Author: COVID-19 NEWS
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Why practice social distancing?
COVID-19 spreads mainly among people who are in close contact (within about 6 feet) for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. Since people can spread the virus before they know they are sick, it is important to stay at least 6 feet away from others when possible, even if you—or they—do not have any symptoms. Social distancing is especially important for people who are at higher risk for severe illness from COVID-19.
If you are sick with COVID-19, have symptoms consistent with COVID-19, or have been in close contact with someone who has COVID-19, it is important to stay home and away from other people until it is safe to be around others.
COVID-19 can live for hours or days on a surface, depending on factors such as sunlight, humidity, and the type of surface. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes. However, this is not thought to be the main way the virus spreads. Social distancing helps limit opportunities to come in contact with contaminated surfaces and infected people outside the home.
Although the risk of severe illness may be different for everyone, anyone can get and spread COVID-19. Everyone has a role to play in slowing the spread and protecting themselves, their family, and their community. In addition to practicing everyday steps to prevent COVID-19, keeping space between you and others is one of the best tools we have to avoid being exposed to this virus and slowing its spread in communities.
For people who have been in close contact with someone who has COVID-19
The following information can be used to counsel breastfeeding dyads on isolation and quarantine practices as well as precautions to take while feeding at the breast, expressing milk, or feeding from a bottle when one or both members of the dyad has been in close contact with someone who has COVID-19. When counseling people with specific living situations, additional information on isolation and quarantine when living in close quarters or living in shared housing during the COVID-19 pandemic can be considered.
Scenario: Breastfeeding person has been in close contact with someone who has COVID-19, but breastfed child has not been in close contact with anyone who has COVID-19
Isolation and quarantine
The breastfeeding person should quarantine themselves for 14 days after their last contact with the person who has COVID-19.
The breastfed child should be monitored for signs or symptoms of COVID-19 but does not require quarantine unless the breastfeeding parent develops COVID-19 symptoms or receives a positive viral test result.
Precautions while feeding at the breast, expressing milk, or feeding from a bottle
During the breastfeeding person’s period of quarantine, they should follow precautions for feeding at the breast, expressing milk, and feeding from a bottle as if they have suspected or confirmed COVID-19 as instructed above.
If the breastfeeding person develops symptoms of COVID-19 or receives a positive viral test result, they should continue these precautions, extending the time frame for taking such precautions to the end of their recommended period of home isolation.
Scenario: Breastfed child has been in close contact with someone other than the breastfeeding person who has COVID-19 (e.g., another caregiver, childcare provider), but breastfeeding person has not been in close contact with anyone who has COVID-19
Isolation and quarantine
The breastfed child should be quarantined for 14 days after their last contact with the person who has COVID-19.
The breastfeeding person should be monitored for signs or symptoms of COVID-19 but does not require quarantine unless the breastfeeding child develops COVID-19 symptoms or receives a positive viral test result.
Precautions while feeding at the breast, expressing milk, or feeding from a bottle
Because of the danger of suffocation, masks should NOT be put on children younger than 2 years.
To minimize possible exposure, breastfeeding people may choose to take precautions as recommended above for those with suspected or confirmed COVID-19 while feeding at the breast, expressing milk, or feeding from a bottle. This includes wearing a mask during any close contact (i.e., less than 6 feet) with the child and cleaning their hands frequently (i.e., before and after touching their child).
Other considerations
If the breastfed child develops symptoms or receives a positive viral test result and the breastfeeding person in this dyad is at increased risk of severe COVID-19 illness, healthcare providers may counsel the breastfeeding person on risks and benefits of continuing to feed at the breast during the child’s COVID-19 illness.
Scenario: Both the breastfeeding person and breastfed child have been in close contact with someone who has COVID-19
Isolation and quarantine
The breastfeeding person and breastfed child should both be quarantined for 14 days after their last contact with the person who has COVID-19.
If either or both member(s) of the dyad develops symptoms or receives a positive viral test result, that person(s) should follow information on home isolation.
If only one member of the dyad develops symptoms or receives a positive viral test result, the uninfected member of the dyad should be quarantined for the duration of the recommended period of home isolation and 14 days thereafter.
Precautions while feeding at the breast, expressing milk, or feeding from a bottle
During the quarantine period, the breastfeeding person should follow precautions for feeding at the breast, expressing milk, and feeding from a bottle as if they have suspected or confirmed COVID-19 as instructed above.
If the breastfeeding person develops symptoms of COVID-19 or receives a positive viral test result, they should continue these precautions, extending the time frame for taking such precautions to the end of their recommended period of home isolation.
If the breastfeeding child develops symptoms of COVID-19 or receives a positive viral test result, breastfeeding people may choose to take precautions as recommended above for those with suspected or confirmed COVID-19 while feeding at the breast, expressing milk, or feeding from a bottle. This includes wearing a mask during any close contact (i.e., less than 6 feet) with the child and cleaning their hands frequently (i.e., before and after touching their child).
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Considerations for well-child visits
Healthcare providers are encouraged to prioritize newborn care and vaccinations. Every effort should be made to conduct newborn follow-up visits in person. During in-person visits, healthcare providers should evaluate feeding and weight gain (particularly given potential breastfeeding disruptions due to COVID-19 illness), assess for dehydration and jaundice, assess caregiver stressors and coping, and provide appropriate supports.
As instructed above, breastfeeding people should be counseled to inform their child’s healthcare provider that either their child, or the caregiver bringing the child, has had close contact with a person suspected or confirmed to have COVID-19 prior to any in-person healthcare visits or if the child develops symptoms of COVID-19. The same approach should be taken with respect to a child who has any other ongoing, close contact with another person who has suspected or confirmed COVID-19.
Healthcare providers should consider how to minimize exposure to COVID-19 for patients, caregivers, and staff in the context of their local COVID-19 epidemiology and practice environment. Information is available for pediatric healthcare providers as well as on the delivery of non-COVID-19 clinical care and infection prevention and control in healthcare settings.
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Considerations for lactation services
Lack of access to professional lactation support (e.g., lactation consultants, pediatric or obstetric healthcare providers) is a barrier to breastfeeding. During the COVID-19 pandemic, it is critical to ensure that people who are breastfeeding or who desire to breastfeed continue to have access to this support. Breastfeeding problems are often urgent and require immediate assistance. Further, breastfeeding consults typically require very close contact between the lactation specialist and the lactating caregiver-child dyad; therefore, the use of appropriate personal protective equipment (PPE) is essential.
