General FAQ

A person is said to have a “case” of COVID-19 if their SARS-CoV-2 infection has been confirmed by a laboratory test.

Close contact is currently defined as being within 6 feet of a person with COVID-19 for a total of 15 minutes or more over a 24-hour period OR having exposure of any duration to the person’s respiratory secretions (for example, being coughed or sneezed on; sharing a drinking glass or utensils; kissing) while they were contagious. A person with COVID-19 is considered to be contagious starting from 2 days before they became sick, or 2 days before they tested positive if they never had symptoms. Exception: In K-12 settings, a student who is within 3-6 feet of an infected student is not considered a close contact as long as both students are wearing well-fitting masks the entire time. This exception may also be applied to school buses when the following criteria are met: 1) Documented seating charts and 2) Assurance that masks are worn and students remain in assigned seats, either via video monitoring if available, or attestation from the bus driver or monitor. 

NOTE: This exposure exception for students does not apply to teachers, staff, or other adults.

To be considered exposed to COVID-19, you have to have had close contact with someone who is suspected or confirmed to have COVID-19. Close contact categories include:

• Being within 6 feet of a person with COVID-19 for a total of 15 minutes or more over a 24-hour period, OR
• Having exposure to respiratory secretions from a person with COVID-19 (e.g., being coughed or sneezed on, sharing a drinking glass or utensils, kissing), OR
• Caring for a person who has COVID-19, OR
• Living in the same household with a person who has COVID-19 

Exception: In K-12 settings, a student who is within 3-6 feet of an infected student is not considered a close contact as long as both students are wearing well-fitted masks the entire time. This exception may also be applied to school buses when the following criteria are met: 1.) Documented seating charts and 2.) Assurance that masks are worn and students remain in assigned seats, either via video monitoring if available, or attestation from the bus driver or monitor. NOTE: This exposure exception does not apply to teachers, staff, or other adults.      

A person with COVID-19 is considered to be contagious starting two (2) days before they become sick (or 2 days before they test positive if they never had symptoms) and lasting until they meet the criteria to discontinue isolation.

If you are identified as a close contact during contact tracing activities, your local health department will reach out to you with more recommendations. Using the COVIDWISE app on your phone can help keep track of exposure. COVIDWISE is an early notification tool that individuals can use to notify contacts, or be notified themselves of an exposure. 

•  Quarantine. For the general public, VDH recommends that, counting the last time you had contact with that person as day 0,  you self-quarantine (stay home) for 5 days afterwards (i.e. day 0-5) and separate yourself from other people and pets as much as possible. Do not go to work or school during this time period. Avoid all public spaces, public activities, and group gatherings and do not take public transportation. If necessary, your local health department can ensure that your basic needs (for example, food and medication) are being met while you have to be in quarantine. Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.

• • You can end quarantine (leave your home) after Day 5 if you have no symptoms and can wear a mask when around others for Days 6–10. 
  • If you cannot wear a mask around others, quarantine at home until Day 10.
  • If you end quarantine after Day 5, you should avoid areas where you cannot wear a mask, avoid people with weakened immune systems or who are at high risk for severe COVID-19, avoid other people when you are eating, and avoid travel for Days 6–10.
• Monitor your health closely for 10 days after your last contact. When monitoring your health, be aware of the most common signs of COVID-19 (fever, cough, shortness of breath). Other signs of COVID-19 include chills, muscle pain, headache, sore throat and a new loss of taste or smell. Not everyone with COVID-19 will have all symptoms and fever might not be present. 
• Get tested. On day 5 or soon after, if possible. If your test is positive, follow the isolation guidance.
  • Those who are up to date with their vaccines and have ongoing COVID-19 exposure (i.e., household contact, caregiver) should get tested at least 5 days after their first exposure and again get tested 5-7 days after the end of isolation for the person with COVID-19. More information can be found on the VDH COVID-19 Testing page. Easy to read information on COVID-19 testing is also available.
• Answer the phone call. Your local health department may reach out to you with more recommendations if you are identified as a close contact during contact tracing. If you know you were a close contact to someone with COVID-19 while they were contagious, stay home and monitor your health, even if the health department does not call you.
• Respond to notifications. If you use the COVIDWISE app and receive a notice that you have been exposed, stay home, self-quarantine, and monitor your health after the potential exposure. 

This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). VDH currently recommends that child care facilities not apply the shortened quarantine and isolation periods as a best practice, but these may be considered for staff if there are critical staffing shortages. 

Current evidence shows that most COVID-19 transmission occurs closer to when symptoms start, generally in the 1–2 days before and the 2–3 days after symptoms begin. However, spread is still possible for up to 10 days after infection.

Counting your date of last exposure as Day 0, you should quarantine (stay home) and separate yourself from other people and pets as much as possible for at least 5 days (Days 0–5) after exposure. 

• You can end quarantine (leave your home) after day 5 if you have no symptoms and can wear a mask when around others for Days 6–10. 
• If you cannot wear a mask around others, stay at home until Day 10.

If you end quarantine after Day 5, you should avoid areas where you cannot wear a mask, avoid people who are at high risk for severe COVID-19, and avoid travel for Days 6–10.   Even if you do not stay home for the recommended 5 days, it is very important to continue monitoring yourself for symptoms during the 10 day period  and follow all isolation recommendations if you develop symptoms.

This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). VDH currently recommends that child care facilities not apply the shortened quarantine and isolation periods as a best practice, but these may be considered for staff if there are critical staffing shortages. 

Certain people are not required to stay home (quarantine) after exposure. This includes: 

• Are up to date with your COVID-19 vaccines.
• Had COVID-19 within the last 90 days (you tested positive using a viral test).
• Schools may consider forgoing quarantine for students ages 12-17 years who completed their primary vaccine series but have not yet received all eligible boosters. 
• Healthcare personnel (HCP) who are up to date on their vaccinations  for COVID-19 should be tested on days 2 and 5-7 after exposure, even if they don’t have symptoms. However, they do not need to stay home (self-quarantine) after a workplace or community-associated exposure or be restricted from work as long as they are not immunocompromised (e.g., organ transplant, cancer treatment) or do not have any symptoms. HCP should continue to follow quarantine recommendations after close contact and follow all travel recommendations. For additional details, visit CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic.
• People who have been fully vaccinated for COVID-19 and who have either traveled in the United States or arrived back in the United States after traveling internationally should visit VDH’s Travelers website for information about testing requirements and recommendations for travelers.
• People who have had close contact with a person who was a close contact to someone with COVID-19 (“contact of a contact”). Only if your contact person tests positive for COVID-19 should you stay home (self-quarantine). 

*It is very important that people who are not up to date with their COVID-19 vaccinations, but who are not required to stay home (quarantine) because they have had COVID-19 in the past 3 months, monitor their health for 10 days after their last exposure and continue following all COVID-19 prevention recommendations (e.g., wear a mask, stay at least 6 feet away from others, avoid crowds and poorly ventilated areas, and wash hands often) during that 10 day period. Even if you are up to date on your vaccinations, to maximize protection from the variants that cause COVID-19 and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.

People who are not required to stay home (quarantine) after exposure must still watch for symptoms of COVID-19 for 10 days and continue to wear a mask, stay at least 6 feet away from others, avoid crowds and poorly ventilated indoor spaces, and wash hands often.

If you are not up to date with your COVID-19 vaccines and are identified as a close contact of a person with COVID-19, VDH recommends being tested 5 days (or soon after) following your last contact with the person with COVID-19.

You should also quarantine for 5 days following their last exposure and wear masks when around others for a total of 10 days after their last exposure. 

People who are up to date with their vaccines and  have come into close contact with someone with COVID-19 should also be tested on day 5 (or soon after) following the day of their last exposure. 

People with ongoing COVID-19 exposure (e.g.,as a household contact or caregiver) should get tested 5-7 days after their first exposure and again get tested 5-7 days after the end of isolation for the person with COVID-19. They should wear a mask when in contact with the person with COVID-19 throughout the infected person’s isolation period.

More information can be found on the VDH COVID-19 Testing website.

It can take up to 10 days after an exposure for you to develop symptoms of COVID-19. Symptoms typically appear 2 to 10 days after exposure to the virus that causes COVID-19. Symptoms might develop sooner (2-4 days) with the Omicron variant compared to other variants.

Whether a person needs to quarantine after they have been exposed to someone with COVID-19 depends on their vaccination and booster status or history of prior infection in the past 90 days:

 People who are up to date with their COVID-19 vaccinations and those who had COVID-19 in the last 90 days do not need to quarantine.

