COVID-19 and Child Care Centres

If staff do not pass the screening they cannot enter the child care centre. If staff become ill while at work, they must leave immediately. Ill staff are recommended to go directly to an assessment centre for testing. They must then self-isolate until the results are received. If the results are negative they can return to work once their symptoms have resolved, following routine exclusion policies at their workplace. If their symptoms persist or worsen, re-testing should be considered.

If they are not tested, staff must remain off work until 14 days after onset of symptoms, provided they have been fever free and symptoms have improved for 72 hours.

Staff that are positive will be followed up by Public Health.

* All ill staff and children should be reported to the Health Unit, at 1-800-660-5853 extension 2222

The use of cohorts minimizes the number of exposed people should a staff or child become ill and facilitates contact tracing by Public Health.

A cohort is defined as a group of children and the staff members assigned to them, who stay together throughout the duration of the program for minimum 7 days. The cohort of the same group of 10 people or less (2 staff, 8 children) must be maintained day over day. Each member of the cohort must not be in contact with another cohort for the full 7 day period at a minimum, ideally cohorts should be maintained week over week.

Note: Additional information not covered in documents: if a cohort is changed after 7 days, it should be preceded by a two day absence from the centre (i.e. Saturday and Sunday) for each member of the new cohort. Since cases are considered to be contagious 2 days before onset of symptoms, anyone developing symptoms on the Monday would not have exposed the previous week’s cohort.

See question #1 above. No one can be forced to get tested. They do have to follow the protocol for someone who chooses not to be tested, which, in this case, is being excluded from the childcare for 14 days.

Yes. If screeners follow the appropriate precautions when screening and escorting children to the program, as per the Ministry of Education “Operational Guidance During COVID-19 Outbreak: Child Care Re-Opening” document, they can work with children within a cohort.

Appropriate Precautions include:

• maintaining a distance of at least 2 meters/6 feet from those being screened or being separated by a barrier
• wearing personal protective equipment (surgical/procedure mask and eye protection); this includes proper procedures for putting on and taking off PPE, and changing it at appropriate times (i.e. when wet or soiled).

The purpose of installing a temporary physical barrier is to ensure separation of cohorts. A curtain may not be effective in maintaining separation if the children are able to easily pass through to the other side. While the document does not specify what materials the physical barrier should be made of, keep in mind the cleaning requirements that must also be maintained. Frequently touches surfaces should be cleaned and disinfected at least twice a day. Surfaces that are smooth, non-absorbent and easily cleanable are advised.

It is the responsibility of each centre to ensure the appropriate safety measures are in place based on Guidance from the Ministry of Education and the Leeds, Grenville and Lanark District Health Unit. Your plan will not require Health Unit approval to re-open your child care setting. Child Care Centres do not require an inspection prior to re-opening if they are operating under an existing license. However, an onsite inspection will follow at a later date to ensure childcare centres are meeting their requirements to keep children, their families and child care workers protected.

Surgical/Procedure masks are required for staff when they must be in close contact with an ill child. Child Care Centre staff should consider using a non-surgical, cloth mask when they are unable to maintain physical distancing with other staff or children, such as during toileting/diapering.

Face coverings protect those around you by preventing your respiratory droplets from contaminating others or landing on surfaces. It is a way to cover your cough or sneeze and to contain droplets when you talk or sing.

Face coverings should not be placed on or used by: children under the age of two, anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

When wearing a face covering, take the following precautions to protect yourself:

• Wash your hands before putting it on and taking it off.
• Avoid touching your face covering while using it.
• Use your own face covering and do not share yours with others.
• Clean surfaces that your dirty face covering touches.
• Change it as soon as it gets damp or soiled. Cloth face coverings can be laundered with other items using a hot cycle, and then dried thoroughly.

Frequently touched surfaces include toilets, faucets, sinks and counter tops which are required to be cleaned at least twice a day. All surfaces must receive additional cleaning when soiled or potentially contaminated.

Note: Bathrooms should be dedicated to a single cohort. One cannot schedule specific times in the day for when different cohorts can use the bathroom and are therefore represent a common, high-touch area between cohorts. Any centre that wishes to share a bathroom between one or more cohorts must include a detailed plan to the Health Unit as to how this will be done safely in a feasible and effective way. Also see questions 22 and 23.

Fountains should be disabled or made inaccessible.

There is not a prescribed frequency for cleaning toys. The virus is able to survive on smooth surfaces for several days. Handling contaminated toys can contaminate hands with the virus, which then can lead to infection if hands are brought to the eyes, nose or mouth. Regular disinfection will kill the virus. Frequent hand hygiene will reduce contamination of toys and prevent infection of children and staff.

Toys must remain designated to a cohort and cleaned and disinfected as often as possible.

Mouthed toys must be cleaned and disinfected after each use. All toys that are shared between cohorts must be cleaned and disinfected between cohorts. Sensory toys should be single use and not shared between children.