During the COVID-19 pandemic, lactation specialists should use alternative approaches, such as telemedicineexternal icon, to provide lactation support services whenever possible, particularly when providing support to breastfeeding dyads with suspected or confirmed COVID-19.
In-person support may be necessary to effectively support some breastfeeding dyads. Further, not all families may have access to telemedicine. Lactation support is delivered in a variety of settings including outpatient clinics or offices or in the breastfeeding person’s home. The following considerations address infection prevention and control measures including the use of PPE in outpatient and home settings.
In-person lactation visits in the healthcare setting (e.g., hospital, clinic, doctor’s office)
Lactation specialists working in healthcare settings should follow recommended infection prevention and control measures for those settings.
In-person lactation visits in a breastfeeding person’s home
Lactation specialists conducting home visits, breastfeeding people receiving in-home lactation services (hereafter, clients), and any other household members should screen themselves for COVID-19 as instructed below before entering the home as well as take necessary infection prevention and control measures detailed below.
Lactation specialists should stay home if they are sick with COVID-19, think they might have COVID-19, or have been in close contact with someone who has COVID-19. Refer all clients to another lactation specialist until the criteria for healthcare workers returning to work after SARS-CoV-2 infection have been met.
Screen clients by telephone for COVID-19 symptoms and recent exposure to people diagnosed with COVID-19 prior to conducting home visit. Keep in mind that screening for symptoms will not identify people who are asymptomatic or pre-symptomatic with COVID-19. If any person in the household has suspected or confirmed COVID-19, it is recommended that lactation services be provided via telemedicine for the recommended period of home isolation plus any additional recommended quarantine period for other household members.
If the client or any other household member has COVID-19 and in-home support is deemed necessary and critical, use all recommended personal protective equipment as described in Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) for caring for a patient with suspected or confirmed COVID-19.
If neither the client nor any of the household members is known to have suspected or confirmed COVID-19, wear a surgical mask while inside the client’s home. Discard disposable surgical masks between clients. Surgical masks offer both source control (i.e., blocking the spread of respiratory secretions from the wearer) and protection for the wearer against exposure to splashes and sprays of infectious material from others. Additionally, in communities with moderate to substantial community transmission, consider wearing eye protection in addition to a surgical mask to ensure that the eyes, nose, and mouth are all protected from exposure to respiratory secretions while providing breastfeeding support.
For all home visits regardless of the client or family’s COVID-19 status:
Require the client as well as any other household members aged 2 and older to wear a mask. Because of the danger of suffocation, do NOT put masks on babies or children younger than 2 years. Masks should also not be worn by anyone who has trouble breathing, is unconscious, cannot move, or is otherwise unable to remove the mask without assistance. Information on how to wear a mask is available.
When not providing hands-on support or close observation, stay at least 6 feet away from the client and others in the home. Masks should be worn at all times and are even more important when less than 6 feet apart.
Wear disposable gloves when touching the client or the child. Wash hands with soap and water for at least 20 seconds when entering and leaving the home, when adjusting or putting on or off masks, and before putting on and after taking off disposable gloves. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Learn more about proper handwashing. Safely dispose of gloves after use.
Clean and disinfect surfaces and equipment such as infant scales.
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Breastfeeding and expressing milk in workplaces
When counseling breastfeeding people on precautions to take prior to breastfeeding or expressing milk in workplaces, healthcare providers should discuss a person’s individual circumstances (e.g., level of exposure to people with suspected or confirmed COVID-19, availability and proper use of personal protective equipment). All people breastfeeding or expressing milk in workplaces should be counseled to clean their hands, as instructed above, before touching any pump or bottle parts. They should also follow CDC information on how to properly clean and sanitize breast pumps. If possible, a single-user pump should be used; if using a multi-user pump, CDC information on how to properly clean and sanitize breast pumps should be followed for disinfecting before and after use.
For breastfeeding people who work in settings with higher risk of potential exposure to SARS-CoV-2, such as healthcare providers and first responders, they should wear a mask while breastfeeding or expressing milk in the workplace. Additional information for healthcare personnel, including those who are pregnant or have underlying medical conditions from COVID-19, is available.
Employers should provide breastfeeding employees with a private, non-bathroom space for milk expression. Information is available on providing lactation break time and space in all industriesexternal icon. If a workplace has a multi-user lactation room, efforts should be made to implement engineering and administrative controls to enable physical distancing (e.g., spacing lactation stations at least 6 feet apart, installing physical shields between lactation stations, staggering lactation schedules, encouraging telework). There is evidence that SARS-CoV-2 may remain on surfaces for several hours to days. However, there is no evidence on whether precautions such as cleansing the breast (e.g., using soap and water) prior to breastfeeding or milk expression or disinfecting external surfaces of milk collection devices (e.g., bottles, milk bags) reduce potential transmission of SARS-CoV-2. Breastfeeding people may consider additional steps such as these to minimize potential routes of exposure. Additional information on disinfecting facilities, such as workplace lactation rooms, is available.
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Pasteurized donor human milk
Pasteurized donor human milk is important in the care of preterm infants when a lactating caregiver’s milk is not available. Current evidence suggests that breast milk is not a likely source of SARS-CoV-2 infection.1 Further, there are also data suggesting that pasteurization inactivates SARS-CoV-2 in donor human milk; therefore, pasteurized donor human milk is very unlikely to be a source of SARS-CoV-2 infection. Disruptions in human milk donations may be seen during the COVID-19 pandemic. If hospitals have difficulty acquiring donor human milk, available supplies should be prioritized for preterm infants who will benefit most from human milk feeds.
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Monitoring and Evaluation Findings May Be Useful to K-12 Schools
Monitoring and evaluation provides practical information for state and local public health and education agencies, school and district administrators, and evaluation professionals to make timely decisions to support health and safety of all students, faculty, and staff and to promote health equity.
Education and public health agencies, in collaboration, may use the example evaluation questions, indicators, and data sources below to develop a monitoring and evaluation protocol and determine a scope feasible for their situation. These are not exhaustive lists of questions, indicators, or data sources, and they may be adapted to align with community priorities and needs.
CDC’s Checklist of Key Considerations When Planning for Monitoring and Evaluation of COVID-19 Mitigation Strategies Implemented in K-12 Schools provides actionable considerations for determining the scope of a monitoring and evaluation plan.