People who are not up to date with their COVID-19 vaccinations should quarantine for 5 days following their last exposure, even if they have a negative test during this period: If you do not develop symptoms, counting your date of last exposure as Day 0, you should get tested on or soon after Day 5, if possible. People who had COVID-19 in the last 90 days do not need to get tested.

• If you test negative, you can end quarantine (leave your home) after Day 5 if you can wear a mask when around others for Days 6–10. If you cannot wear a mask around others, quarantine at home until Day 10 after your last exposure.
  

      More information can be found on the VDH COVID-19 Testing website.

 If you had or continue to have close contact with a contact of someone who tested positive for COVID-19, you do not need to be tested or stay home (quarantine) just because you are a contact of a contact. But stay in touch with that contact person. If your contact person tests positive for COVID-19, then you become a true close contact and may have be tested and stay home (quarantine), depending on your vaccination, booster or recent COVID-19 recovery status

Yes. You can lower your COVID-19 risk (1) by having the person with COVID-19 wear a mask, (2) by staying at least 6 feet away from the infected person, (3) by wearing a mask yourself, and (4) by limiting the amount of time you spend in the room. Having good ventilation in the room, such as by opening windows, can help, too. The best way to lower your risk is to be up to date on all recommended COVID-19 vaccine doses.

If you have been in close contact with a person with COVID-19, you should take your temperature twice daily* and remain alert for signs of illness, including fever, cough, chills, muscle or body aches, headache, sore throat, new loss of taste or smell, shortness of breath or difficulty breathing, congestion or runny nose, nausea or vomiting or and diarrhea. 

 *NOTE: It is important to not eat, drink, or exercise for at least 30 minutes before taking your temperature.

 It may take up to 10 days after an exposure for you to develop COVID-19, which is why it is important to stay home during this entire time period. Some people with COVID-19 will be asymptomatic (have no symptoms), or have very mild symptoms but even these people with no or mild symptoms can still spread the disease. 

You can download VDH’s Daily Symptom Monitoring Log to help keep track of your symptoms. The health department might also use an electronic symptom monitoring program for those who have been assessed as exposed to COVID-19.

For more information on what you should do if you have been exposed to COVID-19

VDH Exposure to COVID-19 Website

People with COVID-19 might not have any symptoms. If they do have symptoms, these can range from mild to severe illness.

Symptoms can include:

Not everyone with COVID-19 will have all symptoms and fever might not be present. These symptoms may appear 2-10 days after exposure. This list does not include all possible symptoms and will be updated as we learn more about COVID-19. See the list of symptoms on the CDC website.

Because the symptoms of COVID-19 can look different in different people, it is important to get tested and/or speak to your healthcare provider if you have any concern.

Since no vaccine is 100%, COVID-19 infections, even after vaccination, are possible. 

You can use the Coronavirus Self-Checker to help determine when to seek testing or medical care. 

 Yes. It is possible to test positive for the flu (as well as other respiratory infections) and COVID-19 at the same time. It is important to stay up to date on your vaccinations against both COVID-19 and influenza. 

Both influenza (flu) and COVID-19 are contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by the SARS-COV-2 virus and flu is caused by influenza viruses. Symptoms of flu and COVID-19 can be similar, so testing will likely be needed during flu season to know which disease you have.

Both the flu and COVID-19 can cause symptoms such as fever or feeling feverish/chills, cough, shortness of breath or difficulty breathing, fatigue (tiredness), sore throat, runny or stuffy nose, muscle pain or body aches, and headache among others. Change in or loss of taste or smell is sometimes seen in COVID-19 but is not seen with flu.

If you have any of these symptoms, you should contact your Healthcare Provider for evaluation, treatment and testing. Since both the flu and COVID-19 are contagious and can lead to serious illness, it is important to stay home while sick and for the recommended length of time after symptoms improve.   

Flu and COVID-19 are vaccine preventable diseases.

More information regarding similarities and differences between flu and COVID-19 is available.

VDH has created a chart comparing the symptoms of seasonal allergies, the common cold, strep throat, flu, and COVID-19.

If you have concerning symptoms, you should contact your healthcare provider for evaluation, treatment and possible testing.

If you think you might have COVID-19, it is important for you to stay home and away from others as much as possible. You should get tested. Rest and take care of yourself. If you are concerned about the symptoms you are having or they get worse, call your healthcare provider. If symptoms are severe, such as if you are having trouble breathing, call 9-1-1 and get emergency care. The recommendations provided here apply to anyone who is symptomatic without testing or tests positive for COVID-19.  You should isolate (stay home and away from others) for at least 5 days, after testing positive or from when your symptoms began. You can leave isolation on day 6 if you are fever-free for 24 hours without fever-reducing medication and other symptoms have improved. You should wear a well-fitting mask on day 6-10. If you cannot wear a well-fitting mask for days 6-10, you should isolate at home for the full 10 days. Additional VDH guidance is available for isolation. 

Tell your close contacts that they may have been exposed to COVID-19. An infected person can spread COVID-19 starting 48 hours (or 2 days) before the person has any symptoms or tests positive. By letting your close contacts know they may have been exposed to COVID-19, you are helping to protect everyone. Visit Exposure to COVID-19 to learn more about how to monitor your health and protect your community if you’ve been exposed to a person with COVID-19.  

Call 9-1-1 if you have a medical emergency: If you have a medical emergency and need to call 9-1-1, notify the dispatch personnel that you might have COVID-19. If possible, put on a mask before emergency medical services arrive. Emergency warning signs include (but are not limited to): trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse a person, or pale, gray or blue-colored skin, lips or nail beds, depending on skin tone. This list does not include all possible symptoms. Please consult your healthcare provider for any symptoms that are severe or concerning.

If you have symptoms or a positive test for COVID-19, follow COVID-19 prevention steps to help prevent the disease from spreading to people in your home and community. Find more details on VDH’s What to do if You are Sick webpage. 

You can use the Coronavirus Self-Checker to help determine when to seek testing or medical care. 

This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). VDH currently recommends that child care facilities not apply the shortened quarantine and isolation periods as a best practice, but these may be considered for staff if there are critical staffing shortages. 

 If you have symptoms or a positive test for COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community:

• Stay home except to get medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-shares, or taxis. Stay in touch with your doctor. Be sure to get care if you feel worse or think it is a medical emergency. 

• Separate yourself from other people and animals in your home as much as possible and avoid contact with other household members, including pets. This is known as home isolation.

• You should isolate (stay home and away from others) for at least 5 days, after testing positive or from when your symptoms began. The first day of symptoms  should be counted as Day 0. If you have a positive test and no symptoms, Day 0 is the day you tested. You can leave isolation on day 6 if you are fever-free for 24 hours without fever-reducing medication and other symptoms have improved. You should wear a well-fitting mask on day 6-10. If you cannot wear a well-fitting mask for days 6-10, you should isolate at home for the full 10 days. Additional VDH guidance is available for isolation. 

• Call ahead before visiting your healthcare provider if you think you might have COVID-19, so the healthcare provider’s office can take steps to keep other people from getting infected or exposed.

• Get tested if you have symptoms, regardless of vaccination status. 

• • If you cannot find a test, continue to follow steps for isolation until you can get tested.

• Wear a well-fitting mask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. Make sure to remove your mask correctly, wash or store your mask properly and wash your hands after touching a used mask. Proper mask use and physical distancing is very important if you leave isolation on day 6. 

• Cover your coughs and sneezes and dispose of any tissues in a lined trash can. If you are able, wash your hands with soap or use an alcohol-based hand sanitizer that contains at least 60% alcohol right away.

• Clean your hands often. Avoid touching your eyes, nose, and mouth. Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.

• Avoid sharing personal household items (e.g., dishes, drinking glasses, towels, etc.)

• Clean all “high-touch” surfaces every day and your “sick room.” Let someone else clean and disinfect common areas but not your bedroom and bathroom. Clean and disinfect any surfaces that may have blood, stool, or body fluids on them. Follow the instructions on the label to ensure safe and effective use of the product. Increase ventilation in your home to help decrease the chance of getting others in your home sick.

• Tell your recent close contacts that they may have been exposed to COVID-19. An infected person can spread COVID-19 starting 48 hours (or 2 days) before the person has any symptoms or tests positive. Visit Exposure to COVID-19 to learn more about how to monitor your health and protect your community if you’ve been exposed to a person with COVID-19.  

• Call 9-1-1 if you have a medical emergency. Emergency warning signs include (but are not limited to): trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse a person, or pale, gray or blue-colored skin, lips or nail beds, depending on skin tone. Please consult your healthcare provider for any symptoms that are severe or concerning.

