COVID-19 Guidance for Early Care and Education

Wearing Masks

All ECEs are required to adhere to any health officer orders requiring masking in the City of Pasadena, and to have plans in place to communicate such requirements to the workforce, visitors, parents and caregivers, and students. Unless the ECE site has elected to implement a more restrictive masking policy in order to provide a higher level of safety for all, the current Pasadena Public Health Department Health Officer Order recommends that all persons wear a mask and consider the current transmission when deciding which prevention behaviors to use and when (at all times or at specific times), based on their own risk for severe illness and that of members of their household, their risk tolerance, and setting-specific factors. The recommendation to mask applies to children 2 years (24 months) and older, employees, staff, volunteers, parents and caregivers, and all visitors to an ECE site. Some limited exceptions to the masking recommendations are identified in the Health Officer Order and below:

The following masking guidance is based on the current health officer order; however individual ECE providers, programs, and facilities may retain more restrictive policies:

• Employees*: At this time, ECE providers are required to offer upon request, for voluntary use, surgical-grade masks (also referred to as medical procedure masks) and higher-level PPE (e.g. KN95 or N95 respirator masks) to all ECE employees who work indoors or in vehicles around others. For those wearing surgical masks, double masking with a cloth face covering worn over the surgical mask is recommended for enhanced protection. Most cloth face coverings do not provide the same level of source control or personal protection as a proper surgical mask or higher-level PPE.
  • Consider also offering gloves for tasks such as serving food, diapering, handling trash, or using cleaning and disinfectant products.
• Masking with an upgraded mask may be required for a limited time both indoors and outdoors when around others in special circumstances such as a student or staff member in school who was recently isolating following a positive COVID-19 test or the onset of symptoms of COVID-19, or is quarantining after an exposure to a confirmed case.
• Mask Exemption Policy: At times when the Health Officer Order requires universal masking in indoor public settings including ECE sites, alternative protective strategies may be adopted to accommodate students who cannot tolerate masks or in situations where the use of masks is challenging due to pedagogical or developmental reasons (e.g., communicating or assisting those with special needs), student safety, or an existing disability. Individuals may be exempt from wearing a mask for the following reasons:
  • Persons younger than two years old.
  • Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
  • Persons with a medical condition, mental health condition, or disability or whose medical provider has determined that it is unsafe for them to wear a mask, may file for an exemption with their school. A certification from a state licensed health care provider attesting that the student has a condition or disability that precludes them from wearing a mask safely will be accepted as proof of exemption. The following licensed health care professionals may provide such attestations: Medical providers including physician (MD or DO), nurse practitioner (NP), or physician assistant (PA) practicing under the authority of a licensed physician; and licensed mental and behavioral health practitioners including Clinical Social Worker (LCSW), clinical psychologist (Psy.D.), Professional Clinical Counselor (LPCC), or Marriage and Family Therapist (LMFT).

At times when the Health Officer Order may require universal indoor masking, students who are exempt from wearing a mask are strongly recommended to wear a face shield with a drape at the bottom, as long as their condition allows it. Schools should enter into an interactive process with individuals who are exempt from wearing a mask and may choose to implement alternative protective strategies when accommodating such students in school. Alternative strategies to consider may include:

• Regular (weekly) screening testing of any unmasked students;
• Strategies to improve ventilation in indoor spaces that accommodate unmasked students;
• Seating unmasked students closer to open windows, exhaust fans, HVAC intake vents, and free standing air purifiers; and
• Offering students and staff who share indoor air spaces with unmasked students upgraded respirator masks (i.e., N95, KN95, or KF94).

Please Note: Regardless of universal indoor masking policy, the City of Pasadena Quarantine Order currently requires close contacts to a case who remain asymptomatic to wear a highly protective mask for 10 days after last exposure when around others while indoors, and to test at least once 3-5 days after exposure, if they wish to avoid quarantine at home. Students who are identified as close contacts with a valid mask exemption who wish to remain in school after an exposure must remain asymptomatic, monitor for symptoms for 10 days after last exposure, and test negative for COVID-19 at least once 3-5 days after exposure and once again 6-9 days after exposure. Students who are not able to meet these requirements and cannot wear a mask after exposure will need to remain at home for ten days after last exposure. Furthermore, students, staff, and administrators at schools must cooperate with instructions from PPHD outbreak investigators who may implement temporary strategies that differ from these protocols if an outbreak occurs at the school. For example, students who are unable to mask may be instructed to stay home during an active outbreak for the safety of those students and the campus population as a whole .

