The centers for Disease Control and Prevention (CDC) have proposed a number of procedures to reduce the likelihood of coronavirus transmission at childcare and student supervision centers [1]. These include suggested procedures at drop-off, screening children on arrival, and temperature checks.

Parent drop-off and pick-up

• Set-up hand hygiene stations at the entrance so that children can wash their hands at arrival. If a sink is not available, provide hand sanitizer with at least 60% alcohol next to parent sign-in sheets. Keep hand sanitizer out of children’s reach and supervise use. If possible, place sign-in stations outside, and provide sanitary wipes for cleaning pens between each use.
• Consider staggering arrival and drop off times and plan to limit direct contact with parents as much as possible.
• Have staff greet children outside as they arrive.
• Upon their arrival, stand at least 6 feet away from the parent/guardian and child.
• Designate a parent to be the drop-off/pick-up volunteer to walk their child/children to their classroom, and at the end of the day, walk their child/children back to their car. Ideally, the same parent or designated person should drop off and pick up the child every day. If possible, older people such as grandparents or those with serious underlying medical conditions should not pick-up children, because they are more at risk for severe illness from COVID-19.

Screening children at arrival

Persons who have a fever of 100.40 (38.00C) or above or other signs of illness should not be admitted to the facility. Encourage parents to be on the alert for signs of illness in their children and to keep them home when they are sick. Screen children upon arrival, if possible.

• Ask parents/guardians to take their child’s temperature before coming to the facility.
• Ask the parent/guardian to confirm that the child does not have fever, shortness of breath or cough.
• Make a visual inspection of the child for signs of illness which could include flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), or fatigue.

Staff conducting temperature screening of children on arrival should

• Perform hand hygiene, i.e. wash their hands with soap and water for 20 seconds. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
• Put on disposable gloves, a facemask, and eye protection (goggles or disposable face shield that fully covers the front and sides of the face).
• Take the child’s temperature.
• If performing a temperature check on multiple individuals, ensure that you use a clean pair of gloves for each child and that the thermometer has been thoroughly cleaned in between each check.
• If you use disposable or non-contact (temporal) thermometers and did not have physical contact with an individual, you do not need to change gloves before the next check.
• If you use non-contact thermometers, clean them with an alcohol wipe (or isopropyl alcohol on a cotton swab) between each client. You can reuse the same wipe as long as it remains wet.
• After each screening after the session, remove and discard PPE, and wash hands.

If available, a physical barrier, such as a glass or plastic window or partition can serve to protect the staff member’s face and mucous membranes from respiratory droplets that may be produced if the child being screened sneezes, coughs, or talks. If using a barrier, make sure the staff member’s face stays behind the barrier at all times during the screening.

Your program may consider indicating that the child has passed through the screening process by using some kind of easily identifiable marker. For example, placing a colored dot on the child’s name tag and using a different color dot each day allows staff to easily recognize which children have been screened at arrival each day.

Screening staff at arrival

• Ask staff members to take their temperature before coming to the facility.
• Ask staff members to confirm that they do not have fever, shortness of breath or cough.
• Make a visual inspection of each staff member for signs of illness which could include flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), or fatigue.

Consider taking each staff member’s temperature on arrival and using an easily identifiable marker (such as a colored dot on their name tag) to indicate that each staff member has passed through the screening process.

CDC defines social distancing as avoiding large gatherings and maintaining distance (approximately 6 feet or 2 meters) from others when possible [2]. The County Health Officer of Santa Clara County requires each essential business, include childcare providers, to develop, post and implement a social distancing protocols.  

• Limiting the number of people who can enter into the facility at any one time to ensure that people in the facility can easily maintain a minimum six-foot distance from one another at all times, except as required to complete the Essential Business activity;
• Where lines may form at a facility, marking six-foot increments at a minimum, establishing where individuals should stand to maintain adequate social distancing;
• Providing hand sanitizer, soap and water, or effective disinfectant at or near the entrance of the facility and in other appropriate areas for use by the public and employees, and in locations where there is high-frequency employee interaction with members of the public (e.g. cashiers);
• Providing for contactless payment systems or, if not feasible to do so, the providing for disinfecting all payment portals, pens, and styluses after each use;
• Regularly disinfecting other high-touch surfaces; and
• Posting a sign at the entrance of the facility informing all employees and customers that they should: avoid entering the facility if they have a cough or fever; maintain a minimum six-foot distance from one another; sneeze and cough into one’s elbow; not shake hands or engage in any unnecessary physical contact.

In-depth guidance is available on the county's web site:

Template for Social Distancing
https://www.sccgov.org/sites/covid19/Pages/social-distancing-protocol.aspx

Requirements for All Businesses:
https://www.sccgov.org/sites/covid19/Documents/COVID-19-Requirements-for-All-Businesses.pdf​

What Should Customers See in EVERY Business?​
https://www.sccgov.org/sites/covid19/Documents/COVID-19-What-Should-Customers-See.pdf​

The State of California is requiring the community to wear face coverings in public in response to updated information from the CDC [4]. Wearing a face covering reduces the chance that those with asymptomatic infection will spread the infection to others.

• All individuals are required to cover their nose and mouth with a face covering, such as a bandana, scarf, towel, or other piece of cloth or fabric, when in public spaces.
  