Conducting monitoring and evaluation may help K-12 schools examine their unique circumstances and make the best proactive decisions for their students, teachers, and staff, including:
Identify which factors help or hinder effective implementation of COVID-19 mitigation strategies in K-12 schools to reduce the spread of SARS-CoV-2
Inform allocation of resources to effectively reduce the spread of SARS-CoV-2 in schools
Identify and communicate about needs for additional resources and support to effectively implement mitigation strategies in schools
Understand which mitigation strategies are effective in schools to reduce the spread of SARS-CoV-2, to maximize the positive outcomes while minimizing related negative consequences
Ensure the needs of individuals at increased risk and disproportionately affected populations are met
Inform decision-making about strengthening, focusing, and relaxing mitigation strategies (e.g., determining the optimal schedule for cleaning and disinfecting frequently touched surfaces in the school)
Assess how different populations participate in, and are affected by, school-based mitigation strategies to ensure the health and safety of all students, faculty, and staff and to promote health equity
Share data and lessons learned about practices to prevent and reduce spread of SARS-CoV-2 with key stakeholders, including local policy makers, education and health agency officials, school board members, superintendents, surrounding community, other district leaders, families, and caregivers
Potential Data Sources
Education and public health agencies, in collaboration, determine the best way to collect data for their local jurisdiction that reflects circumstances in their communities. State and local data already being collected are potential monitoring and evaluation data sources1. These data may include policies (e.g., stay-at-home orders, mass gathering restrictions, mask-wearing requirements, school or district policies and recommendations) and school administrative records1 (e.g., past and current student and faculty absenteeism, school cancellations, school plans for reopening, standardized testing scores). Primary data may also be collected, including from school-developed surveys, school district administration surveys, interviews, focus groups, health department community surveys, and others. CDC has several data sources related to school health that are available to health departments and school districts, including the CDC COVID-19 Data Tracker2 and the Youth Risk Behavioral Surveillance System (YRBSS)3.
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Example Questions, Indicators, and Data Sources
Here are example questions, indicators, and data sources that may be used to monitor and evaluate COVID-19 mitigation strategies implemented in K-12 schools.
1. Which mitigation strategies are being implemented in K-12 schools in my area (i.e., school, district, city, state), and how and when are they implemented?
Related qualitative and quantitative indicators
Policies, implementation, and adherence to mitigation strategies in schools to prevent and reduce the spread of SARS-CoV-2 among students, faculty, and staff, including but not limited to the following:
Use of distance learning, including hybrid designs, vs. in person
Symptom screening procedures (at-home vs. in-school)
Social distancing strategies in school, including modified layouts, physical barriers (e.g., desk dividers), one-way hallways, reduced class sizes, etc.
Modifications to class (i.e., cohorting or podding) and school operations (e.g., traffic flow in hallways, single entry/exit)
Plans to teach, reinforce, and/or require behaviors that reduce spread such as hand hygiene or use of masks for students, faculty, and staff
Protocols for cleaning and disinfection of frequently -touched surfaces and reducing sharing of common objects
Improvements to ventilation systems in buildings to optimize air flow
Availability and use of appropriate resources (e.g., masks, hand soap, hand sanitizer) to promote behaviors that reduce spread of SAR-CoV-2 for faculty staff, and students
Modifications for meals and food service, such as pre-plating and staggered meal service
Modifications to large gatherings, after-school sports, after-care, school events, field trips, and extracurricular activities
Considerations for students, faculty, and staff with developmental and behavioral disorders, with disabilities, or at increased risk for severe illness from COVID-19
Modifications of transportation to and from school, including school arrival and dismissal procedures, carpooling, changes to school bus service, and accessible transportation for students, faculty, and staff with disabilities
Plans for risk communication within schools, including posting of signs in visible locations, broadcast announcements, and provision of educational materials in accessible formats for individuals with disabilities or limited English proficiency
Policies for SAR-CoV-2 testing in school or upon returning to school
Plans for and implementation of educational sessions and professional development for students, faculty, and staff regarding COVID-19
Plans for and implementation of communication with parents, caregivers, and guardians on prevention of COVID-19 at school
Policies and plans for absenteeism, excused absences, and sick leave for students, faculty, and staff, including encouraging to stay home when sick, changes to remote learning, methods for students to make up lessons, and having back-up staffing plans
Policies and infrastructure for isolation of symptomatic students, faculty, and staff
Policies and plans in place for response to positive cases in students, faculty, and staff, including:
Notification to public health departments
Isolation of and safe transport of suspected/confirmed cases including a designated isolation area with a dedicated bathroom, if possible
Notification and engagement of parents, caregivers, and guardians, and sharing of deidentified information with broader community
Appropriate disinfection of areas used by sick persons
Notification and quarantine guidance for close contacts
Approach to return to school for cases and close contacts, including individuals at increased risk for severe illness
Thresholds for school and classroom closure
Plans for communication and collaboration with local and state public health officials
Plans for staying informed about increases/decreases in cases in the community and nearby schools/school districts
Modifications to social, behavioral, mental health resources and support for students, faculty, and staff
Potential data sources
School/District policies and recommendations
School administrative records
School-developed surveys
School district administration surveys
2. What are the facilitators, barriers, and factors that affect implementation of mitigation strategies in K-12 schools?
Related qualitative and quantitative indicators
School characteristics and infrastructure, including but not limited to the following:
School size, number of students
Range of class sizes, student-faculty ratio
Nurses
Availability of water for handwashing
Availability of classrooms with windows that open and other ventilation capacity
Availability of space or designated area to evaluate and isolate individuals who might be sick
Ability for single entry and single exit or one-way traffic flow in hallways
Ability to provide accommodations for specific populations of students, faculty, and staff for whom mitigation measures are not feasible or require additional adaptation
Available funding and resources to implement mitigation strategies
Available technology to support mitigation strategies
Available supplies, including cleaning and disinfection supplies, soap and water, hand sanitizer, and masks
Number and types of staff available to support the implementation (e.g., substitute faculty, bus drivers, school nurses, counselors, and other staff) of COVID-19 school mitigation strategies
School, staff, and parent willingness and ability to adopt virtual technology or use alternative teaching or learning methods if needed
Knowledge, attitudes, and practices for mitigation strategies among parents, caregivers, guardians, students, faculty, and staff
Misinformation or perceived stigma around COVID-19
Parental or community attitudes and involvement
Staff retention and/or attrition rates
Potential data sources
School-developed surveys
School administrative records
School policy records
Qualitative study (i.e., interviews, focus groups)
