Standard Operating Procedure (SOP)

Issued: 8/26/2020 (Updated 8/12/2021) Revised: See Change Log (Appendix D)

SUBJECT: Investigation of COVID-19 in Pre-K-12 Schools

Maine Center for Disease Control and Prevention

Division of Disease Surveillance

I. BACKGROUND AND RATIONALE

SARS-CoV-2, the virus that causes COVID-19, has become widespread globally and in the United States.
Evidence indicates that children of all ages are susceptible to COVID-19 although their clinical
presentation is often less severe than that seen in adults. However, severe disease is possible, including rare
fatalities and a multisystem inflammatory syndrome in children that can lead to a severe and life-
threatening illness in rare cases.

II. PURPOSE

This SOP provides a framework for responding to COVID-19 among students, teachers, or staff within a
school. It will be updated as necessary. The guidance in this SOP is not exhaustive, nor does it replace
direct engagement with Maine Center for Disease Control and Prevention (Maine CDC). The Maine DOE
Nurse Consultants are Maine CDC’s primary points of contact for schools.

III. OBJECTIVES

The primary reason to investigate cases or outbreaks of COVID-19 in schools is to control the spread,
prevent or quickly identify outbreaks, and, with lessons learned from investigations, help prevent future
outbreaks. Specific objectives of investigations may include, but are not limited to:

1. Implementing measures to prevent or mitigate transmission of COVID-19 within a school setting.

2. Determining the magnitude of the outbreak and characterizing chain(s) of transmission (e.g., secondary
transmission among children, school staff members, and household members).
3. Describing characteristics of school populations, including demographic, health status, clinical
characteristics (for cases), and exposures, stratified by COVID-19 case status.

IV. METHODS

A. Case Definitions
Maine CDC will follow CSTE case definitions for COVID-19. These case definitions are subject to
change. COVID-19 interim case definitions can be found at
https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/. The
2021 approved case definition can be found at https://www.cste.org/resource/resmgr/21-ID-01_COVID-
19_updated_Au.pdf

B. Investigation Approaches
Interviews with school staff are useful to assess the school environment and strategies adopted by the
school to prevent or mitigate COVID-19 spread. Gathering detailed information on school operations,

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 space layout, number of staff members, teachers and students, class sizes (density), and daily schedule
(pick up, drop off, rotation through different classrooms and other school spaces) will help with
understanding the daily routine and potential mixing among students from different classes.
Maine CDC will initiate an investigation when it learns of a confirmed or probable case (or cases)
associated with a school.

In the event that the school is informed of a confirmed or probable case (or cases) of COVID-19 prior to
Maine CDC, the school or School Administrative Unit (SAU) will alert the Maine DOE by calling the
reporting hotline at (207) 624-6717 or completing the online DOE reporting form. The DOE will
contact Maine CDC to report the case(s). During off hours, Maine CDC case investigators will call the
school nurse at the school for an individual case. If the school nurse is unavailable the case investigator
will leave a message. If there is an additional contact on the voicemail, the case investigator will reach out
to that individual. If an outbreak investigation is opened during off hours, the outbreak investigator will
notify DOE’s school nurse consultant in such circumstances.

Recommended public health actions will depend on the number of cases, the location of the cases, and the
degree of contact those cases may have had with other students, teachers, or staff. Table 1 below
summarizes the various stages of public health recommendations based on these factors. It is important to
note that the circumstances of a specific outbreak may result in a deviation from these recommendations.

C. School Responsibilities
A designated school staff member affiliated with the school where a positive case is identified will be an
essential part of the public health investigation. The designated person will serve as the primary point of
contact for public health investigators. The designee should also contact the school nurse, applicable
designated school administrators, school health advisors/school physicians, and, where possible, the
primary care provider of the student who has tested positive.

As noted in Section V (Notification and Communication) below, the school nurse shall serve as the
primary point of contact with families of confirmed cases. When the school nurse communicates with the
family of a confirmed case, the school nurse should share isolation information as well as
quarantine information for family members living in the same household. Based on the Maine CDC case
investigation surge plan (serious or critical only), nurses may be able to give an anticipated release from
isolation date, specifically for those who will not be investigated. Doing so will save time prior to Maine
CDC contacting the family and may reduce the likelihood of further transmission. The school nurse
should communicate that any school-aged siblings that live in the same household, are unvaccinated, and
do not participate in pooled testing should be sent home from school and placed into quarantine. The
school nurse or other designated school staff can make social service referrals with family’s permission to
covidsocialsupport@maine.gov, this can support the family with a variety of resources. Please reach out to
a school nurse consultant or Maine CDC for more information.

The school nurse should recommend that the parent/guardian monitor other family members for symptoms
of COVID-19. These include: fever (>100.4◦F) or chills, cough, shortness of breath or difficulty breathing,
fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose,
nausea or vomiting, diarrhea, confusion or change in mental status, persistent pain or pressure in the chest,
blue/gray/pale skin/lips/nail beds, or inability to wake or stay awake.

The school nurse should also advise families to ensure that the COVID-19-positive student remain in
proper isolation, especially from people who are at higher risk for getting sick from COVID-19. Families
where a member has tested positive for COVID-19 should alert their health care provider, especially if
symptoms worsen. In addition, the school nurse can provide a brief overview of the case investigation
process, contact tracing, and Sara Alert system for the family (see Appendix A). Symptomatic close

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 contacts should seek a COVID-19 test and schools should not initiate contact tracing until the
symptomatic close contact has received a positive COVID-19 test.

Designated school staff can then begin the process of determining who within the school may constitute a
close contact (see Sections F and G below).

