Risk mitigation tool for child and youth settings operating during the COVID-19 pandemic

In response to the COVID-19 pandemic, many provinces and territories required child/youth settings to close, except for those providing childcare for essential workers. As provinces and territories adjust public health measures, child/youth settings need to implement risk mitigation measures as they re-open and operating during the COVID-19 pandemic. This tool is designed as a resource intended to be used alongside and in support of guidance from provincial/territorial health authorities, ministries of education and Indigenous community governance structures. Guidance from provincial/territorial health authorities will consider local epidemiology, which varies widely across the country. Therefore, implementation of guidance is not expected to be uniform throughout Canada.

For the purposes of this document, child and youth settings includes early learning and daycare centres, schools (K-12), day programs, summer camps, and other settings where children and youth represent the majority of the population accessing the setting. It is acknowledged that some early learning programs are inclusive of children and their parents/caregivers. While they are not explicitly addressed in this guidance, when parents/caregivers are present, they should be made aware of, and comply with risk mitigation measures in place.

Public health measures implemented by child/youth settings are part of Canada's collective approach to mitigate the transmission of COVID-19. This tool is based on concepts outlined in the guidance developed for community-based measures titled: Community-Based Measures to Mitigate the Spread of Coronavirus Disease (COVID-19) in Canada. It reflects the currently available scientific evidence and expert opinion, and is subject to change as new information on transmissibility, epidemiology, and effectiveness of public health and risk mitigation measures becomes available. It also provides advice for congregate living settings in the context of overnight camps and student residences/housing for children and youth.

In interpreting and applying this guidance, it is important to recognize that the health, age, ability status, or other socio-economic and demographic circumstances faced by some individuals and groups may limit their ability to follow the recommended measures. This may necessitate adapted responses and recommendations in some situations.

Indigenous communities may choose to implement child and youth programs specific to the needs of their communities, including remaining closed or limiting attendance as a risk mitigation measure. Respect and support for these decisions is needed, as well as recognition of the disproportionate burden of communicable diseases on some Indigenous communities, and the legacy of past pandemics.

It will be important to promote and provide mental health support services as children/youth, as well as staff and volunteers may experience increased stress associated with COVID-19. Mental health and wellness support may contribute to the resiliency of children/youth and the staff responsible for them in these settings. Mental health and wellness support need to be made accessible for diverse groups (e.g. considerations based on factors such as age, gender, ethnicity/culture, and other socio-economic and demographic factors). Additional information is available for parents, children and youth on taking care of physical and mental health during COVID-19, along with relevant resources.

What are the COVID-19 risks in children and/or youth setting?

The following facts about COVID-19 and associated questions can help you consider the risks of COVID-19 in the children/youth settings under your responsibility.

The risk level is affected by whether there is COVID-19 transmission in the local community. If there is known COVID-19 activity in the community, the likelihood that it could be introduced into the settings is higher. The risk of COVID-19 introduction and spread is also presumed to be greater if a higher proportion of individuals visit the setting from outside of the community. Measures put in place to mitigate risk should be proportionate with the risk in the community. PHAs can be consulted for information about local COVID-19 transmission.

COVID-19 spreads from person to person, most commonly through respiratory droplets (e.g. generated by coughing, sneezing, laughing, singing or talking) during close (i.e. within 2 metres) or prolonged (i.e. lasting more than 15 minutes and may be cumulative) interactions. People who have COVID-19 may have few to no symptoms, or symptoms may be mild. COVID-19 can be spread by infected individuals who have mild symptoms, or who have not yet or who may never develop symptoms.