• For employees who are unable to wear a mask, refer to Cal/OSHA Emergency Temporary Standards (Cal/OSHA ETS) for return-to-work requirements after an exposure event.

* The terms “employees” and “staff” refer to individuals who work in an ECE site in any capacity associated with teaching, student support, site cleaning or maintenance, administration, or any other activity required for the ECE to function. “Employees” or “staff” may include individuals who are: paid directly by the ECE, paid by entities acting as contractors to the ECE, paid by outside entities acting in collaboration with the ECE to serve students, or unpaid volunteers acting under ECE direction to carry out essential functions. The term “parents” refers to any persons serving as caregivers or guardians to students.

Testing

Develop a plan or protocol for incorporating COVID-19 testing into regular ECE operations.

• At a minimum, the plan should describe the strategy for ensuring access to testing for students and employees, regardless of vaccination status, who are symptomatic or have known or suspected exposure to an individual infected with SARS-CoV-2. Note that the current (Cal/OSHA ETS) require employers to offer testing at no cost to employees during paid time for:
  • • Symptomatic employees, regardless of vaccination status or known exposure.
    • All employees after an exposure with the exception of staff close contacts who were previously infected with COVID-19 within the last 90 days.
    • All employees in an outbreak (3 or more employee cases), regardless of vaccination status.
• The ECE may consider a strategy for periodic testing for asymptomatic individuals with no known exposure.
• Please note: Screening testing is not recommended for persons who have recovered from laboratory confirmed COVID-19 within the past 90 days and are asymptomatic.

Symptom Screening and Responding to Cases

Maintain signage to remind everyone who enters your establishment that they should NOT enter if they have symptoms of COVID-19 or if they are under isolation.

Exclude any person or isolate any child or staff showing symptoms of a contagious disease or illness until they can be transported home, as required by CDSS Community Care Licensing Division (CCLD) and pursuant to Title 22 in CCR sections 101216(h), 101226.1(a)(1) and 102417(e).

• Isolate children who begin to have COVID-19 symptoms while in care from other children and staff.
• Ensure that isolated children continue to receive adequate supervision and that the health of the child is continually observed throughout the day according to licensing requirements.

Follow and educate families on public health guidelines for quarantine or isolation.

Daily symptom screenings are highly recommended to be conducted before students, visitors and staff enter the ECE. Screenings should include a check-in concerning symptoms consistent with possible COVID-19 and any other symptoms the individual may be experiencing. These checks can be done remotely (using a digital app or other form) or in-person upon arrival. A temperature check with a no-touch thermometer at entry should be included as part of the screening, if feasible, especially for visitors who may not be part of a systematic at-home screening process.

Initiate ECE Exposure Management Plan with guidance from the PPHD COVID-19 Exposure Management Plan to respond to and report all clusters of 3 or more COVID-19 cases to PPHD. The following elements are required:

• Reporting all clusters of 3 or more COVID-19 cases among employees, students, or visitors in a classroom, office, or pre-defined or identifiable group who were at the ECE at any point 14 days prior to the illness onset date to PPHD.
  • The illness onset date is the symptom onset date of the infected person, or for an asymptomatic person, the COVID-19 test date.
  • All cluster notifications should be reported to PPHD immediately, and no later than 1 business day of the school being notified of the third case within a 14-day period using the COVID-19 Case and Contact Line List for Education Sector. If needed, additional time may be requested. Secure (encrypted) online email via nursing@cityofpasadena.net is the preferred method for notifying PPHD of COVID-19 exposures; or FAX (626) 744-6115.
  • PPHD will work with the school to determine whether the cluster is an outbreak that will require a public health outbreak response.
• Family childcare homes must report a communicable disease outbreak, when determined by the local health authority, to CCLD through their local Regional Office pursuant to Title 22, CCR section 102416.2(c)(3). 

Maximizing Ventilation

• Verify the ECE site’s HVAC system is in good, working order. Consider having the HVAC system evaluated by an appropriate engineer familiar with the CDPH Ventilation Guidance for Reopening Schools and the American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Guidance for HVAC Systems. Upgrade HVAC filters to a higher efficiency (MERV-13 or higher rating is preferred).
• Consider installing portable high-efficiency air cleaners, upgrading the building’s air filters to the highest efficiency possible, and making other modifications to increase the quantity of outside air and ventilation in all working areas.
• Consider how to safely bring fresh air into the facility. When conditions allow, increase fresh outdoor air by opening windows and doors, adhering to fire and other safety standards. Consider using child-safe fans to increase the effectiveness of open windows; always position window fans to blow air outward, not inward. Existing fire codes requiring closure of fire-rated doors must be respected.
• Decrease occupancy in areas where outdoor airflow cannot be increased.
• If your business utilizes transport vehicles, such as buses or vans, it is recommended to open windows to increase outdoor airflow when it is safe to do so and weather permitting.

