As your partner in health and safety, we are continuously monitoring regulatory updates that may affect your operations. See the CDC's latest COVID-19 updates and resources below.
Guidelines for Collecting, Handling and Testing Clinical Specimens
CDC provided updates to their testing processes from persons for COVID-19 in specimen type and priority. For initial diagnostic testing for SARS-CoV-2, CDC recommends collecting and testing an upper respiratory specimen. The following are acceptable specimens:
- A nasopharyngeal (NP) specimen collected by a healthcare provider; or
- An oropharyngeal (OP) specimen collected by a healthcare provider; or
- A nasal mid-turbinate swab collected by a healthcare provider or by a supervised onsite self-collection (using a flocked tapered swab); or
- An anterior nares (nasal swab) specimen collected by a healthcare provider or by home or supervised onsite self-collection (using a flocked or spun polyester swab); or
- Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by a healthcare provider.
Swabs should be placed immediately into a sterile transport tube containing 2-3mL of either viral transport medium (VTM), Amies transport medium, or sterile saline, unless using a test designed to analyze a specimen directly, (i.e., without placement in VTM), such as some point-of-care tests. If VTM is not available, see the standard operating procedure for public health labs to create viral transport medium in accordance with CDC’s protocol.
The NW specimen and the non-bacteriostatic saline used to collect the specimen should be placed immediately into a sterile transport tube.
Testing lower respiratory tract specimens is also an option. For patients who develop a productive cough, sputum should be collected and tested for SARS-CoV-2. The induction of sputum is not recommended.
Recommendations for Tribal Ceremonies & Gatherings
CDC recognizes the cultural importance of ceremonies such as sweat lodge, social gatherings and seasonal ceremonies, birthday parties and larger gatherings such as pow wows and rodeos and offers these considerations regarding levels of risk:
- Lowest risk: Tribal ceremonies or gatherings are conducted virtually (e.g., by communicating online, or by video conferencing or telephone), if traditions allow.
- More risk: Small in-person ceremonies or gatherings are held. Gatherings take place outside or in larger structures with good air flow. No food is served at ceremonies or gatherings. Tribal members remain at least 6 feet (or about 2 arms’ lengths) away from others, wear cloth face coverings, and do not share or touch the same items.
- Higher risk: Medium-sized in-person ceremonies or gatherings are adapted to allow tribal members to remain at least 6 feet apart. Tribal members are encouraged to wear cloth face coverings. Food is served in pre-packaged boxes with disposable utensils.
- Highest risk: Large in-person ceremonies or gatherings are held where it is difficult for tribal members to remain at least 6 feet apart because of increased number of participants based on the venue size. Tribal members share or touch the same items. Food is served “potluck” or family style. Tribal members attending the ceremony or gathering come from multiple tribal communities or from outside the local geographic area.
Tribal leaders and elders might consider:
- Postponing, rescheduling, canceling or going virtual
- Limit the size of ceremonies
- Hold events in a large, well ventilated area or outdoors
- Encourage social distancing with ample seating and physical guides such as tape to mark floors
- Encourage face coverings
- Promote hand hygiene
- Increase cleaning and disinfection
- Consider not serving food or changing how food is served
Guidelines for Non-US Healthcare and Outpatient Facilities
CDC in collaboration with WHO has outlined strategies for implementation of infection prevention control in preparation for a worldwide second wave of infections. The outpatient clinic document is focused to:
- Minimize disease transmission to patients and health workers (HWs),
- Identify persons with signs and symptoms of suspected COVID-19 for rapid isolation and triage, and
- Maintain essential health services.
The hospital and healthcare facility document is focused on these areas:
- Triage of patients upon initial encounter at a healthcare facility
- Limiting the entry of healthcare workers and visitors with suspected COVID-19
- Identification and isolation of inpatients with suspected COVID-19
Seroprevalence Survey Infographic Released
CDC released infographic for the general public explaining antibody testing also known as serology.
FAQs For People Who Use Drugs or Have Substance Use Disorder and Clinicians
Severe illness from COVID-19 for people who use drugs or have substance use disorder is not known, people who use drugs may have underlying medical conditions that put them at increased risk for severe illness. CDC provided an FAQs including guidance for relapse and use resistance support, harm reduction strategies, naloxone, telemedicine.
Tracking of Multi-System Inflammatory Syndrome in US Children
CDC updated hospital reported cases meeting these criteria: Hospitalized patients, 21 years old, fever >24 hours, Laboratory evidence of inflammation, >2 organs involved, evidence of SARS-CoV-2 or exposure in the prior month. Epidemiology of MIS-C Hospital-reported MIS-C Cases by State:
- 16 states reported 1-6 cases
- 4 states reported 7-14 cases
- 1 state reported 15-21 cases
- 4 states reported 22-29 cases
Funeral Home Workers
CDC updated guidance on funeral home workers and handling the body of a person who has died of COVID-19. A funeral or visitation service can be held. The funeral home workers should follow their routine infection prevention and control precautions when handling a decedent including standard precautions during embalming and PPE (disposable gown, face shield or goggles, N95 respirator, heavy duty gloves over nitrile disposable gloves). Use EPA approved products for disinfection.
Guidance for Lab Safety Practices
CDC updated guidance is to address the general workflow safety concerns of laboratory personnel. In addition to the usual COVID-19 precautions of social distancing, hand hygiene, cleaning and disinfection, and face coverings, labs are to perform risk assessments that take the following into account:
- Analyze the number of people that the laboratory space can realistically and safely accommodate while maintaining social distancing.
- Assess the flow of personnel traffic. Where possible, design one-way paths for staff to walk through the laboratory space.