In general, a close contact is defined as an individual with exposure to the confirmed or probable case
within 6 feet for 15 minutes or more (cumulatively in one day) regardless if individuals were wearing face
coverings, or having direct physical contact with a person with confirmed COVID-19 during the
infectious period (physical touch or direct contact with secretions or excretions of an infected individual).

Vaccinated close contacts do not need to quarantine unless they themselves become symptomatic.
However, vaccinated close contacts should be tested 3-5 days following exposure and wear a mask until
they receive a negative test result.

To help protect students in the school and out of an abundance of caution, Maine CDC considers everyone
within a classroom to be close contacts unless there is assigned seating as described in Table 4. Close
contacts of a school case who are participating in school pooled testing do not need to quarantine from
class or other school-related activities, but they do need to quarantine from other community outings. In
addition to close contacts from the classroom setting, the designated staff can begin to compile
information on close contacts related to transportation and extracurricular activities. Designated school
staff, along with other school officials, should make initial contact with the determined close contacts to
ensure they begin their quarantine period in a timely manner. If close contacts need to quarantine from
school (unvaccinated and/or non-pooling close contacts) but are determined while school is in session,
they may complete the day. If private transport is unavailable, taking the bus home is acceptable. Schools
will inform close contacts and/or parents that they will be enrolled in Sara Alert for monitoring before
sending the close contact list to the DOE Contact Tracing Team through the approved process. Close
contacts who are enrolled in the pooled testing program should be informed of their need to quarantine
outside of school activities and monitor for symptoms. Do not include these close contacts on the Contact
Tracing template submitted to DOE to avoid confusion for families.

D. Laboratory Testing
Maine CDC recommends testing for all close contacts of persons with SARS-CoV-2 infection.
Unvaccinated close contacts should test as soon as possible after exposure, regardless of symptoms. If that
test is negative, the close contact should be re-tested 5-7 days later. Vaccinated close contacts should test
3-5 days after exposure.

Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that close
contacts of individuals with SARS-CoV-2 infection be quickly identified and tested in the appropriate
time frame. Unvaccinated and non-pooling close contacts must remain in quarantine for 10 days
irrespective of the test result. Testing of close contacts also helps identify additional cases. This allows
identification of further close contacts who should be in quarantine. PCR confirmation of a positive
antigen test is no longer required provided that the antigen test is conducted on an individual with a
known exposure to a positive case or with a linked positive PCR pooled test. In general, individuals
who test positive should not be retested for 90 days following the date of the positive test result. However,
an individual who develops new onset of symptoms consistent with COVID-19 infection during the 90-
day period following the initial positive test collection date should be retested and should isolate until 24
hours after symptoms have resolved although there will not be contact tracing. An individual who tests
positive again 90 days after the last positive test must complete isolation following the new, positive
result.

Pooled testing participants do not need to be tested if identified as close contacts through school
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 exposures, through extracurricular activity for example, since they will test on a weekly basis.
Completeness of reporting for all individuals testing positive or negative can optimize investigation efforts
for case classification and provide an initial assessment of attack rates when combined with line lists
provided by the school.

Maine CDC will work with School Administrative Units (SAU) to identify potential locations where
students, faculty, or staff could obtain COVID-19 testing. Maine CDC cannot guarantee the availability of
on-site testing for every school experiencing an outbreak. State-sponsored sample collection sites can be
found on Governor Mills’ COVID-19 site; additional options can be found at Get-Tested-COVID19.org.

Maine CDC does not investigate or accept home-based testing results. These are not counted as cases or
in outbreaks. Schools may choose to accept home-based testing results. Maine CDC strongly encourages
that schools that choose to accept a home-based test result do so only with those from a validated
application that accompanies the test kit. This application will allow you to verify the collection date and
patient. Maine CDC does not recommend accepting pictures of test kits as a validated result. A home-
based test is not reported to the state and will not result in a confirmed or probable case.

E. School-Based Pooled Testing

The Maine CDC and Department of Education (DOE) have implemented a pooled PCR testing program,
available to public and private schools (private Pre-K-only programs are not eligible to apply). Pooled
testing involves mixing several test samples together in a “batch” or “pool” and then testing the pooled
sample with a PCR test for detection of SARS-CoV-2.

If a pooled test result is negative, then all individuals within that pool are presumed negative and may
remain in school. If a pooled test result is positive, then all individuals in the pool must be retested
individually (see Table 1 below for an example timeline). The Abbott BinaxNOW rapid point-of-care
antigen test will be the primary source of this individual follow-up testing. SAUs that are not already
enrolled in the Abbott BinaxNOW initiative are invited to complete that process.

Table 1. Example of Weekly Overview for Pooled PCR Testing Program

Day* Monday Tuesday Wednesday Thursday Friday
Test Type Pooled PCR Results from pooled PCR testing BinaxNOW Second round of
samples are returns in 24-48 hours antigen testing BinaxNOW
collected antigen testing,
if needed
Action Pooled samples If a positive PCR test returns from a If a positive case This will only
are delivered to pool, then BinaxNOW is performed is identified occur if the first
lab for on those who were in the pool the using the round of
processing. same or next day. BinaxNOW, BinaxNOW
then the case testing did not
leaves school detect a positive
and isolates. case. All
Initiate SOP. students will
Other pooled remain in school
participants if the second
return to class. round does not
identify a
positive case
and no further
testing will

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 occur until the
next designated
pooled PCR
testing day.
*Schools will have a designated day to perform pooled testing, but not every schools pooled testing day will be
Monday.

