Respiratory Virus Guidance: Child Care, Elementary & Secondary Schools

Last updated: March 24, 2023

This page includes respiratory virus guidance and resources that may be applicable for both child care centres (includes licensed child care centres, home child care agencies, before and after school programs and early years programs) and schools (JK to grade 12).

For information on other School Health resources visit our Health Information & Resources for Elementary & Secondary Schools webpage.

Schools, licensed child care centres, home child care agencies, before and after school programs and EarlyON settings should follow the guidance provided by the Ministry of Health and Ministry of Education for the management of COVID-19:

Ministry of Health

Ministry of Education

Reporting a Communicable Disease to Toronto Public Health:

  • If a disease of public health significance is suspected/confirmed, child care centres and school principals/administrators must report to the Communicable Disease Notification Unit (CDNU) at 416-392-7411 during business hours Monday to Friday 8:30 am to 4:30 pm, or fax: 416-392-0047.
  • Exception for COVID-19: Current provincial guidelines do not require child care centres and schools to report positive cases of COVID-19 to Public Health.

At this time, the risk of MPOX (formerly known as monkeypox) to children in Toronto is low. Learn more about MPOX, including how to spot the differences between MPOX, Chickenpox and Hand, Foot & Mouth disease. 

Non-reportable communicable diseases do not need to be reported to public health. Examples of non-reportable communicable diseases include: the common cold; hand, foot and mouth disease; pink eye; ringworm; and strep throat. See the Communicable Disease Information for Schools & Child Care Centres for more information about common reportable and non-reportable diseases.

What do I do if my child care centre or school is experiencing high absenteeism?

Child care centres and schools are to continue to monitor their own absence rates. Should the absence rate in a child care centre or school increase above what would typically be experienced at that time, and absences are not perceived to be linked to other factors (e.g., holidays), follow the steps below:

  • Child care:
  • Schools:

When to Contact Toronto Public Health (TPH):

  1. The child care operator/school principal/administrator has reviewed all the information on these pages and has additional questions;

OR

  1. The individuals are absent due to gastrointestinal illness (nausea, vomiting, diarrhea).

Contact the TPH Communicable Disease Notification Unit at 416-392-7411 during business hours Monday to Friday 8:30 am to 4:30 pm.

The agent will receive your report and a member of the communicable disease team will contact you for further support.

Please refer to the Infection Prevention and Control Measures for more information on infection prevention and control in child care centres.

Visit Early Learning & Child Care Partners to see Toronto Children’s Services’ resources and supports available to child care centres.

The following recommendations are intended to help JK to Grade 12 schools and school boards reduce the spread of respiratory viruses, including COVID-19, influenza, and respiratory syncytial virus (RSV), for the 2022-23 school year. They are in line with provincial Ministry of Education guidelines, COVID-19: health and safety measures at schools and Ministry of Health guidance, including Management of Cases and Contacts of COVID-19.

For publicly-funded schools (i.e. Toronto District School Board (TDSB), Toronto Catholic District School Board (TCDSB), CS Viamonde, and CSC MonAvenir), where there is a difference between this document and the school board’s internal policies and procedures, the school board’s policies and procedures should be followed.

School Liaison Public Health Nurses (SL PHNs) have been assigned to provide support to publicly-funded schools in Toronto. SL PHNs are available for consultation, education and support regarding reducing the spread of respiratory viruses, the Student Immunization Program, Comprehensive School Health, and other public health programs.

Update to Health and Safety Measures

The Province of Ontario has released updated COVID-19 health and safety measures for schools for the 2022-2023 school year.

Toronto Public Health’s guidance for schools is consistent with the guidance provided by the Ministry of Education and the Office of the Chief Medical Officer of Health.

Toronto Public Health continues to recommend the following measures to reduce the spread of respiratory infections:

  • Stay home if feeling sick.
  • Wear a well-fitted, high-quality mask in indoor public settings especially:
    • If individuals are at higher risk of getting very sick from a respiratory virus.
    • If individuals live, work or spend time with someone who is at higher risk of becoming very sick from a respiratory virus, such as seniors, those with a weak immune system, or young children.
    • If individuals are in a crowded indoor setting with poor ventilation.