• Do children/youth have interactions with many people while at the setting? A higher number of interactions with others is presumed to have greater risk of transmission.
• Do children/youth have close interactions with others, including staff, during their visit to the setting? Close interactions are defined as those within 2 metres of others. Closer interactions are presumed to have greater risk of transmission than interactions at a distance.
• Do children/youth have prolonged close interactions with others, including staff, during their visit to the setting? Prolonged contact is defined as lasting for more than 15 minutes^{Footnote 1}, and may be cumulative (i.e., over multiple interactions). Person-to-person spread is more likely with prolonged contact.
• Is the setting crowded (i.e., high density of people) on a regular basis? A crowded setting is presumed to have greater risk of transmission.
• Is the setting indoors or outdoors? If indoors, can windows be opened? A confined indoor space is presumed to have greater risk of transmission

COVID-19 can also be spread through touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands.

• Do children/youth frequently have contact with high-touch surfaces (i.e., frequently touched by others)? A higher frequency of contact with high-touch surfaces (e.g., door handles, toilet handles, faucets, communal toys, playground equipment and structures, electronic devices) is presumed to have greater risk.

COVID-19 can cause more severe disease or outcomes among older adults (increasing risk with each decade, especially over 60 years); people of any age with chronic medical conditions (e.g., lung disease, heart disease, high blood pressure, kidney disease, liver disease, stroke or, dementia); people of any age who are immunocompromised, including those with an underlying medical condition (e.g., cancer) or taking medications which lower the immune system (e.g., chemotherapy); and people living with obesity (BMI of 40 or higher).

• Do children/youth, staff or volunteers belong to any of these higher risk groups?
• Are you aware of children/youth residing with those who belong to any of these higher risk groups (e.g., grandparents, medically at risk parent/guardian, sibling, caregiver)?

COVID-19 spread can be reduced by consistently practicing personal preventive practices.

• Are children/youth able to follow hygiene practices such as frequent hand hygiene, respiratory etiquette, physical distancing, and identifying when they are feeling ill and staying home? The ability of a child/youth to complete tasks and follow direction will be dependent on a variety of factors (e.g. age, maturity, physical ability, comprehension) and can impact their ability to comply consistently with personal practices without assistance. If assistance is required, is there adequate supervision?
• Are facilities available where participants can wash and/ or sanitize their hands frequently, before and after eating, and after contact with high-touch surfaces (e.g., access to hand hygiene stations/supplies)?
• Are supplies available for hygiene practices (e.g. hand hygiene supplies, tissues, wastebaskets)?

How can child/youth settings mitigate COVID-19 risks?

To prevent or limit the spread of COVID-19 in community-based settings, such as those focused on children/youth, consider the following risk mitigation principles and measures. Risk mitigation measures that are more protective involve separating people from each other or shared surfaces through physical distancing and physical barriers. However, these most protective measures are not always the most practical in settings such as these. Measures that are less protective rely on individuals to consistently follow personal preventive practices (e.g., environmental cleaning and disinfection, conducting frequent hand hygiene, wearing of non-medical masks or cloth face coverings). In some settings, physical distancing or separation may not be possible. To maximize safety, use a "layered" approach with multiple measures to reduce the risk of COVID-19 spread, including decreasing the number of interactions with others and increasing the safety of interactions. Layering of multiple mitigation measures strengthens the risk mitigation potential overall. The following examples of risk mitigation measures are provided for consideration. They are not exhaustive -those responsible for these settings are encouraged to find creative and adaptive ways to mitigate risk that align with public health advice and are respectful of children/youth, staff and volunteers.

For mitigation measures specific to employees (e.g. staff and volunteers in child/youth settings), such as the use of personal protective equipment and non-medical masks, the Risk mitigation tool for workplaces/businesses operating during the COVID-19 pandemic is available.

Prohibit individuals who have symptoms of/or have had exposure to COVID-19 from entering the child/youth setting.