Find more details about what to do if you are sick at: What to do if you are Sick. 

This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). VDH currently recommends that child care facilities not apply the shortened quarantine and isolation periods as a best practice, but these may be considered for staff if there are critical staffing shortages.

Clean high touch surfaces everyday. Practice routine cleaning of high touch surfaces and your “sick room.” Let someone else clean and disinfect common areas but not your bedroom and bathroom. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Clean the area or item with soap and water or another detergent if it is dirty. Then use a household disinfectant.

If a caregiver or other person needs to clean and disinfect a sick person’s bedroom or bathroom, they should do so on an as-needed basis. The caregiver should wear a mask and wait as long as possible after the person has used the bathroom. The caregiver/other person should wear a mask and disposable gloves while cleaning. Do not touch your face while cleaning and be sure to wash your hands with soap and water after cleaning. If possible, open doors and windows to increase air circulation.

Clean and disinfect  any surfaces that may have blood, stool, or body fluids on them. Visitors, other than caregivers, are not recommended. See CDC’s Caring for Someone Sick at Home for more advice for caregivers.

Be sure to follow the instructions on the label to ensure safe and effective use of the product. Many products recommend keeping the surface wet for several minutes to ensure germs are killed. Many also recommend precautions such as wearing gloves and making sure you have good ventilation during use of the product. Most EPA-registered household disinfectants should be effective.

For more information, visit CDC’s Cleaning and Disinfecting Your Home.

 Older people (≥65 years of age) and persons living in a nursing home or long-term care facility are at greater risk for serious illness. 

People of any age with certain medical conditions and disabilities are at increased risk of severe illness from COVID-19. A list of specific medical conditions can be found on the CDC website.

Systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting very sick and dying from COVID-19. See CDC’s website for steps you can take to reduce the risk of COVID-19.

Most people with COVID-19 can be ‘released’ from isolation and can be around others after: 

• • At least 5 days have passed since your symptoms first appeared AND
  • At least 24 hours with no fever without fever-reducing medication AND
  • Other symptoms have improved (Note: the loss of taste or smell might last for weeks or months after recovery. This should not delay the end of isolation) AND

• Wear a well-fitting mask and physically distance from others through days 6-10 after the start of symptoms or the day of a positive test if asymptomatic, which is Day 0.

This VDH guidance applies to general community settings, including K-12 schools, colleges and universities, and workplaces. It does not apply to healthcare facilities or high-risk congregate settings (e.g., correctional and detention facilities, homeless shelters, or cruise ships). VDH currently recommends that child care facilities not apply the shortened quarantine and isolation periods as a best practice, but these may be considered for staff if there are critical staffing shortages.

 For more information, see:
 What to do if you have confirmed or suspected coronavirus disease (COVID-19)?
 CDC Interim Guidance on Home Isolation 

With certain diseases, including sometimes with COVID-19, the amount of oxygen in our blood can sometimes fall below normal levels. When oxygen levels are too low, we may need to take extra oxygen in a process called oxygen therapy. An oxygen concentrator is a medical oxygen therapy device that can sometimes help get extra oxygen into the body but it should only be sold and used with a
doctor’s prescription.

Because there are risks involved in both getting too much oxygen and not enough oxygen, using an oxygen concentrator to get extra oxygen without talking with a doctor first can do more harm than good. On one hand, getting oxygen concentrations that are too high can damage your lungs. On the other hand, if you really do have COVID-19, using an oxygen concentrator on your own can lead to a delay in receiving the best available treatment.

Sometimes oxygen concentrators are sold online but buying or using any of these without a prescription is not approved by the FDA. Using an oxygen concentrator on your own should not replace staying alert for early COVID-19 symptoms such as fever and cough or seeking medical help when you need it.

The FDA provides information on their Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy website.

A pulse oximeter is a device used by healthcare professionals to measure the oxygen level (oxygen saturation) of the blood. Low blood oxygen levels can be a sign of COVID-19, but it is only one of many signs and symptoms that may be present during illness. Use of a pulse oximeter should only be used under the direction and supervision of a physician. A pulse oximeter should not replace being alert for early COVID-19 symptoms such as fever and cough.

Any private medical information should be shared only at the discretion of the individual and with healthcare providers who need the information to provide necessary medical care services. 

On the other hand, a person suspected or confirmed to have COVID-19 (1) should notify people who they have been in close contact with so that the contacts can follow public health recommendations and (2) should follow any disease reporting policies set up where they work to help prevent the spread of disease. 

Finally, if you have a confirmed positive COVID-19 lab result, both the lab and your healthcare provider are required by state regulation to report your infection status to the local health department. Someone from the health department may get in touch with you to ask about your close contacts. If you don’t hear from someone from the health department, you can anonymously notify your contacts.

Use Virginia’s free COVIDWISE Exposure Notification app to report your positive COVID-19 test. This will send an anonymous notification to people you were in close contact with who also use the app. Expect a text from VDH (804-336-3915 or 855-922-2644) if you tested positive for COVID-19 or get your COVIDWISE verification code here: https://apps.vdh.virginia.gov/CWP.

Reinfection means a person was infected (got sick) with COVID-19 once, recovered, and then later became infected again. Cases of reinfection with COVID-19 have been reported, but remain uncommon​. Based on what we know from similar viruses, some reinfections are expected. We are still learning more about COVID-19. At this time, whether you have had COVID-19 or not, the best way to prevent infection is to take steps to protect yourself. 

A CDC MMWR highlighted the fact that for people who had a natural COVID-19 infection, not being vaccinated after having COVID-19 was associated with more than twice the chance of reinfection compared with being fully vaccinated.

For more information on reinfection, visit the CDC website.

A breakthrough infection is an infection with the virus that causes COVID-19 even after you have been fully vaccinated. This is an expected occurrence for a small percentage of those receiving any vaccine, since no vaccine for any disease is 100% effective in preventing infection in every person who receives it. However, if breakthrough infections occur, they appear to be mild. The COVID-19 vaccines continue to be highly protective against severe illness.

Although most people with COVID-19 get better within weeks to months of illness, some do not. CDC and experts around the world are working to learn more about short- and long-term health effects associated with COVID-19, who gets them, and why. CDC uses the term post-COVID conditions to describe health issues that persist more than four weeks after first being infected with the virus that causes COVID-19.

Experts do not know why or how often some people experience post-COVID conditions. Other infectious diseases can also cause longer-term symptoms for a variety of reasons. Some post-COVID conditions are likely to be similar to those seen in other infectious diseases, but others may be more specific to COVID-19.  Some post-COVID conditions involve symptoms similar to those caused by other health problems. Scientists are actively investigating the causes of post-COVID conditions.

More information on long-term effects of SARS-CoV-2 infection and COVID-19 illness can be found on CDC’s Post-COVID Conditions website.

Long COVID is also known as post-COVID conditions. Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

• Tiredness or fatigue
• Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
• Headache
• Loss of smell or taste
• Dizziness on standing
• Fast-beating or pounding heart (also known as heart palpitations)
• Chest pain
• Difficulty breathing or shortness of breath
• Cough
• Joint or muscle pain
• Depression or anxiety
• Fever
• Symptoms that get worse after physical or mental activities

More information on long-term effects of COVID-19 illness can be found on CDC’s  Post-COVID Conditions website.

Yes, but the risk is much lower than in unvaccinated people.

First, we know that fully vaccinated people have a much lower risk, at least 50-60% lower, of getting infected with COVID-19.  

Second, even among those few fully vaccinated people who do get (breakthrough) COVID-19 disease, recent information from a large population in Scotland suggests that, compared to unvaccinated people who get COVID-19 infection, only about half as many fully vaccinated people with COVID-19 infection have symptoms lasting more than 28 days. 

A summary of several recent “Long COVID” studies is available. Additional studies will be needed to look into the ultimate burden of “Long COVID” in vaccine breakthrough cases.

Most post-COVID conditions can be diagnosed and managed by primary care providers, and if needed specialty care providers and support services (e.g., occupational therapy, physical therapy, social work) to maximize functional improvement and rehabilitation efforts. Healthcare professionals may also consider referral to multidisciplinary post-COVID care centers, where available, for additional care considerations. 

There are a number of post-COVID care centers (PCCC) in Virginia. The following list may not include all centers. VDH does not recommend or endorse specific clinics.