School measures from Ministry of Education and Health to support in-person learning:

  • Good hand hygiene
  • Stay up-to-date with vaccinations
  • Screen daily with updated screening tool
  • Stay home when sick
  • Enhanced cleaning procedures
  • Improved ventilation
  • Availability of high-quality masks for students and staff

Recommendations for schools to reduce the spread of respiratory viruses

Daily Self-screening

Respiratory Etiquette, including Cleaning Hands Often

  • Support and encourage proper hand hygiene and respiratory etiquette.
  • Educate staff and students on proper hand hygiene and respiratory etiquette.
  • Wash your hands with soap and water or use an alcohol-based hand sanitizer (70-90% alcohol concentration), provided hands are not visibly soiled. Remind staff and students to avoid touching their face, nose and mouth with unwashed hands.
  • Cover your cough or sneeze with a tissue. Dispose of tissue immediately after use in a garbage receptacle with lined plastic bags.
  • Monitor supplies to ensure adequate amounts of liquid soap, paper towel, (air dryer if paper towels are not available), hand sanitizer, tissues and waste receptacles with lined plastic bags.
  • Provide alcohol-based hand sanitizer (70-90% alcohol concentration) in dispensers near entrances, service counters and other high touch locations for staff, student and visitor use. Monitor and refill as needed.
  • Schools must ensure that staff /students have the ability to practice hand hygiene when needed:
  • Incorporate hygiene into breaks/recess, between school activities and before and after snacks and lunchtime/meals.

Masking

  • Masks protect ourselves and others from respiratory infections, especially when indoors. Toronto Public Health (TPH) recommends wearing a well-fitted, high-quality mask in indoor public settings to protect ourselves and others from respiratory infections especially:
    • If individuals are at higher risk of getting very sick from a respiratory virus.
    • If individuals live, work or spend time with someone who is at higher risk of becoming very sick from a respiratory virus, such as seniors, those who have a health condition, or young children.
    • If individuals are in a crowded indoor setting with poor ventilation.
  • More information is available here.
  • As some students or staff may choose to or be required (under certain circumstances) to continue to wear masks, school boards can continue to make masks available.
  • Schools and school boards can continue to encourage mask use especially indoors and/or in crowded settings and/or in areas with poor ventilation, while respecting individual choices regarding masks based on one’s own risk assessment.
  • Schools and school boards are encourage to promote respectful, welcoming and inclusive practices and communications within their school communities.
  • Students/staff may still be required to wear a mask in school, for example, if they are a close contact of someone with COVID-19. Masks may also be required for some health services such as vaccine clinics held in schools.
  • Masking is recommended when returning to school after symptoms of a respiratory infection, for 10 days from the first day after any symptom started, even if the individual tests negative for COVID-19. See page 2 of the TPH screening questionnaire and our TPH website Face Masks and Respirator for more information on when masks should be worn.
  • Schools and school boards should be prepared that there may be a need to resume a requirement for mask wearing if a new variant of concern emerges, or potentially during the winter months when the circulation of other respiratory viruses is likely to increase again.

Consider safe options for large gatherings

  • Masks are not mandatory, but consideration can be given to encouraging student/staff/visitors to wear masks during large indoor crowded gatherings with limited ventilation.
  • Physical distancing is not mandatory, but can be considered where possible.
  • Outdoor large gatherings may be preferable to indoor ones.

Encourage vaccination

Implement enhanced environmental cleaning and disinfection practices

  • Assign dedicated facility staff to complete environmental cleaning and disinfection duties.
  • Ensure frequent cleaning and disinfecting of high-touch surfaces and shared objects (e.g. doorknobs, water fountain knobs, light switches, toilet and faucet handles, electronic devices, tabletops) at least once a day and when visibly dirty.

Maintain water fountains and bottle filling stations

  • Water fountains and bottle filling stations can be used and are recommended to be cleaned and disinfected daily, or more often if needed, for example if visibly soiled.
  • Filling water bottles rather than drinking directly from the mouthpiece of water fountains is encouraged.

