to stay up-to-date on all vaccinations recommended by their health care provider.
- Review vaccination requirements for entry into K–12 schools and pre-K/child care settings. Visit the CDPH Shots for School site for resources related to school or child care immunization requirements.
- Of note, COVID-19 and influenza vaccines are not currently included in the list of required immunizations for school or child care (see Title 17, Cal. Code of Regulations, section 6000 et seq.). However, both COVID-19 and influenza vaccination can greatly reduce the risk of serious illness, outbreaks, absences and school disruptions, and is strongly recommended for all eligible people in California, including children, providers, teachers, staff and individuals sharing homes with child care community members. More information may be found at CDPH Get the Facts on COVID-19 Vaccines.
- Work with local health departments and/or community partners to conduct school-located vaccine events whenever possible. This includes hosting events in the fall to protect against winter respiratory viruses, and events in the spring or summer to administer vaccines for school admission and grade advancement.
Optimizing Indoor Air Quality
The risk of getting and spreading respiratory infections is greater in indoor settings with poor air quality. Effective ventilation and filtration can reduce the spread of these infections and may also protect students, children, and staff from exposure to wildfire smoke, airborne allergens, and other pollutants.
1. Follow CDPH recommendations to improve indoor air quality. Facility maintenance staff may also review technical considerations (PDF). Note that although the air quality guidance was developed to manage COVID-19, many of the recommendations also reduce the spread of other airborne pollutants and other respiratory infections.
2. Optimize ventilation in transport vehicles, such as buses or vans. Open windows to increase airflow from outside when feasible and safe to do so.
3. In circumstances where outdoor air quality is poor (such as from wildfire smoke), consult with local health department officials to determine the best approach forward and also consult CDC guidance on Ventilation in Schools and Childcare Programs. Considerations include using:
- Air filtration strategies that do not rely on outdoor air sources, such as portable air cleaners;
- Use of alternative spaces with better air quality;
- Keeping windows and doors closed to not introduce outdoor air;
- Use of higher quality face masks (e.g., N95s, KN95s, or KF94s) as detailed in the CDPH When and Why to Wear a Mask; and
- Use of alternative ways to commute to/from school.
4. Whenever possible, and in compliance with relevant laws, facility HVAC upgrades can improve indoor air quality while supporting energy efficiency.
Using Face Masks
Face masks, particularly high-quality and well-fitting masks, are effective, inexpensive, and easy to implement tools to protect oneself and others.
No person can be prevented from wearing a mask as a condition of participation in an activity or entry into a venue or business including schools or childcare, unless wearing a mask would pose a safety hazard.
1. Support access to face masks.
- Develop and implement local protocols to provide appropriately sized, high-quality masks to children who do not have one and desire to use one.
- As noted in Cal/OSHA COVID-19 Prevention Non-Emergency Regulations, “Employers shall provide face coverings and ensure they are worn by employees when required by a CDPH regulation or order.”
2. Unless otherwise directed by local health departments, follow CDPH Guidance to When and Why to Wear a Mask, including the following:
- Consider wearing a mask around others if you have respiratory symptoms (e.g., cough, runny nose, and/or sore throat).
3. The following individuals should not wear face masks:
- Infants and children younger than 2 years old because of the risk of suffocation;
- All persons when they are eating or sleeping;
- Persons with a medical condition, mental health condition, or disability that precludes wearing a mask safely and effectively. This includes persons with a medical condition for whom wearing a mask could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a mask without assistance; and
- Persons for whom wearing a mask would create a safety hazard to the person related to their work, as determined by local, state, or federal regulators or workplace safety guidelines.
Maintaining Good Hygiene
Keeping hands clean with frequent hand washing can help prevent the spread of communicable diseases. Other good hygiene practices can also protect the health of students and staff at school and child care facilities.
- Ensure adequate supplies, including soap and water, tissues, and no-touch trashcans.
- If used, hand sanitizers should contain at least 60 percent alcohol and should be stored up, away, and out of sight of younger children. Supervise children ages 5 years and younger to avoid ingestion and eye contact. Hand sanitizer is not recommended for children under 24 months.
- Teach and reinforce proper handwashing to lower the risk of spreading communicable diseases. Handwashing with soap and water is preferred over the use of hand sanitizers and is the only effective way to remove or neutralize some pathogens.
- Teach and reinforce the practice of covering coughs and sneezes to help keep individuals from spreading communicable diseases.
- Discourage sharing of personal items such as cups, food, utensils, water bottles, lip balm, cell phones, and makeup.
Managing Individuals with Symptoms
Staying home when sick can lower the risk of spreading communicable diseases.
- For suspected or confirmed COVID-19 infection, follow CDPH COVID-19 Isolation Guidance.
Follow guidance for when a child has symptoms of illness in a school or child care to support decision-making about whether to send children home or permit them to remain on site.
- Avoid policies that incentivize coming to school or child care while sick.