See CDPH Interim guidance for Ventilation, Filtration, and Air Quality in Indoor Environments and CDC Ventilation in Schools and Child Care Programs pages.

Hand Hygiene

Implement measures to promote frequent hand washing by staff, students, and visitors. These may include:

• Give students and staff frequent opportunities to wash their hands for 20 seconds. Wash hands with soap, rubbing thoroughly after application, and use paper towels (or single-use cloth towels) to dry hands thoroughly.
• Schedule students for frequent handwashing breaks, including before and after eating, after toileting, after outdoor play, and before and after any group activity.
• Instruct staff to model frequent handwashing to reinforce students’ healthy habits and monitor proper hand washing.
• Place handwashing stations or ethyl alcohol-based (contains at least 60% ethanol) hand sanitizer at entry and other convenient locations with signage promoting use. Be sure that hand sanitizer is out of the reach of children. Supervise children under the age of 6 when they use hand sanitizer to prevent swallowing alcohol or contact with eyes.
• Swallowing alcohol-based hand sanitizers can cause alcohol poisoning. Hand sanitizer should not be out in the open and should only be used with adult supervision for children under age 9. Inform faculty and staff of the risk of ingestion and that they should call Poison Control at 1-800-222-1222 if there is reason to believe that a student has consumed hand sanitizer.
• Provide hand sanitizer, soap and water, tissues and trash cans at or near the entrances, the main office reception area, other office spaces, and anywhere else inside the workplace or immediately outside where people have direct interactions.

Cleaning and Disinfection

Cleaning and disinfecting surfaces can reduce the risk of infection. Train and monitor staff to follow the infection control practices related to requirements for cleaning and disinfection, housekeeping and sanitation principles listed below:

• Follow cleaning and disinfection requirements as laid out in CCR sections 101216(e)(2), 102416(c), 101238(a) and 102417(b).
• Laundry, such as clothing and bedding, should be washed using the appropriate hot water setting and allow items to dry completely. If handling dirty laundry from a person who is sick, wear gloves and a mask.
• Use cleaning products that are effective against COVID-19 (listed on the Environmental Protection Agency (EPA) List N), and follow product instructions.
• The Healthy Schools Act requires that anyone using disinfectants at child care centers complete annual California Department of Pesticide Regulation-approved training. Online training can be found by going to the California School & Child Care Integrated Pest Management. Note: This does not apply to family child care homes.

For more information about cleaning and disinfection, see CDC guidance on Cleaning and Disinfecting Your Facility.

Communication

Post and maintain signage so that visitors who are entering your building are aware of policies, including the recommendation or requirement (per current City of Pasadena Health Officer Orders and the ECE’s policy) for all visitors, employees and children over 24 months to wear a face mask while indoors. Update your parent manual and online platforms to share ECE site’s COVID-19 safety policies with parents/caregivers and the public.

COVID-19 Mental Health Resource Guide

As the world continues to combat COVID-19, many children and their families continue to face challenges that can be stressful and overwhelming. It is natural to feel stress, anxiety, grief, and worry during the COVID-19 pandemic. If a child, family member or employee are having a hard time coping, help is available 24/7. For information about accessing local mental health services, refer to PPHD’s COVID-19 Mental Health Resource Guide, which includes listing of services that can help children, youth, and families cope during the pandemic.

Below are additional resources and recommendations to help in dealing with stress:

• California's playbook on Stress Relief during COVID-19 provides guidance on how to notice stress in kids and outlines tools and strategies on how to reduce stress for children and adults
• Promote healthy nutrition, sleep, and physical activity habits and self-care.
• Discuss and share stress reduction strategies with colleagues and families.
• Encourage staff and children to talk with people they trust about their concerns and feelings.
• Communicate openly and often with staff, children, and families about mental health support services available in the community.
• Consider posting signage for CalHOPE and the national distress hotline: 1-800-985-5990, or text “TalkWithUs” to 66746.
• Encourage staff to call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), 1-888-628-9454 for Spanish, or Lifeline Crisis Chat if they are feeling overwhelmed with emotions such as sadness, depression, or anxiety; or call 911 if they feel like they want to harm themselves or others.