Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697629640177.pdf (Antigua and Barbuda)
GOVERNMENT OF ANTIGUA AND BARBUDA MINISTRY OF HEALTH, WELLNESS AND THE ENVIRONMENT ADVICE ON THE MANAGEMENT OF THE SICK CHILD AND STAFF AT SCHOOL IN THE CONTEXT OF COVID-19 October 10, 2020 Daily health screening for early signs of illness can sometimes prevent a child from becoming ill while attending school (during school hours).
This screening can also eliminate problems for school having to care for a sick child until the parent or guardian is able to come to the school to pick the child up or exposing the other children and staff to communicable diseases.

What to look for in a Sick Child or Staff Suspected to have COVID-19 People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.

Symptoms may appear 2-14 days after exposure to the virus.
A sick child or staff suspected to have COVID-19 may have: A.

Acute onset of fever AND cough; OR B.
Acute onset of ANY THREE OR MORE of the following signs or symptoms: Fever (measured temperature of >= 100 ﹾF or 37.7 ﹾC with onset within the last 10 days), cough, general weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnea, anorexia/nausea/vomiting, diarrhoea, altered mental status C. Recent onset of anosmia (loss of smell) or ageusia (loss of taste) in the absence of any other identified cause 1 Persons who are moderately to severely ill may have Emergency Warning Signs for COVID-19.

a.
a.

If a child or staff is displaying any of these signs, they must be mentioned when calling the EMS and the Nurse: - Trouble breathing - Persistent pain or pressure in the chest - Confusion - - Bluish lips or face Inability to wake or stay awake The following steps should be taken to facilitate the safe and efficient management of a sick child or staff at school Child: 1.
If a child becomes ill during school hours, he/she must be placed in a supervised isolation area with a clean appropriate place to lie down.

2.

The child must don a medical mask (if tolerated) 3.

The ill child must also be provided with the appropriate supervised attention while waiting for their parent or guardian to arrive at the school 4.
The illness must be reported immediately to: - Parent(s) or guardian - Designated Public Health Nurse in the community (see listed below for your school) - Emergency Medical Services (EMS) at 562 2432 or 464 6303 5.

A designated member of staff or “Point of Contact” should provide the Nurse and EMS with a brief summary of the child’s name, age, contact of parents, address and symptoms or signs and any underlying illness or chronic conditions 6.
Parents or guardians are required to come to the school to remove the ill child within 1 hour, but after the medical assessment by the Nurse and/or EMS has taken place 7.

The school and parents/guardians should make provisions for children whose parents/guardians are unable to accompany them home from school 8.
If a moderately or severely sick child requires immediate hospital assessment and management, parents must be notified, and a responsible staff member should accompany the child until the parent is able to do so Sick Staff: 1.

If a staff member becomes sick at school, the school must notify: - Designated Public Health Nurse in the community (see listed below for your school) - Emergency Medical Services (EMS) at 562 2432 or 464 6303 2.
A designated member of staff or “Point of Contact” should provide the Nurse and EMS with a brief summary of the sick staff’s name, age, contact, address and symptoms or signs and any underlying illness or chronic conditions 2 3.

The sick staff member, if mildly ill and not suspected to have COVID-19 infection as defined above, may leave the school premises but should be encouraged to seek medical attention as soon as possible 4.
If the staff is moderately or severely ill, he/she must be placed in a supervised isolation area with a clean appropriate place to lie down until the Nurse and/or EMS is able to assess him/her 5.

The sick staff must don a medical mask (if tolerated) 6.

The Nurse will assess the staff, complete a COVID-19 Investigation Form and give instructions for isolation, monitoring of signs and symptoms and follow-up as required The Isolation Area 1.
Persons supervising the isolation area should wear appropriate Personal Protection Equipment (PPE).

A surgical mask is required if they remain a distance of less than 3 to 6 feet from the sick child or staff.

However, in cases where the supervisor is likely to come into contact with or hold a sick child or staff, a surgical mask, face shield and gown should be donned, and frequent handwashing or sanitizing is required.

2.
2.

If multiple persons are sick at the same time, they should be isolated no less than 6 feet apart, in a well-ventilated area, adhering to the other infection control and prevention measures mentioned for the isolation area.

3.

When the sick child or staff is removed from the school, the area where the child or staff was waiting must be cleaned and sanitized by the school.

4.

It is recommended to separate the isolation area for sick staff from that for children.

5.
5.

Confidentiality should be maintained at all times, and measures should be put in place to reduce stigmatization or bullying of child or staff member upon their return to school.

The Nurse reports to the Epidemiology and Surveillance Unit which is responsible for making recommendations to the Chief Medical Officer (Quarantine Authority).

Any decision to be made about the Quarantine of any school must be done by the Quarantine Authority in conjunction with the Director of Education.
3 Criteria for a Child or Staff to Return to School A.

A sick child or staff who does not meet the requirements of the case definition for COVID- 19 infection, but misses school due to an illness, must present a School Note certifying their fitness upon their return to school.

B.

A child or staff who meets the requirements of the case definition for COVID-19 infection, must be tested and isolated for 14 days.

After which, they will be retested to have 2 consecutive negative COVID-19 PCR results.
- The office of the Chief Medical Officer will then present the staff or parents/ guardian with a letter confirming the individual’s fitness to return to school C. If a child or staff is identified as a contact of a confirmed case, the risk of exposure will be assessed.

a.

If the risk of exposure is high, the child or staff will be tested.

I. II.

If COVID-19 PCR result is positive, they will be isolated for 14 days, after which they will be retested to have 2 consecutive negative COVID-19 PCR results.
If COVID-19 PCR is still positive on retesting, they will have weekly retesting until 2 consecutive negative tests are obtained.