• Ensure that strict exclusion policies are in place for children/youth, staff and volunteers who are ill.
• Implement absenteeism/attendance policies that support staff, volunteers and children/youth to stay home if exhibiting symptoms of COVID-19, if in quarantine (self-isolation) due to exposure of COVID-19, or if taking care of someone who has COVID-19 (e.g. consider partial refunds, discourage the use of perfect attendance awards and incentives).
• Require that children/youth, staff and volunteers stay at home if ill with symptoms of COVID-19 until criteria to discontinue isolation have been met, in consultation with the local public health authority (PHA) or healthcare provider.
• Strengthen communication strategies (including accessible signage) about staying at home when exhibiting symptoms of/or after exposure to COVID-19 to children/youth, families, staff, volunteers in languages/formats appropriate for age.
• Teach children/youth in age-appropriate and non-stigmatizing language how to identify symptoms of COVID-19 and instruct them to speak to a staff member immediately if they are experiencing symptoms.
• Follow directions from your PHA about entry screening of children/youth, staff and volunteers for symptoms of COVID-19 or for exposure to COVID-19 in the past 14 days, before allowing the child/youth, staff or volunteer to access the setting.
• Notify the PHA promptly of unusual situations, such as when absenteeism of children/youth or staff is greater than would be expected, or when illness is observed or reported.

Promote and facilitate personal preventive practices. Everyone plays a part in making child/youth settings safer, including children/youth, staff and volunteers and families.

• Keep children/youth, staff, volunteers and families informed about current public health advice.
• Reassure children/youth, staff, volunteers and families that there are many things they can do to stay healthy (e.g. personal practices).
• Promote the use of personal practices (e.g. frequent hand hygiene, avoid touching face, respiratory etiquette).
• Post signage that is appropriate for age, ability, reading level and language preferences to remind individuals to practice good hygiene.
• Teach children and youth about why, how and when to clean hands and cover coughs and sneezes, using age appropriate learning resources and tools (e.g. "Glow-germ" hand washing demonstrations and how to use hand sanitizer).
• Implement a schedule for frequent hand hygiene.
• Provide increased access to hand hygiene facilities (e.g. by placing hand sanitizer dispensers in easy to see locations) and ensure accessibility for those with disabilities or other accommodation needs.
• Ensure adequate supplies to reinforce hand hygiene and respiratory etiquette such as soap, an alcohol-based hand sanitizer (at least 60% alcohol), paper towels, tissues, and no-touch waste receptacles.

Examples of protective public health measures mitigation strategies tailored for age categories

Younger children

• reinforce and remind children not to touch others or put toys or objects in their mouths.
• ensure assistance/supervision of children when performing hand hygiene
• consider increasing staffing complement to reduce the staff to child ratio, according to jurisdictional recommendations and budgetary limitations
• incorporate fun strategies to encourage compliance (e.g. hum catchy songs while handwashing)

Older children and youth

• implement classroom and/or grade level projects (e.g. point programs, poster contests)
• organize "spirit week" (school wide) awareness initiatives
• leverage technology and use social media (e.g. post your most creative video on handwashing)

Promote physical distancing as much as possible. Keeping a 2 metre distance from others helps to reduce the spread of illness; however, it is not always practical in child and youth settings. Layering of multiple mitigation measures in these circumstances strengthens the risk mitigation potential overall.

• Reinforce general practices to maintain physical distancing, such replacing physical greetings like high fives, fist bumps and hugs with friendly verbal greetings or virtual high fives.
• Where possible, establish a 2 metre separation between children/youth, staff and volunteers. In settings with very young children, this may not be possible, and maintaining a 2 metre separation between groups of children (e.g. those separated by age) will be important.
• Reduce contact between children/youth during transportation including separation of children/youth on school buses by 2 metres where possible. If separation of children/youth is not possible, the importance of personal practices (e.g. hand hygiene before boarding, avoid touching face, respiratory etiquette) and frequent environmental cleaning and disinfection of high touch surfaces with approved products should be encouraged. The use of non-medical cloth masks or face coverings should be considered for children over the age of 2 years (see section on non-medical masks later in this document).
• Restrict or manage flow of people in common areas including hallways, entrances/foyers (e.g. with entry and exit procedures). In narrow hallways or aisles of the setting, encourage unidirectional travel where possible by painting or placing arrows on the ground.
• Use visual cues to encourage physical distancing (e.g., accessible signage, floor markings).
• Postpone assemblies, team sports or extracurricular activities where physical distancing cannot be maintained or where touching of common equipment cannot be avoided e.g., choir (or singing/chanting in groups). Where appropriate, offer these activities "virtually" using technology.
• Limit or restrict non-essential visitors/guests.
• Establish a process for essential visits, e.g. parents picking up children outside of drop-off/pick-up hours where physical distancing can be maintained.
• Develop plans in advance on how to safely care for children/youth, staff or volunteers who need care (e.g. injury, illness or emotional upset) while on site. For those who have symptoms associated with COVID-19, it will be important to consider: the importance of having the individual remain isolated until they can go home safely in private vehicle, maintaining a distance of 2 metres between the ill person and others, and what to do if 2 meters cannot be maintained and/or direct care is unavoidable (e.g. the use of personal protective equipment). The PHA should be consulted for this advice.

