COVID and School

Philippine Pediatric Society
Pediatric PHILIPPINE
PHILIPPINE
Infectious Disease PEDIATRIC
PEDIATRIC
Society SOCIETY SOCIETY
of the Philippines
PEDIATRIC INFECTIOUS DISEASE
PEDIATRIC INFECTIOUS DISEASE SOCIETY OF THEOF SOCIETY THE PHILIPPINES
PHILIPPINES
WORKING
WORKING GROUP
GROUP
INFECTION CONTROL AND PREVENTION OF COVID-19 TRANSMISSION:
Ad HocAd INTERIM
Committee RECOMMENDATIONS
Chair:
Hoc Committee Chair:
Dr. Ma.Dr.
Carmen FORB.SCHOOLS
B. Nievera
Ma. Carmen Nievera IN THE PHILIPPINE SETTING
Team Lead:
TeamDr.
Lead:
Anna
Dr.Lisa
AnnaT. Lisa
Ong-Lim (August 6, 2020)
T. Ong-Lim
Members:
Members:
Dr. John
Dr.Andrew T. Camposano
John Andrew T. Camposano
Dr. Ma.Dr.
Liza Antoinette M. Gonzales
Ma. Liza Antoinette M. Gonzales
Dr. Francesca
Dr. Mae
FrancescaT. Pantig
Mae T. Pantig
THIS GUIDANCE AIMS TO SUPPORT PHYSICIANS WHO COLLABORATE WITH SCHOOLS AND
Dr. PaulDr.
Sherwin O. Tarnate
Paul Sherwin O. Tarnate
GOVERNMENT IN CREATING INFECTION CONTROL POLICIES FOR SCHOOL RE-ENTRY IN THE TIME
OF COVID-19 PANDEMIC, WHILE TAKING INTO CONSIDERATION THE OVER-ALL HEALTH OF
EVERYONE,
REFERENCES BASED ON AVAILABLE EVIDENCE. THE GUIDANCE IS A DYNAMIC ONE AND MAY
REFERENCES
CHANGE DEPENDING ON THE RAPIDLY EVOLVING KNOWLEDGE, DATA, AND UNDERSTANDING
Anjue
OFTang et al. AIN
SARS-COV-2
Anjue Tang etretrospective
THE
al. ACOUNTRY.study ofstudy
retrospective the clinical characteristics
of the clinical of COVID-19
characteristics infectioninfection
of COVID-19 in in
26 children.
26 MedrxivMedrxiv
children. [preprint]. Posted Posted
[preprint]. March March
10, 2020.
10, Available
2020. from
Available from
<https://www.medrxiv.org/content/10.1101/2020.03.08.20029710v1>.
Important Considerations:
Cai et Cai
al. A
et Case
al. A Series of children
Case Series with 2019
of children with novel
2019 coronavirus infection:
novel coronavirus clinical clinical
infection: and and
1. Decisions
epidemiological for school
epidemiological features. resumption must always be in full
features. ClinicalClinicalInfectious cognizance of
InfectiousDiseases, the risks vs. benefits
Diseases,ciaa198,ciaa198,
<https://doi.org/10.1093/cid/ciaa198>
of doing so, with constant re-evaluation of such decision based on ongoing risks and the
success of implementing mitigation strategies in each school setting.
CentersCenters
for Disease ControlControl
for Disease and Prevention. 2020. Coronavirus
and Prevention. diseasedisease
2020. Coronavirus 2019 (COVID-19).
2019 (COVID-19).
Updated 7 March
2. School
Updated 2020. Available
policies2020.
7 March should at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
be adaptable
Available to changes in response to new information, with
at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
management-patients.html
administrators willing to refine approaches when specific policies are not working.
3.for Strategies
CentersCenters Disease to be implemented
Control
for Disease and Prevention.
Control are Discontinuation
those that
and Prevention. can be
of revised and adapted
homeofisolation
Discontinuation home depending
for persons
isolation with on with
for persons
COVID-19 (Interim Guidance).
the transmission
COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
of the virus inhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
(Interim Guidance). local community and school settings, and on the available
home-patients.html.
resourcesAccessed
home-patients.html.that can on sustained
be March
Accessed on 22, 2020.
through
March the schoolyear, in collaboration with the local
22, 2020.
public health authorities.
Centers for Disease Control and Prevention. Interim Guidelines for Collecting, Handling, and
Testing 4.
Clinical Specimens
Policies should befrom Persons
feasible, for Coronavirus
practical and Disease 2019 (COVID-19). Available
Testing Clinical Specimens from Persons forappropriate
CoronavirusforDisease
the developmental stage ofAvailable
2019 (COVID-19). the
at www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html. Accessed 23
students.
Mar 2020.
Mar 2020.
5. Special considerations and accommodations to account for the diversity of the student
Centers for Disease Control and Prevention. Mental health and coping during COVID-19.
population
Centers shouldControl
for Disease be made, particularly Mental
and Prevention. for thehealth
vulnerable and disadvantaged
and coping during COVID-19.
