Case Management Guide

Introduction

The purpose of this document is to provide the campus with a general overview of the University’s Case Management process for COVID-19, so that our community can anticipate the general steps/actions of a case that they may be involved with. Please note that this document does not cover every detail or step of the process, which, at times, may be altered for the entire campus or on a case-by-case basis, following best practices or to better address unique variables of each case.

The University community is also encouraged to review two other documents that are essential to mitigating the risks connected the COVID-19 pandemic:

Stay up-to-date with University cases via our dashboard.

If you are experiencing symptoms or have been exposed to COVID-19 please report this to the University's Case Management team:

Before 3pm EST: Please report in Campus Clear
After 3pm EST: Please report by
- Contacting Case Management
  - Call/Text: 269-815-8892
  - Email: covid19@andrews.edu
- Reporting in Campus Clear the following day, before 3pm EST.

The Case Management Guide has the following sections

Overview
Symptom/Exposure Monitoring
Symptom/Exposure Assessment
Potential Case Review
Case Type Specific

Overview

The University’s Case Management process involves the following:

Campus wide monitoring of symptoms and exposures
Assessment of symptoms/exposures for potential cases
Review of potential cases - which will then be assigned as an open case status or closed
Open cases are then managed through the appropriate individual processes: Pending, Quarantine, Probable, or Isolation.

It should be noted that individuals may be ill for reasons unrelated to COVID-19. At minimum, individuals with a non-COVID-19 related sickness should also remain home until they have been without symptoms for 24 hours.

Communication
Individual case communication will be conducted via phone or email. The campus is encouraged to save this contact information for the COVID-19 Case Management Team to be able to identify, share and quickly respond to any case related information.

Email: covid19@andrews.edu
Phone: 269-815-8892 (call or text)

If the Case Management Team is unable to reach an individual in a timely manner, they may then reach out to the individual’s academic advisor/chair, Student Life dean, or supervisor (as applicable) to help facilitate a timely response and intervention. While some cases may require same-day contact of the individual, other case-related communication should occur within the first 48 hours. To assist with contact trace efforts with a potential COVID-19 case, the Case Management team may also make contact with event organizers, faculty, Student Life deans, and/or supervisors to identify potential close contacts.

Faculty will be alerted to a student’s ability to attend in-person classes via the faculty’s class roster in iVUE, where each student will be listed daily as cleared or not cleared to attend in-person classes. This updated status will be based on both the student’s participation in the semester’s screening requirements as well as the student’s status in a COVID-19 related case (such as being in isolation or quarantine). Students who are out of class for being sick with a non-COVID-19 illness should communicate directly with their faculty.

Faculty/Supervisor Communication: If an individual is directed to not attend class/work through Campus Clear, it is the individual’s responsibility to take a screenshot of their Campus Clear directions and send the screenshot to his/her faculty/supervisor.

Symptom/Exposure Monitoring

Campus-wide monitoring of symptom/exposure can occur through any of the following methods:

Campus Clear
COVID-19 email or phone
On-campus testing
Third-party reports

The primary method for monitoring and mitigating risk is the campus wide use of Campus Clear. Students and employees who are either on-campus or remote while living in the local Michiana area are expected to report any symptoms or exposures using Campus Clear.

Reports of symptoms or exposures should be made prior to accessing the campus, and ideally prior to the Campus Clear data being collected, which occurs daily at 3:00 pm.

Depending on the symptoms/exposures reported in Campus Clear, the user will receive different directions:

Level	Attend Class/Work	Access Dining Services	Monitor Symptoms	Contact Case Management	Pursue Testing	Isolate Immediately
1	Yes	Yes	No	No	No	No
2	Yes	Yes	Yes	No	No	No
3	No	Yes	Yes	No	No	No
4	No	No	Yes	Yes	Yes	No
5	No	No	Yes	Yes	Yes	Yes

Symptom/Exposure Assessment

Through the assessment of symptoms/exposures, reports are identified as a Potential Case based on the following criteria:

Reported exposure (close contact)
- Individuals who are fully vaccinated at the time of exposure/close contact should report the exposure.
Severity/type of symptom(s)
- Individuals who are experiencing vaccine-related symptoms within 72 hours of receiving a vaccination dose are not required to report those symptoms.
Quantity of symptoms
Frequency of symptom(s)

Reports that are not identified as a Potential Case are then closed for that day (NOTE: the criteria for frequency of symptoms does include prior closed reports).