Examples of physical distancing mitigation measures tailored for age categories

Younger children

• create and play games that encourage physical distancing, e.g. set up play stations and limit the number of children at each station, allowing for sufficient breaks for environmental cleaning and disinfection before children change stations
• consider, if policies support, the use of educational videos and online programs where children can sit independently with space between them for short periods of time, and as their attention spans permit
• ensure children are separated during large group activities e.g. reading/circle time
• consider moving large group activities outside when space and weather permits
• increase the distance between napping mats/beds
• recommend that only one parent/guardian do drop-offs and pick-ups, and to remain in designated waiting areas (if walking) or in vehicle if driving, e.g., children to be brought to waiting areas or vehicles (would not apply in circumstances where parents/caregivers are in attendance as a part of the program)

Older children and youth

• assess whether infrastructure can be enhanced, even temporarily, to provide more space, e.g. portables, repurposing existing space
• consider the option of online/remote or correspondence learning, especially for older children or those at risk of more severe disease or outcomes - consideration to those with limited access to the electronic devices and the internet will be important
• increase desk distance between children/youth
• ensure sufficient space between individuals for smaller groups/clubs e.g. reading, cultural, environmental
• stagger break times where children come together, e.g. recess
• install accessible signage or floor markings to restrict or managing flow of common areas including hallways, cafeteria, dining halls, foyers, atriums
• implement locker/change room policies if applicable, which take into consideration physical distancing, personal preventive measures and environmental cleaning and disinfection

Create physical barriers between children/youth, staff and volunteers when physical distancing is not possible.

• If possible or appropriate, consider installing physical separations between groups of children/youth, staff and volunteers (e.g. physical barriers like a plexiglas window or cubicle higher than head-height).

Examples of physical barrier mitigation measures tailored for age categories

Younger children

• consider use of dividers between children during naps if safe to do so

Older children and youth

• install barriers in offices where appropriate or feasible
• consider barriers for staff as a reminder for students to maintain physical distancing (e.g. low walled barrier at front of classroom)

Increase ventilation.

• Ensure that the ventilation system operates properly.
• Increase air exchanges by adjusting the HVAC system.
• Open windows if possible and, if weather permits^{Footnote 2}.
• Move activities outdoors when possible (e.g. lunch, classes, physical activity).

Mitigate risks from exposure to high-touch surfaces (i.e., surfaces frequently touched by others).

• Increase frequency of environmental cleaning and disinfection, especially washrooms and high touch surfaces or equipment (e.g. pencil sharpeners, water fountain knobs and push buttons, doorknobs, faucet handles, toys, electronic devices, school bus hand rails and seats).
• Reduce the number of common surfaces that need to be touched (e.g., prop doors open, no-touch waste containers).
• Reduce or restrict access to non-essential shared equipment (e.g. play structures, gym equipment, balls) and implement post-play hand hygiene practices.
• Avoid sharing communal equipment/supplies, if possible or implement post-use hand hygiene and environmental cleaning and disinfection (e.g. toys, tablets, electronic devices, sleeping mats).
• Ensure adequate supplies where possible to minimize sharing (e.g. art supplies, toys, pencils).
• Clean and disinfect essential shared equipment before and after use (e.g. electronic devices).
• Keep belongings separated from others (e.g. in cubbies or separated areas).
• Limit items to be carried between the child/youth setting and home. Reinforce no sharing of home items.
• Reinforce "no sharing" food and drink policies.

