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Respiratory illness guidance for specific settings

Guidance for providers and administrators of healthcare, residential congregate settings, schools and childcare in San Francisco.

Department of Public Health

Acute Care Hospitals (ACHs)

Outbreak definitions for respiratory illness:

  • COVID-19: ≥ 2 cases of probable or confirmed COVID-19 among patients 4 or more days after admission for a non-COVID condition, with epidemiologic linkage OR  ≥2 cases of suspect, probable or confirmed COVID-19 among HCP AND ≥1 case of probable or confirmed COVID-19 among patients 4 or more days after admission for a non-COVID condition, with epidemiologic linkage (source: CORHA COVID-19 definition)
  • Influenza: ≥2 lab confirmed cases in patients with symptom onset ≥ 72 hours after admission, with epidemiologic linkage (source: CORHA influenza definition)
  • Non-COVID-19, non-influenza, respiratory illness: ≥1 case of a laboratory-confirmed respiratory pathogen, other than influenza or COVID-19, in the setting of a cluster (≥2 cases) of acute respiratory illness (ARI)* with symptom onset ≥ 72 hours after admission

Skilled Nursing Facilities (SNFs)

Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2025-26

Outbreak definitions for respiratory illness:

  • COVID-19: ≥2 cases of probable or confirmed COVID-19 within a 7-day period among residents, with epidemiologic linkage OR  ≥2 cases of suspect, probable or confirmed COVID-19 within a 7-day period among HCP and ≥1 case of probable or confirmed COVID-19 among residents, with epidemiologic linkage
  • Influenza: ≥2 lab confirmed cases identified within a 72-hour period in residents, with epidemiologic linkage
  • Non-COVID-19, non-influenza, respiratory illness: ≥1 case of a laboratory-confirmed respiratory pathogen, other than influenza or COVID-19, in the setting of a cluster (≥2 cases) of acute respiratory illness (ARI)* within a 72-hour period

Non-healthcare settings

CDPH general population guidance for respiratory viruses

Long-term congregate settings (e.g. RCFE, RCF, ARF)

Outbreak definitions for respiratory illness:

  • COVID-19: ≥1 case of probable or confirmed COVID-19 in residents in the setting of a cluster (≥3 cases) of acute respiratory illness (ARI)* within a 7-day period
  • Non-COVID respiratory illness: ≥1 case of a laboratory-confirmed respiratory pathogen, other than COVID-19, in residents in the setting of a cluster (≥3 cases) of acute respiratory illness (ARI)* within a 72-hour period

Schools, childcare, and youth programs

Report cases of acute respiratory illness among students if:

  • At least 10% of the average daily attendance of students are absent and/or reporting symptoms of acute respiratory illness (ARI)* within a 7-day period (minimum of 3 cases)
  • OR if there are a greater number of expected cases than usual for a given time of year
  • OR if there is increased severity of illness, such as hospitalizations or fatalities among cases

CDPH Guidance for Sc​​​hool & Child Ca​re Communicable Disease Mitigation​ ​​​​

* Acute respiratory illness (ARI) is defined as new onset of any two or more of the following symptoms (not better explained by chronic conditions, e.g., seasonal allergies): fever or chills, cough, sore throat, runny or stuffy nose, difficulty breathing, body aches; AND/OR has tested positive for a specific respiratory pathogen, including COVID-19, influenza, or RSV

For reporting, questions, and/or clarifications, contact the Communicable Disease Program by phone at (628) 217-6100. We are here to help!

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