• Face coverings are critical for activities, such as attending or staffing a childcare program, when being in the vicinity of people outside of one's household is unavoidable.
• Cloth face coverings must be combined with maintaining social/physical distancing and hand washing. Wearing a face covering does not mean that people can come in closer contact with one another as face coverings may reduce the spread of the virus, but they do not completely stop the spread.
• Face coverings are not required to be worn when you are at home, in your car alone or solely with members of your household or when you are exercising outdoors, like walking, hiking, bicycling, or running. However, people are recommended to have a face covering with them and readily accessible when exercising.
• Face coverings are not necessarily recommended for children 6 years old or younger.
• Persons younger than two years old must not wear a face covering because of the risk of suffocation.
• Masks are not required for anyone who has trouble breathing, is incapacitated, or otherwise unable to remove a face covering without assistance, anyone who has been advised by a medical professional not to wear a face covering or any worker to the extent wearing a face covering creates a safety hazard at work under established health and safety guidelines.
• Essential businesses, such as childcare providers, are required to ensure that their staff wear a face covering in any area where others may be present, even if there are no customers or members of the public present at the time. This is to avoid the spreading of respiratory droplets in areas where others may be exposed at some point.
• Essential businesses, such as childcare providers, should inform children and families about the need to wear a face covering, including posting signs at the entrance to the facility.
  

You may need to modify your existing sickness policy and procedures and communicate these changes to families and staff. Children and staff who are sick on arrival should not be admitted to the facility. Children or staff who become sick during the day should be isolated and sent home as soon as possible.

• Communicate to parents the importance of keeping children home when they are sick.
• Communicate to staff the importance of being vigilant for symptoms and staying in touch with facility management if or when they start to feel sick.
• Ensure children and staff who come to the facility sick or become sick while at your facility are sent home as soon as possible.
• Keep sick children and staff separate from well children and staff until they can be sent home.
• Sick staff members should not return to work until they have met the criteria to discontinue home isolation.
• Plan to have an isolation room that can be used to isolate a sick child or staff member.
• Older children should wear masks, if they agree, since masks worn by sick persons help prevent the spread of germs to others.
• Ensure that you have the necessary supplies and procedures so that your program can disinfect your facility if someone is sick.

Guidance on cleaning and disinfecting facilities is provided by the CDC [5] and by the California Department of Industrial Relations Division of Occupational Safety and Health (Cal/OSHA) [6].

EPA List N: Disinectants
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19​

Hygiene practices

Programs should emphasize the importance of good hygiene practices including:

• The importance of frequent handwashing with soap and water (or using hand sanitizer where soap and water are not available).
• Methods to avoid touching eyes, nose, and mouth.
• Limiting close contact with others as much as possible and maintaining more than six feet of physical separation, “social distancing”.
• Coughing and sneezing etiquette.
• Safely using cleaners and disinfectants on surfaces and objects.

Routine cleaning and disinfection

• Staff should wear disposable gloves to clean and disinfect.
• Programs should routinely clean and disinfect frequently touched surfaces and objects (e.g., doorknobs, light switches, classroom sink handles, countertops, shared toys) using soap and water.
• Following cleaning, disinfect using an EPA-registered household disinfectant by following the instructions on the label. Alternatively, a diluted household bleach solution (1/3 cup bleach per gallon of water) can be used if it is safe for the surface. Check the label beforehand to ensure that it can be used for disinfection and has not expired. Finally a 70% alcohol solution can be used for disinfection. Leave the disinfecting solution on the surface for at least 1 minute.
• For soft surfaces, clean the surface using soap and water or with cleaners appropriate for use on these surfaces, launder items (if possible) according to the manufacturer’s instructions. Use the warmest appropriate water setting and dry items completely.
• For electronics, such as tablets, touch screens, keyboards, remote controls, and ATM machines, follow the manufacturer’s instruction for cleaning and disinfecting. In the absence of any guidance, use alcohol-based wipes or sprays containing at least 70% alcohol and then dry the item thoroughly.
• For clothing, towels, linens and other items, launder items according to the manufacturer’s instructions. Use the warmest appropriate water setting and dry items completely. Wear disposable gloves when handling dirty laundry from a person who is sick. Dirty laundry from a person who is sick can be washed with other people’s items. Do not shake dirty laundry. Clean and disinfect clothes hampers according to guidance above for surfaces.

Cleaning after a person has been sick or confirmed with COVID-19

Cleaning after a child or staff member has been identified as being sick requires additional procedures and precautions to reduce the likelihood of additional illness or infection.

• Close off areas used by the person who is sick.
• Open outside doors and windows to increase air circulation in the areas.
• Wait up to 24 hours or as long as possible before you clean or disinfect to allow respiratory droplets to settle before cleaning and disinfecting.
• Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas.
• If more than 7 days have passed since the person who is sick visited or used the facility, additional cleaning and disinfection is not necessary and you can return to routine cleaning and disinfection.
  

The COVID-19 situation remains fluid and guidance from local, state and Federal authorities is likely to change over the coming weeks. Providers are encouraged to monitor the guidance provided by the County of Santa Clara Public Health Department, the California Departments of Education, Social Services and Public Health, and the Federal Centers for Disease Control and Prevention (CDC) for the most current information.

[1] https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html

[2] https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html

[3] https://www.sccgov.org/sites/covid19/Documents/executive-summary-order-07-02-2020.pdf​

[4] https://www.sccgov.org/sites/covid19/Pages/learn-what-to-do.aspx#howto

[5] https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

[6] https://www.dir.ca.gov/dosh/Coronavirus/COVID-19-Infection-Prevention-in-Childcare-Programs-Guidance.pdf