- The office of the Chief Medical Officer will then present the staff or parents/ guardian with a letter confirming the individual’s fitness to return to school If COVID-19 PCR result is negative, then they will be quarantined for 14 days, after which they will be retested to have 1 negative COVID-19 PCR result.
- The office of the Chief Medical Officer will then present the staff or parents/ guardian with a letter confirming the individual’s fitness to return to school b.

If the risk of exposure is low, the child or staff will be placed in quarantine for 14 days, after which they will be tested to have 1 negative COVID-19 PCR result.
- The office of the Chief Medical Officer will then present the staff or parents/ guardian with a letter confirming the individual’s fitness to return to school 4 DESIGNATED NURSES IN NURSES’ SCHOOL DISTRICTS FOR PRIMARY AND SECONDARY SCHOOLS AND OTHER PUBLIC INSTITUTIONS FOR LEARNING (This list will be updated monthly to reflect any changes) A.
Eastern Area Responsible Nurse: PHN Nurse Kay Tomlinson Contact: 460 4270 Schools/Institutions: Parham Primary, Pares Primary, Pares Secondary, Nelvie N. Gore Primary, Newfield Primary, Glanvilles Secondary, Freetown Primary B.
Northern Area Responsible Nurse: Nurse Althea Georges Contact: 462 4127 Schools/Institutions: Clare Hall Secondary, Potters Primary, Pigotts Primary, St Michaels Primary, Antigua Grammar School, TOR Memorial, T.N Kirnon School, School for the Deaf, The Adele School, St Anthony’s Secondary, St Andrews Primary, St Nicholas Primary, Christian Union Jr. Academy, Gospel Light, Christ the King High School, Sunnyside Tutorial, ABICE, ABIIT, Cedar Grove Primary, St Joseph’s Academy, Sir Novelle Richards Academy, Victory Centre, St John’s Catholic, Foundations of Faith, Simon Bolivar Preschool, New Winthorpes Primary C. Southern Area Responsible Nurse: Nurse Miasha Carr Contact: 462 6304 Schools/Institutions: Jennings Primary, Jennings Secondary, S.R Olivia David Primary, Urlings Primary, Trinity Academy, Old Road Primary, Bendals Primary, St Mary’s Secondary School D. Gray’s Farm Area Responsible Nurse: Nurse Latoya Mussington and Nurse Margaret Joseph Contact: 462 0681 Schools/Institutions: Green Bay Primary School, Five Islands Primary, Temple Academy, Nyabinghi Theocracy 5 E. Bishop Gate Area Responsible Nurse: PHN Cherise Greenaway and Nurse Edith Desilva Contact: 462 0501 Schools/Institutions: Villa Primary, Antigua Wesleyan Jr. Academy, Grace Christian Academy, Divine Academy, Princess Margaret School, Better Chance Primary, Antigua Girls’ High School F. Browne’s Avenue Area Responsible Nurse: Nurse Alden Robins and Nurse Joseanne Campbell Contact: 562 3076 Schools/Institutions: Golden Grove Primary, Antigua State College, Ottos Comprehensive, Mary E Pigott School, SDA Primary, SDA Secondary, Minoah Magnet, Sunny Dale, Tabernacle Academy, St John’s Lutheran, Baptist Academy, Kids Unlimited, Sea View Academy, Grays Crescent Primary, St. Peters Primary, Foundation Mixed School, National Public Library G. All Saints Area Responsible Nurse: PHN Denise Williams Contact: 460 1003 Schools/Institutions: Sea View Farm Primary, J.T Ambrose School, All Saints Secondary, Freemansville Primary, Liberta Primary, Irene B Williams, Cobbs Cross Primary, C.T Samuel Primary, Post Millenial Academy, New Bethel SDA Academy, Island Academy, Buckleys Primary H. Barbuda Responsible Nurse: PHN Jenita Cuffy Contact: 721 2686 Holy Trinity School, Sir McChesney George Secondary School 6 LIST OF PRESCHOOLS AND DAYCARE CENTERS IN NURSING AREAS The nurses assigned to schools and public institutions of learning are also assigned to preschools and daycares in their designated areas.
AREA ALL SAINTS AREA Liberta PRESCHOOL DAYCARE NAME Cobbs Cross All Saints Sea View Farm and Freemans Village Swetes Liberty Moravian 11th Hour Tender Heart Samaritan Baptist Sunshine Christian Union Cana Moravian New Adventure SOUTHERN AREA Jennings Cedar Hall BARBUDA GRAYS FARM AREA North South NORTHERN AREA Potters Cedar Grove William Cody Kelly Burnice Lewis Toddlers Paradise Baby’s Paradise Greenbay Grays Green Promise Land Temple Academy Kuddles Kiddies Haven Denieces Golden Achievers La Petite Learning Center St. Peters Primary Tabernacle Academy Tiny Treasures Learning Ladder Touna World Little Flower Pigotts Clare Hall I Clare Hall II BISHOPGATE STREET HC X X X X X X X X X X X X X X X X X X X X X Sunnyside Primary St. John’s Catholic Bible Believers Little Feet Big Steps Sprout Angels Christian Union Raising the Standard of Excellence Academy Hundred Acre Little Diamonds Jump for Joy Kids Castle Learning Center Children’s Academy Curious Minds Little Explorers Simon Bolivar Share and Care Precious Gems Moravian Ethlyn Williams Gentle Touch Gentle Scholars Deanery Lane Smart Kids Excelsior Sandy Montesorri Dr. Rosa Lee Villa Better Chance Grace Christian BROWNES AVENUE St. John’s II District A District B Baptist Academy Precious Little Angels X Abraham Center X Salvation Army Agape Sunnydale Mount Zion Baptist 9