Available at www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
populations (i.e., medically fragile, living in poverty, developmentally challenged, and
Che Zhanghaving
et al. special
Clinicalhealth care needsofor34
characteristics disabilities) with coronavirus
children with the goal of safe reopening of
disease-2019 in school.
the
Che Zhang et al. Clinical characteristics of 34 children with coronavirus disease-2019 in the
west of China: a multiple-center case series. Medrxiv [preprint]. Posted March 16, 2020.
6. from
west
Available
Whenever
China:possible and feasible,case
on-line learning, depending
ofhttps://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1.
a multiple-center series. Medrxiv on the
[preprint]. class and
Posted or subject
March 16, 2020.
Available from https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1.
matter, is the preferred teaching method, over classroom teaching.
Chen, Z., Fu, J., Shu, Q. et al. Diagnosis and treatment recommendations for pediatric
Chen,infection
respiratory Z., Fu, caused
J., Shu, byQ. the
et al.
2019Diagnosis and treatmentWorld
novel coronavirus. recommendations for pediatric
J Pediatr (2020).
Background:
respiratory infection caused by
<https://doi.org/10.1007/s12519-020-00345-5> the 2019 novel coronavirus. World J Pediatr (2020).
<https://doi.org/10.1007/s12519-020-00345-5>
Chen School
H, Guo closures
J, WanghaveC, been
Luo F,oneYu of
X, the public
Zhang W ethealth measures
al. Clinical implemented
characteristics and to control the
intrauterine
verticalChen H, Guo
transmission J, Wang
potential C, Luo F,
of COVID-19 Yu X, Zhang W et al. Clinical characteristics and intrauterine
outbreak of COVID-19 in the Philippines infection
and in thein nine pregnant
rest of women:
the world. As ofa this
retrospective
writing, the
review vertical
of transmission
medical records.potential of
Lancet. COVID-19 infection in
2020;395(10226):809-15. nine pregnant
Epub women:
2020/03/11. a retrospective
doi:
Philippine government has set, as a condition
review of medical records. Lancet.
for the opening of face-to-face classes, the
10.1016/S0140-6736(20)30360-3. PubMed PMID: 2020;395(10226):809-15.
3215133 Epub 2020/03/11. doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
PEDIATRIC
of the Philippines
PHILIPPINES
WORKING
WORKING GROUP
availability of a GROUP
vaccine against COVID-19. Some countries, however, have resumed, or have plans
of, resuming face-to-face classes as their cases of COVID-19 decrease. Some advocates have
Ad HocAdCommittee Chair: Dr.
Ma.Dr.Carmen B. Nievera
Ma. Carmen B. Nievera
called
Team Lead:for Lead:
TeamDr.
theAnna
opening
Dr.Lisa
of
AnnaT.schools
Ong-Lim
Lisa
in areas of the Philippines where there are no cases, such as in
T. Ong-Lim
isolated
Members: areas
Members:
Dr. and
John islands.
Dr.Andrew T.Successful
John Andrew Camposano implementation of health safety protocols to reduce the
T. Camposano
risk of transmission
Dr. Ma.Dr.
LizaisAntoinette
Ma. ofLiza
paramount importance
M. Gonzales
Antoinette once face-to-face classes resume.
M. Gonzales
Dr. Francesca Mae T. Mae
Dr. Francesca Pantig
T. Pantig
Dr. PaulDr.
Studies conducted Sherwin
Paul O. Tarnate
Sherwin
on COVID-19 O.
in Tarnate
children show that a majority of cases are mild and that
children are less likely than adolescents and adults to get infected and to have severe disease.
Current observations demonstrate that children are less infectious than adults, and the role of
REFERENCES
REFERENCES
children in transmission is still unclear. There is also equivocal evidence on the impact of school
closures
Anjue Anjueon
Tang et the
al. Acontrol
Tang al. Aofretrospective
the epidemic.
etretrospective study ofstudy
the clinical characteristics
of COVID-19 in in
26 children.
26 MedrxivMedrxiv
[preprint]. March March10, 2020.
10, Available
2020. from from
Available
UNESCO identifies the following six key dimensions to assess the
<https://www.medrxiv.org/content/10.1101/2020.03.08.20029710v1>. readiness of schools to reopen
and to provide basis for planning: policy, financing, safe operations, learning, reaching the most
Cai marginalized,
et Cai
al. A
et Case A Series
al. and Case of children
Series withThe
of children
well-being/protection. 2019
with novel
2019
risk of coronavirus
novelspread
potential infection:
coronavirus
of clinical
infection:
COVID-19 and
in theclinical
school and
epidemiological
epidemiological features.
features. ClinicalClinicalInfectious
InfectiousDiseases,
Diseases, ciaa198,ciaa198,
setting must be weighed against the significant academic, social, emotional, and other benefits
that schools provide to children.
CentersCenters
2019 (COVID-19).
ThisUpdated
Updated document addresses
7 March7 2020. relevant
Available at issues on infection control and prevention of transmission of
www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
March 2020. Available at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
SARS-CoV-2 in schools, and serves as a complement to recommendations from other authorities
and policy-making bodies to guide decision-making for school resumption.