When COVID-19 community transmission reaches emergency levels as determined by Maine CDC and
physical distancing is again required, schools that choose to participate in the Pooled PCR Testing
program are not required to adhere to 3-foot spacing in school, except during meals, where 6-feet of
distancing still applies. Moving below the 3-foot distancing recommendation during emergency applies
only to schools where 30% of the school’s total students/staff population, participate in the Pooled PCR
Testing program. If a school is in an outbreak status, then spacing requirements may return. For further
guidance on pooled testing protocol and guidance, please review the materials provided in Maine Pooled
PCR Testing Guidance for K-12 Schools and Maine’s K-12 Pooled PCR Testing Program
Frequently Asked Questions. This includes required steps to participate, preconditions for pooled testing,
vendor information, and logistics.

No matter a school’s pooled testing participation status, in the event of a positive case, contact tracing and
isolation still apply. Note also that someone can have close contacts outside of their own pool and not all
pool-mates will necessarily be close contacts. Pools are not formed on the basis of close contact
determination.

Schools also have the option of using BinaxNOW as a standalone tool and should review the guidance
materials from DHHS.

F. Isolation and Quarantine

Students, teachers, or staff who test positive for COVID-19 shall isolate until they meet the U.S. CDC
criteria for release for isolation.

Close contacts must be notified for every COVID-19 case in students or staff (see Appendix A, 2nd letter).
The close contact definition is exposure within 6 ft for more than 15 minutes within a 24-hour period or any
direct physical contact. Close contacts must quarantine for 10 days from COVID-19 exposure from school
and school activities except if at least one of the following conditions applies to the close contact:
1. The close contact (staff or student) is vaccinated and if the exposure occurred more than 14 days
after the individual’s completion of the vaccine series. If the exposure occurred after vaccination
but prior to the 14 days, the close contact must quarantine for the full time period: or
2. The close contact (staff or student) has a previous positive COVID-19 test result (molecular or
antigen) collected within 90 days of the exposure: or
3. The close contact (staff or student) participates in weekly school pooled testing and the exposure
was a school exposure; or
4. The school has a mandatory masking policy. If so, then an exposed classroom student does not
need to quarantine from regular school-day activities when the student close contact was at least 3
feet from an infected student (laboratory-confirmed or a clinically compatible illness) provided that:
i. The school enforces consistent and correct use of well-fitting masks; and
ii. no direct physical contact occurred.

Exception #4 is limited to classroom exposures only. Exposures that occur in buses, cafeterias, and school-
sponsored activities are not eligible for exception #4. The exception does not apply to teachers. staff or
other adults in the classroom.

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 Staff and students who do not fall within exceptions 1-4 above must quarantine if they are a close contact,
regardless of the location of exposure. Although pooled testing participants do not need to quarantine from
school/school activities if exposure occurs at school, they must follow Maine CDC guidelines for
community exposure. All unvaccinated close contacts (participating in pooled testing or not) must
quarantine outside of class and other school-based functions (e.g., sports or extracurricular activities).

Table 2: Summary of Quarantine Exceptions

Quarantine Status (see 1-4 Community Classroom Quarantine from school- School notification?
under “F. Isolation & Quarantine? Quarantine? related sports and
Quarantine”) activities?
Exception 1: Vaccination No No No Letter
Exception 2: 90 days No No No Letter
Exception 3: Pooled testing Yes No No Letter
Exception 4: School Students
with universal Yes No Yes Letter + Sara Alert
masking Staff Yes Yes Yes Letter + Sara Alert
No exceptions or symptomatic Yes Yes Yes Letter + Sara Alert

In a school setting, close contacts may range from a few people in a classroom, an entire classroom to the
entire school, depending on the number and location of confirmed cases. Tables 3 and 4 summarize the
public health actions that can be taken in response to cases detected within schools depending on the
mitigation practices within classes.

Table 3: Public Health Actions for COVID-19 in Schools Without Assigned Seating Who Do Not Participate
in Pooled Testing
Number of Location Testing ** Quarantine *** Cleaning/Closure Notes
Cases
1 or 2 Single All students/staff All students/staff in the Routine cleaning Additional potential
classroom/cohorts/pod within the classroom classroom locations for close
contacts include
busses, after-school
activities, etc.
1 or 2 Two or more All students/staff All students/staff in the Routine cleaning Additional potential
classrooms/cohorts/pod within both classrooms classrooms locations for close
contacts include
busses, after-school
activities, etc.
3+ Single All students/staff All students/staff in the Routine cleaning Additional potential
(outbreak*) classroom/cohort/pod within the classroom classroom locations for close
contacts include
busses, after-school
activities, etc.
3+ Multiple classrooms/ All students/staff in All students in the same Routine cleaning Additional potential
(outbreak*) cohorts/ pods the same classrooms, classrooms, cohorts, locations for close
cohorts, pods, buses, pods, buses, and contacts include
and extracurricular extracurricular activities busses, after-school
activities are are considered close activities, etc.
considered close contacts and will need
contacts and are to quarantine for 10 If and only if students
recommended to be days, regardless of test are cohorted in one
tested. results classroom, it is
possible that only
Close contacts may Close contacts may affected classrooms
expand to include the expand to include the will be closed.
entire school entire school depending
depending on the on the epidemiological
epidemiological investigation,
investigation, considering factors such
considering factors as adherence with
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 such as adherence with public health guidelines
public health and the age of the
guidelines and the age students.
of the students.

