COVID-19 Hospital Admission Levels and Associated Prevention Strategies
CDC’s COVID-19 hospital admission levels help communities and individuals make decisions about what COVID-19 prevention strategies to use based on whether their community is classified as low, medium, or high. These levels take into account COVID-19 hospitalization admission rates. Recommendations outlined for the COVID-19 hospital admission levels are the same for schools and ECE programs as those for the community. Schools and ECE programs that serve students from multiple communities should follow prevention recommendations based on the COVID-19 hospital admission level of the community in which the school or ECE program is located.
School and ECE program administrators should work with local health officials to consider other local conditions and factors when deciding to implement prevention strategies. School and ECE-specific indicators—such as rates of absenteeism among students and staff or presence of students or staff who are at risk of getting very sick with COVID-19—can help with decision-making. Additional community-level indicators that might be considered for use in decision-making about COVID-19 prevention are pediatric hospitalizations, results from wastewater surveillance, or other local information.
When the COVID-19 hospital admission level indicates an increase, particularly if the level is high or the school or ECE program is experiencing an outbreak, schools or ECE programs should consider adding layered prevention strategies, described below, to maintain safe, in-person learning and keep ECE programs safely open. Although most strategies are recommended to be added or increased at a high COVID-19 hospital admission level, schools might want to consider adding layers when at medium, such as those in the Considerations for Prioritizing Strategies section below, based on school and community characteristics.
When the COVID-19 hospital admission level moves to a lower category or after resolution of an outbreak, schools and ECE programs can consider removing prevention strategies one at a time, followed by close monitoring of COVID-19 transmission within the school or ECE and the COVID-19 hospital admission level of their community in the weeks that follow.
Wearing a well-fitting mask or respirator consistently and correctly reduces the risk of spreading the virus that causes COVID-19. At a high COVID-19 hospital admission level, universal indoor masking in schools and ECE programs is recommended, as it is in the community at-large. Policies for use of masks in school nurse offices should follow recommendations outlined in the Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) guidance. Recommendations for masking in nurses’ offices may depend on factors such as COVID-19 hospital admission level, outbreak status, and patient access. People who have known or suspected exposure to COVID-19 should also wear a well-fitting mask or respirator around others for 10 days from their last exposure, regardless of vaccination status or history of prior infection.
Anyone who chooses to wear a mask or respirator should be supported in their decision to do so at any COVID-19 hospital admission level, including low. At a medium and high COVID-19 hospital admission level, people who are immunocompromised or at risk for getting very sick with COVID-19 should wear a mask or respirator that provides greater protection. Since wearing masks or respirators can prevent spread of COVID-19, people who have a household or social contact with someone at risk for getting very sick with COVID-19 (for example, a student with a sibling who is at risk) may also choose to wear a mask at any COVID-19 hospital admission level. Schools and ECE programs should consider flexible, non-punitive policies and practices to support individuals who choose to wear masks regardless of the COVID-19 hospital admission level.
Schools with students at risk for getting very sick with COVID-19 must make reasonable modifications or accommodations when necessary to ensure that all students, including those with disabilities, are able to access in-person learning. Schools might need to require masking in settings such as classrooms or during activities to protect students with immunocompromising conditions or other conditions that increase their risk for getting very sick with COVID-19 in accordance with applicable federal, state, or local laws and policies. For more information and support, visit the U.S. Department of Education’s Disability Rights webpage. Students with immunocompromising conditions or other conditions or disabilities that increase risk for getting very sick with COVID-19 should not be placed into separate classrooms or otherwise segregated from other students.
Because mask use is not recommended for children ages younger than 2 years and may be difficult for very young children or for some children with disabilities who cannot safely wear a mask, ECE programs and K-12 schools may need to consider other prevention strategies—such as improving ventilation and avoiding crowding—when the COVID-19 hospital admission level is medium or high or in response to an outbreak. K-12 schools or ECE programs may choose to implement universal indoor mask use to meet the needs of the families they serve, which could include people at risk for getting very sick with COVID-19.
For more information about masks please visit Types of Masks and Respirators.
Schools and ECE programs can offer diagnostic testing for students and staff with symptoms of COVID-19 or who were exposed to someone with COVID-19 in the K-12 or ECE setting, or refer them to a community testing site, healthcare provider, or to use an at-home test. Each COVID-19 test with an emergency use authorization (EUA) has a minimum age requirement. Schools and ECE programs should only use tests that are appropriate for the person being tested. For more information on when someone should test, where to get tests, and what results mean, please visit COVID-19 Testing: What You Need to Know.
Screening testing identifies people with COVID-19 who do not have symptoms or known or suspected exposures, so that steps can be taken to prevent further spread of COVID-19.
CDC no longer recommends routine screening testing in K-12 schools. However, at a high COVID-19 hospital admission level, K-12 schools and ECE programs can consider implementing screening testing for students and staff for high-risk activities (for example, close contact sports, band, choir, theater); at key times in the year, for example before/after large events (such as prom, tournaments, group travel); and when returning from breaks (such as holidays, spring break, at the beginning of the school year). In any screening testing program, testing should include both vaccinated and unvaccinated people. Schools serving students who are at risk for getting very sick with COVID-19, such as those with moderate or severe immunocompromise or complex medical conditions, can consider implementing screening testing at a medium or high COVID-19 hospital admission level. Nucleic acid amplification tests (NAATs) and antigen tests can be used for screening purposes; however, the school should consider the characteristics of different test types (including accessibility, accuracy and practicality) to determine which best suits their particular need. Schools and ECE programs that choose to rely on at-home antigen test kits for screening testing should ensure equal access and availability to the tests; establish accessible systems that are in place for ensuring timely reporting of positive results to the school or ECE program; and communicate with families the importance of following isolation guidance for anyone who tests positive. Communication strategies should take into account the needs of people with limited English proficiency who require language services, and individuals with disabilities who require accessible formats.