CentersCenters
for Disease and Prevention. Discontinuation
and Prevention. of homeofisolation
Discontinuation for persons
home isolation with
for persons with
COVID-19 (Interim
COVID-19 Guidance).
(Interim https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
Guidance). https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
Addressing all issues
home-patients.html. pertinent
Accessed to infection
on March prevention during school opening is necessary. With
home-patients.html. Accessed on 22, 2020.
March 22, 2020.
regard to risk-prevention, the disease transmission rates at the local community level should be
analyzed
Centers - where
for Disease widespread
Control local transmission
and Prevention. of COVID-19
Interim Guidelines is occurring,
for Collecting, schools
Handling, andare
recommended
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Clinical Specimens
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Persons
from
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no orAvailable
(COVID-19).
2019 low disease
Available
at www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html.
transmission, as determined by the relevant health authorities such as the Inter-AgencyAccessed 23 Task 23
at www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html. Accessed
Mar Force
2020. on Emerging Infectious Diseases (IATF-EID) or the local Epidemiology Bureau, gradual
Mar 2020.
resumption of face-to-face classes may be considered if: the school has appropriate policies and
Centersin for
protocols Disease
place Controltransmission
for preventing and Prevention.amongMental healthand
its students and coping
staff, during
school staff isCOVID-19.
well-
trained on implementing these health protocols, and children, parents, and the community are
Chewell-informed of thesecharacteristics
Zhang et al. Clinical plans. Engineering and administrative
of 34 children controls,
with coronavirus as well asin use
disease-2019 the of
westappropriate
of China: personal protective equipment, are recommended.
a multiple-center case series. Medrxiv [preprint]. Posted March 16, 2020.
west
Available ofhttps://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1.
from China: a multiple-center case series. Medrxiv [preprint]. Posted March 16, 2020.
PREVENTING/REDUCING
Chen,infection
respiratory Z., Fu, caused THE
J., Shu, RISK
Q.
by et OF
the al.TRANSMISSION
2019Diagnosis andINtreatment
THE SCHOOL
novel coronavirus.
SETTING
recommendations
World for pediatric
J Pediatr (2020).
<https://doi.org/10.1007/s12519-020-00345-5>
General considerations:
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W et al. Clinical characteristics and intrauterine
verticalChen H, Guo J,
transmission Wang C,
potential Luo F, Yu X,
of COVID-19 Zhang inWnine
et al.pregnant
Clinical women:
characteristics and intrauterine
SARS-CoV-2, the virus causing COVID-19, infection
is primarily spread a retrospective
from person to person via droplet
review vertical
of transmission
medical potential
records. of
Lancet. COVID-19 infection in
2020;395(10226):809-15. nine pregnant
Epub women:
2020/03/11. a retrospective
doi:
transmission.
review of Thus, infection
medical control Lancet.
records. strategies2020;395(10226):809-15.
to reduce infections are designed
Epub to2020/03/11.
protect doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
PEDIATRIC
of the Philippines
PHILIPPINES
WORKING
WORKING
against GROUP
this GROUP
mode of spread, including hand washing, physical (1-2 meter) distancing, face (nose,
mouth and eyes) coverings, and disinfection. Furthermore, the interventions recommended
Ad HocAdCommittee Chair: Dr.
Ma.Dr.
Carmen B. Nievera
below
Team Lead:areLead:
TeamDr.
most
Anna effective
Dr.Lisa
Anna
when
T. Lisa
Ong-Lim observed altogether to optimize their cumulative benefits for
T. Ong-Lim
infection
Members: prevention
Members:
Dr. John andAndrew
Dr.Andrew
John control
T. inCamposano
Camposano
T. the school setting. School authorities are expected to be
models and examples
Dr. Ma. Liza
Dr. ofLiza
these
Antoinette
Ma. health practices
M. Gonzales
Antoinette at all times.
M. Gonzales
Dr. Francesca PantigT. Pantig
Dr. Paul
Good Personal Sherwin
Dr. O. Tarnate
Paul Sherwin
Hygiene O. Tarnate
School administrators should promote, demonstrate, and monitor regular hand-washing and
positive hygiene behavior. Information dissemination via regular announcements, posting easy-
REFERENCES
REFERENCES
to-understand visual reminders in conspicuous places, encouraging good hand and respiratory
hygiene
Anjue Anjue practice,
Tang et as Awell
al. Aetretrospective
Tang al. as study
providing
retrospective theinformation
ofstudy clinical on characteristics
COVID-19
characteristics
of the clinical andof prevention
of COVID-19 ofin its in
infectioninfection
COVID-19
26 transmission,
children.
26 should
Medrxivbe
children. done in a[preprint].
sustained
[preprint].
Medrxiv Posted manner.March
Posted SpotMarch
checkers,
10, i.e. designated
2020.