*An outbreak is defined as 3 or more PCR confirmed cases from different households within 14 days in a school.
** Individuals with a previous positive COVID-19 test should not retest.
*** Individuals with a previous positive COVID-19 test who are exposed to a COVID-19 case do not need to
quarantine if the exposure is within 90 days from their positive test collection date(unless they become symptomatic)
AND/OR individuals who have completed the COVID-19 vaccine series and more than 14 days have passed since the
individuals last vaccine do not need to quarantine (unless they become symptomatic).

Table 4: Public Health Actions for COVID –19 in Schools with Assigned Seating in All Classrooms/Spaces
Who Do Not Participate in Pooled Testing
Number of Location Testing ** Quarantine *** Cleaning/Closure Notes
Cases
(within a
14-day
period)
1 or 2 Single All students/staff who All students/staff who Routine cleaning Additional potential
classroom/cohorts/pod meet close contact meet close contact locations for close
definition. definition contacts include
busses, after-school
activities, etc.
3+ Single All students/staff All students/staff in the Routine cleaning Additional potential
classroom/cohorts/pod within the classroom classroom locations for close
contacts include
busses, after-school
activities, etc.
1 or 2 Multiple classrooms/ All students/staff who All students/staff who Routine cleaning Additional potential
cohorts/pods meet close contact meet close contact locations for close
definition definition contacts include
busses, after-school
activities, etc.

3+ Multiple classrooms/ All students/staff in All students in the same Routine cleaning Additional potential
cohorts/ pods the same classrooms, classrooms, cohorts, locations for close
cohorts, pods pods contacts include
busses, after-school
activities, etc.

*An outbreak is defined as 3 or more PCR confirmed cases from different households within 14 days in a school.
** Individuals with a previous positive COVID-19 test should not retest.
*** Individuals with a previous positive COVID-19 test who are exposed to a COVID-19 case do not need to
quarantine if the exposure is within 90 days from their positive test collection date AND/OR individuals who have
completed the COVID-19 vaccine series and more than 14 days have passed since the individuals last vaccine do not
need to quarantine (unless they become symptomatic).

G. Contact Tracing in Schools

Maine CDC uses the following criteria to determine when isolation and/or quarantine for exposed contacts
of confirmed or probable cases is necessary. There may be alternative public health actions if assigned
seating is used in classrooms/spaces (Table 4).

(1) For one or two confirmed or probable case(s) in a student/staff/teacher in single or multiple classrooms:
• All other students/staff/teachers in that classroom/pod are considered close contacts regardless of
the setup of the classroom or face covering use.
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 o Art, library, and cafeteria exposures for student/staff/teacher will follow US CDC’s 6-foot,
15-minute recommendations. Any unique cases can be reviewed on a case-by-case basis by
calling 1-800-821-5821 or call the DOE Hotline (207) 624-6717.
o Not utilizing social distancing and masking as a mitigation strategy may result in an
increased number of identified close contacts and increased transmission. Standard Maine
CDC quarantine requirements for close contacts at schools not participating in the pooled
testing program will remain in effect.
• Strategies to reduce the number of close contacts:
o Implement Table 4 for all school-sponsored settings. Assigned seating/seating charts are
useful tools to make informed decisions regarding contact tracing.
o When possible, physically distance more than 6 feet apart.
• The classroom where the case is located should be cleaned according to U.S. CDC guidelines found
here: https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html.
• It is not necessary to wait 24 hours before cleaning or disinfecting schools.

(2) Bus exposures:

• In general, if a COVID-19 case is on a bus for fewer than 15 minutes cumulative within 24 hours,
no one else on the bus is considered a close contact.
• In general, if a COVID-19 case is present on a bus for greater than 15 minutes cumulative within
24 hours those identified as being within six feet will be considered close contacts.
• Any bus that carried a confirmed or probable case should be cleaned according to U.S. CDC
guidelines https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html

(3) After school activities:

• Anyone with more than 15 minutes within 24 hours of cumulative exposure within 6 feet or direct
physical contact will be considered a close contact.

(4) Evaluation of sports-related activities:

• If a COVID-19 case plays a sport while infectious, close contacts will be considered to be
individuals within 6 feet of the infected person for 15 minutes or longer, or who have any direct
physical contact with the infected individual. Support staff of a team (i.e., officials, referees,
athletic trainers), and where applicable, team opponents, will be assessed individually by Maine
CDC case investigators or school designated staff. This will depend on the nature of the activity,
setup, mitigation strategies in place by the school staff and the assessment conducted by a case
investigator.
• Those deemed to be close contacts may not play any sports during their period of quarantine. The
exception to this is if they are enrolled in pooled testing or if they are vaccinated and
asymptomatic. These school-related close contacts do not need to quarantine from school-related
activities.
▪ Relaxed outdoor mask recommendations do not exempt people from quarantine should
they be deemed a close contact and are unvaccinated or not participating in pooled testing.
Not utilizing social distancing as a mitigation strategy may result in an increased number
of identified close contacts and increased transmission. Not utilizing masking as a
mitigation strategy may result in increased transmission.

Exceptions to contact tracing can be found above in E. Isolation and Quarantine and in Table 2. Maine
CDC recommends that school community members be notified when a confirmed or probable case has
been detected that is associated with the school (see Appendix A).