CDC COVID-19 Data Tracker2
3. Which factors contribute to K-12 schools’ decisions to strengthen, focus, or relax mitigation strategies over time?
Related qualitative and quantitative indicators
Availability of resources to implement mitigation strategies, including but not limited to:
Funding
Technology
Staff availability and hours
Supplies, including cleaning and disinfection supplies, soap and water, hand sanitizer, and masks
Educational materials
Readiness, needs, or community risk assessments findings
Guidance from public health or education agencies
Levels of SARS-CoV-2 transmission within the school and community (e.g., percent positivity, trends in case counts, number and size of outbreaks in K-12 schools)
Potential data sources
4. What is the association between implementation of mitigation strategies and minimizing COVID-19 associated morbidity and mortality in K-12 schools?
Related qualitative and quantitative indicators
Number/percent of students who have been kept home, isolated in-school, and sent home for COVID-19 like symptoms
Number of students, faculty, and staff who test positive for SARS-CoV-2, and number given clinical diagnosis of COVID-19 (including dates of diagnosis)
Number of days missed by students, faculty, and staff due to COVID-19
Number of hours from onset of symptoms to isolation in school or at home
Number of hours from school notification of positive case to notification of close contacts (someone who was within 6 feet of an infected person a total of 15 minutes or more) and initiation of quarantine measures
Number of days the school closed or cancelled classes due to COVID-19
Number of students, faculty, staff, and caretakers who were hospitalized due to COVID-19
Number of students, faculty, staff, and caretakers who died from COVID-19
Number and size of outbreaks (defined as at least 2 positive cases with a known connection) in school
Potential data sources
5. What is the relationship between implementation of mitigation strategies and academic achievement and social, behavioral, and mental health outcomes in K-12 schools?
Related qualitative and quantitative indicators
Markers of academic achievement4 , including (but not limited to) standardized test scores, school absenteeism, graduation rate, dropout rate, and GPA
Other indicators of student achievement, such as mastery of college preparedness skills, career readiness skills, grade-specific education competencies, and developmental stages (i.e., cognitive, language/communication, fine/gross motor, and social/emotional skills)
Rates of disciplinary action (suspensions, expulsions, or detentions) for violation of school rules (fighting, bullying, and other prohibited behavior)
Number and percent of students, faculty, and staff who report feeling stress related to COVID-19 or that COVID-19 has had a negative impact on their mental health
Number and percent of students, faculty, and staff who have sought mental health care or resources for stress and coping
Occurrence of suicide ideation and attempts by students, faculty, and staff
Potential data sources
6. What, if any, impact have mitigation strategies had on health disparities or social determinants of health for students, faculty, or staff in K-12 schools?
Related qualitative and quantitative indicators
Indicators of changing disparities among students, faculty, and staff assessed separately or in combination by age, gender, race and ethnicity, geography, disabilities, and markers of socioeconomic status, including but not limited to the following:
Number of eligible students who participate in free- or reduced-price lunch program
Percent decrease or increase in reports of child abuse and domestic violence
Rates of COVID-19 cases
Rates of school absenteeism
Number of students, faculty, or staff who have ability to utilize mitigation guidelines
Number of students who have access to resources for remote learning (e.g., internet access)
Number of students, faculty, or staff who have supplies to support behaviors that reduce spread and maintain healthy environment (e.g., soap, hand sanitizer, masks, and cleaning and disinfection supplies)
Number of students, faculty, or staff who have mental health and healthcare services
Number of students referred/enrolled in support programs
Number and percent of students, faculty, and staff experiencing housing instability and homelessness
Number and percent of students, faculty, and staff experiencing food insecurity
Potential data sources
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1Indicators and data sources may be tailored to align with the context of the intended evaluation and local communities, including what is important and feasible to assess and what data are available. Some data may be available at the local level and may not need to be collected from child care programs independently. It is critical to maintain confidentiality and privacy of the child, staff member, or volunteer as required by the Americans with Disabilities Act and the Family Education Rights and Privacy Act.
2For indicators related to COVID-19 Epidemiology, Community Characteristics, Healthcare Capacity, and Public Healthcare Capacity being tracked, refer to existing data sources: CDC COVID Data Tracker or https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/surveillance-data-analytics.html as well those being monitored in your state/local jurisdiction.
3Ensure the data collection tools and sources used to assess these indicators adequately capture data prior to and following mitigation strategy implementation to ensure changes are attributable to the mitigation strategies. Ensure other environmental and contextual factors are taken into account that may have an impact on these indicators. It is important to establish a process to collect this information that can be used to compare to previous data and to monitor for changes in social/behavioral/mental health markers moving forward.
4The National Survey of Children’s Health (NSCH)external icon provides rich data on multiple, intersecting aspects of the lives of children (ages 0-17 years)—including physical and mental health, access to quality health care, and the child’s family, neighborhood, school, and social context. The most recent year of available data is 2018.
5Disclaimer: This data source is provided as an example and does not constitute an endorsement of the entity or its guidance or policies by CDC or the federal government. CDC is not responsible for the content of the individual organization sites listed in this document.
6National Health Interview Survey (NHIS) is used to monitor progress towards national health objectives; evaluate health policies and programs; and track changes in health behaviors and health care use. NHIS includes a Sample Child questionnaire, which collects information on health status, health care services, and health behaviors of children under the age of 18 years. The most recent year of available data is 2018.
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Monitoring and Evaluation Findings May Be Useful to K-12 Schools
Monitoring and evaluation provides practical information for state and local public health and education agencies, school and district administrators, and evaluation professionals to make timely decisions to support health and safety of all students, faculty, and staff and to promote health equity.
Education and public health agencies, in collaboration, may use the example evaluation questions, indicators, and data sources below to develop a monitoring and evaluation protocol and determine a scope feasible for their situation. These are not exhaustive lists of questions, indicators, or data sources, and they may be adapted to align with community priorities and needs.
CDC’s Checklist of Key Considerations When Planning for Monitoring and Evaluation of COVID-19 Mitigation Strategies Implemented in K-12 Schools provides actionable considerations for determining the scope of a monitoring and evaluation plan.