Examples of mitigation measures for high-touch items, tailored for age categories

Younger children

• increase frequency of environmental cleaning and disinfection of commonly touch objects/surfaces unique to setting e.g. table tops, chairs, highchairs, booster seats, strollers and toys
• remove toys that cannot be easily cleaned like plush toys, dress up clothes, water stations, indoor sand stations or playdough
• keep enough toys available to encourage individual play

Older children and youth

• consider having children/youth fill water bottles rather than having them drink directly from the mouthpiece of water fountains
• encourage youth to leave personal items in lockers (e.g., cell phones, head phones)

Mitigate risk for people at risk of more severe disease or outcomes.

• Encourage children/youth, staff or volunteers who are at risk of more severe disease or outcomes to stay at home.
  • Provide alternative ways to provide programming (if possible) that is meaningful so children/youth do not fall behind in their studies and maintain a sense of meaning/belonging.
  • Accommodations for children/youth with limited access to electronic devices and the internet should be considered.
• Encourage those who are at risk of more severe disease or outcomes to avoid contact with the setting (e.g., caregivers, grandparents, and volunteers who are older adults, have chronic medical conditions, are immunocompromised, or are living with obesity).

Modify practices to reduce how long children are in contact with each other and how many children come into contact with each other.

• Consider modifying delivery of programs (e.g. reducing the number of children/youth using the same space at the same time). When considering numbers of individuals within a space, it will be important to take into account the size of the space, the number of individuals (including their ages/sizes) to promote physical distancing.
• Divide classes/groups into smaller numbers of children/youth.
• If possible, cohort the same children/youth in classes/groups with the same staff or volunteers each day.
• Limit or cancel activities that bring children together from multiple groups or classrooms.
• Stagger schedules to limit the numbers of children/youth in attendance at one time.
• Stagger the timing of breaks during the day to limit numbers in the same location at the same time.
• Discourage activities that can contribute to the spread of COVID-19 in confined indoor spaces (e.g., choir for older children, close contact sports or vigorous physical activity).
• Close or restrict access to non-essential common areas.
• Postpone or cancel non-essential activities.
• Move some activities outdoors if possible.
• Ensure that COVID-19 measures do not introduce new occupational hazards to the setting (e.g., do not prop open fire doors to reduce exposure to frequently touched door handles)

Examples of mitigation measures for changing practices, tailored for age categories

Younger children

• encourage children to have individual bathrooms breaks as needed over group bathroom breaks, maintaining required supervision
• encourage fixed seating arrangements over flexible seating arrangements where relevant
• encourage separation of at least 2 metres between groups of children (e.g. those separated by age) where relevant
• consider staggering naps, or having children sleep "head to toe" during nap time
• stagger drop-off and pick-up times
• modify practices around the use of play structures (e.g. post-play hand hygiene)
• postpone public library visits

Older children and youth

• consider staggering the school day or week to reduce the number of children/youth in the setting at same time
• stagger class rotation times
• consider having staff travel to classes, rather than children/youth travelling to classrooms
• favour meals in classrooms as opposed to cafeteria/hall
• close or limit number of concurrent users in computer laboratories
• limit number of concurrent users of gyms, libraries
• postpone in person "school-wide" events e.g. assemblies
• postpone field trips

Should children/youth wear non-medical cloth masks or face coverings in community settings?