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 H. Outbreak Response
Once a school reaches outbreak status1 as determined by a Maine CDC outbreak investigator:
• All individuals associated with the school should be notified by the school of the outbreak (see
Section V below). School officials should make such notifications in writing, using a template
provided by Maine CDC (see Appendix A).
• A Maine CDC outbreak investigator will coordinate with the school, and each case will still be
assigned a case investigator who will follow the standard investigation protocol.
• If three cases are spread across multiple classrooms:
o All students/staff/teachers of any classroom where the student/staff/teacher attended a
class are considered close contacts regardless of the setup of the classroom/pod or face
covering use.
o The school will follow cleaning guidance from U.S. CDC:
https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html
o Unvaccinated, non-pooling close contact students, teachers, and staff who test negative
must complete a 10-day quarantine from the last day of exposure in the school.
• School outbreak status does not necessarily warrant school closure and can be evaluated on a case-
by-case basis.
• Maine CDC may recommend suspending all in person extra-curricular activities for the duration of
the outbreak.
• In situations where students are in a single classroom and teachers rotate through the classroom,
where there is a single case, all the teachers who rotated through the classroom will be considered
close contacts.
• Close contacts may expand to include the entire school depending on the case or outbreak
investigation, considering factors such as adherence with public health guidelines and the age of
the students.
• Outbreaks are preliminarily closed 14-days after the last positive test or symptom onset, whichever
is later, and officially closed 28-days after the last positive test or symptom onset date, whichever
is later. If a school is in an outbreak, and the school is past their 14-day preliminary close, the
school may choose to follow Table 4.

V. NOTIFICATION AND COMMUNICATION

Notification of a Confirmed or Probable Case to Schools

The Maine CDC case investigator will alert school nurses of a laboratory confirmed or probable
COVID-19 case in the schools and begin an investigation. Case investigators must inform the school if
the case was physically in attendance during their infectious period. Case investigators are encouraged to
inform the school if the case was in attendance during their exposure period. Maine CDC will have a
designated investigator(s) who will work closely with the Maine Department of Education (DOE) on
COVID-19 related matters in schools. Maine CDC and Maine DOE School Nurse Consultant will
monitor new cases.

Notification of a Confirmed or Probable Case to Maine CDC

School officials may be notified of a confirmed or probable case among a student or staff member by the
individual or parents (if the case is a student). If school staff are notified by a parent/guardian that their
child received notice from their health care provider that their COVID-19 test was positive, school staff
should contact the school nurse. The school nurse or designated staff will report the suspect case using
the DOE Positive Case Reporting Form or by calling the DOE COVID-19 Hotline at 624-6717 . Once
Maine CDC receives the positive lab report a case investigator will begin the COVID-19 investigation.
The school will be notified by either Maine DOE or Maine CDC that the case has been confirmed and the

1 An outbreak is defined as 3 or more PCR confirmed cases from different households within 14-days.
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 school will begin its notifications of close contacts. The school nurse will be the communication link
among the family, the Maine DOE School Public Health Response Team, and the Maine CDC.

Communication with Family Members

Maine CDC recommends that the school nurse communicate with the family of a confirmed or probable
case (when that case is a student). The school nurse will be best suited to provide information to the family
and reassure the family that Maine CDC investigators will be in contact with them. The school nurse
should also reach out to the DOE reporting hotline, 207-624-6717 or use the reporting link to inform
Maine DOE of the case. Maine DOE’s School Nurse Consultant will coordinate with Maine CDC's school
investigator(s). The school should notify family members of students that will be in quarantine. This
should include information about Sara Alert and symptom monitoring. A sample letter is available in
Appendix A.

Communication with School Community

Maine CDC recommends that school community members be notified when a confirmed or probable case is
detected that is associated with the school. The school is best able to notify parents, staff, teachers, and
other community stakeholders (e.g., Board of Education, Superintendent, etc.) of the confirmed or probable
case(s). Template letters for such communication are available in the appendices. Maine CDC strongly
recommends confirming COVID-19 cases and outbreaks prior to schools sending public communications.

Public Reporting
Maine CDC may report publicly when an epidemiological investigation has confirmed an outbreak of
COVID-19 associated with a school, as it does in other settings. Superintendents should notify their school
community before Maine CDC announces a school is in outbreak status when possible. In general, such
investigations are opened after three or more epidemiologically linked cases are identified within a 14-day
period.

After Hours
A Maine CDC case investigator will reach out to a school nurse when identifying a confirmed or probable
case who attended school while infectious. If the school nurse is unavailable the case investigator will leave
a message. If there is an additional contact on the voicemail, the case investigator will reach out to that
individual prior to 5 PM. If no contact has been made, the Maine CDC case investigator will reach out to
the DOE in a final attempt to contact the school. If Maine CDC opens an outbreak investigation after hours,
the outbreak investigator may contact the superintendent of the school administrative unit as well as the
DOE’s on-call contact after hours or the next business day.

VI. CONTACT TRACING PROTOCOLS IN SCHOOLS

Maine DOE will work with school officials to conduct contact tracing and symptom monitoring for close
contacts of confirmed COVID-19 cases within schools.

Maine uses a platform called Sara Alert to conduct symptom checks on close contacts of confirmed cases.
The Maine DOE Contact Tracing team will enroll asymptomatic close contacts of confirmed cases—whether
students or staff—into Sara Alert for daily symptom monitoring during the quarantine period if the close
contact did not participate in the School Pooled Testing Program. Maine DOE will monitor those close
contacts during their quarantine period and, if any of those individuals becomes symptomatic, will provide
guidance on testing and other clinical evaluation. The DOE school nurse consultant and a Maine CDC school
investigator will have access to the Sara Alert system. Note that school contacts will be enrolled into a
dedicated jurisdiction within Sara Alert.