Anything that can be handled by children should be easily cleanable – smooth, non-absorbent. Consider putting them higher where the children can see but not touch.

The cook would be counted as part of the cohort only if they are not able to maintain physical distancing (2 metre/6 feet distance from cohort). Ensure other staff and children are not able to enter the kitchen by using physical barriers. Ensure that the delivery/pick up method to provide food does not bring the cook into close contact with cohorts or vice versa.

An inspection is not required prior to reopening.

Yes – Public health should be notified when a child or staff demonstrates symptoms of illness or becomes sick. Public Health will discuss the situation with the child care centre, assess the risk to the child care centre and provide advice regarding exclusions and extra precautions. Please contact the Health Unit at 1-800-660-5853 and dial extension 2222. Leave a message if necessary. Do not call or leave telephone messages for individual staff members.

Using cohorts minimizes the number of exposed people should a staff or child become ill and facilitates contact tracing by Public Health.

A cohort is defined as a group of children and the staff members assigned to them, who stay together throughout the duration of the program for minimum 7 days. The cohort of the same group of 10 people or less (2 staff, 8 children) must be maintained day over day. Each member of the cohort must not be in contact with another cohort for the full 7 day period at a minimum, ideally cohorts should be maintained week over week.

If you do change cohorts after 7 days, ensure surfaces and toys are cleaned in between cohorts. Efforts should be made to keep the same children in the cohort week after week. The changing of cohorts should be preceded by a 2 day absence from the centre for each member of the cohort (see question #2 above).

Asymptomatic staff testing is not required for child care centre staff as part of Ontario Health’s Targeted Testing Campaign at this time. It is important to remember that a negative test in the past does not guarantee you will remain negative in the future. The results reflect a snapshot in time. It is important to maintain all infection control measures such as active screening, physical distancing, hand hygiene and environmental cleaning at all times, even after a negative test. It is important for staff to self-monitor for symptoms of COVID-19 at all times.

The Ministry of Education guidance document requires the use of surgical/procedure masks and eye protection (goggles or face shield) for screeners. Donning procedure masks and eye protection should also be considered when caring for a sick child and when cleaning up blood and body fluid spills if there is a risk of splashing. List of PPE suppliers in Leeds & Grenville.

Refer to the most recent version of The COVID-19 Reference Document for Symptoms for a list of typical and atypical symptoms of COVID-19. The Child Care Centre should develop an internal policy for documenting allergies and other underlying conditions for all attendees.

The lunch bag and contents of it would be considered a personal item brought from home. It should be well labelled and kept with that child’s personal items. If it requires refrigeration, place inside another bag from the centre first so it does not contact other food items. Preferably, bagged lunches should contain only non-hazardous and non-perishable foods.

Cohorts must maintain physical distancing from other cohorts at all times. Your plan must include how you will be able to ensure this is maintained at your centre. If staff and children must pass through an area used by another cohort, hand hygiene should be performed before passing through and consider the use of barriers or visual cues. Any surfaces that may be touched or contaminated must be cleaned and disinfected between cohorts, including hand rails, sinks, toilets etc.

Ideally, each cohort should have its own bathroom. If this is not possible because of the layout of your centre, it is your responsibility to ensure your plan covers how you will maintain physical distancing between cohorts, and clean and disinfect surfaces between cohorts when spaces are shared, including bathrooms.

See above answer. Children may need to use the washroom outside of their scheduled time – ensure your plan includes how to manage this situation safely. Consider having an “occupied” sign on the door, or having a potty in the child care room for emergencies.

Anyone outside the cohort must maintain physical distancing from the children and staff in the cohort, including custodial staff. If custodial staff need to enter child care centre spaces they should arrange to do so when the children and staff are not in the room, if possible. If they must come into the room when the cohort is present, they must maintain physical distancing from the cohort. Consider the use of barriers or visual cues to maintain separation. PPE is not required if physical distancing can be maintained, with the exception of PPE that is used for other reasons such as gloves or safety glasses for contact with cleaning chemicals.

Cohorts must maintain physical distancing or be separated by an impermeable barrier. If the fence materials allow for contact between cohorts, your plan should include how you will ensure the physical distancing will be maintained between the cohorts in your defined area or you may choose to make adjustments to the fence.

General Guidance for disinfectants:

• Use only disinfectants that have a Drug Identification Number (DIN). A DIN is an 8-digit number given by Health Canada that confirms it is approved for use in Canada.
• Follow the manufacturer’s instructions on any products being used:
  • Properly prepare solutions;
  • Allow adequate contact time for disinfectants to kill germs (see product label);
  • Wear gloves when handling cleaning products if indicated on the product label, including wipes;
  • Wear any other personal protective equipment recommended by the manufacturer.
  • Check expiry dates of all products.

