7.2.55-C19: Management & Reporting of Communicable Diseases

Purpose of Policy

The purpose of this Policy 7.2.55-C19 is to ensure all staff members are aware of and adhere to the directives established by Toronto Public Health regarding the identification, management and reporting of communicable diseases, including COVID-19 (i.e. diseases of public health significance) as well as their responsibilities under the Health Protection and Promotion Act.

Specifically, the purpose is to take all reasonable precautions in the protection of the staff, child and families when there is a positive or suspected COVID-19 case or a case of communicable disease in a Child Care Centre. For a list of communicable diseases, please refer to Appendix A.

LEF’s Child Care Centres will follow the guidelines and direction provided by Toronto Public Health.

This Policy 7.2.55-C19 must be read together with Excluding Sick Children 7.2.54-C19 and Children’s Sick Day 7.2.08-C19.

Surveillance for Signs and Symptoms of Infections

Ensuring that all environmental conditions are constantly monitored is essential in prevention and reducing illness.

Surveillance includes doing the following:

Screen children, staff and all essential visitors for illness upon arrival by following Health Screening 7.2.59-C19.
Record symptoms of illness for each child, staff and essential visitor including signs or complaints the child may describe (e.g., sore throat, stomach ache, head ache etc.), including the date and time that the symptoms occur.
Record the room the child attends (e.g., room number/description).
Record attendances (arrival and departure) and absences of each child, staff and essential visitor, using the Main Attendance Form.

The Supervisor must monitor these records for an increase from baseline illness, i.e. an increase in above normal amount of illnesses among other employees and children by looking at the normal occurrence of illness at that location and during the specific time period. Baseline incidence is the normal level of illness in a given place or time.

Reporting and Communication of Suspected COVID-19 Cases

Supervisor’s Responsibilities

If a child or staff has been excluded due to symptoms related to COVID-19 (a suspected COVID-19 case), the Supervisor will report as follows.

Toronto Public Health

For requirements on immediate reporting to Toronto Public Health, please refer to Exclusion of Sick Children 7.2.54-C19.

LEF Management

The Supervisor must Immediately inform the following:

Their Senior Manager.
Human Resources Department.
LEF’s Joint Health and Safety Committee, using the Health and Safety Health and Safety Accident, Incident, Injury Investigation Report Form 6.2.20-1.

Ministry of Education – Serious Occurrence

In consultation with their Senior Manager, the Supervisor must ensure a Serious Occurrence in the Ministry of Education’s CCLS portal is completed as set out in Exclusion of Sick Children 7.2.54-C19. Please refer to Serious Occurrence Policy 7.2.25.

Senior Manager’s Responsibilities

The Senior Manager will Inform LEF’s management.

Cohort Exposure (Close Contacts)

Continued Cohorting

Staff and children who were exposed to an individual who became ill with symptoms (i.e.

suspected COVID-19 case) must continue to be grouped together (i.e. cohorted) and monitored for

signs and symptoms of illness.

Communication

For requirements for communication to Cohorts in case of suspected or confirmed COVID-19, please refer to the appropriate section in Exclusion of Sick Children 7.2.54.

Reporting and Communication of Positive COVID-19 Cases

Supervisor’s Responsibilities

In all cases of a positive COVID-19 case, once a positive test result has been received, the Supervisor will report as follows:

Toronto Public Health

For requirements on immediate reporting to Toronto Public Health, please refer to Exclusion of Sick Children 7.2.54-C19.

LEF Management

The Supervisor must Immediately inform the following:

Their Senior Manager.
Human Resources Department.
LEF’s Joint Health and Safety Committee, using the Health and Safety Accident, Incident, Injury Investigation Report Form 6.2.20-1.

Cohort and Community

The Supervisor will:

Consult with their Senior Manager on key messages.
Send out any communication provided Toronto Public Health to following groups:
- Families of children who are direct contacts with a confirmed COVID-19 case.
- LEF staff who are direct contacts with a confirmed COVID-19 case.
- All other families and staff who are not direct contracts with a confirmed COVID-19 case and are not being excluded from the Child Care Centre.

Ministry of Education – Serious Occurrence

Senior Manager’s Responsibilities

The Senior Manager will Inform LEF’s management.

HR Department

The Human Resources Department will:

Ensure incident occurrence(s) is completed using the Health and Safety, Accident, Incident, Injury Report Form 6.2.20-1 and WSIB reporting is completed with input from the Supervisor and Senior Manager.
Notify the Ministry of Labour, Training and Skills Development within four (4) days of the occurrence, if a C&F Employee has an occupational illness due to an exposure at the workplace or that a claim has been filed with the Workplace Safety and Insurance Board (WSIB).

If A Staff Member Tests Positive for COVID-19

C&F Employee’s Responsibilities

A C&F Employee who tests positive for COVID-19 must:

Self-isolate immediately and monitor symptoms for the next 14 days.
Inform their Supervisor immediately.
Cooperate with LEF management and Toronto Public Health to identify close contacts and follow the direction from Toronto Public Health and their Supervisor.

Exclusion of Staff and Children in the Same Room (Close Contacts)

All C&F Employees and children who are in the same room as the staff member who has tested positive:

Will be excluded from the Child Care Centre for 14 days, unless indicated otherwise by Toronto Public Health.
Must self-isolate at home and monitor for symptoms for the next 14 days.
Should get tested as soon as any symptoms develop.
If asymptomatic, are also encouraged to get tested any time within 14 days of the potential exposure. They will need to continue to self-isolate for 14 days even if the test is negative.
To determine when the staff member can return to work, please refer to Exclusion of Sick Children Policies 7.2.54.