For individuals who have previously tested positive (and who have completed isolation) within the last 90 days may test positive a second time when participating in asymptomatic/precautionary COVID-19 testing (either as part of the University’s requirements or requirements from other organizations). These individuals with a second positive result will be assessed differently than those who are testing positive for the first time. The assessment for repeat positive tests will be based on two factors: first, the elapsed time since the previous positive test result (specifically, whether the elapsed time is under/over 90 days) and second, both the presence and explanation of any symptoms.

For individuals who test positive within 90 days and are asymptomatic:
- No further action would be initially required by the University.
- The results and known history will be reported to the Berrien County Health Department for any additional guidance/direction.
For individuals who test positive within 90 days and are symptomatic:
- Those individuals will initially be asked to stay home “sick”, just as if they were sick or ill for any cause (regardless of COVID-19).
- The duration of “staying home sick” for that individual would then depend on any additional factors (additional testing, potential cause/explanation of symptoms, and medical/Health Dept. input).
- The minimum duration would be 24hrs at home or residence without symptoms (the same protocol for any illness).
Individuals who test positive outside of 90 days will follow standard isolation protocols, pending further input from the Berrien County Health Department.

Potential Case Review

The Case Manager will contact the individuals who are Potential Cases and determine whether the case should be closed or remain open.

Cases may be closed due to: accidental symptom selection, known non-illness related cause (e.g. fatigue due to staying up all night studying for an exam), or by not meeting close contact definition.

Open cases will be classified by the Case Manager as: Pending, Quarantine, Probable, or Isolation. Changes to a case status can only be determined by either a University Case Manager or the Health Department. If changes are communicated to the individual by the Health Department and prior to Case Manager contact, the individual should report those changes to the Case Management Team via email or call/text.

Communication with faculty/supervisors regarding their student/employee and Potential Case is dependent on the case type. Faculty/Supervisors should also contact the Case Management team if they:

Faculty
- Have a student out of class for more than two days due to illness and
- Do not see a change in their iVUE class roster status (cleared/not-cleared)
Supervisors
- Have an employee out of work for more than two days due to illness with symptoms associated with COVID-19.

Pending

Pending Cases are divided into two sub-categories:

Continued Monitoring — individuals should:
- Remain at home.
- Work with Case Managers to determine if symptoms escalate; persist, worsen, increase (number of symptoms), or if the symptoms are no longer explained. If symptoms do escalate, individuals would be referred for testing.
Referred for Testing — individuals should:
- Remain at home.
- Pursue COVID-19 diagnostic testing (such as a PCR or rapid)

Pending Cases are then completed by being:

Closed by the Case Manager as unrelated illness due to:
- Symptoms remain explained and/or did not escalate.
- Negative COVID-19 test result.
- NOTE: Individuals must be symptom-free for 24hours before returning to regular campus access.
Changed to Isolation by the Case Manager (due to positive COVID-19 test result)

Pending Case Communication:

Individuals should provide screenshots of their Campus Clear results to relevant faculty/supervisors.
Students work with Faculty on academic requirements during the quarantine period.
Employees must notify their supervisor that they are unable to work in-person.

Quarantine

Quarantine cases are for individuals that have been in confirmed close contact with a COVID-19 Probable or Positive person. (NOTE: This determination is made either by a Case Manager or the Health Department). Following CDC guidance and risk assessment, the University responds to quarantine cases as follows.

The CDC's definition of Close Contact* includes:

Being within 6 feet of the individual for a cumulative total of 15 minutes over a 24 hour period
Having direct physical contact (hug/kiss) with the individual
Sharing eating utensils
NOTE: The use of face masks is not a factor for determining close contact (aside from an N-95).

If you believe you have been in close contact with a COVID-19 positive person, please report this to the University's Case Management team:

Before 3pm EST: Please report in Campus Clear
After 3pm EST: Please report by
- Contacting Case Management
  - Call/Text: 269-815-8892
  - Email: covid19@andrews.edu
- Reporting in Campus Clear the following day, before 3pm EST.