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 VII. GLOSSARY

Term Definition
Close contact In general, being within 6 feet of an infected person (with or without a face mask) for
at least 15 minutes (cumulatively in a day), or having unprotected direct physical
contact with a person with confirmed COVID-19 during the infectious period
Community Occurs when individuals acquire COVID-19 through contact with someone in their
transmission local community, rather than through travel to an affected location.
Confirmed case A person who has tested positive for SARS-CoV-2 infection (the virus that causes
COVID-19) using a molecular test.
Contact tracing Process of identifying individuals who have had close contact (see definition above)
with someone infected with COVID-19
Cohort A consistent group of students and staff who interacts with each other but not with
members of other groups on a regular basis. When in a cohort, each group must
physically distance themselves from each other and from other cohorts.
Direct physical Direct contact with any person infectious with COVID-19 in which contact with
contact secretions or excretions cannot be ruled out
COVID-19 Abbreviation for the disease caused by the novel coronavirus SARS CoV-2
Incubation period The time between exposure to an infection and the appearance of first symptoms. The
virus that causes COVID-19 has an incubation period of 2 -14-days.
Infectious period 2-days prior to testing (the date of the swabbing was conducted) until federal CDC
(asymptomatic criteria to discontinue isolation are met
cases)
Infectious period 2-days before any symptom onset within 10 days prior to positive test result until
(symptomatic federal CDC criteria to discontinue isolation are met
cases)
Isolation Process of separating individuals who are infected with COVID-19 from others.
Isolation lasts a minimum of 10-days from symptom onset if symptomatic. If a person
infected with COVID-19 has no symptoms, isolation lasts a minimum of 10 days from
the date of test specimen collection (test). For individuals with severely
immunocompromising conditions, isolation is at least 20-days.
Outbreak 3 or more confirmed cases from different households within 14-days linked in space
(i.e., same school, same event etc.).
Pooled testing An individual who is participating in school pooled testing that has either tested in the
participant most recent pooled testing or was absent and used a BinaxNOW test in place of
pooled testing.
Protocol Recommended actions to follow in the event of a probable or confirmed case of
COVID-19
Probable case Individual who has a positive antigen test, or is a symptomatic close contact of a lab-
tested case of COVID-19

Quarantine Process of separating and restricting the movement of individuals who were in close
contact with someone who tested positive or had symptoms of COVID-19.. Persons in
quarantine should get tested, and self-monitor for symptoms and seek medical advice
if needed.
Screening Assessing individuals for symptoms of COVID-19 verbally or via self/parent
attestation. Temperature checks may be performed by the school if desired.
Symptomatic A person who is experiencing one or more of the symptoms of COVID-19 as defined
individual in U.S. and Maine CDC guidelines.
Testing Three types of tests are available for COVID-19: molecular, antigen, and antibody
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 tests. Molecular and antigen tests indicate if you have a current infection while
antibody tests indicate a previous infection. Throughout this document, 'testing' refers
to either molecular or antigen-based tests to diagnose a person with current COVID-
19 infection.

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Appendix A: Sample notification letters to school communities

Dear Staff, Students, and Families,

This letter is to inform you that an individual associated with [School] recently tested positive for Coronavirus Disease 2019
(COVID-19). We are informing you out of an abundance of caution. Please monitor yourself/your student for signs and
symptoms. Call a health care provider if symptoms start. Stay home if you are sick or are experiencing any listed symptoms

COVID-19 is a respiratory illness that ranges from mild to severe. It can be more severe in adults 60 years and older and in
those with underlying conditions. The virus mainly spreads when an infected person coughs or sneezes and an uninfected
person breathes in the virus. Signs and symptoms include:

• fever or chills • congestion or runny nose

• cough • nausea or vomiting
• shortness of breath or difficulty breathing • diarrhea
• fatigue • confusion
• muscle or body aches • pressure or pain in the chest
• headache • blue/gray-tinged skin/lips/nail beds
• new loss of taste or smell • inability to wake or stay awake
• sore throat

Please keep in mind that many things can cause respiratory illness, so students and staff should be up-to-date on influenza
and routine vaccinations.

Maine DOE or a school representative will contact you directly if you are identified as a close contact of someone who
tested positive. Close contacts who are unvaccinated and not a pooled testing participant will be asked to quarantine from
school for 10-full-days from last exposure to the positive individual. All unvaccinated close contacts will be asked to
quarantine from non-school activities as well. A negative test result does not get an individual out of quarantine.

Maine CDC recommends prevention measures to prevent the spread of COVID-19. These measures include proper
handwashing with soap and warm water, which is especially important after using the bathroom, before eating, and after
blowing your nose, coughing, or sneezing. When soap and water is not available, use an alcohol-based hand sanitizer with
at least 60 percent alcohol. Avoid touching your eyes, nose, and mouth with unwashed hands and avoid close contact with
people who are sick. Stay home while you are sick and avoid close contact with others. Wear a cloth face covering in public
indoor spaces, especially if you are not vaccinated. Cloth face coverings are recommended in schools and childcare settings
for people over 5 years of age. Get a COVID-19 vaccine when it is available to you. When in public, avoid social distances of
less than 6 feet and direct physical contact.

Questions for the school can be directed at (Name of school representative) by calling (contact number). For general
COVID-19 questions, dial 211 (or 1-866-811-5695). You can also text your ZIP code to 898-211 or email info@211maine.org.
Call a health care provider for questions about your symptoms. More information can be found at
www.maine.gov/dhhs/coronavirus or www.cdc.gov/coronavirus.