Maintain heating, ventilation and air conditioning (HVAC) systems

  • Increase the introduction and circulation of outdoor air by maximizing the outdoor air ratio of the HVAC system settings, or by opening windows and doors, where possible, or using air filtration or purifiers. However, do not open windows and doors if doing so poses a safety risk to school staff and students.
  • See the Ministry of Education COVID-19: health and safety measures at schools | ontario.ca.
  • Keep areas near HVAC inlets and outlets clear.
    • Seating should be arranged away from areas with high airflow (i.e. not in front of air vents).
  • Increase air-exchanges if possible.
  • Schools without HVAC systems should increase ventilation by opening windows (when possible) and classroom doors.
  • Rooms where ceiling fans are used should have an upward airflow rotation.
  • If portable fans are used, limit the blowing of air across people and surfaces by positioning them to provide an upward movement of air.
  • During the winter months when the temperatures are cold, consider opening windows or doors when students are not in the classroom, or for very brief periods every hour.
  • Detailed school ventilation guidance and checklists are provided in 2021:B14 School Ventilation.
  • School boards are expected to continue to work with qualified persons to plan for and continue to make upgrades to improve ventilation infrastructure, where required. Projects should be prioritized to meet appropriate minimum ventilation guidelines from the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standard 62.1-2019.
  • For more information please visit the Public Health Ontario Heating, Ventilation and Air Conditioning (HVAC) Systems in Buildings and COVID-19 fact sheet.

Nutrition/third party food programs and non-instructional food events such as pizza day should ensure food handlers use adequate food handling and safety practices.

Ensure protocols are in place for personal protective equipment for staff

  • Masks and eye protection are not required for staff in schools, school board offices and on student transportation as per guidance from the Ministry of Education. However, staff may continue to choose to wear masks and eye protection based on their own personal risk assessment. School boards and schools are encourage to promote respectful, welcoming and inclusive practices for those who continue to do so.
  • Staff should consult with their Occupational Health and Safety lead on the circumstances when Personal Protective Equipment (PPE) is required. In these situations, instructions on how to wear PPE should be provide.
  • The existing requirement for staff who perform aerosol generating medical procedures (AGMP), or who are in the same room when the procedures are being performed, to wear a fitted N95 mask continues to be in place.

Reporting a Communicable Disease to Toronto Public Health

Learn more about communicable diseases and when to report to Toronto Public Health.

High Absenteeism

Learn more about what to do if your school is experiencing a high absentee rate and when to contact Toronto Public Health.

Students that become sick while at school

Symptomatic students

  • For detailed guidance for symptomatic, students, staff and their household contacts, see:
  • Separate and provide a mask to students who become sick with symptoms while in school. Notify parents/guardians or emergency contacts to pick up the ill student as soon as possible.
  • If there is more than one sick individual who presents with symptoms, ideally they should be placed in separate designated well-ventilated rooms (if more than one room has been assigned for this purpose). If this is not possible, ensure the room is large enough so that students are kept more than two metres/six feet apart.
  • Staff supervising the sick student are advised to maintain physical distancing as best as possible, and wear PPE as required.
  • Clean and disinfect the area immediately after the student with symptoms has been sent home.

Resources

See Toronto Public Health respiratory virus resources for school administrators, child care operators, parents/caregivers and students/children.

References

This information is also available in French

It is recommended that individuals continue to complete a self-screening questionnaire before entering school/child care each day. Individuals with a chronic health issue that is medically diagnosed and unrelated to COVID-19 or another respiratory virus should look for new, different or worsening symptoms. Symptoms should not be chronic or related to other known causes or conditions (see examples here).

Stay Home and Self-Isolate if you are Sick

Self-Isolation means:

  • Stay home and do not attend work, school, child care or other public places.
  • Only leave home if there is a medical emergency or to get a clinical assessment or test. See COVID-19 Clinical Assessments and Testing for more information.

Follow Extra Measures means:

For 10 days after the start of symptoms OR a positive COVID-19 test (whichever came first) OR for 10 days after your last close contact with a person who has symptoms or a positive COVID-19 test:

  • Wear a well-fitted mask in all public settings (including schools/child care, unless <2 years of age);
  • Avoid non-essential activities where you need to take off your mask (e.g., dining out, playing a wind instrument, high contact sports where masks cannot be safely worn), with reasonable exceptions such as when eating in a shared space at school while maintaining as much distancing as possible;
  • Do not visit people or settings (e.g. hospitals, long-term care homes) at higher risk, including where there are seniors or those who are immunocompromised.

