Residential Practice in COVID
Caring For Sick Children
Quarantine and Isolation
Developing protocols for quickly screening, assessing, and isolating sick children while also quarantining those who may have been exposed is imperative. While the CDC recommends quarantining all potentially COVID-exposed households, this can become untenable in a residential setting, where many children may be housed together and where there continues to be traffic in and out of units by staff as well as youth who are returning from extended leave or AWOC. Therefore, youth who may have come in “close contact” (as defined by the CDC) with a COVID-19 case, but who are not symptomatic, may need to be quarantined within their cottage/unit. The attached protocols reflect the shifting policies regarding quarantine as it became evident that quarantining entire cottages/units became untenable. Mostly important, all programs should follow CDC guidelines as quarantining children in a residential setting is challenging.
The JCCA Quarantine and Isolation Policy and Procedure (date March 29th, 2020) was an initial effort to establish a quarantine protocol. The policy shifted as the pandemic progressed. In order to separate youth who are either symptomatic (prior to readily accessible testing) and/or who test COVID Positive, an isolation cottage/unit should also be identified and prepared to care for sick children. Guidance on reporting to families as well as providing consistent/constant updates (all of which should be documented) should also be developed.
The CDC as well as state/local departments of health provide guidelines regarding the management of non-hospital isolation units. These guidelines should be disseminated and discussed with medical personnel in the residential program. Guidelines should include information related to:
- General infection control precautions
- Use of PPE (including masks, gloves, gowns, safety goggles) and PPE disposal for all staff and patients
- Physical attributes of isolation quarters (including issues of ventilation, traffic control, cleaning and disinfecting, etc.)
- Special considerations related to Bathing, meals, and laundry
Simple, easy-to-read printables can remind staff of cleaning, sanitizing, and other infection control measures after treating ill patients in isolation.
Childcare staff and other non-medical personnel can also be provided with digestible Quarantine and Isolation Protocols for Childcare Staff that detail how to organize and manage various aspects of life within a cottage or unit that is quarantined or in isolation.
Again, protocols should include information regarding the following:
- Supporting social distancing
- Serving meals
- Encouraging personal hygiene
- Use and disposal of PPEs
- Recreation and socialization
- Traffic control
- Medical, nursing, and other clinical services
When quarantine or isolation is warranted, it is also imperative to connect with parents promptly in order to discuss how the agency will care for their sick child. It is generally recommended that these initial calls be made jointly by medical staff (who can speak to any medical concerns on the part of the parents) and by casework staff who are familiar with the family. Ongoing notifications should be made regularly and as often as possible by casework staff with ongoing support from the medical team. The attached Exposure Talking Points document can be used to provide guidance for staff who are having these challenging conversations.
Specific criteria for the discontinuation of isolation must be established and messaged to all personnel. These practices should follow guidelines set out by the CDC, state, and local departments of health. For example, the New York State Department of Health issued guidelines in the spring of 2020 recommending the discontinuation of isolation for patients with COVID-19 when they met the following conditions:
- At least three days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications; AND
- Improvement in respiratory symptoms (e.g., cough, shortness of breath); AND
- At least seven days have passed since symptoms first appeared.
Tracking the status of children who are quarantined and placed in isolation can help programs more effectively implement quarantine and isolation guidelines/protocols, thereby assisting to contain the virus. Simple trackers can be developed to log residents’ symptoms and track symptom duration in order to more effectively make decisions regarding when a child can be released from quarantine or isolation. In aggregate, data from these trackers can also provide information regarding the efficacy of quarantine and isolation protocols/policies. Attached protocols provide information regarding procedures for quarantine and isolation, as well as testing protocols and procedures.
Transportation of Sick Children
At times, staff will be required to transport an ill youth to medical personnel on grounds or to a hospital. Written guidelines should be developed for staff who are providing such transportation. These guidelines should include information related to advanced communication between staff, locations of drop-off, use of agency vehicles, managing social distancing in agency vehicles, use of PPE’s, disinfecting vehicles, etc. See attached, Safe Transport of Ill Youth (JCCA), as an example protocol.
It is also important to continue to monitor emerging conditions that may be related to COVID-19 and ensure that you are informing your clients of such as appropriate. For example, Pediatric Multi-System Inflammatory Syndrome (PMIS) is a rare but serious complication that appears to be related to COVID-19. Facts sheets should be generated about such illnesses, and staff should discuss these with families and caretakers during phone calls and other virtual visits. Caretakers should be informed of what to look for and what to do if they identify any possible symptoms. For non-medical personnel, providing talking points to assist in this discussion is helpful.
Signs and Symptoms of COVID-19 (CDC)
CDC: How are quarantine and isolation different?
JCCA Quarantine and Isolation Policy and Procedure (dated: 3.29.20)
COVID protocol for children
COVID-19 Related Guidelines for Non-hospital Isolation
JCCA Quarantine and Isolation Protocol for childcare staff (dated: 3.31.20)
Printable: Important Infection Control Message
DOH COVID-19: Discontinuation of Isolation in Hospitals and Congregate Care Settings (dated: 4.19.20)
NYC Health Discontinuing of Isolation and Isolation and Transmission-Based Precautions (dated: 5.14.20)
Quarantine and isolation tracker
Triage Guide for Sick Room Visits
Safe Transport of Ill Youth (JCCA)
Pediatric Multi-Symptom Inflammatory Syndrome (PMIS) flyer
Telehealth Guide for PMIS Talking Points
Exposure Talking Points: Guidelines for talking to youth and families when quarantine or isolation is required