- Support access to education resources and health-related information (such as AAP Healthy Children) when appropriate.
Reporting diseases to local health departments and other authorities and responding to outbreaks
Notifying local health departments and other authorities about communicable diseases and potential or confirmed outbreaks in schools and child care can facilitate deployment of additional strategies and resources to contain transmission.
1. Review reporting regulations.
- Schools should review California Code of Regulations (CCR) Title 17 §2500 and §2508 for reporting requirements. Note that CCR Title 17 §2500 has been temporarily modified by the State Public Health Officer Order of October 4, 2022.
- Child care centers (CCR Title 22 section 101212(d)) and family child care homes (CCR Title 22 section 102416.2(c)(3)) should also review Child Care Licensing requirements for outbreak reporting and consult their local regional office (PDF) for assistance.
- Workplaces, schools and certain child care providers are subject to COVID-19 workplace outbreak reporting requirements set forth in Cal/OSHA COVID-19 Non-Emergency Regulations FAQ.
2. Typically, local health departments will lead response to disease outbreaks and provide recommendations on next steps, including assessing possible exposures.
- Recommendations for exposure notifications and symptom monitoring should be guided by the local health department. School administrators and child care providers should support the local health department in contact tracing efforts.
- Local health department officials are encouraged to contact CDPH for consultation as needed to address outbreaks. See CDPH Workplace Outbreak Employer Guidance for more information.
Clean and well-maintained facilities reduce the spread of communicable diseases that are transmitted by contact with contaminated or high touch surfaces.
- Routine daily cleaning with water and mild detergent is generally sufficient to remove most bacteria and viruses from surfaces, although additional sanitization might be necessary during certain disease outbreaks.
- School administrators and child care providers should consult with local health departments when there is an outbreak.
- Drinking fountains should be open for use by students and staff. Routine cleaning is recommended.
- Train and monitor staff to follow the infection control practices for cleaning and disinfection, housekeeping and sanitation principles, and universal health precautions. The Healthy Schools Act requires anyone who uses disinfectants at a school or child care center to complete the annual California Department of Pesticide Regulation-approved training. Note: This requirement does not apply to family child care homes.
Testing can detect and reduce transmission of communicable diseases. At-home antigen-based testing, currently widely available for COVID-19, provides individuals with convenient, rapid, and accurate test results.
- For COVID-19:
- Facilitate access to COVID-19 testing. Review testing resources offered by healthcare insurers, local, state, and federal sources and share this information with your community. Review CDPH school specific resources and the CDPH Testing site.
- Follow the CDPH COVID-19 Isolation and Quarantine Guidance for guidance on what to do when exposed or when testing positive for COVID-19 and see additional information on where to obtain COVID-19 tests in the CDPH COVID-19 Testing site.
- Additional testing can be considered in situations where there are COVID-19 surges or outbreaks and for individuals with increased risk of getting severe COVID-19. Consult with your local health department for further guidance.
- Follow Cal/OSHA COVID-19 Non-Emergency Regulations for guidance on when employee testing is required.
At this time, there are no widely available at-home tests for the vast majority of communicable diseases. When testing is available (e.g., influenza and RSV), it should be considered by a healthcare provider based on related symptoms. Testing is generally not recommended to receive clearance to return to school or child care.
Considerations for children with disabilities or other health care needs: When implementing this guidance, schools should carefully consider how to address legal requirements related to the provision of free appropriate public education. School administrators and certain child care providers must also ensure compliance with the Americans with Disabilities Act (ADA) and afford reasonable accommodation to children with disabilities. For additional recommendations for children with disabilities or special health care needs, refer to guidance provided by the American Academy of Pediatrics (AAP). Note that although the AAP guidance was developed to manage COVID-19, many considerations are broadly applicable in schools and child care.
Considerations for higher risk activities: Certain activities that involve close physical contact and/or increased and forceful exhalation can pose increased risk for getting and spreading communicable diseases, particularly if conducted indoors, in poorly ventilated settings, and/or without the use of masks. Accordingly, school administrators and child care providers may consider implementing additional measures to mitigate transmission in these settings, particularly during disease outbreaks or increased rates of community transmission of certain diseases. Consultation with local health departments is recommended.
Considerations for in-person learning: Broad disruptions to in-person learning, such as temporary closures of schools, classrooms, or child care settings due to a communicable disease outbreak should remain a last resort and be considered only after all available resources have been exhausted and after conferring with local health department officials.
Considerations for direct service providers at K–12 schools or child care settings: It is important to allow access for these providers (including persons providing vision, hearing, or dental screening) when developing disease mitigation procedures.
Considerations for boarding schools and programs that may operate residential components: Persons residing in congregate settings are at increased risk of contracting and spreading communicable diseases. Accordingly, such settings should have infection control plans that use multiple strategies described in this guidance to create a “layered” approach to preventing the spread of disease.