COVID Scenarios and Guidance

Documentation

A parent/guardian, if the symptomatic person is a minor, or adult may complete an After-Illness Return Attestation or verbally attest that criteria for ending isolation have been met. A note from a healthcare provider is not required. A staff person may self-attest or may complete an After-Illness Return Attestation that criteria for ending isolation have been met. A note from a healthcare provider is not required. RIDOH can provide a note to the confirmed case documenting release from isolation. RIDOH can provide a note to close contacts documenting release from quarantine.

Case isolation

Case isolation Confirmed case must isolate until CDC/RIDOH symptom-based criteria for ending isolation are met: For a symptomatic person who tests positive: Use the symptom-based strategy for discontinuing isolation: o Fever free for 24 hours (without use of fever medication); AND o Symptoms have improved; AND o 10 days since symptoms first appeared (20 days if severely immunocompromised). For an asymptomatic person who tests positive: Use the time-based strategy for discontinuing isolation: o 10 days since the date of specimen collection (20 days if severely immunocompromised). If symptoms develop, use the symptom-based strategy above. Note: The test-based criteria for ending isolation is not recommended. After a person is diagnosed with COVID-19 by a positive test and completed the recommended isolation, additional tests are not necessary or recommended and are strongly discouraged.

Close contact quarantine

Close contacts must quarantine for 14 days from the last day of exposure to the case. All close contacts should self-monitor for COVID-19 symptoms and promptly report any new symptoms to their healthcare provider, RIDOH, or school staff. If feasible, it is ideal for each close contact to quarantine in a location separate from the symptomatic person and from other close contacts. If a close contact is in the same household, the contact must quarantine throughout the case's isolation period (10 days) and for an additional 14 days after the date of the case's end of isolation. A household contact who has ongoing exposure to the confirmed case is usually quarantined for at least 24 days. RIDOH offers testing of close contacts through the K-12 COVID Test Scheduling Service for asymptomatic case finding. Testing negative is not an alternative to completing quarantine. Close contacts must quarantine for 14 days from the last day of exposure to the case. Close contacts who have tested positive in the last 90 days are assumed to have short-term immunity from COVID-19 for 90 days after infection. They do not have to quarantine but are instructed to self-monitor for symptoms and seek medical attention for any symptoms of COVID19.

Probable Case of COVID-19

One of the following symptoms: Cough Shortness of breath Difficulty breathing New loss of taste or smell or Two of the following symptoms: Fever Chills (rigors) Muscle aches (myalgias) Headache Sore throat Nausea or Vomiting Diarrhea Fatigue Congestion or runny nose

Scenario 3: Symptomatic student/staff member who tests positive (confirmed case)

RIDOH will notify The Met upon receipt of positive test results. If you learn of a positive test result from another avenue, notify RIDOH's COVID-19 unit by calling 401-222-8022. The confirmed case must continue to isolate and will receive a case investigation phone call from RIDOH. RIDOH calls the confirmed case and conducts a case interview and contact tracing. RIDOH will call The Met to obtain the list of close contacts from the school, to advise on further actions or closures, and to provide communications materials. RIDOH provides isolation instructions to the confirmed case. RIDOH calls close contacts and provides quarantine instructions. RIDOH counsels people who are diagnosed with symptomatic COVID-19 and remain asymptomatic after recovery that retesting is not recommended within 90 days after the date of symptom onset of the initial COVID-19 infection.

Scenario 4: Symptomatic student/staff member who tests negative on lab-processed PCR test

Symptomatic person who tests negative on lab-processed PCR test may return to work/school when: o They are fever free for 24 hours (without use of fever-reducing medication) AND o Symptoms have improved (back to usual health). Any household contact or other close contact(s) in quarantine may end quarantine. In certain cases, if there is a higher risk for, or clinical suspicion of COVID-19 due to symptom and exposure history, RIDOH may recommend continuing isolation for the symptomatic person and quarantine of close contacts or repeat testing of the probable case. A parent/guardian, if the symptomatic person is a minor, or adult may complete an After-Illness Return Attestation or verbally attest that criteria for ending isolation have been met. A note from a healthcare provider is not required. A staff person may self-attest or may complete an After-Illness Return Attestation that criteria for ending isolation have been met. A note from a healthcare provider is not required.

Scenario 1: Symptomatic student/staff member who is not a probable case

The symptomatic person is sent home and is advised to seek medical advice. Symptoms should be monitored, seek medical advice as needed, and obtain testing if advised. A COVID-19 test result is not required but should be considered with any presenting symptom(s) at the discretion of the treating healthcare provider. Some patients with COVID-19 have presented with only one mild symptom or atypical symptoms (i.e. only with diarrhea or other GI complaints) and patients or providers may prefer to test in situations even when the probable case definition is not met. For symptomatic students/staff, if a rapid diagnostic test result (PCR or antigen) is negative, a confirmatory diagnostic COVID-19 PCR test should be sent to a lab. The symptomatic student/staff may return to school/work when: o They are 24 hours fever free (without use of fever-reducing medication) and o Symptoms are improved (back to usual health). If the symptomatic person is a minor, a parent/guardian may complete the After-Illness Return Attestation or attest verbally that resolution of symptom criteria have been met. A note from a healthcare provider is not required. A staff person may attest verbally or may complete the After-Illness Return Attestation that resolution of symptom criteria have been met. A note from a healthcare provider is not required.

Scenario 2: Symptomatic student/staff member who is a probable case

The symptomatic person is sent home and is advised to seek medical advice. The staff member, student, or student's parent/guardian should schedule a COVID-19 test through the K-12 COVID Test Scheduling Service. Notify RIDOH's COVID-19 Unit of a probable case by entering the information into the probable portal on the day they exhibited symptoms. (Only assigned school staff can enter a probable case into the portal.) Probable case report includes: o Patient name and date of birth; o Parent/guardian name and phone number; o School or program attended; o History of symptoms and time of onset; and o Results of rapid test and/or name of the lab processing the sample. The symptomatic person must isolate at home while awaiting COVID-19 test results. Household contacts (roommates are considered household contacts) must quarantine pending the symptomatic person's COVID-19 test result. If feasible, it is ideal for each close contact to quarantine in a location separate from the symptomatic person and from other close contacts. Quarantine of additional close contacts pending probable case test results may be advised by RIDOH when one or more confirmed cases have occurred in the school within the past 14 days. Close contacts who have tested positive in the past 90 days do not have to quarantine. They are considered to have short-term immunity for 90 days after infection. When test results are obtained: o Follow Scenario 3 if probable case test result is positive. o Follow Scenario 4 if probable case test result is negative.