10, Available
2020. personnel
from atfrom
Available
critical locations, may call the attention of student and
<https://www.medrxiv.org/content/10.1101/2020.03.08.20029710v1>. staff to remind them about hand and
respiratory hygiene, as an example. Specific class sessions to orient and remind students and staff
Cai on
et Cai
al. Aet Case
infection A Series
al.control
Case of children
Series
measures and with
of good
children 2019
with novel
personal 2019 coronavirus
hygiene novel infection:
shouldcoronavirus
be done clinicalincluding
infection:
frequently, and
clinical and
epidemiological
epidemiological features.features. ClinicalClinicalInfectious Infectious Diseases,Diseases, ciaa198,ciaa198,
demonstrations and return demonstrations of proper procedures.
Note: Infection prevention and good hygiene should extend to the home. Parents should be
informed
CentersCenters
for Diseaseof theControl
practices
for Disease
used
and
Control
in the school
Prevention. and Coronavirus
2020.
and Prevention.
these should also be disease
disease
2020. Coronavirus
practiced at home.
2019 (COVID-19).
2019 (COVID-19).
Updated 7 March7 2020.
Updated MarchAvailable at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
2020. Available at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
Handwashing
• Ensure soap and clean water are available at easily accessible hand washing stations.
CentersCenters
home isolation with
for persons with
COVID-19• Encourage
(Interim
COVID-19 Guidance).
frequent
and thorough
Guidance). hand washing (at least 20 seconds).
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
home-patients.html. Accessed
home-patients.html. on March
March 22, 2020.
• Provide alcohol-based hand sanitizers in toilets, classrooms, halls, and near entrances and
Centers forexits,
Disease
whereControl and Prevention. Interim Guidelines for Collecting, Handling, and
possible.
Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19). Available
• www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html.
at Ensure adequate, clean and separate toilets for girls and boys. Accessed 23
Accessed 23
Mar 2020.
Mar 2020.
Suggested
Centers messaging
for Disease to reinforce
Control handwashing
and Prevention. arehealth
Mental the following: Wash
and coping your COVID-19.
during hands often,
Centers
especially for Disease Control and Prevention. Mental health and coping during COVID-19.
before and after eating; after blowing your nose, coughing, or sneezing; after going to
the bathroom/ toilets/latrines, and whenever your hands are visibly dirty. If soap and water are
Chenot readily
Zhang et available,
al. Clinicaluse an alcohol-based
characteristics of 34hand sanitizer
children withwith at least 60%
coronavirus alcohol. Always
disease-2019 wash
in the
westhands
of China:
with a
soap multiple-center
andawater, case series.
if hands arecase Medrxiv
visiblyseries. [preprint]. Posted March 16, 2020.
dirty. Medrxiv [preprint]. Posted March 16, 2020.
west
from China: multiple-center
Chen,infection
J., Shu, byQ. the
et al.
J Pediatr (2020).
<https://doi.org/10.1007/s12519-020-00345-5>
infection et al.pregnant
Clinical women:
a retrospective
vertical transmission potential of COVID-19 infection in nine
review of medical records. Lancet. 2020;395(10226):809-15. Epub 2020/03/11. pregnant women: a retrospective
doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133 2020;395(10226):809-15. Epub 2020/03/11. doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
PEDIATRIC
of the Philippines
PHILIPPINES
WORKING
WORKING
Cough GROUP GROUP
etiquette
• Ensure that everyone covers their mouth and nose when they cough and sneeze, using a
Ad HocAd
Committee Chair: Dr.
Ma.Dr.
Carmen B. Nievera
Teamtissue,
Team Lead: Lead:
Dr. handkerchief,
AnnaDr.Lisa
AnnaT. LisaorT.one’s
Ong-Lim inner elbow.
Ong-Lim
Members:
Members:
Dr. JohnDr.Andrew T. Camposano
• Direct
Dr. Ma.everyone
Liza to place
Antoinette M. used tissues straight into the garbage can. Bins should be
Gonzales
Dr. Ma. Liza Antoinette M. Gonzales
provided
Dr.inFrancesca
Dr. Francescaevery
Mae classroom
T. Mae T.for
Pantig used tissues, and should be emptied regularly (ideally,
Pantig
use hands-free
Dr. PaulDr. covered
Sherwin bins).
O. Tarnate
• Avoid touching one’s eyes, nose and mouth
REFERENCES
REFERENCES
•
Always wash hands with soap and water, or use a hand sanitizer after coughing and/or
Anjuesneezing.
Anjue Tang et al. Aetretrospective
Tang study ofstudy
al. A retrospective the clinical characteristics
of COVID-19 in in
26 children.
26 MedrxivMedrxiv
10, 2020.
10, Available
2020. from
Available from
Use<https://www.medrxiv.org/content/10.1101/2020.03.08.20029710v1>.
of Masks
The use of masks is part of a comprehensive package of the prevention and control measures
Cai et Cai
al. A Case A Series of children with 2019 novel coronavirus infection: clinical clinical
and
that canetlimit
al. the Case Series
spread of respiratory
of certain children with
viral2019 novel
diseases, coronavirus
including infection:
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epidemiological
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used either for protectionfeatures.
of healthy persons
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transmission).
Centers forNotwithstanding,
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anduse
and Prevention. of a2020.
mask Coronavirus
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2020. isCoronavirus
insufficient
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2019
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level
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7 March
Updated 2020.