Disinfecting wipes can be used in a child care centre provided the manufacturer’s instructions are followed. Long contact times can be difficult to maintain with a wipe and may require several wipes to achieve. Also, if they are to be used to wipe toys that may be mouthed by children, follow the manufacturer’s instructions for whether a potable water rinse is required following the contact time. To determine whether your disinfectant is effective against COVID-19, visit the Health Canada website and enter the product name or DIN.

For more information on cleaning and disinfection refer to our Child Care Infection Control Manual.

No – however use caution when using a “touchless” infrared (“laser”) type thermometer as they tend to be less accurate and affected by outside temperatures. Always have a back-up method such as a tympanic (ear) thermometer. These can be used with disposable covers or be disinfected between uses. We recommend that parents do the temperature checks in the morning at home and record the temperature upon screening; however, you must have a thermometer in case they forget or in case a child becomes ill during the day.

We recommend that parents do the temperature checks in the morning at home and record the temperature upon screening; however, you must have a thermometer in case they forget or in case a child becomes ill during the day. The screening questions should be asked upon arrival; however, parents/guardians should have a copy of the screening questions at home. Ideally, children should stay home and parents/guardians should call in if they will not pass screening.

Outdoors is better; however, if the screening occurs indoors, limit the drop-off to a single family member with the child, maintain 2 meters distance from the child and their parent until they pass screening OR use a barrier (plexiglass or similar material). Ensure other staff and children are not in the screening area. You may request that parents wear a face covering if maintaining 2 meters distance is difficult. Ensure these safety measures are included in your plan and communicated with all staff and families.

Sensory materials, including sand should be provided for single use (i.e. available to the child for the day) and labelled with the child’s name. Avoid the use of sandboxes. Some outdoor play areas are covered in sand. Ensure children clean their hands and discourage sand play as much as possible.

Screening is required for anyone entering the childcare centre. The screening questions must include whether the child has been in close contact with someone (including their parents/guardians) who is ill or has travelled outside of Canada. If parents/guardians are ill or have travelled, the children will not meet the screening criteria, as they will be contacts of probable case of COVID-19. When developing your screening questions consider asking them in the following way:

1. Do you or your child have any of the following symptoms?

   Fever (temperature of 37.8 degrees C or greater), new or worsening cough, shortness of breath

   Other symptoms – sore throat, difficulty swallowing, new olfactory or taste disorder(s), nausea, vomiting, diarrhea, abdominal pain, runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.)

   Other signs – clinical or radiological evidence of pneumonia

   Atypical symptoms and signs – unexplained fatigue/malaise/myalgias, delirium (a serious medical condition that involves confusion, changes to memory, and odd behaviours), unexplained or increased number of falls, acute functional decline, worsening of chronic conditions, chills, headaches, croup, conjunctivitis, multisystem inflammatory vasculitis in children, unexplained tachycardia (heart rate over 100 beats per minute), including age specific tachycardia for children, decrease in blood pressure, unexplained hypoxia (even if mild i.e. O2 sat <90%), lethargy and difficulty feeding in infants (if no other diagnosis).

2. Have you or your child travelled outside of Canada in the past 14 days?
3. Do you or your child have symptoms compatible with COVID-19 and laboratory diagnosis of COVID-19 is inconclusive?
4. Have you or your child lived with, or provided care for, or spent time with someone who has
   • tested positive for COVID-19, or
   • is suspected to have COVID-19, or
   • has an inconclusive laboratory diagnosis of COVID-19, or
   • who has symptoms that started within 14 days of travel outside of Canada?
5. If yes to number 4, were you and/or your child wearing appropriate Personal Protective Equipment while in contact with this person? If no, do not meet screening criteria.

If the answer is YES to questions 1-3, the child does not pass screening and should not enter the child care centre.

If the answer to question 4 is YES and 5 is NO, the child does not pass screening and should not enter the child care centre.

If the answer to question 4 is YES but 5 is YES, the child may enter the childcare centre.

*Contact public health is you need advice regarding specific screening situations.

The Health Unit recognizes the need for staff coverage during breaks and also the necessity to maintain the required staffing ratios. However, a person moving from cohort to cohort seriously compromises the integrity of all cohorts entered and risks potentially transmitting infection throughout the facility.

In order to reduce this risk, the following options are offered:

1. Attempt to limit as much as possible situations where a floater would be needed, or
2. Where a “floater” is needed:
   • try to have them come in at slow times (i.e. during nap time) when they are unlikely to be needed to get within 6 feet of anyone, and sit near the door. If they are needed to help with a child (i.e. enter a child’s 6 feet area), they must wear full PPE (surgical/procedural mask and eye protection minimum, a gown and gloves if there is a chance of clothing contamination) which should be available near the entrance to the room. The PPE then must be doffed (removed) and safely discarded when leaving the room; or
   • wear PPE, which is donned (put on) at the door (see above) when entering and properly doffed (removed) and discarded when leaving the room