INOVA Post COVID-19 Recovery and Rehabilitation (Northern Virginia)

UVA Post COVID clinic (Charlottesville, VA)

Sheltering Arms Post-COVID-19 (coronavirus) rehabilitation (Mechanicsville, VA)

Centra Health Post-COVID Recovery Care Program (Lynchburg, VA)

Sentara Heart Hospital Post-COVID Clinic (Norfolk, VA)

The VCU Health Long COVID-19 Clinic (Richmond, VA)

Check out the following website(s):

VDH What to do if you have confirmed or suspected coronavirus disease (COVID-19)?

CDC COVID-19 Symptoms Website

CDC also provides easy to read materials: 

Things to Know about COVID-19

10 Things to Know When You Have COVID-19

Staying Away from People When You Have COVID-19

People with mild illness should stay home, rest, drink plenty of fluids, and take over-the-counter (OTC) medications to relieve the symptoms they are having. Be sure to follow the instructions on the package of the OTC medication, and do not give OTC cough or cold medicine to children under 6 years old. A table of types of OTC medications you can take for each symptom is available on VDH’s If You Are Sick or Infected webpage. Continue to monitor your symptoms and call your healthcare provider if they get worse or you are concerned.  Be sure to stay away from others (isolate) in the home to prevent the spread of disease.

For most persons with mild illness, these measures may be all that is needed. Healthcare providers may recommend treatment with a monoclonal antibody or antiviral for mild illness in a person who is considered high risk for progression to severe COVID-19. Persons with medical conditions or disabilities that put them at high risk for severe COVID-19 should contact their healthcare provider as soon as symptoms start.

People with more serious illness should call their healthcare provider and follow their recommendations for treatment and self-care. 

People who develop emergency warning signs such as (1) trouble breathing, (2) persistent pain or pressure in the chest, (3) new confusion or inability to arouse or (4) bluish lips or face, need immediate medical attention and 911 should be called.  Please note this list is not all inclusive and any person who has other severe or concerning symptoms should contact his/her medical provider. If you need to call 911, notify the dispatch personnel that you have, or are being evaluated for, COVID-19. If possible, put on a mask before emergency medical services arrive. Do not place a mask of any kind on children under 2 years of age. Please see the American Academy of Pediatrics (AAP) recommendations on “Face Masks for Children During COVID-19.”

Please consult a licensed physician or other healthcare provider for additional recommendations about disease treatment. Further information can be found on CDC’s Treatments Your Healthcare Provider Might Recommend if You Are Sick webpage and on the VDH’s “Treatments are available for COVID-19”, Monoclonal Antibody and Therapeutics websites. 

The FDA has approved remdesivir, an antiviral drug, to treat hospitalized adults and children aged 12 years or older.  

Remdesivir can be used to treat some cases of COVID-19. Gilead Sciences Inc., the pharmaceutical company that makes remdesivir, received approval from the U.S. Food and Drug Administration (FDA) in October 2020 to allow the medication to be used for hospitalized COVID-19 patients who are aged 12 years or older.  Healthcare providers can give remdesiver to children younger than 12 years of age through an Emergency Use Authorization (EUA) from the FDA. 

Other medications are also being evaluated as potential treatments for COVID-19. Please consult a licensed physician or other healthcare provider for additional recommendations about disease treatment.

Yes. 

Paxlovid has recently been authorized for use under an Emergency Use Authorization (EUA) to treat COVID-19 patients 12 years or older who are felt to be at high risk of having severe COVID-19. A large study has indicated that if the drug is used within the first five days of illness onset, it is nearly 90% effective in preventing development of severe COVID-19. Effectiveness in those 65 years or older is 94%.

Also, use of molnupiravir was recently authorized under an EUA to treat infected adults aged 18 years and older who are felt to be at risk of severe outcomes of COVID-19. Because testing of molnupiravir in animals suggested a risk of fetal harm, it should not be used in women who are pregnant, at risk of becoming pregnant or who are breastfeeding.

Neither of these two drugs are to be considered as a substitute for COVID-19 vaccination and both are currently in short supply.  

Other antiviral medications are being studied to see if they might help treat COVID-19.  

For example, the use of convalescent plasma, which involves taking the plasma from a person who has recovered from COVID-19 and infusing it into a person with a current illness, is being studied. For more information about therapies under investigation, please visit CDC’s Treatments Your Healthcare Provider Might Recommend if You Are Sick webpage and the VDH’s “Treatments are available for COVID-19”, Monoclonal Antibody and Therapeutics websites

Patients can use the COVID-19 Treatment Locator to find a pharmacy near them that carries the medication. Both oral antiviral medications require a prescription from a healthcare provider.

When a virus (or other germ) enters your body, your immune system responds by producing antibodies, which help the body fight off infection. Monoclonal antibodies are versions of these antibodies that your body naturally makes, but they are made in a laboratory. 

Monoclonal antibodies can be used in three different ways: 1) to prevent COVID-19 in someone before they are exposed to the virus (pre-exposure prophylaxis), 2) to prevent COVID-19 in someone who has already been exposed to the virus (post-exposure prophylaxis), and 2) to treat someone who has COVID-19 (treatment). 

Pre-Exposure Prophylaxis

The FDA has authorized Evusheld, a combination of two different monoclonal antibodies for emergency use as pre-exposure prophylaxis (prevention before exposure) for COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 AND:

• Who have moderate to severe immune compromise and may not mount an adequate immune response to COVID-19 vaccination, OR
• For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction.

Evusheld has been shown to retain its effectiveness when used against the Omicron variant of SARS-CoV-2 virus.

Post-Exposure Prophylaxis (Changes due to the Omicron variant.)

The FDA had previously authorized two combinations of monoclonal antibodies for emergency use as post-exposure prophylaxis (prevention after exposure) for COVID-19 in certain adults and pediatric individuals who were at high risk for progression to severe COVID-19. These were:  

• FDA authorizes REGEN-COV monoclonal antibody therapy for post-exposure prophylaxis (prevention) for COVID-19 (For individuals 12 years of age and older weighing at least 40 kg.)
• FDA authorizes bamlanivimab and etesevimab monoclonal antibody therapy for post-exposure prophylaxis (prevention) for COVID-19 (For all ages, newborn and older).

However, as of late December 2021, neither REGEN-COV nor the combination of bamlanivimab and etesevimab appear to be effective in treating infections with the new and rapidly spreading Omicron variant of SARS-CoV-2. In light of recent National Institutes of Health (NIH) clinical guidelines published on Dec. 30, 2021, and the significant variability in prevalence of the Omicron Variant of Concern (VOC), all states and territories can continue to order both bamlanivimab plus etesevimab and Regeneron (casirivimab plus imdevimab) monoclonal antibody products from HHS based on allocated amounts for clinically appropriate use.

Treatment

Use of sotrovimab, another monoclonal antibody, has been authorized under an FDA EUA to treat non-hospitalized patients 12 years and older who are confirmed as having COVID-19 and are felt to be at high risk of severe disease because of an underlying disease or because they are immunosuppressed. This therapy has been shown to retain effectiveness against the Omicron variant of SARS-CoV-2 virus.

Information on specific therapies can be found on VDH’s Therapeutics webpage and  NIH’s COVID-19 Treatment Guidelines website.

FDA has also issued an emergency use authorization for Actemra, a monoclonal antibody that may be used in certain hospitalized individuals (aged 2 years or older).

There are clinical trials underway to see if other monoclonal antibodies are safe and effective at preventing or treating COVID-19. For more information about monoclonal antibodies and COVID-19, visit the National Institutes of Health (NIH) websites and the VDH Therapeutics website.

Patients can use the COVID-19 Treatment Locator to find a monoclonal antibody administration site near them. This treatment is only available by prescription.  Most monoclonal antibody administration sites require a prescription and an appointment for treatment. 

Yes, the majority of administering sites require a referral and an appointment to receive treatment. Most sites do not take walk-in patients.

Side-effects vary based on the type of treatment. Common reported side effects across products, may include: fever, difficulty breathing, rapid/slow heart rate, nausea, vomiting, or hyperglycemia.
IV infusions and injections also may cause brief pain, bleeding, skin bruising, soreness, swelling, and infection at the location where it was given. Therapeutics may cause other side effects. Talk to your healthcare provider if you experience any side effect that bothers you or does not go away quickly. 

If you have fully recovered from COVID-19, you may be able to help patients currently fighting the infection by donating your plasma. Because you successfully fought the infection, your plasma probably now contains lots of COVID-19 antibodies. These antibodies in your plasma helped your immune system fight the virus when you were sick, so your plasma may also be useful to help others fight off the disease.

For information on how to donate plasma if you have recently recovered from COVID-19, please see information from the FDA.