7 March or 2020.
sourceAvailable
Available control, and
at other personal and community level measures should
alsomanagement-patients.html
be adopted to suppress transmission of respiratory viruses. Whether or not masks are used,
compliance with hand hygiene, physical distancing and other infection prevention and control
CentersCenters
Discontinuation home for persons
isolation with
for persons with
(IPC) measures
COVID-19 (Interim
are critical to prevent
Guidance).
human-to- human transmission of COVID-19.
COVID-19 (Interim
Indirect evidenceAccessed Guidance).
for the use of maskshttps://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
(medical or other) by healthy individuals in the wider
home-patients.html.
Accessed on 22,
March 2020.22, 2020.
community from evidence in studies studying household transmission suggest that such
individuals
Centers would
for Disease
Centers
need toControl
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for Disease
be
andinPrevention.
close proximity to an
Interim
and Prevention.
infected
Guidelines
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person infor
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for Collecting,
Guidelines
orHandling,
Handling,
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at and
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Testing Clinical Specimens
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Testingwhere
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from cannot
Persons beforachieved, to become
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2019 with the
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Cloth Accessed 23
at face coverings are meant to protect other people in case the wearer is unknowingly
www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html. Accessed 23
Mar 2020.
infected
Mar 2020.but does not have symptoms. To some extent, they also protect the wearer’s nose and
mouth
Centers forfrom inhaling
Disease virus from
Control and an infected person
Prevention. Mentalwho might
health andnotcoping
be wearing
during a mask, or is too
COVID-19.
Centers
close at for
physically. Disease Control and Prevention. Mental health and
An (acrylic) eye shield protects the wearer from virus from infected people coping during COVID-19.
Available www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
coughing or sneezing towards the wearer. For younger children who cannot tolerate wearing face
Chemasks,
Zhangthey may
et al. be exempt
Clinical from doingofso34
characteristics provided
childrenthat
withphysical distancing
coronavirus is observed.
disease-2019 in the
west of• China:Masks a multiple-center
shouldabemultiple-center case
worn at schoolcaseseries. Medrxiv
by students [preprint]. Posted March 16, 2020.
Availablewestfrom China: series.and
ofhttps://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1. staff. Masks
Medrxiv should
[preprint]. be worn
Posted even
March when2020.
16,
going from
Available outside school and when riding public transportation. In addition, whenever
https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1.
possible, wearing of face shields should be encouraged to increase protection. Should
Chen,
respiratory teachers
Z., Fu,
infection findJ.,it difficult
causedShu, byQ.totheteach
et al.
2019with a face covering,
Diagnosis
novel and treatment
coronavirus. he/she may opt to use a face
recommendations
World J Pediatr forshield
(2020). pediatric
respiratory infection caused
<https://doi.org/10.1007/s12519-020-00345-5> by the 2019 novel coronavirus. World
while the students in the class maintain physical distancing and wear their own masks.(2020). J Pediatr
<https://doi.org/10.1007/s12519-020-00345-5>
• Cloth face coverings may serve as substitutes for medical grade masks. Face coverings
Chen H, Guo mayJ,be Wang C, Luo for
challenging F, Yu X, Zhang
students W et al.
(especially Clinicalstudents)
younger characteristics
to wearand intrauterine
in all-day settings
transmission
suchtransmission
Wang C,
potential
as school. Face of Luo F, Yu X,
COVID-19
coverings
Zhang inWnine
infection
should beinfection
et al.pregnant
worn by in
Clinical women:
staff and
characteristics
a
studentswomen:
and intrauterine
retrospective
(particularly older
review vertical
of medical records. potential of COVID-19
Lancet. 2020;395(10226):809-15. nine pregnant
Epub 2020/03/11. a retrospective
doi:
students) as feasible, and are most essential in times when
review of medical records. Lancet. 2020;395(10226):809-15. Epub 2020/03/11. doi: physical distancing is difficult.
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
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REFERENCESo Anyone who is incapacitated or otherwise unable to remove the cloth face
REFERENCES
covering without assistance
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Anjue et al. Aetretrospective
Tang study ofstudy
of COVID-19 in in
26 children.
26 MedrxivMedrxiv
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Cai et Cai
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infection: and and
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InfectiousDiseases,
CentersCenters
2019 (COVID-19).
Updated 7 March 2020. Available at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
Screening Prior to Entry
Health
Centers forscreening
Disease (including
Control andtemperature,
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Guidance). that have re-opened. On the other hand, pre-testing (with either
home-patients.html.
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home-patients.html. of all on March
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symptoms (see 23
Accessed
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Mar 2020. 1), or has had close contact with a person who has tested positive or has COVID-19
Mar 2020.
symptoms, should stay home and not go to school at all. The school authorities, or
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checks and reporting symptoms upon arrival at the school and before2020.
https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1. [preprint]. Posted March 16,
entering the classroom. Having students take their own temperatures may be considered
Chen, Z., in Fu,schools withQ.
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as face shields, masks and gloves, and clean thermometers after each use; these materials
<https://doi.org/10.1007/s12519-020-00345-5>
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Clinical women:
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doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
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[preprint]. Marchchild 10,
March 2020.
