The North Carolina Department of Health and Human Services has issued revised guidelines for controlling the spread of communicable diseases such as COVID-19 in schools.

Control measures are proven, long-standing, and well-established public health practices to prevent the spread of serious communicable diseases, such as measles, pandemic influenza, Ebola, varicella, Severe Acute Respiratory Syndrome (SARS), and COVID-19.

In North Carolina, all persons are required by law to follow specific communicable disease control measures. In the administrative rules implementing this law, the Commission for Public Health prescribes the specific control measures for communicable diseases. For COVID-19, the general control measure rule prescribes that the recommendations and guidance from the Centers for Disease Control (CDC) are the required control measures that must be followed.

The StrongSchoolsNC Toolkit, which is published by the North Carolina Department of Health and Human Services and adopted by the North Carolina State Board of Education, identifies isolation, quarantine, and exclusion as control measures for schools, students, teachers, and staff that are consistent with the CDC published control measures.

Due to recent actions of some school boards and questions received by the department, DHHS is providing a closer look at the implementation of the control measures of isolation, quarantine, and exclusion in North Carolina.

Isolation, Quarantine, and Exclusion
Terms

Isolation is a control measure used to separate people who have been infected with a communicable disease from others who are not infected. To prevent the spread of disease to others, the separation lasts until the person who is infected is no longer contagious. This control measure breaks the chain of transmission from someone known to be infected to someone not infected.

Quarantine is a control measure used to separate someone who has been exposed to a communicable disease, during the time period in which they may become sick or infectious to others after the exposure (incubation period), to prevent the spread of that disease. For COVID-19, the incubation period is up to 14 days. Quarantine breaks the chain of transmission because the exposed person is at risk of becoming infected and then spreading the infection to others. Schools are required to exclude students, teachers, and staff who meet the criteria to quarantine.

NOTE: Staff, teachers, and students who are fully vaccinated and do not have symptoms do not need to quarantine or be excluded from school based on exposure. Students who were exposed by another student do not need to quarantine or be excluded from school if they do not have symptoms and face masks were being used appropriately by both the student with COVID-19 and the potentially exposed student at the time of the exposure.

Exclusion is a control measure to ensure individuals who have been infected with a communicable disease or have been exposed to a communicable disease do not spread the disease to others. For COVID-19, students, teachers, and staff who met the criteria to isolate or quarantine are to be excluded from school.

Implmentation
Isolation, Quarantine, and Exclusion for students and staff can be minimized by adopting the layered prevention strategies in the StrongSchoolsNC Toolkit. Numerous studies have shown that viral transmission in school settings can be very low, if layered prevention strategies are in place.

The isolation period for people with COVID-19 is 10 days if, at the end of the 10-day period, the person has not had a fever for 24 hours and other symptoms (if experienced) are improving. Schools are required to exclude students, teachers, and staff that meet the criteria to isolate.

Quarantine and exclusion from in-person learning can be avoided for close contacts of a person with COVID-19 in the following circumstances:

• Staff, teachers, and students who are fully vaccinated and do not have symptoms do not need to quarantine or be excluded from school based on exposure.
• Students who were exposed by another student do not need to quarantine or be excluded from school if they do not have symptoms and face masks were being used appropriately by both the student with COVID-19 and the potentially exposed student at the time of the exposure.
• Staff, teachers, and students who have had a COVID-19 infection in the past 90 days and who do not have symptoms do not need to quarantine or be excluded from school based on exposure.
• People who do not meet the above exceptions to quarantine and exclusion must quarantine and the school must exclude those individuals from school in accordance with CDC recommendations and North Carolina law governing control measures.

The CDC continues to recommend quarantine of 14 days after the last exposure, the entirety of the incubation period. However, the CDC has identified two shorter quarantine options that can be adopted by the local health department:

• 10 days of quarantine if the person has no symptoms.
• 7 days of quarantine if the person has no symptoms, and the individual has received results of a negative antigen or PCR/molecular test that was conducted no earlier than day 5 of quarantine.

If quarantine is discontinued before day 14 and an individual is permitted by the school to return to school under the shortened periods above, the individual should continue to monitor symptoms and strictly adhere to all non-pharmaceutical interventions (e.g., wear a mask, practice physical distancing) through 14 days after the date of last exposure.

People who do not meet the above exceptions must quarantine and be excluded from school after an exposure in accordance with CDC recommendations and North Carolina law governing public health control measures. Written isolation and quarantine orders may be issued but are not necessary to create a legal requirement to comply with control measures, including exclusion from school.

Role of Schools
All schools have specific obligations with regards to communicable diseases and required control measures under North Carolina public health laws, which are incorporated and set forth in the StrongSchoolsNC Toolkit.

  1. Notification. If a student or staff member tests positive for COVID-19, the school principal must notify the local health director or designee of the positive case.
  2. Records. The school must provide medical or other records pertaining to the COVID-19 case upon request from the local health director or designee, to prevent further spread or to investigate a suspected outbreak. This information request can include, but is not limited to, class rosters, seating charts, team rosters, locker assignments, teaching schedules, and parent contact information.
  3. Exclusion. Schools must ensure that students, teachers, and staff that have tested positive for COVID-19 or have been identified as a close contact exposed to COVID-19 are excluded from school for the periods of time set forth in the Toolkit and outlined above. Per page 15 of the Toolkit: “Isolation is required for all presumptive or confirmed cases of COVID-19” and “Quarantine is required for an individual who has been a close contact … of someone who is determined positive with COVID-19.”. The exclusion criteria are set out in the chart on pages 17 and 18 of the Toolkit.

Strong collaboration and communication between the local health department and the school is critical to preventing the spread of COVID-19 within the school and community. It is critical that the local health department and the school work together to identify students, teachers, and staff subject to isolation or quarantine and exclusion. The local health director, or designee, will provide guidance to the school about the applicable quarantine period, if a shortened quarantine period is to be used.