It is important to note that the cost of the medications and the cost to administer them are separate.  Because the federal government purchased the monoclonal antibody drugs, there is no cost to the patient for the medicine. However, there may be costs incurred from administration of the product. Checking insurance coverage is advised. Please review the attached HHS document on the cost of therapeutics: https://combatcovid.hhs.gov/sites/default/files/documents/Outpatient-Cost-Cover age-072021.pdf 

There is currently no scientific evidence to show that taking ibuprofen while sick with COVID-19 will lead to worsening illness. For persons looking for a medication to reduce their fever, acetaminophen might be preferable. Both acetaminophen and ibuprofen, like any other medication, can have serious side effects. You should consult with your healthcare provider if you are unsure what the best medication is for you.

No. Animal products containing ivermectin SHOULD NOT be used in people. These

products can cause serious health effects, including death. While there are approved uses for ivermectin in people and animals, it has not been shown to be a safe or effective way to prevent or treat COVID-19. 

Please help us protect public health by reporting any animal drug advertising/animal ivermectin products with claims about preventing or curing COVID-19 by emailing FDA-COVID-19-Fraudulent-Products@fda.hhs.gov or calling 1-888-InfoFDA (1-888-463-6332). 

Ivermectin tablets are approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms. In addition, some topical forms of ivermectin are approved to treat external parasites like head lice and for skin conditions such as rosacea. If your health care provider writes you an ivermectin prescription, fill it through a legitimate source such as a pharmacy, and take it exactly as prescribed.

Seek immediate medical attention or call the poison control center hotline (1-800-222-1222) for advice if you have taken ivermectin or a product that contains ivermectin and are having symptoms. Signs and symptoms include gastrointestinal effects (nausea, vomiting, abdominal pain, and diarrhea), headache, blurred vision, dizziness, fast heart rate, and low blood pressure. Other severe nervous system effects have been reported, including tremors, seizures, hallucinations, confusion, loss of coordination and balance, decreased alertness, and coma.

For more information, please see FDA FAQ: COVID-19 and Ivermectin Intended for Animals and FDA: Why You Should Not Use Ivermectin to Treat or Prevent COVID-19

Check out the following websites:

VDH: Treatments are available for COVID-19

VDH: If You Are Sick

CDC: What to Do If You Are Sick

CDC: Caring for Someone Sick at Home

CDC: Treatments Your Healthcare Provider Might Recommend for Severe Illness

Virginia law requires that school boards provide in-person instruction in the 2021-2022 school year in adherence, to the maximum extent practicable, with applicable CDC mitigation strategies.

Virginia schools should select appropriate, layered prevention strategies to decrease the transmission of COVID-19 in schools. School officials, together with public health officials, need to consider multiple factors when making decisions about layered prevention strategies. In addition to important context about local communities, vulnerable populations, and equity concerns, the primary factors to consider are the level of community transmission, vaccination coverage, trends in school-related outbreaks or increasing cases, data from school screening testing programs, and the ages of the children served in a given school. Key prevention strategies include: promoting vaccination; consistent and correct use of masks; physical distancing; screening testing; ventilation; handwashing and respiratory etiquette; cleaning and maintaining healthy facilities; staying home when sick and getting tested; and contact tracing in combination with isolation and quarantine.

As of August 12, 2021, a Public Health Order requires all individuals aged two and older to wear masks when indoors at public and private K-12 schools, regardless of vaccination status. The Order also applies to Pre-K if the program is at a K-12 school. The Order does not apply to outdoor school settings. VDH recommends those who are not fully vaccinated wear masks in crowded outdoor settings or during outdoor K-12 settings or during outdoor activities that involve close contact with other people, but it is not a requirement.

For additional details, please see VDH Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools. 

Yes. On August 12, 2021, the State Health Commissioner reissued a Public Health Order requiring all students, teachers, staff, and visitors in K-12 schools to wear masks indoors, regardless of vaccination status. This Order reinforces current state law, which requires Virginia schools to adhere to mitigation strategies outlined by the Centers for Disease Control and Prevention. 

For additional information, see VDH Information on Mask Webpage and Interim Guidance for the 2021-2022 school year. 

Additional FAQs on the Public Health order are available.

Please see the Department of Education FAQs for additional information. 

Yes. On January 29, 2021, CDC issued an Order that required face masks to be worn by all people while on public transportation. This included the requirement for all individuals aged two and older to wear a mask on a school bus. Bus drivers are not required to wear a mask when alone on a bus. VDH encourages and promotes awareness of the federal order, but the federal order is not enforceable by VDH.

Keeping students in school for in-person learning remains a priority of the Commonwealth. Masks are a proven tool to reduce in-school transmission, even in communities with low vaccination rates and high levels of spread. In many cases, wearing a mask in school can help prevent a child from having to quarantine when classmates test positive for COVID-19. Delta is more contagious than earlier forms of the virus, causing more children to become infected and have more severe symptoms of COVID-19 than previous variants. Virginia’s hospitalization and fatality data by age group and locality are available.  CDC’s Pediatric Data Dashboard provides current data on COVID-19 in children at national and state levels. The VDH outbreak dashboard provides information about reported outbreaks across the state and can be sorted by locality and exposure setting.

 Additional FAQs on the Public Health order are available.

The Order states that This Order shall be effective August 12, 2021, and shall remain in full force and effect until the CDC guidelines for K-12 schools change, unless this Order is sooner amended or rescinded. Several factors may also be considered, including the level of community transmission, health system capacity, and vaccine eligibility. The Order is a temporary but necessary measure, and until CDC guidelines change or trends are more favorable, the Order will remain in place.

If you would like to report a violation of the Public Health Order, contact your local health department. Contact information for your local health department can be found here: https://www.vdh.virginia.gov/local-health-districts/.

VDH fully expects all individuals to comply with this Public Health Order. Orders of the Commissioner or the Board of Health may be enforced pursuant to Virginia Code §32.1-27 which provides, in part, that any person not obeying an order of the Commissioner may be compelled in a proceeding instituted in an appropriate court by the Board or Commissioner to obey such order. Any parent or guardian of a student aggrieved by a school board action should consult with an attorney as to how to proceed.

Each school division is deciding how to safely teach children by applying everyday prevention measures in the school setting. Many decisions involve ways to minimize interactions and maximize distance between people within the school. Please contact your local school division for more information regarding reopening of schools. Frequently asked questions are available at Virginia Department of Education FAQs.  

CDC provides additional FAQs here: Parents and Caregivers – What Is Your School Doing to Protect Your Child from COVID-19?

If your child is identified as a close contact of someone with COVID-19, your child needs to follow testing and quarantine guidance from your school. A representative from the local health department may also call parents of close contacts to provide quarantine guidance.

 If your child develops symptoms at any point during quarantine (even if they are fully vaccinated and have been exposed), they need to get tested and be isolated immediately. If you are able and willing to get tested, getting tested on Day 5 of isolation or quarantine is preferred. Getting tested soon after Day 5 is also acceptable.

Information for schools and parents about contact tracing and quarantine is available on the VDH K-12 page. VDH’s Exposed to COVID-19 webpage also provides the most updated information. Your local health department continues to be the best resource and point of contact for guidance regarding your specific potential exposure. Large exposure events require extensive resources from local health departments, so response times may be slower as they follow up with people identified as close contacts.

VDH has a data dashboard called COVID-19 Outbreaks by Selected Exposure Settings, that is available. VDH posts information about reported COVID-19 outbreaks, including those in grades K-12 public and private schools with 30 or more students and staff members, on this dashboard. This dashboard is updated weekly. You can look at all the outbreaks reported to VDH across all exposure settings or you can use the filter to look at only the outbreaks in the K-12 settings (select “K-12” in the Facility Type drop-down menu). There will be no identifiable information in the data presented.

 School districts may choose to continue more stringent isolation and quarantine requirements or may implement the CDC guidance on quarantine and isolation.  

• The new guidelines apply to K-12 settings when individuals can properly and consistently mask for an additional 5 days after ending their 5 day isolation or quarantine. 
• For isolation (people with confirmed or suspected COVID-19):  If an individual is unable to consistently and correctly wear a mask (e.g., young children, developmental issues, etc.), they should isolate at home for the full 10 days.
• For quarantine (certain people exposed to someone with COVID-19): 

• • You do not need to quarantine after close contact if you:
    • Are up to date with your COVID-19 vaccines.
    • Had COVID-19 within the last 90 days (you tested positive using a viral test).