Sincerely,

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Sample notification letter for close contacts who meet no quarantine exceptions (Table 2 above)

Dear ,

This letter is to inform you that Maine CDC identified you/your student as a close contact to a Coronavirus Disease 2019
(COVID-19) case from a school-based exposure. This means that you/your student will need to quarantine at home for 10-
full-days from last exposure to this individual. While a negative test result will not remove the requirement for you/your
student to quarantine, testing is recommended. Unvaccinated close contacts should test as soon as possible after
exposure, regardless of symptoms and if that test is negative, the close contact should be re-tested 5-7 days later. Five to
seven days is the average length of time it takes to have enough virus in the body to show up on a test result. If you/your
student tests positive, it may increase the length of time that you/your student would need to stay home. Currently,
you/your student can come back to school on [DATE] so long as they do not have any symptoms and have not tested
positive.

All unvaccinated non-pooling close contacts’ names and phone numbers will be uploaded to Sara Alert and they will start
receiving text messaging. Close contacts can opt-out by blocking the text. Blocked text messages will receive one phone call
from a contact tracer to check in. A contact tracer will also call those (parents of or non-minor close contacts) without a cell
phone number, those needing interpreter services or any (guardians of) close contacts reporting symptoms. You will
receive a message from the SARA Alert system for symptom monitoring and a contact tracer will call you if needed.

COVID-19 is a respiratory illness that ranges from mild to severe. It can be more severe in adults 60 years and older and in
those with underlying conditions. The virus mainly spreads when an infected person coughs or sneezes and an uninfected
person breathes in the virus. Signs and symptoms include:

• fever or chills
• cough
• shortness of breath or difficulty breathing
• fatigue
• muscle or body aches
• headache
• new loss of taste or smell
• sore throat
• congestion or runny nose
• nausea or vomiting
• diarrhea
• confusion
• pressure or pain in the chest
• blue/gray-tinged skin/lips/nail beds
• inability to wake or stay awake

Maine CDC recommends prevention measures to prevent the spread of COVID-19. These measures include proper
handwashing with soap and warm water, which is especially important after using the bathroom, before eating, and after
blowing your nose, coughing, or sneezing. When soap and water is not available, use an alcohol-based hand sanitizer with
at least 60 percent alcohol. Avoid touching your eyes, nose, and mouth with unwashed hands and avoid close contact with
people who are sick. Stay home while you are sick and avoid close contact with others. Wear a cloth face covering in public

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indoor spaces, especially if you are not vaccinated. Cloth face coverings are recommended in schools and childcare settings
for people over 5 years of age. Get a COVID-19 vaccine when it is available to you. When in public, avoid social distances of
less than 6 feet and direct physical contact.

Questions for the school can be directed at (Name of school representative) by calling (contact number). For general
COVID-19 questions, dial 211 (or 1-866-811-5695). You can also text your ZIP code to 898-211 or email info@211maine.org.
Call a health care provider for questions about your symptoms. More information can be found at
www.maine.gov/dhhs/coronavirus or www.cdc.gov/coronavirus.

Sincerely,

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Sample notification letter for close contacts who meet exceptions 1-4 in Table 2 above:

Dear ,

This letter is to inform you that Maine CDC identified you/your student as a close contact to a Coronavirus Disease 2019
(COVID-19) case from a school-based exposure. You/your student will not need to quarantine from the classroom (and
other school-based activities if you/they meet exceptions 1-3, see table below) but quarantine rules apply at home and in
the community for individuals who meet exceptions 3-4. While a negative test result will not remove the requirement for
you/your student to quarantine, testing is recommended. Vaccinated close contacts should test 3-5 days after exposure.
Unvaccinated close contacts should test as soon as possible after exposure, regardless of symptoms and If that test is
negative, the close contact should be re-tested 5-7 days later. Five to seven days is the average length of time it takes to
have enough virus in the body to show up on a test result. If you/your student tests positive, it may increase the length of
time that you/your student would need to stay home. Currently, you/your student can return to school immediately so
long as you/they do not have any symptoms and have not tested positive.

A Guideline to Quarantine Exceptions

Close Contacts who meet the Community Classroom Quarantine from school- School notification
following exceptions experience Quarantine Quarantine related sports and activities
modified quarantine:
Exception 1: Vaccination complete No No No Letter
Exception 2: Within 90 days of a
positive molecular or antigen test No No No Letter
Exception 3: Pooled testing
participant Yes No No Letter

Exception 4: School enforces

masking
Students
Yes No Yes Letter + contact tracing
Staff Letter + contact tracing
Yes Yes Yes
No exceptions or symptomatic Letter + contact tracing
Yes Yes Yes

COVID-19 is a respiratory illness that ranges from mild to severe. It can be more severe in adults 60 years and older and in
those with underlying conditions. The virus mainly spreads when an infected person coughs or sneezes and an uninfected
person breathes in the virus. Signs and symptoms include:
• fever or chills • congestion or runny nose
• cough • nausea or vomiting
• shortness of breath or difficulty breathing • diarrhea
• fatigue • confusion
• muscle or body aches • pressure or pain in the chest
• headache • blue/gray-tinged skin/lips/nail beds
• new loss of taste or smell • inability to wake or stay awake
• sore throat

Please keep in mind that many things can cause respiratory illness, so students and staff should be up-to-date on influenza

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and routine vaccinations.

Maine CDC recommends prevention measures to prevent the spread of COVID-19. These measures include proper
handwashing with soap and warm water, which is especially important after using the bathroom, before eating, and after
blowing your nose, coughing, or sneezing. When soap and water is not available, use an alcohol-based hand sanitizer with
at least 60 percent alcohol. Avoid touching your eyes, nose, and mouth with unwashed hands and avoid close contact with
people who are sick. Stay home while you are sick and avoid close contact with others. Wear a cloth face covering in public
indoor spaces, especially if you are not vaccinated. Cloth face coverings are recommended in schools and childcare settings
for people over 5 years of age. Get a COVID-19 vaccine when it is available to you. When in public, avoid social distances of
less than 6 feet and direct physical contact.