Conducting monitoring and evaluation may help K-12 schools examine their unique circumstances and make the best proactive decisions for their students, teachers, and staff, including:
Identify which factors help or hinder effective implementation of COVID-19 mitigation strategies in K-12 schools to reduce the spread of SARS-CoV-2
Inform allocation of resources to effectively reduce the spread of SARS-CoV-2 in schools
Identify and communicate about needs for additional resources and support to effectively implement mitigation strategies in schools
Understand which mitigation strategies are effective in schools to reduce the spread of SARS-CoV-2, to maximize the positive outcomes while minimizing related negative consequences
Ensure the needs of individuals at increased risk and disproportionately affected populations are met
Inform decision-making about strengthening, focusing, and relaxing mitigation strategies (e.g., determining the optimal schedule for cleaning and disinfecting frequently touched surfaces in the school)
Assess how different populations participate in, and are affected by, school-based mitigation strategies to ensure the health and safety of all students, faculty, and staff and to promote health equity
Share data and lessons learned about practices to prevent and reduce spread of SARS-CoV-2 with key stakeholders, including local policy makers, education and health agency officials, school board members, superintendents, surrounding community, other district leaders, families, and caregivers
Potential Data Sources
Education and public health agencies, in collaboration, determine the best way to collect data for their local jurisdiction that reflects circumstances in their communities. State and local data already being collected are potential monitoring and evaluation data sources1. These data may include policies (e.g., stay-at-home orders, mass gathering restrictions, mask-wearing requirements, school or district policies and recommendations) and school administrative records1 (e.g., past and current student and faculty absenteeism, school cancellations, school plans for reopening, standardized testing scores). Primary data may also be collected, including from school-developed surveys, school district administration surveys, interviews, focus groups, health department community surveys, and others. CDC has several data sources related to school health that are available to health departments and school districts, including the CDC COVID-19 Data Tracker2 and the Youth Risk Behavioral Surveillance System (YRBSS)3.
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Example Questions, Indicators, and Data Sources
Here are example questions, indicators, and data sources that may be used to monitor and evaluate COVID-19 mitigation strategies implemented in K-12 schools.
1. Which mitigation strategies are being implemented in K-12 schools in my area (i.e., school, district, city, state), and how and when are they implemented?
Related qualitative and quantitative indicators
Policies, implementation, and adherence to mitigation strategies in schools to prevent and reduce the spread of SARS-CoV-2 among students, faculty, and staff, including but not limited to the following:
Use of distance learning, including hybrid designs, vs. in person
Symptom screening procedures (at-home vs. in-school)
Social distancing strategies in school, including modified layouts, physical barriers (e.g., desk dividers), one-way hallways, reduced class sizes, etc.
Modifications to class (i.e., cohorting or podding) and school operations (e.g., traffic flow in hallways, single entry/exit)
Plans to teach, reinforce, and/or require behaviors that reduce spread such as hand hygiene or use of masks for students, faculty, and staff
Protocols for cleaning and disinfection of frequently -touched surfaces and reducing sharing of common objects
Improvements to ventilation systems in buildings to optimize air flow
Availability and use of appropriate resources (e.g., masks, hand soap, hand sanitizer) to promote behaviors that reduce spread of SAR-CoV-2 for faculty staff, and students
Modifications for meals and food service, such as pre-plating and staggered meal service
Modifications to large gatherings, after-school sports, after-care, school events, field trips, and extracurricular activities
Considerations for students, faculty, and staff with developmental and behavioral disorders, with disabilities, or at increased risk for severe illness from COVID-19
Modifications of transportation to and from school, including school arrival and dismissal procedures, carpooling, changes to school bus service, and accessible transportation for students, faculty, and staff with disabilities
Plans for risk communication within schools, including posting of signs in visible locations, broadcast announcements, and provision of educational materials in accessible formats for individuals with disabilities or limited English proficiency
Policies for SAR-CoV-2 testing in school or upon returning to school
Plans for and implementation of educational sessions and professional development for students, faculty, and staff regarding COVID-19
Plans for and implementation of communication with parents, caregivers, and guardians on prevention of COVID-19 at school
Policies and plans for absenteeism, excused absences, and sick leave for students, faculty, and staff, including encouraging to stay home when sick, changes to remote learning, methods for students to make up lessons, and having back-up staffing plans
Policies and infrastructure for isolation of symptomatic students, faculty, and staff
Policies and plans in place for response to positive cases in students, faculty, and staff, including:
Notification to public health departments
Isolation of and safe transport of suspected/confirmed cases including a designated isolation area with a dedicated bathroom, if possible
Notification and engagement of parents, caregivers, and guardians, and sharing of deidentified information with broader community
Appropriate disinfection of areas used by sick persons
Notification and quarantine guidance for close contacts
Approach to return to school for cases and close contacts, including individuals at increased risk for severe illness
Thresholds for school and classroom closure
Plans for communication and collaboration with local and state public health officials
Plans for staying informed about increases/decreases in cases in the community and nearby schools/school districts
Modifications to social, behavioral, mental health resources and support for students, faculty, and staff
Potential data sources
School/District policies and recommendations
School administrative records
School-developed surveys
School district administration surveys
2. What are the facilitators, barriers, and factors that affect implementation of mitigation strategies in K-12 schools?
Related qualitative and quantitative indicators
School characteristics and infrastructure, including but not limited to the following:
School size, number of students
Range of class sizes, student-faculty ratio
Nurses
Availability of water for handwashing
Availability of classrooms with windows that open and other ventilation capacity
Availability of space or designated area to evaluate and isolate individuals who might be sick
Ability for single entry and single exit or one-way traffic flow in hallways
Ability to provide accommodations for specific populations of students, faculty, and staff for whom mitigation measures are not feasible or require additional adaptation
Available funding and resources to implement mitigation strategies
Available technology to support mitigation strategies
Available supplies, including cleaning and disinfection supplies, soap and water, hand sanitizer, and masks
Number and types of staff available to support the implementation (e.g., substitute faculty, bus drivers, school nurses, counselors, and other staff) of COVID-19 school mitigation strategies
School, staff, and parent willingness and ability to adopt virtual technology or use alternative teaching or learning methods if needed
Knowledge, attitudes, and practices for mitigation strategies among parents, caregivers, guardians, students, faculty, and staff
Misinformation or perceived stigma around COVID-19
Parental or community attitudes and involvement
Staff retention and/or attrition rates
Potential data sources
School-developed surveys
School administrative records
School policy records
Qualitative study (i.e., interviews, focus groups)