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Cai et al.and
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March 22, 2020.
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Mar 2020.
“bubble” to which they may have interactions and to which they have a traceable contact
Centers forhistory,
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at www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
• Innovative
Che Zhang scheduling,
et al. Clinical includingofstaggering
characteristics classes,
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coronavirus can come and
disease-2019 leave
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Che the
Zhang et al. Clinical characteristics of 34 children with coronavirus disease-2019 in the
west of China:school in batches, may
a multiple-center decrease
case series.the number[preprint].
Medrxiv of exposures of one
Posted student
March 16, to2020.
others,
west of China: a multiple-center case series. Medrxiv [preprint].
andhttps://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1.
Available from Posted March
more properly enables the suggested physical distancing. Holding shorter face-to- 16, 2020.
face class durations (i.e. only in the morning, or only in the afternoon, or classes only on
Chen, Z., alternate
Fu, J., Shu, Q.complemented
et al. Diagnosis and treatment recommendations for pediatric a
respiratory Z., Fu,days),
Chen,infection J., Shu,
caused Q. the
by et al. by
2019
online
Diagnosis
novel
instructions,
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may be
and treatment done to accommodate
recommendations
World J Pediatr for pediatric
(2020).
smaller class
respiratory size. caused by the 2019 novel coronavirus. World J Pediatr
infection (2020).
<https://doi.org/10.1007/s12519-020-00345-5>
• If possible, a separate entrance and exit gate should be designated, with unidirectional
<https://doi.org/10.1007/s12519-020-00345-5>
Chen H, Guo path
J, clearly
Wang marked to Yu
C, Luo F, minimize congestion/crossing
X, Zhang W et al. Clinical of students, staff,
characteristics andandintrauterine
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Chen H, Guo
Parents andJ, Wang C, Luo
non-essential
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visitorsinfection
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Lancet. from
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2020;395(10226):809-15. nine pregnant women:
Epub 2020/03/11. doi:
a designated school authority. a retrospective
review of medical records.
10.1016/S0140-6736(20)30360-3. PubMedLancet.
PMID: 2020;395(10226):809-15.
3215133 Epub 2020/03/11. doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
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PHILIPPINES
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REFERENCES
REFERENCES
children, children with cognitive disabilities) should not attend physical classes and may
Anjue Tang
Anjue beetaccommodated
Tang via other
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Cai et Cai
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discouraged; one parent/caregiver, per student, may accompany a child to school, as
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relevant
Available to transportation as formulated by the authorities.
CentersCenters
home isolation with
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March 22, 2020.
Mar 2020.
Mar 2020.
Mealtimes
It is of utmost importance to make students and teachers realize that the highest risk of infection
westwill
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Che Zhang et al. Clinical 34 shields when
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is time to eat. As16,
such,
disease-2019meals
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China: a multiple-center series. Medrxiv [preprint]. Posted March 2020.
west
are best
Available of China:
taken
from a multiple-center case series. Medrxiv [preprint]. Posted
by one’s self, with no one beside and in front of anyone who is eating.
https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1. March 16, 2020.
• Meals should preferably be done in the classroom to minimize movement and mixing.
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Chen,
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WorldnotJbePediatr for pediatric
shared. (2020).
<https://doi.org/10.1007/s12519-020-00345-5>by the 2019 novel coronavirus. World J Pediatr (2020).
• Meals and drinks should also not be shared. It is preferred that students bring their own
<https://doi.org/10.1007/s12519-020-00345-5>
Chen H, Guo foodJ, to school.
Wang C, Luo F, Yu X, Zhang W et al. Clinical characteristics and intrauterine
Chen H, Guo
vertical transmission J, Wang C,
Clinical women:
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•
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The transmission
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review of medical records. Lancet. 2020;395(10226):809-15. Epub 2020/03/11. pregnant women:
cross-contamination. a retrospective
doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
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PHILIPPINES
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REFERENCES
REFERENCES
Anjue Tang
Tang study ofstudy
of COVID-19 in in
26 children.
26 MedrxivMedrxiv
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Cai et Cai
al. A
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infection: and and
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CentersCenters
2019 (COVID-19).
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There
Centers foris Disease
Centers littleforevidence
Control
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Discontinuation
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studies
COVID-19(Interim Guidance).
suggest(Interim
that insufficienthttps://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
Guidance).ventilation increases disease transmission. There is insufficient
home-patients.html.
data to estimateAccessed
the minimum
ventilation
March requirements
22, 2020. in schools, offices and other non-
hospital buildings, to prevent the spread of airborne infection. Likewise, no technical
Centers for and
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Testing Clinical Specimens from Persons for Coronavirus Disease (COVID-19). Available
Testing Clinical Specimens from
transmission in indoor spaces are available. Persons for Coronavirus Disease 2019 (COVID-19). Available
• Classrooms and other school rooms should be properly ventilated, and indoor air should
Mar 2020.
Mar 2020.
have appropriate egress outdoors by opening windows and doors. Consider utilizing
Centers foroutdoor
Disease Control and Prevention.DoMental health and coping during COVID-19.
Centers for spaces Diseasewhenever
Control possible.