If A Child Tests Positive for COVID-19

Primary Contact’s Responsibilities

In the event a child tests positive for COVID-19:

The Primary Contact must inform the Supervisor immediately.
The child will be managed by Toronto Public Health in regard to COVID-19.

Exclusion of Staff and Children in the Same Room (Close Contact)

All staff and children who are cohorted in the same room as the child who tested positive:

Will be excluded from the Child Care Centre for 14 days, unless indicated otherwise by Toronto Public Health.
Must self-isolate at home and monitor for symptoms for the next 14 days.
Should get tested as soon as any symptoms develop.
If asymptomatic, are encouraged to get tested any time within 14 days of the potential exposure. They will need to continue to self-isolate for 14 days even if the test is negative.
To determine when the child can return to work, please refer to Exclusion of Sick Children Policies 7.2.54.

If A Household/Close Contact of a Child or Staff Tests Positive for COVID-19

Responsibilities

In the event that a family/household member or close contact of a child or staff tests positive for

COVID -19:

The C&F Employee or the Primary Contact must inform the Supervisor immediately.
Toronto Public Health, Case and Contact team will be contacting the individual to assist with the isolation period for the family.
The staff member or child will be required to isolate and will be excluded from the Child Care Centre for a minimum of 14 days to monitor for symptoms, unless indicated otherwise by Toronto Public Health.

Outbreaks of Other Communicable Diseases, Including Gastroenteritis

COVID-19 Protocols Take Precedence

This part of the policy only comes into effect if children or staff experiencing symptoms of COVID-19 test negative for COVID-19, as outline above.

The COVID-19 Policies must be used in addition to Toronto Public Health’s “Infection Prevention and Control in Child Care Centres Requirements and Best Practices” (IPC-CCCRBP) document. In the event of any differences between LEF Policy 7-C19 and the IPC-CCCRBP, the IPC-CCCRBP will prevail.

Description of an Outbreak

An outbreak is when a greater than expected number of children and staff have a similar symptom of illness in a given period of time. For a list of communicable diseases, please refer to Appendix A.

Gastroenteritis Outbreak

Outbreaks of gastrointestinal illness in child care centres are most frequently caused by viruses such as noroviruses and rotaviruses. However, bacteria and other pathogens can also cause outbreaks.

A case of gastrointestinal illness can be defined as:

Two (2) or more episodes of diarrhea within a 24hr period
Two (2) or more episodes of vomiting within a 24hr period
One (1) or more episodes of diarrhea and one or more episodes of vomiting within a 24hr period.

An Outbreak of gastroenteritis is defined as:

Two or more people (child or staff) with the same symptoms in the same room within 48 hrs.

If there is a gastroenteritis outbreak this will be reported to the Medical Officer of Health

Outbreak Management

When suspecting an outbreak, C&F Employees should immediately:

Isolate all ill children until they can be taken home and send ill C&F Employees home.
A designated isolation space will be identified by the Supervisor for each Child Care Centre.
Notify Primary Contacts or emergency contacts to pick-up ill children as soon as possible. See Exclusion of Sick Children Policy 7.54-C19 for full directions.
Start a line list provided by Toronto Public Health: record names, dates of birth, gender, all symptoms, the date and time children and staff became ill and their room number or type (e.g. infant or toddler room). Refer to Day Nursery Enteric Outbreak Line List 7.2.55-1.
Start additional control measures:
- Secure adequate supplies for Hand Hygiene and for cleaning and disinfecting.
- Increase cleaning and disinfection of washrooms and high traffic areas.
- Minimize staff and child movement between rooms as much as possible.
- Suspend water and sensory play activities.
- Reinforce with staff, children and visitors the importance of keeping hands clean.
Ill children and C&F Employees must stay at home until they are symptom-free of vomiting and diarrhea for 48hrs.
Contact staff and the Primary Contacts of children that are away from the Child Care Centre (before the outbreak was declared) to inform them of the outbreak and to identify if they are cases (e.g. do they have similar signs and symptoms of those currently ill?). If so, they are to be added to the line list.
Contact Toronto Public Health to report the Outbreak by calling the Communicable Diseases Surveillance Unit (CDSU) at 416-392-7411. For more information, please refer to Appendix A.
Distribute Outbreak advisory letters as directed by Toronto Public Health.
Post Outbreak notification once the Outbreak is confirmed by Toronto Public Health.
Obtain permission from Primary Contacts to submit stool specimen samples to the Public Health Laboratory.

A medical doctor should examine any child, who has recovered from a contagious communicable disease, before the child returns to the Child Care Centre.

Declaring the Outbreak Over

Toronto Public Health will declare when an outbreak is over; generally five (5) days from the onset of the symptoms in the last case.

Record Keeping

Critical data and information (such as immunization records) will be kept in the child's file in the Supervisor's office.

Review and Signature

Management & Reporting of Communicable Diseases Policy 7.2.55-C19 must be reviewed and signed at least annually by all C&F Employees.

7.2.55-C19: Management & Reporting of Communicable Diseases
Effective Date: July 2, 2020	Revised:
Prepared and Approved by Executive Director