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Over the past month, students across the Valley have returned to school for the first time since the federal COVID-19 public health emergency declaration ended on May 11.

COVID-19 has largely been absorbed into school districts' general guidance for respiratory illness for students and staff. Here's what to know.

What is the current state of COVID-19 in Maricopa County?

The U.S. Centers for Disease Control and Prevention is using weekly hospital admissions and deaths due to COVID-19 as the primary indicators of transmission. In Maricopa County, there has recently been a slight uptick in the number of COVID-19 hospital admissions, which is in line with the national trend, said Nick Staab, a medical epidemiologist at the Maricopa County Department of Public Health.

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According to the most recent CDC tracking data, hospital admissions in Maricopa County for the week of July 30 through Aug. 5 were up 19.3 percent from the prior week. Nationally, the change in COVID-19 hospital admissions for that same time period was 14.3 percent.

Despite the upward trend, the level of COVID-19 hospital admissions in the county is classified as low by the CDC, meaning there are fewer than 10 admissions per 100,000 people.

There were 105 COVID-19 hospital admissions in Maricopa County total that week, according to CDC data.

The Maricopa County Department of Public Health is also seeing a slight increase in the number of cases being reported, which is likely due to the new, fast-spreading strain of COVID-19, EG.5, nicknamed "Eris," Staab said. The department hasn't seen an increase in deaths reported, he said.

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What do public health officials advise for schools?

Rather than having specific COVID-19 policies, the Maricopa County Department of Public Health recommends schools return to a more general approach when addressing illness.

"Our messaging really transitioned at the end of the public health emergency," Staab said. "What we're trying to message is a transition from COVID-19-specific guidance to what the CDC is calling a pan-respiratory response."

Fewer people are going to treat their symptoms as "possibly COVID-19 and more just like anything else," he said. "We want people to have an appropriate response to any time they're sick."

Schools, then, should have guidance that includes all respiratory viruses that are transmitted during the fall and winter seasons, like the flu and RSV, as well as COVID-19, Staab said. They should return to standard guidance for respiratory illness, which is that to return to school, a child's symptoms should be improving, and they should be fever-free for 24 hours without the use of fever-reducing medications, Staab said.

Students and staff should self-monitor for symptoms and stay home from school if they are sick, he said.

Last year's influenza and RSV seasons occurred earlier than usual and were significantly higher than usual, he said, which should be a warning that "respiratory illness can be transmitted at very high rates and is something that we need to be aware of ... because individuals who are at high risk can become severely ill and can die from any of these infections."

"So, we need to take it seriously," he said.

The CDC recommends that additional COVID-19-specific strategies in schools be tied to hospital admission levels. "Currently, our level is low," Staab said. "But should that level rise into either a medium or high level, then we encourage schools to have what we call a layered approach," which could include recommendations for wearing masks and social distancing.

At all COVID-19 hospital admission levels, the CDC recommends that schools optimize ventilation, reinforce proper handwashing, clean surfaces at least once a day and promote equitable access to vaccination.

The CDC also recommends students stay up to date with COVID-19 vaccinations and stay home when they have symptoms of respiratory or gastrointestinal infections like a cough, fever, sore throat, vomiting or diarrhea.

For specific cases and immunocompromised children and adults, "I always recommend that they talk with their primary care doctor or their specialist who takes care of them," Staab said, as well as the school health staff so they can be aware of the risks and communicate if they're starting to see transmission of something that might be of concern to the family.

The CDC recommends that individuals who test positive for COVID-19 isolate for five days from the onset of symptoms or a positive test and wear a mask until day 11.

But when it comes to COVID-19-specific isolation, schools land in a gray area, Staab said. "Their policies may include the COVID-specific isolation, but they may have a student or staff member who just has respiratory symptoms that aren't clearly COVID-19 because they haven't tested positive for that," Staab said. And it's not CDC or Maricopa County guidance that students or staff must be tested if they are sick, he said.

"So then, because a lot of schools don't require testing in order to return to school, a lot of those students may be treated as just respiratory illness" and fall under the standard guidance of returning to school after being fever-free for 24 hours and having improved symptoms.

What policies do Maricopa County schools have in place?

Arizona school districts have largely absorbed COVID-19 into their general sick policies.

In Mesa Public Schools, the state's largest district, COVID-19 falls under the district's general sick policy, according to spokesperson Jennifer Snyder. Students are asked to stay home if they have a fever above 99.9 and must be fever-free without medication for 24 hours before they return, with other symptoms improved. The district continues to encourage hand washing and sneezing etiquette, Snyder said.

Washington Elementary School District, the largest elementary school district in the Phoenix area, has the same policy regarding when children should return to school and follows CDC guidance regarding cleaning, handwashing, ventilation and encouraging vaccines, according to spokesperson Pam Horton. Kyrene Elementary School District in Tempe is not actively tracking COVID-19 cases, according to spokesperson Erin Helm, though the district continues to watch the CDC's COVID data tracker for nationwide trends. If staff or families self-report a case, the district refers them to the county and CDC's COVID-19 guidance, Helm said.

According to Staab, most schools stopped doing COVID-19 testing on site. The CDC no longer recommends routine screening testing in K-12 schools.

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Have there been any COVID-19 outbreaks in Maricopa County so far this school year?

Maricopa County defines an outbreak as three or more confirmed COVID-19 cases in a 14-day period that are linked in the school and are not linked in another setting.

So far, two COVID-19 outbreaks have been reported to the county since July 24, both by elementary schools, according to Staab. But this is likely not reflective of the number of cases in schools because many schools are not asking for COVID-19 tests for sick kids to return to school. And while the department still encourages schools to report outbreaks of illness so its outbreak response team can provide guidance, the guidelines for reporting are "no different than what they were asked to do before COVID," he said. Generally, he finds that schools reach out when they need extra support.

"A lot of these schools learned a lot during COVID-19," Staab said. "And if they feel like they don't need public health guidance, then I think those are the schools that may not be reaching out to us."

Still, he said, "we are certainly seeing respiratory illness being transmitted in the community right now ... and I think a lot of this is being driven by kids going back to school."

"We will see an increased number of cases across the community," he said. "But ... what we're seeing right now in our numbers doesn't require that schools be doing anything extraordinary."

When should students get their flu and COVID-19 booster vaccines?

In Maricopa County, approximately 5% of individuals between the ages of 5 and 19 are up to date on COVID-19 vaccination, meaning they've received the CDC-recommended bivalent COVID-19 booster that protects against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5.

New COVID-19 boosters are expected in late September.

The Maricopa County Department of Public Health is encouraging residents to plan to get the new COVID-19 booster, as well as the flu vaccine and, if eligible, the RSV vaccine, ideally in late September or early October, which is when there's typically an increase in transmission for those infections.

Staab recommends that students get all their recommended vaccines at the same time. "It's safe," he said. "You're much more likely to get all the vaccines that you're recommended to get if you just get them at one time."

Residents can find locations offering COVID-19 and flu vaccines near them at vaccines.gov. The Maricopa County Department of Public Health's calendar of free vaccine events can be found at maricopa.gov/5659/Vaccine-Locations#calendar. Residents can also call the department's CARES team to find an event located near them at 602-506-6767.

The department is working with schools to plan school-based immunization clinics for CDC-recommended vaccines in the fall, according to Staab.

This article originally appeared on Arizona Republic: Here's how Phoenix-area schools are handling COVID-19 this year