Questions for the school can be directed at (Name of school representative) by calling (contact number). For general
COVID-19 questions, dial 211 (or 1-866-811-5695). You can also text your ZIP code to 898-211 or email info@211maine.org.
Call a health care provider for questions about your symptoms. More information can be found at
www.maine.gov/dhhs/coronavirus or www.cdc.gov/coronavirus.

Sincerely,

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Sample notification letter for outbreaks

Dear Staff, Students, and Families,

This letter is to inform you that there is an outbreak of Coronavirus Disease 2019 (COVID-19) at (School Name). An
outbreak means that there are three or more confirmed cases of COVID-19 within a 14-day period that are
epidemiologically linked. Based on recommendations from the Maine CDC, we are cleaning the school/classrooms and
closing the school or classroom to help prevent further spread of COVID-19. Your child can return on (date). Please monitor
yourself/your student for signs and symptoms. Call a health care provider if symptoms start. It is important that you call a
health care facility before you show up in person.

COVID-19 is a respiratory illness that ranges from mild to severe. It can be more severe in adults 60 years and older and in
those with underlying conditions. The virus mainly spreads when an infected person coughs or sneezes and an uninfected
person breathes in the virus. Signs and symptoms include:
• fever or chills • sore throat
• cough • congestion or runny nose
• shortness of breath or difficulty • nausea or vomiting
breathing • diarrhea
• fatigue • confusion
• muscle or body aches • pressure or pain in the chest
• headache • blue/gray-tinged skin/lips/nail beds
• new loss of taste or smell • inability to wake or stay awake

Please keep in mind that many things can cause respiratory illness, so students and staff should be up-to-date on influenza
and routine vaccinations.

Maine DOE or a school representative will contact you directly if you are identified as a close contact of someone who
tested positive. Close contacts will be asked to quarantine for 10-days from last exposure to the positive individual. A
negative test result does not get an individual out of quarantine.

Maine CDC recommends prevention measures to prevent the spread of COVID-19. These measures include proper
handwashing with soap and warm water, which is especially important after using the bathroom, before eating, and after
blowing your nose, coughing, or sneezing. When soap and water is not available, use an alcohol-based hand sanitizer with
at least 60 percent alcohol. Avoid touching your eyes, nose, and mouth with unwashed hands and avoid close contact with
people who are sick. Stay home while you are sick and avoid close contact with others. Wear a cloth face covering in public
indoor spaces, especially if you are not vaccinated. Cloth face coverings are recommended in schools and childcare settings
for people over 5 years of age. Get a COVID vaccine when it is available to you. When in public, avoid social distances of less
than 6 feet and direct physical contact.

Questions for the school can be directed at (Name of school representative) by calling (contact number). For general
COVID-19 questions, dial 211 (or 1-866-811-5695). You can also text your ZIP code to 898-211 or email info@211maine.org.
Call a health care provider for questions about your symptoms. More information can be found at
www.maine.gov/dhhs/coronavirus or www.cdc.gov/coronavirus.

Sincerely,

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 19
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 20
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Appendix D: Change Log

Date of original version: 8/26/2020

Date of Change Description of Change Author

9/9/2020 To reflect designation of close contacts from Team
school sports
9/15/2020 To clarify conditions under which an outbreak Team
investigation is opened

9/23/2020 To clarify the definition of close contacts in an Team

outbreak
9/28/2020 To clarify case investigation process, AHOC, and bus Team
windows
9/29/2020 To clarify the role of antigen testing and, separately, Team
school sports by creating Appendix B
9/30/2020 To clarify bus exposures and, separately, to add Team
Appendix C for school-based testing documents
10/2/2020 To clarify cleaning guidance and community-based Team
sports
10/4/2020 To add Appendix D, which will track all subsequent NDS
revisions
10/31/2020 Updated Outbreak G section to match Table 4 AF
11/14/2020 Updated Community sports link, probable case AF
investigation, outbreak school letter
12/8/2020 Updated with changes to definition of “probable JML
case,” case investigation prioritization, contact
tracing, quarantine, and community sports
12/12/2020 Updated background section and formatting AF
2/25/2021 Updated requirements of quarantine and isolation for MA
those with a previous positive test in the last 90
days, quarantine requirements for fully vaccinated
individuals; Addition to role of school nurse, DOE
contact tracing team and superintendent if school
deemed an outbreak, insert page numbers; Updated
guidance regarding quarantine of individuals who
are identified as close contacts of a case and use of
antigen testing, role of the school nurse clarified use
of BinaxNOW testing for essential teachers/staff

3/31/2021 Clarify the preliminary and official ending of MA

outbreak timelines, updated close contacts within a
school setting
5/13/2021 Addition of pooled testing guidance and home-based MA
testing clarification on close contact for those in
School Pooled testing, updated testing guidance in
sample notification letter for close contacts, updated
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 infectious period for symptomatic cases definition in
glossary
8/3/2021 Simplification of close contact definition, update Team
testing recommendations for vaccinated individuals,
addition of guidance for informing pooling close
contacts of the need to quarantine in the community,
addition of 4 new COVID-19 symptoms
8/10/2021 Interpretation of federal exception for quarantine; Team
reorganization of isolation and quarantine section,
addition of Table 2 for understanding quarantine
exceptions
8/12/2021 Updated exception to close contact quarantine per NDS
US CDC changes.

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