California Department of Public Health Releases Updated Guidance

On the heels of the Governor's plan for reopening schools, the California Department of Public Health released updated guidance for schools planning to reopen for in-person instruction, as well as a COVID-19 School Guidance Checklist. This guidance affects all schools, which are required to post a compliant COVID-19 Safety Plan prior to reopening. Schools that are already open must post their COVID-19 Safety Plan by February 1.
The new guidance includes:
•    Criteria for reopening under the framework of the Blueprint for a Safer Economy;
•    Considerations for school leaders to plan for and prepare to resume in-person instruction, such as stes to take when a student or staff member experiences symptoms of COVID-19 during the school day;
•    Response to confirmed COVID-19 infections;
•    Physical distancing in classrooms; and,
•    Implementation of stable groups of students and staff.
This guidance supersedes previous guidance, with the exception of the Guidance Related to Cohorts for Children and Youth.
Beginning January 25, every Local Education Agency (LEA) and private school in California must notify the Department of Public Health whether it is instructing students in person. The school must provide the following information via a web form that will be made available by the Dept. of Public Health:
•    Is in-person instruction provided full time? Include whether it is provided for all grades or for certain grade spans.
•    Is in-person instruction provided part-time (hybrid model)? Include whether it is provided for all grades or for certain grade spans.
•    Is in-person instruction provided only pursuant to the Guidance Related to Cohorts?

CDPH Updated school REopening Guidance
CDPH COVID-19 checklist

School Nurses as COVID-19 Push Partners

In a webinar sponsored by the California Collaborative for Educational Excellence (CCEE), Dr. Erika Pan, Acting State Health Officer shared the six-step approach to COVID-19 vaccine dissemination (see below). The prioritzaton School Nurses are urged to connect with their local health department express their interest in serving as a push partner to help vaccinate the adults in the school and surrounding community.  California Education Code 49426 and Business and Professions Code 2725 describe how school nurses are qualified to orchestrate and provide these services in educational settings. Prioritization of vaccine dissemination will occur through a four-phased process and details of recommended dissemination may be found here.

Step One
Enroll Vaccine Providers and Establish Allocation Guidelines.  The first step involves enrolling healthcare providers to conduct vaccinations and developing guidelines for the allocation of the initial 327,000 doses of Pfizer’s vaccine among six vaccine regions.  As established by CDPH, the six regions and their respective allocation of Pfizer vaccine doses are as follows:

    Region I (126,750):  Los Angeles, Orange, San Diego, San Luis Obispo, Santa Barbara, Ventura;
    Region II (80, 497):  Alameda, Contra Costa, Del Norte, Humboldt, Lake, Marin, Mendocino, Monterey, Napa, San Benito, San Francisco, San Mateo, Santa Clara, Shasta, Solano, Sonoma;
    Region III (8,592):  Butte, Colusa, Glenn, Lassen, Modoc, Plumas, Santa Cruz, Sierra, Siskiyou, Sutter, Tehama, Trinity, Yuba;
    Region IV (35,145):  Alpine, Amador, Calaveras, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne, Yolo;
    Region V (16,706):  Fresno, Kern, Kings, Madera, Mariposa, Merced; and
    Region VI (59,910): Imperial, Inyo, Mono, Riverside, San Bernardino.

As noted above, the Allocation Guidelines were adopted and distributed by the CDPH on December 5, 2020.  In addition, the CDPH has identified the following hospitals as participating in the vaccination process: Cedars Sinai Medical Center, Los Angeles; Mercy Medical Center, Redding; Rady Children’s Hospital, San Diego; UCD Health, Sacramento; UCSF Medical Center, San Francisco; Valley Children’s Healthcare, Madera; and Zuckerberg San Francisco General Hospital.[2]  According to CDPH, these facilities were chosen based on their ultra-cold storage capabilities, as the Pfizer vaccine must be stored in negative 80-degree freezers, at large “highest-risk” healthcare population and/or their willingness to redistribute vaccines outside their facility and network. The final criteria was one of geography, as the Department said these places were chosen to be spread across the state as evenly as possible.[3]

Step Two
Review Vaccine Orders Submitted by Local County Departments of Health.  Under the Plan, local county departments of health are obligated to submit distribution plans for their respective geographic regions.  Such plans must include various elements including a description of the region’s “vaccine administration capacity” – such capacity being determined based upon multiple factors including the number of registered vaccination providers in the region; the number of “point of dispensing” (“POD”) sites available to vaccinate emergency responders and critical infrastructure personnel in the region; and the COVID-19 vaccine storage capacity at each POD.

Steps Three and Four
Local County Orders.  Steps 3 and 4 involve the process of preparing and filling of the local county orders.

Step Five
Vaccine Delivery Logistics.  Shipping companies like UPS and FedEx will drop off the vaccine to hospitals and vaccine providers who already have approved cold-chain storage units. To increase storage capacity, the State has purchased additional cold storage units for providers to use.

Step Six
 Vaccine Administration.  Once again, the 327,000 Pfizer vaccine doses will be distributed and administered in accordance with the Allocation Guidelines as described above. As explained by Governor Newsom, notwithstanding the initiative of the vaccination process, mask and social distancing rules will remain in place.  Over time, this will change; however, as an initial matter, it is still unclear as to whether vaccinated individuals are still capable of spreading the virus to others.

Additionally, CSNO and the Teachers for Healthy Kids have advocated with the Department of Health Care Services that Vaccination delivery (administration time) should be reimbursable under the LEA Medi-Cal Billing option program, since vaccinations in general are considered EPSDT services.  CSNO sent a letter outlining steps substantiating the length of administration, which contrary to belief, is more than just "jabbing" the student. To access the document please click here:


California Schools Approved for Reopening

COVID-19 Resource Center

During this unprecedented time of COVID-19, resources for school nurses are vital. CSNO has put together a COVID-19 Recovery Plan, as well as pulled together some of the latest guidance, and other resources. We have created a dedicated page to all things COVID-19. Click below to view those resources.

COVID-19 Resources

American Academy of Pediatrics

The Link Between School Attendance and Good Health, January 2019 Policy Statement

Attendance & Health

American Academy of Pediatrics

Role of the School Nurse in Providing School Health Services May 2016 Policy Statement

Policy Statement
AAP Policy Statement on Off-Label Medication Use

The American Academy of Pediatrics has a position statement on the use of off-label medication use with children. The purpose of off-label use is to benefit the individual patient. Practitioners use their professional judgment to determine these uses. As such, the term “off-label” does not imply an improper, illegal, contraindicated, or investigational use. Therapeutic decision-making must always rely on the best available evidence and the importance of the benefit for the individual patient.

Off label AAP Position Statement

A Day in the Life of a School Nurse

Picture​Inside California Education is a public television series that explores the challenges, issues and stories of public education.  Recently the station highlighted school nursing.  Please feel free to share with your school communities.

Day in the life of a School Nurse