• You need to quarantine after close contact if you:

• • Are not up to date with your COVID-19 vaccines. This includes people who are not vaccinated.*
  • *Schools may consider forgoing quarantine for students ages 12-17 years who completed their primary vaccine series but have not yet received all eligible boosters. 

Everyone should wear a well-fitting mask around others for 10 days from the date of their last close contact with someone with COVID-19 (the date of last close contact is considered day 0). They should also get tested at least 5 days after having close contact with someone with COVID-19, unless they had confirmed COVID-19 in the last 90 days and subsequently recovered. For 10 days after their last exposure to someone with COVID-19, they should watch for fever (100.4◦F or greater), cough, shortness of breath, or other COVID-19 symptoms.

Those who test positive or develop COVID-19 symptoms should follow recommendations for isolation. Be sure to notify your school if this happens and reach out to your healthcare provider.

The student or staff member would be considered a close contact of the household member with COVID-19.  While someone is isolating at home, try to minimize close contact with others in the household as much as possible. This includes having the person with COVID-19 in a separate bedroom and using a separate bathroom if possible, staying at least 6 feet apart, minimizing time spent with each other, wearing well-fitted masks, and improving air flow by opening a window. If a household member has close contact with the person isolating at home during their 5-day isolation, then the household member needs to take steps to protect themselves and might need to quarantine. Those who test positive or develop COVID-19 symptoms should follow recommendations for isolation. Be sure to notify your school if this happens and reach out to your healthcare provider.

If you are able and willing to get tested, getting tested on Day 5 of isolation or quarantine is preferred. Getting tested soon after Day 5 is also acceptable. Those who test positive or develop COVID-19 symptoms should follow recommendations for isolation. Be sure to notify your school if this happens and reach out to your healthcare provider. 

CDC and VDH do not recommend requiring a negative COVID-19 test in order for students or staff to return to school. Instead, only those people who have met the CDC criteria for return to school should do so. VDH created a release from isolation or quarantine guide to determine when those exposed to or diagnosed with COVID-19 can return to work or school.  However, some school divisions may require a note from a healthcare provider to return to school or work. Please check with your local school division for guidance.

Schools should avoid offering any self-serve food or drink options, such as hot and cold food bars, salad or condiment bars, and drink stations and serve individually plated or pre-packaged meals, while ensuring the safety of children with food allergies.

As feasible, schools should encourage physical distancing in food service lines and at tables while eating. Students and staff should wash their hands with soap and water for 20 seconds or use a hand sanitizer that contains at least 60% alcohol before and after eating. Schools should clean and disinfect food line areas, tables, and chairs between uses. CDC guidance is available. Your individual school will decide how school lunches will be provided to students. VDOE has provided guidance to schools. Please discuss any concern you may have with your local school division.

For more information, see DOE reopening FAQ (under School Nutrition)

Children who are in the 6-10 day period after isolation or quarantine should ideally be 6 feet away from others during meals and snacks, or other unmasked periods. To ensure confidentiality, VDH recommends that all students maintain 6 feet of distance between  each other during unmasked periods. If a child with COVID-19 is in the 6-10 day isolation period and they spend greater than 15 minutes unmasked and less than 6 feet from others (i.e. 6 feet is not feasible), then the other individuals are considered close contacts and will need to follow the quarantine protocol. 

Make sure that you provide the school with healthcare provider (HCP) documentation of the child’s food allergy and treatment protocols. This includes HCP authorization and parental consent to administer medication to students in the event of anaphylaxis or illness due to exposure. Meet with school staff, including teachers, school nurses and administrators, to discuss safety measures and establish/update a Section 504 plan.  Please discuss any concern you may have with your local school division.

Make sure that you provide the school with health care provider documentation (HCP) of the child’s healthcare needs and treatment protocols. This includes HCP authorization and parental consent to administer medication or administer treatments to students. The CDC offers guidance for families of children needing extra precautions during COVID. Families are encouraged to meet with school staff, including teachers, school nurses and administrators, to discuss safety measures and establish/update a Section 504 plan.  Please discuss any concern you may have with your local school division.

The Virginia Department of Health is encouraging students and their families to prepare for attending school in person. Information for parents is available on the VDH Back to School Website. Many students will need updated immunizations, physicals for enrollment, medication administration, documentation for health conditions and emergency action plans for chronic conditions (asthma, allergy, diabetes and seizures). The AAP offers guidance to families and their children returning Back to School in the fall. Please contact your child’s health care provider to discuss your child’s medical needs.

Children need to continue to get the recommended vaccines on schedule. Vaccines provide individual and community immunity. The Virginia Department of Education is requiring all public school students to have required immunizations to be enrolled in school. Please continue to focus on your child’s immunization.

The Code of Virginia requires that children be adequately immunized (§ 22.1-271.2) and receive a school entrance physical (22.1-270) within the 12 months prior to entering public kindergarten or elementary school. Other required immunizations include Human Papillomavirus (HPV) for girls and boys entering the seventh grade   Diphtheria, Tetanus, and Pertussis (Tdap) booster for entry into seventh grade and Meningococcal  Conjugate Vaccine (MenACWY) for entry into seventh and 12th grade. 

Information for parents is available on the VDH Back to School Website.  

Currently, the COVID-19 vaccine is not mandatory. However, the vaccine is one of the critical tools needed to reduce the spread of this virus. Vaccinating teachers, school staff, and students when eligible for vaccination is a critical layer of prevention and protection for all. Achieving high levels of vaccination among eligible students, teachers and staff is one of the most critical strategies to help schools safely operate. We encourage you to have a conversation with your child’s healthcare provider.

For those that are eligible (5 years and older) to receive the COVID-19 vaccine and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 and other vaccines on the same day, as well as co-administration within 14 days. Information for parents is available on the VDH Back to School Website. 

The state does not require COVID-19 vaccines for students or staff; but local divisions may choose to require the vaccine of school staff as a matter of employment. Additionally, Virginia school division staff may be covered under forthcoming federal vaccination requirements. This requirement is not yet in place and additional information is forthcoming.

Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. Vaccinating teachers, school staff, and students as soon as they are eligible for vaccination is a critical layer of prevention and protection for all. Achieving high levels of vaccination among eligible students, teachers and staff is one of the most critical strategies to help schools safely operate.

For more about the COVID-19 vaccine, and where to find a free one near you, please visit https://www.vdh.virginia.gov/covid-19-vaccine/

School divisions are subject to the Standard for Infectious Disease Prevention of the SARS-CoV-2 Virus That Causes COVID-19, issued by the Virginia Safety and Health Codes Board. The most recent version became effective September 8, 2021.  

The amended Department of Labor and Industry (DOLI) Standard includes requirements for all employers as well as specific requirements for higher-risk workplaces (16VAC25-220-60, page 37), which includes school divisions. The Standard also requires employers with higher-risk workplaces to create a written Infectious Disease Preparedness and Response Plan (16VAC25-220-70, page 44) and requires training (16VAC25-220-80, page 47) of certain employees as well.

 Students enrolled in school for the 2021-2022 school year will need to be up to date on their required school immunizations. Please consult with your healthcare provider for school required vaccine guidance. Information for parents is available on the VDH Back to School Website.  

 Students enrolling in school will need to be up to date on their required school immunizations. Please consult with your healthcare provider for school required vaccine guidance  and TB screening guidance. Testing for TB infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA), can be done before, after, or during the same encounter as COVID-19 vaccination.

The Virginia Department of Health has issued guidance related to recreational and school-based athletics.

The Virginia High School League governs athletic competitions and local school divisions may have their own policies in place (such as vaccine requirements for athletes or mask mandates for outdoor spectators).

Students enrolled in school for the 2021-2022 school year will need to be up to date on their school required immunizations. Please consult with your healthcare provider for school required vaccine guidance. Information for parents is available on the VDH Back to School Website.  

Individuals can participate in sports as long as they can adhere to strict mask usage on days 6-10, including during play. If strict mask use is not possible, participating in sports should be delayed until after day 10 of isolation or quarantine. Schools and families should be aware that team sports or other extracurricular activities, especially indoor activities involving shouting or singing, increase the risk of SARS-CoV2 transmission.  

The risk of disease is lower when your child is outdoors compared to indoors, where there is less fresh air. School divisions have the ability to implement local mask policies based on community level conditions and public health recommendations. VDH recommends that individuals aged two and older who are not fully vaccinated wear a mask in crowded outdoor settings.