Follow this advice even if you test negative for COVID-19 or you did not do a test. These measures are an added layer of prevention against the spread of COVID-19 and respiratory viruses.

A) Does the individual have 1 or more of these new or worsening symptoms on the symptom screener?

  • Fever
  • Cough
  • Difficulty breathing
  • Decrease or loss of taste or smell

B) Does the individual have 2 or more of these new or worsening symptoms on the symptom screener?

  • Sore throat
  • Headache
  • Feeling very tired
  • Runny nose / nasal congestion
  • Muscle aches / joint pain
  • Nausea / Vomiting / Diarrhea

C) Does the individual have any of these new or worsening symptoms?

  • Abdominal pain
  • Conjunctivitis (pink eye)
  • Decreased or lack of appetite

Individual has 1 or more symptom(s) from list A) and / or 2 or more symptoms from list B)

  • The individual is presumed to have COVID-19 or another respiratory virus, and they should not go to school or child care.
  • Next steps for the individual:
    • Stay home and self-isolate. Stay home (self-isolate) until fever is resolved and symptoms have been improving for at least 24 hours (or 48 hours if nausea/vomiting/diarrhea)
    • After self-isolation is completed, for a total of 10 days after the start of symptoms or positive COVID-19 test (whichever came first):
      • Follow extra measures (See above for details on follow extra measures).
    • Follow additional guidance if immunocompromised OR residing in a highest-risk setting OR hospitalized for COVID-19.
    • Follow additional guidance as instructed.
      • If you have been told that you should be quarantining, isolating, staying at home or not attending school or child care right now (e.g., by a doctor, federal border agent, public health), follow the guidance or directions that have been provided to you.
  • Next steps for siblings and household members of the individual:
    • For a total of 10 days after your last close contact with a person who has COVID-19 symptoms or a positive COVID-19 test:
      • Self-monitor for symptoms. Stay home (self-isolate) if you develop any symptoms of COVID-19 and seek testing if eligible / available. Follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
      • Follow extra measures (See above for details on follow extra measures).

Get Tested and Treated if Eligible

  • COVID-19 testing and treatments are available to certain groups. See here for more information.
  • There are Clinical Assessment Centres that are able to assess, test, and provide treatment options to individuals with COVID-19, flu and other respiratory symptoms. Some centres can also assess children. For more information, visit the Ontario Ministry of Health’s COVID-19 testing locations webpage.

Individual has no symptoms from list A) and only one symptom from list B) or list C)

  • The individual should not go to school or child care.
  • Next steps for the individual:
    • Stay home until symptom is improving for at least 24 hours (or 48 hours if nausea/vomiting/diarrhea).
  • Next steps for siblings and household members of the individual:
    • Siblings and other household members do not need to stay home as long as they do not develop symptoms.
  • Following extra measures can be an added layer of protection against the spread of COVID-19 and respiratory viruses.
  • If the individual has one symptom from list B) or list C) AND was a close contact of someone in the household/community, they are to self-isolate and follow guidance under the section, “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”.

Individual has symptoms and has an alternative medical diagnosis

  • If the symptoms are from a known health condition diagnosed by a healthcare provider (not related to COVID-19), the individual does not have to self-isolate and can attend school or child care.
  • Symptoms should not be chronic or related to other known causes or conditions that the individual already has (see examples here). If the symptoms are new, different, or worsening, the individual should stay home and self-isolate, and follow guidance under the section, “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”

Individual has tested positive for COVID-19 (using a PCR, rapid molecular, or rapid antigen test)

  • Next steps for the individual:
    • If sick or not well, even with symptoms not listed in this screening tool, stay home. Talk with a doctor if necessary.
    • If any new or worsening symptoms develop, stay home and self-isolate immediately. Follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
    • Asymptomatic individuals with a positive test result do not need to self-isolate unless symptoms develop.
    • For a total of 10 days after positive test date or for 10 days after the start of symptoms (whichever came first):
      • Follow extra measures (See above for details on follow extra measures).
  • Next steps for siblings and household members of the individual:
    • For a total of 10 days after your last close contact with a person who tested positive for COVID-19:
      • Self-monitor for symptoms. Stay home (self-isolate) if you develop any symptoms of COVID-19 and seek testing if eligible / available. Follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
      • Follow extra measures (See above for details on follow extra measures).