Considerations for individuals who are vaccianted

Close contact individuals who are at least fully vaccinated and asymptomatic may have different expectations than quarantine, based on assessment of several factors. Individuals who are partially vaccinated will need to quarantine. Individuals who are vaccinated (regardless of level) and symptomatic will be considered COVID-19 Probable.

Doses Up-to-Date*	Exposure Risk**	Action
Yes	Low-High	Vaccinated Close Contact
No	Low-Medium	Vaccinated Close Contact
No	High	Quarantine

*Vaccination doses are considered up-to-date based on CDC guidelines by manufacturer and the person's age.
**A person's exposure risk assesses the type of interaction with the positive person and the level of mitigation present. A low exposure could include a classroom setting where everyone is masked. A high exposure could include a residential setting, where the indiviudals share the same sleeping quarters and masks are not expected to be worn.

Vaccinated Close Contacts:

Individuals who were fully vaccinated at the time of close contact will not need to quarantine, but will be required to follow CDC Guidelines:
Day 0: Close Contact with COVID-19 Positive/Probable person
Day 0-10: Take precautions
- Monitor symptoms, including mild symptoms.
  - Individuals symptomatic will be considered COVID-19 probable and should stay away from others and report symptoms to the University's Case Management Team:
    - Before 3pm EST: Please report in Campus Clear
    - After 3pm EST: Please report by
      - Contacting Case Management
        
        Call/Text: 269-815-8892
        
        Email: covid19@andrews.edu
      - Reporting in Campus Clear the following day, before 3pm EST.
- Wear a mask when around others
- Avoid travel
- Avoid being around people who are at high risk
Day 5 (or later): Complete a COVID-19 diagnostic (PCR/rapid) test
- Individuals who test positive should report it to the Univeristy's Case Management team and will be directed to isolate.
Day 10: Last day of precautions

Considerations for individuals who were previously positive:

Individuals who tested positive more than 90 days before their close contact, and who are not vaccinated will be asked to quarantine. Individuals who had tested positive within 90 days of the close contact will not need to quarantine if they meet the following criteria:

They have recovered (no longer in isolation) and
Remain without COVID-19 symptoms

They will however be asked to follow CDC Guidelines:

Day 0: Close Contact with COVID-19 Positive/Probable person
Day 0-10: Take precautions
- Monitor symptoms, including mild symptoms.
  - Individuals symptomatic will be considered COVID-19 probable and should stay away from others.
  - Symptoms should be reported the University's Case Management team.
    - Before 3pm EST: Please report in Campus Clear
    - After 3pm EST: Please report by
      - Contacting Case Management
        
        Call/Text: 269-815-8892
        
        Email: covid19@andrews.edu
      - Reporting in Campus Clear the following day, before 3pm EST.
- Wear a mask when around others
- Avoid travel
- Avoid being around people who are at high risk
Day 10: Last day of precautions
Please note that testing is not expected, as individuals who were previously positive can test positive up to 90-days after their initial positive test.

Contagious Period: The close contact would have had to occur within the contagious time period of the positive individual. The positive individual's contagious time period starts 48hrs prior to either symptom onset or testing positive, whichever occurred first. Their contagious time period would end 5 days after the symptom onset or positive test (whichever occurs first) and could be lengthened if fever symptoms continue past the 5 days.

Close Contact and Indirect Contact: Individuals who have had close contact would need to quarantine. Those with indirect contact would not. Please see diagram below:

Individuals can be identified as a close contact either by self-reporting or through Contact Trace methods that may include:

Interviewing the positive individual.
Review of classroom seating charts and attendance records.
Review of other available information.

Individuals in quarantine are not allowed to physically access the campus for classes, work, or other in-person activities (on-campus residences excluded). Residence Hall students are allowed to access the Campus Center for to-go meals only, where they remain masked/distanced to access the Cafe, and consume their meal in quarantine room.

Depending on the type of exposure, Residence Hall students with roommates may be asked to temporarily relocate to a single occupancy room to complete their quarantine. This type of exposure may include close contact while eating or not wearing masks and space availability.