Ventilation is one component of maintaining healthy environments, and is an important COVID-19 prevention strategy for schools and childcare programs. Wearing a well-fitting, multi-layer mask helps prevent virus particles from entering the air or being breathed in by the person wearing a mask. Good ventilation is another step that can reduce the number of virus particles in the air. The risk of disease is lower when your child is outdoors compared to  indoors, where there is less fresh air.  Along with other preventive actions, ventilation can reduce the likelihood of spreading disease. The CDC has published guidance for schools on ventilation and can be found here:  ventilation in the school setting   

Drinking fountains should be cleaned and sanitized, but encourage staff and students to bring their own water to minimize use and touching of water fountains. For more information is available on the CDC website.

Watch for signs of stress in your child. Some common changes to watch for include excessive worry or sadness, unhealthy eating or sleeping habits, and difficulty with attention and concentration. For more information, see the “For Parents” section on CDC’s website, Manage Anxiety and Stress. Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand. Go to CDC’s Helping Children Cope with Emergencies or Talking with Children About COVID-19 for more information. The Virginia Department of education has resources for families: VDOE Support for Families. Schools are working to support mental health needs of students and staff.  Contact your local school division if you have questions or concerns. Information for parents is available on the VDH Back to School Website and Social Emotional Learning Resources for Parents.

COVID-19 spreads most often when attached to respiratory droplets produced when people cough, sneeze, sing, talk (especially loud talking), or breathe.

Masks act as a physical barrier to the spread of those droplets - and as a barrier to spread of COVID-19 - to uninfected people from already infected people. NOTE: Many infected people are unaware of their infection because they have not developed symptoms. 

Masks are protective in both directions. First, they reduce the amount of COVID-19 virus that infected people – even those who are infected but still without symptoms – shed into their environment. Second, when masks are properly designed and worn, they can also directly protect uninfected people by reducing the chance that they will breathe in enough virus particles shed by infected people to actually become infected themselves. An individual's benefit increases with increasing community mask use.

The CDC has also released several reports that highlight the importance of mask wearing specifically in schools. A summary of those findings can be found on their webpage. To mention a few:

• Schools without a mask requirement were 3.5 times more likely to have COVID-19 outbreaks compared to schools that started the year with a mask requirement. (Link)
• Increases in pediatric COVID-19 case rates during the start of the 2021–22 school year were smaller in U.S. counties with school mask requirements than in those without school mask requirements. (Link) 

Available data also shows that improving mask fit improves protection for the person wearing the mask.

However, it’s important to remember that the COVID-19 protection provided by masks is not absolute. Schools should follow the Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools. This guidance emphasizes several key prevention strategies, including vaccination, masking, physical distancing, screening testing, ventilation, hand hygiene, cleaning, staying home when sick, and prompt contact tracing once any cases are identified. Of all available prevention strategies, vaccination, masking, and physical distancing should be prioritized.

Additional information on masks and mask use can be found on VDH’s Mask webpage and in a CDC Science Brief.

Masks are a key public health measure to decrease viral spread. There is no evidence to show that masks made for public use lower oxygen levels. Cloth and medical (or surgical) masks have breathable layers that will not cause your child to retain carbon dioxide or block the oxygen they need.

Most children, including children with most medical conditions, aged 2 years or older can safely wear face masks for extended periods of time- including an entire school day.

Mask wearing for children at risk of COVID-19 exposure is also recommended as a safe practice by the American Academy of Pediatrics and by the American Lung Association.

There is no evidence that mask wearing weakens the immune system. Also, mask wearing does not interfere with lung development. Wearing a mask in class does not keep children from breathing properly or make their heart work harder, and also does not affect their emotional state or make it harder for them to remember class material. Teachers can learn from what doctors and nurses have done to help them communicate with children while wearing a mask, and use more gestures while speaking, like pointing to help focus children’s attention and waving hello. Posting pictures of the teacher without a mask in the classroom can also help students connect with their teacher.

N-95 masks provide a higher level of protection, but are typically reserved for medical professionals. There is some evidence that prolonged use of an N-95 mask can lead to some increase in carbon dioxide levels in the body. However, these levels are still within short term acceptable levels. Children with lung conditions who may require higher levels of protection from their mask, should speak with their healthcare provider regarding these concerns.

Children with mental health issues that are exacerbated by mask wearing, should speak with their healthcare provider about alternatives and accommodations if needed.

To address parents and caregivers' concerns on the emotional toll the pandemic continues to have on children’s well-being and development, the AAP provides answers to some common questions about young children’s speech and language development with mask use and the physical impact of mask wearing on children. CDC has a resource toolkit designed to support parents in supporting their child’s mental health.

Additional information on this topic is discussed in a CDC Science Brief.

The American Academy of Pediatrics (A.A.P.) offers advice about helping children get accustomed to masks. The A.A.P.’s suggestions include putting a mask on a child’s favorite stuffed animal, decorating masks so they’re more personalized and drawing a mask on your child’s favorite book character.

On August 12, 2021, the State Health Commissioner reissued a Public Health Order requiring all students, teachers, staff, and visitors in K-12 schools to wear masks indoors, regardless of vaccination status. This Order reinforces current state law, which requires Virginia schools to adhere to mitigation strategies outlined by the Centers for Disease Control and Prevention. For additional information, see VDH Information on Mask Webpage.  

Masks are not recommended for those under 2 years old, and anyone else unable to remove the mask on their own. According to the A.A.P., children with “severe cognitive or respiratory impairments” might not be able to tolerate a mask. On the other hand, children who are at high risk for severe COVID-19, including those who are immunocompromised, might need more protection than cloth face coverings offer, and N95 masks are recommended for them. The AAP offers guidance to families and their children returning Back to School in the fall.

Wearing masks during physical activity may be considered. Some people may have a difficult time wearing a mask while exercising or playing a sport, and decisions to wear masks during play should be made on a case-by-case basis. Considerations may include the intensity of the sport and the likelihood of the mask getting caught on equipment or getting wet, and the vaccination status of participants.

The CDC states that “people who are engaged in high intensity activities, like running, may not be able to wear a mask if it causes difficulty breathing.  

On August 12, 2021, the State Health Commissioner reissued a Public Health Order requiring all students, teachers, staff, and visitors in K-12 schools to wear masks indoors, regardless of vaccination status.The Order does allow for exemptions when students are exercising or using exercise equipment, but masks are still strongly encouraged. For additional information, see VDH Information on Mask Webpage

A person may play a wind or brass instrument without a mask, but distancing is recommended in these instances. At least six feet of distance is recommended during any activity when increased exhalation occurs such as when singing, shouting, or playing wind/brass instruments. Consider increasing distance even more (10 feet apart) during these activities if the room size allows for it. Covers may also be used on wind and brass instruments to reduce droplet spread while playing. Limit activities that require close contact between performers (e.g., lifting a dancer, scenes in a play that require very close contact between actors), especially when indoors.  

For additional information, see VDH Information on Mask Webpage and VDH Guidance for Performing Arts. Schools and families should be aware that extracurricular activities, especially indoor activities involving shouting or singing, increase the risk of SARS-CoV2 transmission. 

Yes.

On August 12, 2021, the State Health Commissioner reissued a Public Health Order requiring all students, teachers, staff, and visitors in K-12 schools to wear masks indoors, regardless of vaccination status. This Order reinforces current state law, which requires Virginia schools to adhere to mitigation strategies outlined by the Centers for Disease Control and Prevention. The order applies to all individuals aged two and older. 

• This is based on the observation that COVID-19 infection rates are rapidly increasing across the Commonwealth, the Delta variant is more contagious than previous strains of the virus and can be spread by even those that are vaccinated, and face masks have been scientifically proven to be effective, well-tolerated and safe. For additional information, see Interim Guidance for the 2021-2022 school year. Masks must be worn on school buses, per a federal order.
• For additional information, see VDH Information on Mask Webpage

 CDC Guidance clarifies that child care providers should remove masks “before sleeping, napping, [and] when they may fall asleep (such as in a car seat or stroller).” Sleeping children may be unable to remove their masks if their breathing is obstructed, and children should not wear masks during nap time. For additional information, see VDH Information on Mask Webpage

Camps may follow CDC Guidance for Operating Youth Camps. 

At overnight camps taking place at K-12 schools, camps should follow CDC guidance for overnight camps.   

On August 12, 2021, the State Health Commissioner reissued a Public Health Order requiring all students, teachers, staff, and visitors in K-12 schools to wear masks indoors, regardless of vaccination status. This order applies to all activities on the grounds of private and public schools grounds during instruction, extra curriculars, social gatherings, etc.

The state recommends that schools follow CDC guidance on best practices for preventing the spread of COVID-19. To help school divisions decide how to best serve their communities, VDH and the Department of Education (VDOE) have updated Interim Guidance for K-12 School Reopening. The VDOE also advises local school divisions to work with local health officials and school board counsel on appropriate health and safety practices.