Individual has been identified as a close contact of someone with symptoms or with COVID-19. The individual has no symptoms.

  • The individual may attend school or child care, as long as they do not have any symptoms.
  • All cases in the school/child care set­tings are encouraged to notify their close contacts directly if they have significant one-on-one interactions, without wearing a well-fitted, high-quality mask.
  • Next steps for the individual:
    • For a total of 10 days after your last close contact with a person who has symptoms or a positive COVID-19 test:
      • Self-monitor for symptoms.
        • If symptoms develop, stay home (self-isolate) and seek testing for COVID-19 if eligible / available. Follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
      • Follow extra measures (See above for details on follow extra measures).

Household member has symptoms of COVID-19 or tests positive

  • The household member of the individual with COVID-19 symptoms / positive test result may attend school or child care, as long as they do not have symptoms.
  • For information on how to protect themselves, household members should refer to Public Health Ontario’s fact sheet, Self-Isolation: Guide for caregivers, family members and close contacts.
  • Next steps for the household member:
    • For 10 days after your last close contact with a person who has symptoms or a positive COVID-19 test:
      • Self-monitor for symptoms.
        • If symptoms develop, stay home (self-isolate) and seek testing if eligible / available. Follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
      • Follow extra measures (See above for details on follow extra measures).
  • If additional household members develop COVID-19 symptoms
    • The individual with COVID-19 symptoms is to stay home (self-isolate) and follow guidance under “Individual has 1 or more symptoms from A) and/or 2 or more symptoms from B)”
    • The initial household member(s) with symptoms of COVID-19 do not have to extend their self-isolation based on other household members becoming ill.

Individual has travelled outside of Canada

Individual has been told that they should currently be quarantining, isolating, staying at home, or not attending school or child care

  • This could include being told by a doctor, health care provider, public health unit, federal border agency, or other government authority.
  • The individual should not attend school or child care.
  • Next steps for the individual:
    • Stay home and follow the guidance or directions that have been provided to you including when you can return to school or child care.
  • Next steps for siblings and household members of the individual:
    • Siblings and other people in the home are not required to stay home, unless they were also told to quarantine, isolate, or stay home.

References

This tool is consistent with the Ministry of Health’s (2022) Management of Cases and Contacts of COVID-19 in Ontario and the Government of Ontario’s (2022) COVID-19 School and child care screening.

This information is also available in French

Download the Screening Poster and Questionnaire for Child Care and Schools. Available in multiple languages.

Read Toronto Public Health’s respiratory virus information for parents and caregivers, including what parents need to know if their child is sick or is identified as a close contact at home or in the community.

 

Learn more about COVID-19 vaccines and flu vaccines. For information about COVID-19 vaccines for children, visit Toronto Public Health’s COVID-19 Vaccines for Infants, Children & Youth webpage.

Routine immunization for children and youth is still important during COVID-19. Learn more about routine childhood vaccines and visit the Childhood Vaccines – Quick Reference Guide webpage.

The table below includes links to resources that may be helpful for school administrators, child care operators, parents/caregivers and students/children. Please check the links often as the information is updated on a regular basis.

Guidance Documents:

Source Resource Link Audience
Government of Ontario COVID-19: health and safety measures at schools Staff in JK-12 schools
Government of Ontario COVID-19: health and safety measures for child care Staff in child care centres

TPH Contact List for Child Care/Schools: How to Report Child Care/School Absenteeism

Source Resource Link Audience
Toronto Public Health Communicable Diseases in Child Care Centres and Schools Child care operators / School administrators
Toronto Public Health High Absenteeism Child care operators / School administrators

Screening Tools and Related Resources:

Source Resource Link Audience
Toronto Public Health Screening Questionnaire for Children/Students/Adults Staff and children/students in child care centres and schools
Toronto Public Health Screening Poster for Children/Students/Adults Staff and children/students in child care centres and schools
Government of Ontario COVID-19 school and child care screening Staff and children/students in child care centres and schools
Toronto Public Health Who is a close contact in the community Staff and parents/caregivers of children/students in child care centres and schools

General COVID-19 Resources:

Source Resource Link Audience
Government of Ontario Provincial COVID-19 Testing Locations and Clinical Assessment Centres Parents/caregivers of children/students in child care centres and schools
Toronto Public Health COVID-19 Fact Sheet Parents/caregivers of children/students in child care centres and schools
Toronto Public Health How does COVID-19 Spread? Parents/caregivers of children/students in child care centres and schools
SickKids About Kids Health-COVID-19 Staff, families, and children/students

Vaccine Resources:

Source Resource Link Audience
Toronto Public Health Flu vaccine webpage Staff, families, and children/students
Toronto Public Health Routine childhood immunizations webpage Staff, families, and children/students
Toronto Public Health COVID-19 Vaccine Resources (available in multiple languages) Staff, families, and children/students
Toronto Public Health COVID-19 Vaccines Staff, families, and children/students
Toronto Public Health Information on COVID-19 vaccines and children Staff, families, and children/students
Toronto Public Health COVID-19 & Vaccines: Children Staff, families, and children/students

Hand Hygiene/Respiratory Etiquette Resources:

Source Resource Link Audience
Toronto Public Health Clean Hands Kit resource package Students in grades 4 – 6
Health Canada Hand washing heroes Students in grades JK – 3
Health Canada Coughing and sneezing hygiene for kids Students in grades JK – 3
City of Toronto Cover your Cough Staff in child care centres and schools to use as needed
Toronto Public Health Cover Your Cough Poster Staff in child care centres and schools to use as needed
Toronto Public Health Wash your Hands Staff in child care centres and schools to use as needed
Toronto Public Health Hand Washing Poster Staff in child care centres and schools to use as needed
Toronto Public Health Hand Sanitizing Poster Staff in child care centres and schools to use as needed

Masks Resources:

Source Resource Link Audience
City of Toronto How to wear a mask at school/child care Staff and students/children in child care centres and schools
City of Toronto Helping children wear masks at school/child care Staff and students/children in child care centres and schools
Toronto Public Health How to safely wear a mask Staff and students/children in child care centres and schools
Toronto Public Health Face Mask and Coverings Offer  Best Protection Staff and students/children in child care centres and schools
Toronto Public Health When using a mask, choose one that is high quality and fits well Staff and students/children in child care centres and schools
Toronto Public Health Face Masks & Respirators Staff, families, and children/students

Mental Health Resources:

Source Resource Link Audience
City of Toronto Self-Care Tips for Managing Stress and Anxiety Staff, families, and children/students
City of Toronto COVID-19 Mental Health Support Staff, families, and children/students
Toronto Public Health COVID-19 Mental Health Resources Staff, families, and children/students
Toronto Public Health Taking Care of Your Mental Health and Well-Being Staff, families, and children/students
Toronto Public Health What is Resiliency? Staff, families, and children/students
Toronto Public Health Box Breathing Staff, families, and children/students
Government of Ontario Mental Health, Wellness and Addictions Support Staff, families, and children/students
School Mental Health Ontario School Mental Health Ontario Staff, families, and children/students
School Mental Health Ontario COVID-19-Parents and Families Parents/caregivers of children/students in child care centres and schools
Children’s Mental Health Ontario COVID-19 Resources Staff, families, and children/students

 

Infection Prevention and Control Websites:

Source Resource Link Audience
Government of Ontario – Ministry of Labour COVID-19 and workplace health and safety Child care operators and school administrators
Government of Ontario – Ministry of Labour COVID-19 and the Occupational Health and Safety Act Child care operators and school administrators
Government of Canada Hard-surface disinfectants and hand sanitizers (COVID-19): List of disinfectants with evidence for use against COVID-19 Child care operators and school administrators
Toronto Public Health Infection Prevention and Control in Child Care Centres – Requirements and Best Practices Child care operators and staff

This information is also available in French.