CDC COVID-19 Data Tracker2
3. Which factors contribute to K-12 schools’ decisions to strengthen, focus, or relax mitigation strategies over time?
Related qualitative and quantitative indicators
Availability of resources to implement mitigation strategies, including but not limited to:
Funding
Technology
Staff availability and hours
Supplies, including cleaning and disinfection supplies, soap and water, hand sanitizer, and masks
Educational materials
Readiness, needs, or community risk assessments findings
Guidance from public health or education agencies
Levels of SARS-CoV-2 transmission within the school and community (e.g., percent positivity, trends in case counts, number and size of outbreaks in K-12 schools)
Potential data sources
4. What is the association between implementation of mitigation strategies and minimizing COVID-19 associated morbidity and mortality in K-12 schools?
Related qualitative and quantitative indicators
Number/percent of students who have been kept home, isolated in-school, and sent home for COVID-19 like symptoms
Number of students, faculty, and staff who test positive for SARS-CoV-2, and number given clinical diagnosis of COVID-19 (including dates of diagnosis)
Number of days missed by students, faculty, and staff due to COVID-19
Number of hours from onset of symptoms to isolation in school or at home
Number of hours from school notification of positive case to notification of close contacts (someone who was within 6 feet of an infected person a total of 15 minutes or more) and initiation of quarantine measures
Number of days the school closed or cancelled classes due to COVID-19
Number of students, faculty, staff, and caretakers who were hospitalized due to COVID-19
Number of students, faculty, staff, and caretakers who died from COVID-19
Number and size of outbreaks (defined as at least 2 positive cases with a known connection) in school
Potential data sources
5. What is the relationship between implementation of mitigation strategies and academic achievement and social, behavioral, and mental health outcomes in K-12 schools?
Related qualitative and quantitative indicators
Markers of academic achievement4 , including (but not limited to) standardized test scores, school absenteeism, graduation rate, dropout rate, and GPA
Other indicators of student achievement, such as mastery of college preparedness skills, career readiness skills, grade-specific education competencies, and developmental stages (i.e., cognitive, language/communication, fine/gross motor, and social/emotional skills)
Rates of disciplinary action (suspensions, expulsions, or detentions) for violation of school rules (fighting, bullying, and other prohibited behavior)
Number and percent of students, faculty, and staff who report feeling stress related to COVID-19 or that COVID-19 has had a negative impact on their mental health
Number and percent of students, faculty, and staff who have sought mental health care or resources for stress and coping
Occurrence of suicide ideation and attempts by students, faculty, and staff
Potential data sources
6. What, if any, impact have mitigation strategies had on health disparities or social determinants of health for students, faculty, or staff in K-12 schools?
Related qualitative and quantitative indicators
Indicators of changing disparities among students, faculty, and staff assessed separately or in combination by age, gender, race and ethnicity, geography, disabilities, and markers of socioeconomic status, including but not limited to the following:
Number of eligible students who participate in free- or reduced-price lunch program
Percent decrease or increase in reports of child abuse and domestic violence
Rates of COVID-19 cases
Rates of school absenteeism
Number of students, faculty, or staff who have ability to utilize mitigation guidelines
Number of students who have access to resources for remote learning (e.g., internet access)
Number of students, faculty, or staff who have supplies to support behaviors that reduce spread and maintain healthy environment (e.g., soap, hand sanitizer, masks, and cleaning and disinfection supplies)
Number of students, faculty, or staff who have mental health and healthcare services
Number of students referred/enrolled in support programs
Number and percent of students, faculty, and staff experiencing housing instability and homelessness
Number and percent of students, faculty, and staff experiencing food insecurity
Potential data sources
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Until we know more about how this virus affects animals, CDC encourages pet owners to treat pets as you would other human family members to protect them from possible infection. This means limiting contact between your pets and people outside your household as much as possible and avoiding places where large numbers of people gather.
Some areas are allowing groomers and boarding facilities such as dog daycares to open. If you must take your pet to a groomer or boarding facility, follow any protocols put into place at the facility, such as wearing a mask and maintaining at least 6 feet of space between yourself and others if possible.
Limit pet items brought from home to the groomer or boarding facility, and disinfect any objects that are taken into a facility and returned home (such as leashes, bowls, and toys). Use an EPA-registered disinfectantexternal icon to clean items and rinse thoroughly with clean water afterwards. Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or other products, such as hand sanitizer, counter-cleaning wipes, or other industrial or surface cleaners. If you have questions about appropriate products for bathing or cleaning your pet, talk to your veterinarian.
Do not put masks on pets, and do not take a sick pet to a groomer or boarding facility. Signs of sickness in dogs may include fever, coughing, difficulty breathing or shortness of breath, lethargy, sneezing, discharge from the nose or eyes, vomiting, or diarrhea. If you think your pet is sick, call your veterinarian. Some veterinarians may offer telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet’s treatment and care.
See more information on pets and COVID-19 and recommendations for how to help keep your pet safe.
Evaluate your workplace to identify scenarios where workers cannot maintain social distancing of at least 6 feet from each other and visitors. Use appropriate combinations of controls following the hierarchy of controls to address these situations to limit the spread of the virus that causes COVID-19. A committee of workers and management may be most effective at recognizing all scenarios.
While protecting workers, it is important to note that control recommendations or interventions to reduce risk of COVID-19 must be compatible with any safety programs and personal protective equipment (PPE) normally required for the job task. Approaches to consider may include the following:
Create and implement a COVID-19 Workplace Health and Safety Plan
Review the CDC Interim Guidance for Businesses and Employers and the Resuming Business Toolkit for guidelines and recommendations that all employers can use to protect their employees.
Identify an on-site workplace coordinator who will be responsible for COVID-19 assessment and control.
When developing plans, include all employees in the workplace, for example: staff, utility employees, relief employees, janitorial staff, maintenance, supervisory staff, rig workers, engineers, technicians, managers, maintenance, galley staff, and housekeeping staff.
Identify areas that may lead to close contact among employees, including work areas, break rooms, mess and galley areas, locker rooms, living quarters, and transportation vessels, such as helicopters.
If contractors enter the workspace, develop plans to communicate with them regarding modification to work or service processes.