Screening testing should be done in a way that ensures the ability to maintain confidentiality of results and protect privacy. Consistent with state legal requirements and Family Educational Rights and Privacy Act (FERPA), K-12 schools and ECE programs should obtain parental consent for minor students and assent/consent from students themselves, when applicable.
Management of Cases and Exposures
Students or staff who come to school or an ECE program with symptoms or develop symptoms while at school or an ECE program should be asked to wear a well-fitting mask or respirator while in the building and be sent home and encouraged to get tested if testing is unavailable at school. Symptomatic people who cannot wear a mask should be separated from others as much as possible; children should be supervised by a designated caregiver who is wearing a well-fitting mask or respirator until they leave school grounds.
Schools and ECEs should develop mechanisms to ensure that people with COVID-19 isolate away from others and do not attend school until they have completed isolation. Once isolation has ended, people should wear a well-fitting mask or respirator around others through day 10. Testing is not required to determine the end of isolation or mask use after having COVID-19; however people can use the test-based strategy outlined in the isolation guidance to potentially shorten the duration of post-isolation mask use. If using the test-based strategy, people should continue to wear a well-fitting mask or respirator in the school or ECE setting until testing criteria have been met. People who are not able to wear a well-fitting mask or respirator should either isolate for 10 full days or follow the test-based strategy to determine when they can safely return to the school or ECE setting without a mask, while continuing to isolate until testing criteria have been met. If a person with COVID-19 has been inside a school or ECE facility within the last 24 hours, the space should be cleaned and disinfected. For more information, see Cleaning and Disinfecting Your Facility.
Quarantine is no longer recommended for people who are exposed to COVID-19 except in certain high-risk congregate settings such as correctional facilities, homeless shelters, and nursing homes. In schools and ECE settings, which are generally not considered high-risk congregate settings, people who were exposed to COVID-19 should follow recommendations to wear a well-fitting mask and get tested. K-12 school and ECE administrators can decide how to manage exposures based on the local context and benefits of preserving access to in-person learning. Accommodations may be necessary for exposed people who cannot wear a mask or have difficulty wearing a well-fitting mask. Schools and ECE programs can also consider recommending masking and/or testing for a classroom in which a student was recently exposed who is unable to consistently and correctly wear a mask.
Quarantine is a key component to Test to Stay programs. Since quarantine is no longer recommended for people who are exposed to COVID-19 except in certain high-risk congregate settings, Test to Stay (TTS) is no longer needed. If any school or ECE program chooses to continue requiring quarantine, they may also choose to continue TTS.
Responding to Outbreaks
If a school or ECE program is experiencing a COVID-19 outbreak they should consider adding prevention strategies regardless of the COVID-19 hospital admission level. Strategies that can help reduce transmission during an outbreak include wearing well-fitting masks or respirators, improving ventilation (for example moving school activities outdoors, opening windows and doors, using air filters), screening testing, and case investigation and contact tracing. Early identification of cases to ensure that they stay home and isolate is a critical component of outbreak response. Schools and ECE programs may also consider suspending high-risk activities to control a school- or program-associated outbreak. Schools and ECE programs that are experiencing outbreaks should work with their state or local health department in accordance with state and local regulations. Health departments should provide timely outbreak response support to K-12 schools and ECEs.
Considerations for High-Risk Activities
Due to increased and forceful exhalation that occurs during physical activity, some sports can put players, coaches, trainers, and others at increased risk for getting and spreading the virus that causes COVID-19. Close contact sports and indoor sports are particularly risky for participants and spectators, especially in crowded, indoor venues. Similar risks may exist for other extracurricular activities, such as band, choir, theater, and other school clubs that meet indoors and entail increased exhalation. At a high COVID-19 hospital admission level, schools and ECE programs can consider implementing screening testing for high-risk activities such as indoor sports and extracurricular activities. Schools and ECE programs may consider temporarily stopping these activities to control a school- or program-associated outbreak, or during periods of high COVD-19 hospital admission levels. ECE programs may also consider layering prevention strategies, such as masking, when close contact occurs, such as during feeding and diapering young children and infants.
Considerations for K-12 Residential Dorms and Overnight Child Care
While shared housing, such as K-12 residential dorms, camps, or overnight child care, is considered a congregate setting, it is considered a low-risk congregate setting due to the lower risk of severe health outcomes (such as hospitalizations and death) for children and young adults. Therefore, CDC recommends shared housing facilities follow the general population guidance for isolation, management of exposures, and recommendations under COVID-19 hospital admission levels.
In specific circumstances where the student population may be at risk for getting very sick with COVID-19, schools may opt to follow isolation and quarantine guidance for high-risk congregate settings, which includes recommendations of a 10-day period for isolation. Schools and ECE programs should balance the potential benefits of following that guidance with the impact these actions would have on student well-being, such as the ability to participate in in-person instruction, food service access, and social interactions. Screening testing at all COVID-19 hospital admission levels can also be appropriate in these settings to reduce transmission and improve health outcomes for people who are at risk of getting very sick with COVID-19.