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Mental healthand anddoors if doing
coping so poses
during a
COVID-19.
safetyatorwww.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
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Che Zhangusing et al.the facility.characteristics of 34 children with coronavirus disease-2019 in the
Clinical
west of• China:
Che Zhang
Guidance et al. Clinical
from characteristics
the European of Disease
34 children with(ECDC)
coronavirus disease-2019 in the
a multiple-center case Centers
series. for Control
Medrxiv [preprint]. Postedinclude:
March1) 16,maintain
2020.air-
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Available from of China:
conditioning a multiple-center case series. Medrxiv [preprint]. Posted
systems according to the manufacturer’s current instructions, particularly in
https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1. March 16, 2020.
relation to the cleaning and changing of filters; 2) energy- saving settings, such as
Chen, Z., demand-controlled
Fu, J., Shu, Q. etventilational. Diagnosis and by
controlled treatment
a timer orrecommendations
CO2 detectors, for pediatric
should be avoided;
Chen,infection
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World J Pediatr (2020). for pediatric
3)
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2019 from
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J pathogen
Pediatr (2020).
<https://doi.org/10.1007/s12519-020-00345-5>
dispersion from infected subjects and transmission; 4) avoid the use of air recirculation
<https://doi.org/10.1007/s12519-020-00345-5>
Chen H, Guo as much
J, Wang as possible.
C, Luo F, Yu X, Zhang W et al. Clinical characteristics and intrauterine
Clinical women:
a retrospective
doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
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PHILIPPINES
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REFERENCES may be done after classes are dismissed so that no students are exposed to disinfectant
REFERENCES
chemicals; students should NOT be handling disinfectants.
• For
Anjue Tang
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Cai et Cai
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• Proper
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• Standard precautions should be adopted when providing first aid to students who may
become unwell while in class; for example, use of gloves and an apron when dealing with
CentersCenters
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wipesat immediately.
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• Resources and equipment for regular cleaning and disinfection must be accessible to the
Centers forappropriate
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• Develop
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Che school
Zhanghygiene practices,
et al. Clinical and increaseofstaff
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children as needed. Teachers
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China:serve
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Medrxiv be consistent
[preprint].
Available from https://www.medrxiv.org/content/10.1101/2020.03.12.20034686v1. in
Posted observing
March and
16, 2020.
implementing infection control measures. A phased opening, wherein implementation
Chen, Z., problems are assessed
Fu, J., Shu, Q. et al.and addressed,
Diagnosis should
and be considered.
treatment recommendations for pediatric
Chen, Z., Fu, J., Shu, Q. et al. Diagnosis and treatmentWorld
recommendations for pediatric
• Cleaning
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thebe2019 novel
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personal
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<https://doi.org/10.1007/s12519-020-00345-5>
• Whenever feasible, it is encouraged that school personnel are also trained to do contact
verticalChen tracing
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doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
PEDIATRIC
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PHILIPPINES
WORKING
WORKING
Special GROUP GROUP for the Sick and Vulnerable
Considerations
• Children with underlying medical conditions that may render them vulnerable to infection
Ad HocAd
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Francesca T. Mae
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school.
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• Teachers and staff who are Tarnate
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Dr. Paul O. Tarnate
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REFERENCES attend school.
REFERENCES
• The presence any signs or symptoms or significant exposure to a COVID-19 positive case
Anjue Tang
Anjue should
et al. dictate
Tang al. that
Aetretrospectivethe student/staffthe must
study ofstudy
A retrospective not
clinical
of the attendcharacteristics
school of
characteristics
clinical to COVID-19
prevent spread to others.
infection
of COVID-19 in
infection in
26 • When
children.
26 aMedrxiv
children.child is
Medrxiv[preprint].
sick, Postedfor
the requirement
[preprint]. aMarch
Posted doctor’s 10,
note to2020.
March Available
allow 2020.
10, return classfrom
toAvailable
shouldfrom
be deemed unnecessary, to reduce the need for the child’s leaving the home when he/she
is symptomatic.
Cai et Cai
al. Aet Case
al. Aor Series
Case of children
Series with 2019
of children novel
2019 coronavirus
with (fever, novel or infection:
coronavirus clinical clinical
infection: and
• Children
epidemiological staff who develop symptoms cough sore throat) while at school and
should be isolated in an appropriate area or school clinic with appropriate adult
supervision, and collected by a parent as soon as possible.
• Proper
CentersCenters
for Disease Controland
foreducation
Disease and
Control Prevention.
information 2020. Coronavirus
is necessary
and Prevention. to remove
2020. disease
stigma on
Coronavirus 2019
those(COVID-19).
disease who
2019were sick.
(COVID-19).
Updated 7 March 2020.
They 7should
Updated Available
Marchbe2020.handled at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
in a sensitive
Available manner so that they do not feel “dirty”.
• Creating clear and flexible policies on missing classes may remove the reluctance for
for taking
CentersCentersDisease a leave of absence
Control
for Disease
for both students
and Prevention.