• Non-medical cloth masks (NMM) or face coverings are not considered personal protective equipment (PPE). Commercially-available or homemade cloth masks or face coverings can play a role in reducing the transmission of COVID-19 in the community when consistent physical distancing is not possible. When the local epidemiology and rate of community transmission warrant it, the wearing of NMMs is an additional personal practice that can help to prevent the infectious respiratory droplets of an unknowingly infected person (the wearer) (e.g. child, student, camper, parent, teacher, volunteer) from coming into contact with other people. Those wearing masks should be reminded not to touch their mask and to comply with key essential personal preventive practices such as frequent hand hygiene and physical distancing.
• Using a "layered" approach to mitigation measures (e.g. hand hygiene, respiratory etiquette, staying home when ill), is very important to reduce the spread of COVID-19. NMMs for children and youth should be considered, based on a risk assessment, but may not always be appropriate for a number of reasons:
  • NMMs should not be placed on young children under age 2 as they may be unable to remove the mask without assistance, which could impair their breathing^{Footnote 3}. Screening, strict exclusion policies for those who are ill or who have ill family members and maintaining small groups of the same children are considered to be more effective.
  • For NMMs to be of benefit, they need to be worn correctly. Failing to do so may present a risk rather than a benefit. Children (particularly young children) and youth may not be able to consistently use NMMs correctly and safely during the day, including during meals and snacks (i.e. comply with procedures to put on, change and remove) without assistance. The presence of NMMs could lead to increased facial touching and potentially result in self-contamination and contamination of other surfaces.
  • Children and youth may attend these settings for several hours per day. NMM use in the community is generally recommended for brief, casual interactions where physical distancing is not possible or is unpredictable (such as being on a crowded bus, or while grocery shopping). Wearing NMMs for long durations may not be tolerated by children and youth.
  • Children and youth in the same class/program will have recurrent interactions with one another, much like those of family members or people in a household. For this reason, NMMs may not be recommended. It will be important that class/group sizes are small and that the same children/youth, staff and volunteers are cohorted together as much as possible.
  • NMMs should be changed after they become wet or soiled. This could present operational challenges with respect to supply of NMMs and safe handling of soiled or damp NMMs. Parents/caregivers should be reminded of appropriate use and cleaning.
  • A NMM could become an unintended hazard (e.g. physical injury if it caught on playground equipment, or psychological injury associated with stigmatization or bullying if not all children are/are not wearing a NMM). It is important that NMM or cloth face coverings be worn safely.
• The ability of a child/youth to complete tasks and follow direction will be dependent on a variety of factors (e.g. age, maturity, physical ability, comprehension). It will be important for child/youth staff and/or volunteers to assess ability to properly use and care for NMMs, based on the individuality of children/youth.
  • For settings with very young children (e.g. daycares), there are unique challenges related to maintaining physical distance during activities of daily living such as eating, toileting and comforting. Advice for staff and volunteers on the use of NMMs and personal protective equipment in the context of a workplace can be found in the Risk mitigation tool for workplaces/businesses operating during the COVID-19 pandemic.
  • In settings that older children/youth attend (e.g. schools K-12, summer camps), the use of NMMs may be considered for the children/youth as well as staff. This consideration should be based on a setting-specific risk assessment that includes the following factors: the characteristics of the population (e.g. age, maturity, physical ability, comprehension), the characteristics of the setting, the nature of the activities, community transmission and the potential of the setting to implement risk mitigation measures. In this case, it will be important to establish policies regarding the use of NMMs that align with advice from provincial/territorial public health authorities, as it will vary throughout Canada.
• It should be expected that some children/youth will wear NMMs in settings that have not adopted NMMs policies. Staff and volunteers should monitor for, and address, any discrimination or bullying associated with this practice (whether stigmatization is experienced by those who wear masks, and/or those who do not) and monitor for proper use.
• Childcare providers and schools should always consult with their relevant Occupational Health and Safety team and local public health when considering mask-wearing policies.

Additional Resources:

• Kids Help Phone
• Canadian Paediatric Society - Community-Based Supports for Parents
• Families Canada - Family Support Centres