Notify all workers that any COVID-19 concerns should be directed to the identified coordinator.
Consider standing up a virtual incident command system capable of providing telemedicine consultation, assisting with the management of suspected COVID-19 cases, and coordinating the evacuation of suspected cases to an appropriate onshore medical facility for testing or treatment.
Maintain a daily log of approved visitors. This log should include the date and time the visitor entered and exited the offshore facility as well as their contact information. Regular crew are not considered visitors.
Determine if some tasks can be done remotely to reduce the number of employees on the offshore facility.
Consider reducing personnel on board (POB) to essential personnel only while ensuring workers get enough rest and recovery.
Implement flexible sick leave and supportive policies and practices.
Develop policies that encourage sick employees to stay at home without fear of reprisals, and ensure employees are aware of these policies.
If contractors are employed in the workplace, develop plans to communicate with the contracting company regarding modifications to work processes.
Consider conducting daily in-person or virtual health checks (e.g., symptom and/or temperature screening) of employees on scheduled workdays and visitors before arrival.
Screening options could include having employees self-screen before arriving at work or having on-site screening by taking employees’ temperatures and assessing other potential symptoms prior to beginning work. (see CDC Interim Guidance for Businesses and Employers)
Make sure employees can maintain at least 6 feet of distance while waiting for screening if done on-site.
Make employee health screenings as private as possible and maintain the confidentiality of each individual’s medical status and history.
Take action if an employee or visitor is suspected or confirmed to have COVID-19
Immediately separate employees or visitors who report with or develop symptoms at work from other employees and arrange for private transport home. These employees should self-isolate and contact their health care provider immediately.
Establish an isolation area on the facility that is separate from other personnel and managed by designated health and safety personnel for suspected or confirmed COVID-19 cases.
Field managers should coordinate medevac arrangements with clients and other offshore stakeholders to ensure helicopters and boats are available and equipped to safely transport ill personnel, if necessary.
Facility medical personnel or an onshore advisor should notify appropriate authorities before non-emergency medevac begins.
Perform enhanced cleaning and disinfection after anyone suspected or confirmed to have COVID-19 has been in the workplace. Cleaning staff should clean and disinfect offices, bathrooms, common areas, and shared equipment used by the sick person, focusing especially on frequently touched surfaces or objects. If other workers do not have access to these areas or items, wait 24 hours (or as long as possible) before cleaning and disinfecting.
Employees who test positive for COVID-19 should immediately notify their employer of their results.
Develop hazard controls using the hierarchy of controls to prevent infection among workers. You may be able to include a combination of controls noted below.
Engineering Controls (Isolate people from the hazards)Alter the workspace using engineering controls to prevent exposure to the virus that causes COVID-19.
Modify the alignment of workstations where feasible. For example, redesign workstations so workers are not facing each other.
Where possible, establish physical barriers between workers. This includes all areas of the facilities, including work areas, break rooms, the galley, locker rooms, and living quarters.
Install cleanable transparent shields or other barriers to physically separate employees where distancing is not an option.
Use strip curtains, plastic barriers, or similar materials to create impermeable dividers or partitions.
Close or limit access to common areas where employees are likely to gather and interact, such as break rooms and in entrance/exit areas.
Encourage social distancing of at least 6 feet between employees in all areas of the facilities.
Consider making foot traffic single direction in narrow or confined areas, such as aisles and stairwells, to encourage single-file movement at a 6-foot distance.
Use visual cues such as floor decals, colored tape, and signs to remind workers to maintain distance of at least 6 feet from others, including at their workstation and in break areas.
Place handwashing stations or hand sanitizers with at least 60% alcohol in multiple locations throughout the workplace for workers and visitors.
Use touch-free stations where possible.
Make sure restrooms are well stocked with soap and paper towels.
Make sure the workspace is well ventilatedexternal icon.
Work with facilities management to adjust the ventilation so that the maximum amount of fresh air is delivered to occupied spaces while maintaining the humidity at 40-60%. If possible, increase filter efficiency of heating, ventilation, and air conditioning (HVAC) units to highest functional level.
Portable high efficiency particulate air (HEPA) filtration units may be considered to remove contaminants in the air of poorly ventilated areas.
Additional considerations for improving the building ventilation system can be found in the CDC Interim Guidance for Businesses and Employers and COVID-19 Employer Information for Office Buildings.
Administrative Controls (Change the way people work)Provide training and other administrative policies to prevent the spread of COVID-19.
All workers should have a basic understanding of COVID-19, how the disease is spread, what the symptoms of the disease are, and what measures can be taken to prevent or minimize the transmission of the virus that causes COVID-19.
Trainings should include the importance of social distancing (maintaining a distance of 6 feet or more when possible), wearing cloth face coverings or masks appropriately, covering coughs and sneezes, washing hands, cleaning and disinfecting high-touch surfaces, not sharing personal items or tools/equipment unless absolutely necessary, and not touching their face, mouth, nose, or eyes.
Workers should be encouraged to go home or stay home if they feel sick. Ensure that sick leave policies are flexible and consistent with public health guidance, and that employees are aware of and understand these policies.
Conduct health checks (e.g., screening for temperature and/or other symptoms) for all personnel and visitors before they check-in to board any marine vessels or helicopters (shorebases and heliports) to go offshore.
Consider maintaining small groups of workers in teams (cohorting) to reduce the number of coworkers each person is exposed to.
Limit mixing of cohort groups, if possible.
Consider extending the duration of work shifts, for example from 21 to 28 days, on offshore facilities to reduce turnover and give workers sufficient time to self-quarantine when they are not working.
Clean and disinfect frequently touched surfaces.
If surfaces are dirty, clean them using a detergent or soap and water before you disinfect them.
Use products that are EPA-registeredexternal icon, diluted household bleach solutions, or alcohol solutions with at least 70% alcohol, appropriate for surface disinfection.
Provide cleaning materials and conduct targeted and more frequent cleaning of frequently touched surfaces (workstations, tools, equipment, galley tables and chairs, railings, countertops, doorknobs, toilets, tables, light switches, phones, faucets, sinks, keyboards, etc.).
Provide employees adequate time and access to soap, clean water, and single use paper towels for handwashing.
Remind employees to wash their hands often with soap and water for at least 20 seconds. If soap and water are not available, they should use hand sanitizer with at least 60% alcohol.