Quarantine Timeline:

Day 0: Close Contact with COVID-19 Positive/Probable person - Begin Quarantine
Day 5: First day eligible to be tested/retested for COVID-19 and potential last day in quarantine.
- Testing to leave quarantine must occur on Day-5 or later and must be a diagnositc test (such as PCR or rapid). Antibody tests are not accepted for this type of testing per CDC guidelines.
Day 6: First day elibible to be out of quarantine IF negative test results and asymptomatic.
- Take precautions through Day-10
  - Must continue to wear mask anytime around others, including the public or inside your residence.
  - Avoid travel
  - Avoid being around people who are at high risk
Day 10:
- Without testing & asymptomatic, last day of quarantine
- Last day of precautions

Quarantine Cases are completed by the Case Manager when either:

Individual meets Quarantine Timeline or
Case changed to Probable (symptomatic) or Isolation (positive test result)

Quarantine Case Communication:

Case Managers will notify Faculty through iVUE Class Roster that the student is not cleared for in-person classes (as well as when they are cleared).
Students work with Faculty on academic requirements during the quarantine period.
Employees must notify their supervisor that they are unable to work in-person.

Probable Cases

Probable Cases are for individuals who are either:

Quarantined and symptomatic and/or
Exhibiting specific COVID-19 symptoms (flu-like symptoms in addition to loss of taste/smell or headaches).

Individuals who may be COVID-19 probable should contact the University's Case Management team.

Before 3pm EST: Please report in Campus Clear
After 3pm EST: Please report by
- Contacting Case Management
  - Call/Text: 269-815-8892
  - Email: covid19@andrews.edu
- Reporting in Campus Clear the following day, before 3pm EST.

Probable individuals are directed to be tested for COVID-19 and are not allowed to physically access the campus for classes, work, or other in-person activities until a negative test result is received. Residence Hall students may be relocated to a single room occupancy and/or the campus isolation residence depending on the case details.

Probable Cases are considered complete by the Case Manager when they are:

Changed back to Quarantine Case due to negative results.
Closed due to negative test result and no current quarantine requirements
- NOTE: Individuals must be symptom-free for 24 hours before returning to regular campus access.
Changed to Isolation Case due to positive results.

Probable Case communication:

As a probable case is either based on a pending or quarantine case, there are no additional communication steps beyond the steps described above for those two categories.

Isolation

Isolation cases are for individuals who have tested positive for COVID-19. Following CDC guidance, the University responds to isolation cases as follows.

Individuals who have tested positive for COVID-19 should contact the University's Case Management team.

Before 3pm EST: Please report in Campus Clear
After 3pm EST: Please report by
- Contacting Case Management
  - Call/Text: 269-815-8892
  - Email: covid19@andrews.edu
- Reporting in Campus Clear the following day, before 3pm EST.

Isolated individuals are not allowed to physically access the campus for classes, work, or other in-person activities. Residence Hall students will be relocated to an isolation residence.

Isolation Timeline:

2 Days Prior: Contagious period starts
Day 0: Symptom Onset or Tested Positive, whichever occurred first
- Note: Testing positive refers to the specific day the sample was collected, not when results were received).
Day 5: Potential last day of Isolation (as long as no fever in the past 24 hours and symptoms improving).
- Isolation may be extended due to presence of certain symptoms.
Day 6-10: Take precautions
- Must continue to wear mask anytime around others, including the public or inside your residence.
- Avoid travel
- Avoid being around people who are at high risk
Day 10: Last day of precautions

Isolation cases are completed by the Case Manager when the isolation timeline has been completed.

The timeline of isolation refers to the potential contagious period of the individual. A COVID-19 positive person can continue to experience long-term symptoms and may not be fully recovered after isolation has ended.

Individuals may also continue to test positive for up to 90 days after their initial positive. Due to this, Andrews University does not require a negative test result to end isolation.

Isolation Case Communication:

Case Managers will notify Faculty through iVUE Class Roster that the student is not cleared for in-person classes (and then again when they are cleared for in-person classes).
Students are to work with Faculty on academic requirements during the isolation period.
Employees must notify their supervisor that they are unable to work in-person.