Control
and staff,ofashome
Discontinuation
and Prevention. Discontinuation
well as enable for
ofisolation
continuing
home isolationpersons learning
with
for persons
COVID-19 if the
(Interimneed for quarantine
Guidance). happens. Generous opportunities for making
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in- up for missed with
classes may
home-patients.html.
home-patients.html.
alsoAccessed
Accessed encourage
on March students
on 22,
March2020. and staff to be more forthcoming as regards
22, 2020.
screening for symptoms.
Centers•forAll Disease
children Control and Prevention.
and school staff Interim Guidelines forupdated
Collecting,withHandling, toand
Centers for Disease Control and are encouraged
Prevention. to remain
Interim Guidelines regardHandling,
for Collecting, their and
immunization
Testing requirements,
Clinical Specimens especially
from Persons with vaccines
for Coronavirus against
Disease 2019outbreak-prone and
(COVID-19). Available
Mar 2020. respiratory diseases.
Mar 2020.
Testing,
Centers for Contact
DiseaseTracing,
Controland
andIsolation
Prevention. Mental health and coping during COVID-19.
•
Available atSymptomatic
students and staff should be tested for COVID-19 to facilitate contact tracing
and quarantine of contacts. Schools must coordinate with the local government unit
Che Zhang(LGU)’s
et al. Clinical characteristics orofcity/town
34 children with coronavirus disease-2019 in testing
the
Che Zhang Department of Health
et al. Clinical characteristics health
of 34 personnel
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west and
of to initiate
China: a contact tracing
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series. local
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[preprint].
Whenever
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Chen, Z., theFu, school setting.
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• Schools Fu, J., Shu,
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<https://doi.org/10.1007/s12519-020-00345-5>
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among students or C,
staff,
Luothe
F, school should Whave, in place,
Clinicalguidance on communication
verticalChen H, Guo
transmission J, Wang
potential of COVID-19 Yu X, Zhang
infection et al.
in nine pregnant characteristics
women: and intrauterine
a retrospective
protocols,
vertical designated
transmission physical
potential of space
COVID-19for temporary
infection isolation
in nine
review of medical records. Lancet. 2020;395(10226):809-15. Epub 2020/03/11. of the
pregnant involved
women: person prior
a retrospective
doi:
10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
PHILIPPINE
PEDIATRIC
of the Philippines
PHILIPPINES
WORKING
WORKING goingGROUP
GROUP
to home, appropriate cleaning and contingency plans for closing classrooms or
schools, based on identified cases and in compliance with public health guidelines.
Ad HocAd
Ma.Dr.
Carmen B. Nievera
• Return-to-school
Team Lead:
Team Lead:
Dr. AnnaDr.Lisa
Anna T.guidelines
Ong-Lim
Lisa for students and staff should follow official policies of the
T. Ong-Lim
Members: Department
Members:
Dr. John of Health.
Dr.Andrew
John Children
T. Camposano
Andrew and school staff who were previously sick and suspected
T. Camposano
orDr.
confirmed
Ma.Dr.
Liza to
Ma. have COVID-19
Antoinette may
M. Gonzales
Liza Antoinette be released from isolation and may return to school
M. Gonzales
Dr. Francesca
provided Dr. Mae T. criteria
theFrancesca
following Pantig
Mae T. are met:
Pantig
oDr.Completed
PaulDr.
Sherwin
Paul O. Tarnate
14Sherwin
days O. Tarnate
of isolation or quarantine, AND
o 14 days have passed since the symptoms first appeared, with clinical recovery
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(afebrile for at least 3 days and without respiratory symptoms), OR
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o 14 days after a positive COVID-19 RT-PCR if with no symptoms, OR
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ofstudy
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characteristics
the clinical of COVID-19
of COVID-19 in in
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10, 2020.
10, Available
2020. from
Available
Note: Repeat COVID-19 testing is NOT routinely recommended
<https://www.medrxiv.org/content/10.1101/2020.03.08.20029710v1>. to document recovery andfrom
should not be a requirement for school readmission.
Cai et Cai
al. A
et Case
infection: and and
epidemiological
InfectiousDiseases,
Importance of Communication and Transparency
• School authorities must provide accurate, timely, scientific evidence-based information
CentersCenters
forregularly
Disease Control
to
for Disease and Prevention.
theirControl
staff, students, 2020.
and
and Prevention. Coronavirus
parents. disease
2020. Education about
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the (COVID-19).
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infection Available
control
7 March at
measures
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is essential
Available to successful implementation of these strategies.
•
School administrators should inform parents, staff, and local health facilities what
for measures
CentersCentersDisease are being
Control
for Disease
taken
and by the school.
Prevention.
Control
Regular updates
Discontinuation
and Prevention. of home
Discontinuation
of these efforts
ofisolation
should be
for persons
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with
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COVID-19 in a transparent
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• Provide age-appropriate
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March on
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2020. and its prevention by hygiene, physical
distancing, use of masks and other measures, via television or posters, as feasible based
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the Controlofand
the Prevention. Interim Guidelines for Collecting, Handling, and
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and Prevention. Interim Guidelines for Collecting, Handling, and
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10.1016/S0140-6736(20)30360-3. PubMed PMID: 3215133
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