Provide hand sanitizer, tissues and no touch waste baskets at the cash registers and in the restrooms.
Limit the number of people gathered at one time. (Consult state and local guidance if available.)
Stagger shifts, start times, break times, and mealtimes as feasible.
Consider limiting employees’ movements between floors to only essential work functions and limit staff entering employees’ living quarters unless it is necessary.
Eliminate shared living quarters to the extent possible. If this is not possible, then workers should practice CDC recommended precautions for preventing the spread of COVID-19, and the employer should conduct targeted daily cleaning of these shared spaces.
Remind employees that people may be able to spread COVID-19 even if they do not show symptoms. Consider all close interactions (within 6 feet) with employees and others as a potential source of exposure.
Post signs and reminders at entrances and in strategic places providing instruction on social distancing, hand hygiene, use of cloth face coverings or masks, and cough and sneeze etiquette. Signs should be accessible for people with disabilities (e.g., large print), easy to understand, and may include signs for non-English speakers, as needed.
Communication and training should be easy to understand, in preferred language(s) spoken or read by the employees and include accurate and timely information.
Emphasize use of images (infographics) that account for language differences.
Training should be reinforced with signs (preferably infographics), placed in strategic locations. CDC has free, simple posters available to download and print, some of which are translated into different languages.
Use cloth face coverings or masks as appropriate.
Cloth face coverings or masks are intended to protect other people around you—not the wearer. They are not considered to be personal protective equipment.
Emphasize that care must be taken when putting on and taking off cloth face coverings or masks to ensure that the worker or the cloth face covering or mask does not become contaminated.
Cloth face coverings or masks should be routinely laundered.
Do not wear cloth face coverings or masks if their use creates a new risk (e.g., interferes with driving or vision, or contributes to heat-related illness) that exceeds their COVID-19 related benefits of slowing the spread of the virus. Cloth face coverings or masks should also not be worn by anyone who has trouble breathing or is unable to remove it without assistance. CDC provides information on adaptations and alternatives that should be considered when cloth face coverings or masks may not be feasible (e.g., people who are deaf or hard of hearing, have intellectual or developmental disabilities, or sensory sensitivities).
Consider requiring visitors to the workplace (e.g., service personnel) to also wear cloth face coverings or masks.
Personal Protective Equipment (PPE)
PPE is the last step in the hierarchy of controls because it is more difficult to use effectively than other measures. To be protective and not introduce an additional hazard, the use of PPE requires characterization of the environment, knowledge of the hazard, training, and consistent correct use. This is why special emphasis is given to administrative and engineering controls when addressing occupational hazards, including when applying guidance to slow the spread of the virus that causes COVID-19.
In the current COVID-19 pandemic, use of PPE such as surgical masks or N95 respirators is being prioritized for healthcare workers and other medical first responders, as recommended by current CDC guidance, unless they were required for your job before the pandemic. Offshore oil and gas workers should continue to wear all PPE required for their normal jobs.
Stay home if you are having symptoms of COVID-19.
Stay at least 6 feet away from clients and coworkers, when possible.
Be aware of close contact with your fellow employees. Stagger times to use the break room and enter and exit the building.
Limit the time that you are close to others, to the extent possible (e.g., shorten appointment times, limit gatherings inside the salon, discourage clients from bringing additional people to appointments).
Wear a cloth mask in public and at work, especially when other social distancing measures are difficult to maintain. Cloth masks may prevent people who don’t know they have the virus from spreading it to others. Cloth masks are intended to protect other people—not the wearer. The spread of COVID-19 can be reduced when cloth masks are used along with other preventive measures, including social distancing. A universal face covering policy can be effective in preventing the transmission of the virus in close-contact interactions, including within a salon.
Be careful when putting on and taking off cloth masks:
Don’t touch the cloth mask while wearing it.
Don’t touch your face, mouth, nose, or eyes while taking off the cloth mask.
Wash your hands before putting on and after taking off the cloth mask.
Wash the cloth mask after each use.
Consider carrying a spare cloth mask. If the cloth mask becomes wet, visibly soiled, or contaminated at work, it should be removed and stored to be laundered later.
Cloth masks should not be worn if their use creates a new risk (for example, interferes with driving or vision, or contributes to heat-related illness) that exceeds their COVID-19 related benefits of slowing the spread of the virus. Cloth masks should also not be worn by children under the age of 2, anyone who has trouble breathing or is unable to remove the mask without assistance. CDC provides information on adaptations and alternatives that should be considered when cloth masks may not be feasible (e.g., people who are deaf or hard of hearing, have intellectual or developmental disabilities, or sensory sensitivities).
If you are concerned about the use of cloth masks at your workplace, discuss your concerns with your employer.
Encourage clients over the age of 2 to wear cloth masks.
Clean and disinfect frequently touched surfaces.
Continue to follow applicable state regulations for health and public safety in addition to these recommendations.
Clean and disinfect the following items between each client:
Styling chairs, hair washing sinks, massage tables, credit card devices, keypads, and other items that clients routinely touch.
Consider using reusable chair covers. They should be laundered or cleaned and disinfected after each client.
All non-porous multi-use tools, such as shears, clippers, nippers, brushes, combs, etc.
Clean and disinfect the following areas or items on a routine basis or at least daily:
Countertops, doorknobs, toilets (including handles), tables, light switches, phones, faucets, bathroom sinks, keyboards, etc.
Use single use tools and supplies (e.g., salon capes) where possible.
Launder reusable fabric supplies after each use.
Follow the directions on the cleaning and disinfecting products’ labels, paying particular attention to proper dilution and contact times.
Wash your hands with soap and water afterwards.
Wash your hands regularly with soap and water for at least 20 seconds. You don’t need to wear gloves if you wash your hands regularly (unless they are already required for your job).
Use an alcohol-based hand sanitizer containing at least 60% alcohol if soap and water aren’t available.
Wash your hands at these key times:
Before, during, and after preparing food
Before eating food
After using the toilet
After blowing your nose, coughing, or sneezing
After putting on, touching, or removing cloth masks
Before and after work and work breaks
Before and after each client
After cleaning and disinfecting
Do not touch your face, mouth, nose, or eyes.
Cover your coughs and sneezes.
Use tissues to cover your mouth and nose when you cough or sneeze.
Throw used tissues in the trash.
Wash your hands with soap and water for at least 20 seconds.