The CDC does not currently recommend universal symptom screening for K-12 schools. Parents or caregivers are strongly encouraged to monitor their children for signs of infectious illness every day and keep them home when they are sick. Screening procedures are available for students and staff who arrive with or develop symptoms during the course of the day.  The VDH has developed guidance for parents and school staff When Should a Child Stay Home From School and/or Child Care?.

Please discuss any concern you may have with your local school division.

• Parents or caregivers are strongly encouraged to monitor their children for signs of infectious illness every day. Students who are sick should not attend school in-person.
• CDC does not currently recommend universal symptom screenings (screening all students grades K-12) be conducted by schools.
  For more information, the VDH has developed guidance for parents and school staff When Should a Child Stay Home From School and/or Child Care? 

If a student or employee experiences symptoms of COVID-19 while at school, move the individual out of the classroom or group setting, isolate in a predetermined location, and inform the school nurse or school health staff member. School health staff must wear personal protective equipment (PPE), including a N-95 or surgical mask, goggles and gloves before entering into the room to evaluate the individual. Call the parent or family member of the employee to pick up and take home the ill person. If symptoms persist or worsen, or if laboratory testing might be warranted, they should contact their healthcare provider. If COVID-19 is suspected or confirmed, the ill person must stay home and be isolated from others.   

If there is a confirmed case of COVID-19 in school, the local health department will work closely with school administrators to determine a course of action for their schools. Temporary school closures should only be necessary in the context of controlling spread associated with increased impact to school such as increased numbers of cases or outbreaks. The Virginia Department of Health (VDH) recommends that schools start by reviewing the Centers for Disease Control and Prevention (CDC) Guidance for COVID-19 Prevention in K-12 Schools. The CDC Guidance is best used together with Virginia’s Interim Guidance for COVID-19 Prevention in PreK-12 Schools and COVID-19 Resources provided by the U.S. Department of Education. The VDH will work closely with the school to make environmental cleaning recommendations, conduct contact tracing, and investigate any potential exposures. Please discuss any concern you may have with your local school division.

Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Parents of children who are medically fragile or have one or more chronic conditions should check with their healthcare provider about school attendance. In addition, employees that meet the criteria listed for ‘higher risk’ populations should check with their healthcare provider before returning to work. Schools should provide remote learning exceptions and teleworking options for students and staff who are at high risk of severe illness (as defined by the CDC). People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated. Please discuss any concern you may have with your local school division.

People who are not fully vaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted,  who have had close contact with someone with COVID-19 need to stay home and distanced from others (quarantine) for 5 days followed by strict mask use for an additional 5 days. If a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. 

Close contact means being within about 6 feet for a total of 15 minutes or more over a 24-hour period. In indoor K-12 settings, a student who is within 3-6 feet of an infected student is not considered a close contact as long as both students wore well-fitting masks the entire time. This exception may also be applied to school buses when the following criteria are met: 1.) Documented seating charts are used and 2.) Assurance that masks are worn and students remain in assigned seats, either via video monitoring if available, or attestation from the bus driver or monitor. This exception does not apply to teachers, staff, or other adults in indoor K-12 settings. The VDH document Clarification of VDH K-12 Close Contact Definitions and Quarantine Periods provides clarification on how close contacts are assessed in K-12 schools. These unvaccinated individuals who are close contacts of persons with COVID-19 should be tested 5 days after last exposure or immediately if symptoms develop during quarantine. They can leave quarantine after 5 days if no symptoms develop and continue to wear a mask for 5 days.

The CDC provides guidance for people exposed to people with known or suspected COVID-19. VDH has developed guidance and algorithms to help guide schools: VDH Algorithm for Evaluating Non-Healthcare Workers with COVID-19 Symptoms or Exposures and  When Should a Child Stay Home From School and/or Child Care? Please discuss any concern you may have with your local school division.

If you are able and willing to get tested, getting tested on Day 5 of isolation or quarantine is preferred. Getting tested soon after Day 5 is also acceptable. CDC and VDH do not recommend requiring a negative COVID-19 test in order for unvaccinated students or staff to return to school. Unvaccinated individuals with suspected or confirmed COVID-19 should stay home and physically distance from others for at least 5 days followed by strict mask use for an additional 5 days. If you have a fever, continue to stay home until your fever resolves without the use of fever-reducing medicine and other symptoms have improved. More information is available in the CDC criteria for return to school  and the VDH guide for release from isolation or quarantine.  

Those who have tested positive using a viral test in the past 90 days do not need to quarantine or get tested after exposure as long as they have recovered from their previous illness and have no new symptoms. They should wear a mask when around others for 10 days after exposure. 

 An individual diagnosed with COVID-19 should not return to work or school until they meet all criteria to end isolation using currently available CDC guidance:

Individuals can end isolation after Day 5 if their symptoms are resolving but need to take precautions until day 10; however, if they have a fever, they need to continue to isolate until 24 hours after fever resolves.

VDH has developed algorithms to help guide schools When Should a Child Stay Home From School and/or Child Care?

Contact Tracing for COVID-19 in K-12 Schools: How to Prepare and What to Expect Infographic: VDH staff might need information about who was in different areas within the school or child care setting at a given time or contact information for children or staff associated with the facility and considered potentially exposed to a person with COVID-19. Staff of the school or child care facility will play an important role in supporting health department efforts to obtain this information. Similar collaboration occurs routinely for case and contact investigations of other communicable diseases and would be expected to continue seamlessly for COVID-19 investigations. The VDH document Clarification of VDH K-12 Close Contact Definitions and Quarantine Periods provides clarification on how close contacts are assessed in K-12 schools.  The CDC has developed a toolkit to help schools respond to COVID cases. 

During the COVID-19 pandemic, asthma treatments using inhalers with spacers (with or without a face mask, according to each student’s individualized treatment plan) are preferred over nebulizer treatments whenever possible in the school setting. The use of asthma inhalers (with or without spacers or face masks) is not considered an aerosol-generating procedure.

CDC recommends that nebulizers in school should be reserved for instances where children cannot use inhalers, do not have access to an inhaler or for children who are in significant respiratory distress while awaiting emergency transport. 

Because they are considered aerosol-generating procedures, suctioning and nebulizer treatments should be performed in a space that limits exposure to others and with minimal staff present, limited to the student and staff member performing the treatment. The staff member should put on proper personal protective equipment (N95 mask, goggles or face shield, gloves and gown). Rooms should be well ventilated or the treatment should be performed outside. After the student receives treatment, the room should undergo routine cleaning and disinfection. Routine cleaning and disinfecting of the room is adequate and the room does not need to be vacated for any period of  time. A list of EPA-approved disinfectants can be found here: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Reducing the risk of exposure to COVID-19 by cleaning and disinfection is an important part of  school operations. The CDC has developed reopening guidance for cleaning and disinfecting schools, Cleaning and disinfection, and an infographic on cleaning your facility when someone has been diagnosed with COVID-19.

Being a “close contact” means being within 6 feet of a person who has COVID-19 for a total of 15 minutes or more over a 24-hour period, or having direct exposure to respiratory secretions (e.g., being coughed or sneezed on, sharing a drinking glass or utensils, kissing), or caring for a person who has COVID-19, or living with a person who has COVID-19. Exception: In indoor and outdoor K-12 settings, a student who was within 3 to 6 feet of an infected student is not considered a close contact as long as both students wore well-fitting masks the entire time. This exception may also be applied to school buses when the following criteria are met: 1.) Documented seating charts and 2.) Assurance that masks are worn and students remain in assigned seats, either via video monitoring if available, or attestation from the bus driver or monitor..  Students who were less than 3 feet apart for a total of 15 minutes or more are considered close contacts, even if both students wore masks. The K-12 exception does not apply to teachers, staff, or other adults. This means that the standard close contact definition is applied when assessing exposure in a K-12 setting that involves a student with an infected adult or an exposed adult. The VDH document Clarification of VDH K-12 Close Contact Definitions and Quarantine Periods provides clarification on how close contacts are assessed in K-12 schools.  The CDC has developed a toolkit to help schools respond to COVID cases. 

This information helps school administrations and Local Health Departments make decisions based on the level of COVID-19 transmission rates in the community as well as the school's ability to implement prevention strategies. 

School administration and the local health department will work together to discuss the potential impact on in-person learning in the school setting. Schools may need to make necessary changes to their individual school division educational plan depending on the community’s level of transmission and the ability of a school to implement preventative measures.