- Assess procedures for cleaning and sanitizing commonly shared equipment and areas—for example, counters, bench tops, and desks—to ensure clean surfaces and equipment for all users.
- Review emergency communication and operational plans, including how to protect staff at higher risk for severe illness from COVID-19.
Considerations for Animal Activities at Fairs, Shows, and Other Events
CDC issued updates to clarify precautions for susceptible animals and add details for livestock show precautions. Regarding susceptible animals, implement additional precautions to maintain at least 6 feet separation between any species shown to be susceptible to SARS-CoV-2, including cats and other felids; dogs; small mammals such as mink, ferrets, and rabbits; and other animal shown to be susceptible to this virus.
- Prohibit susceptible animals from fairgrounds if they are not involved in fair or show activities.
- Prevent direct contact and institute policies to ensure at least 6 feet separation is maintained between these susceptible animals and other animals and between these animals and people. The number of exhibitors and animals that can safely fit in a show ring or exhibit area may limit the number of animals that can be shown at one time.
Regarding Livestock and Horse Shows Work to Maintain Social Distancing Through the Following Steps:
- Split classes to limit the number of animals in the show ring.
- Cattle, horse, sheep, and goat shows naturally lend to social distancing when on the walk; adapt spacing to maintain distance between participants.
- Limit the number of people and/or animals in a ring to ensure that at least 6 feet is kept between an animal and its handler and other people and animals including judges. The number of exhibitors and animals that can safely fit in a show ring or exhibit area may limit the number of animals that can be shown at one time.
- Provide separate entry and exit points for visitors so they do not need to pass close together while coming into and going out of the ring.
- Stagger activities in washing and grooming areas, or other shared spaces, so that animals from different farms or households do not interact unnecessarily and so that people can maintain a distance of at least 6 feet apart from each other.
- Stagger animal move-in/move-out times to reduce contact between people and animals.
- Consider a “show-and-go” with animals stalled at a trailer and leaving immediately after the show if this will not compromise animal welfare, for example, because of weather conditions such as high temperature and humidity.
Considerations for Traveling Amusement Parks
CDC offers the following considerations for ways in which operators of these venues can protect staff, guests, and communities from the spread of coronavirus. Guiding principles:
- The more and longer people interact, the higher the potential risk of becoming infected with and spreading SARS-CoV-2, the virus that causes COVID-19.
- The higher the level of community transmission at traveling amusement parks and carnivals, the higher the risk of COVID-19 spreading during park operations.
- The size of an event or gathering should be determined based on state, local, territorial or tribal safety laws and regulations.
Operators are to promote behaviors that reduce the spread.
CDC’s Multiplex Assay for Flu and COVID-19
CDC has developed a single test that detects and differentiates RNA from SARS-CoV-2, influenza A virus, and influenza B virus in upper or lower respiratory specimens. The assay is important because:
- Serves as a single test to diagnose infection caused by one of three viruses: SARS-CoV-2, influenza A, and influenza B
- Allows laboratories to process more tests in a given period
- Gives public health officials information they need in their efforts to control the spread of COVID-19 and flu
- Allows for ongoing flu surveillance while also testing for SARS-CoV-2
- Conserves important testing materials that are in short supply
This is a different test kit than the currently available COVID-19 only kits. Multiplex Assay Test kits are in production and will be shipped to public health laboratories once production, including quality control and assembly, has been completed. Public Health laboratories are to coordinate with the International Reagent Resource to obtain the tests.
Testing in Non-Healthcare Workplaces
CDC provided additional strategies for SARS-CoV-2 testing wherein antibody (blood serology) tests are used to detect past infection and should not be the sole basis for diagnosis current infection and viral tests evaluate whether the virus is present in the respiratory tract of a tested individual. There are five categories of prioritization.
- Testing individuals with signs or symptoms consistent with COVID-19
- Testing asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 to control transmission
- Testing asymptomatic individuals without known or suspected exposure to SARS-CoV-2 for early identification in special settings
- Testing to determine resolution of infection (e.g., discontinuation of home isolation)
- Public health surveillance for SARS-CoV-2
Testing in Healthcare Workplaces
CDCC updated summary of considerations and recommendations for testing healthcare personnel (HCP). Testing of HCP can be considered in four situations:
- Testing HCP with signs or symptoms consistent with COVID-19
- Testing asymptomatic HCP with known or suspected exposure to SARS-CoV-2
- Testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 for early identification in special settings (e.g., nursing homes)
- Testing HCP who have been diagnosed with SARS-CoV-2 infection to determine when they are no longer infectious
Quarantine if Suspected Exposure
CDC released specific guidance for general public for people who might have been exposed to COVID-19. Close contact is what qualifies as exposure. People with exposure are to:
- Stay home for 14 days after your last contact with a person who has COVID-19
- Watch for fever (100.4◦F), cough, shortness of breath, or other symptoms of COVID-19
- If possible, stay away others, especially people who are at higher risk for getting very sick from COVID-19
Last day of quarantine ends 14 days after the potential exposure, even if having been in quarantine prior.
Isolate if Sick
CDC updated language indicating isolation as the key means to reduce spread. Isolation is used to separate people infected with the virus (those who are sick with COVID-19 and those with no symptoms) from people who are not infected. People who are in isolation should stay home until it’s safe for them to be around others. In the home, anyone sick or infected should separate themselves from others by staying in a specific “sick room” or area and using a separate bathroom (if available). Isolation can end after:
- 3 days with no fever and
- Respiratory symptoms have improved and
- 10 days since symptoms first appeared
CDC published education describing epidemiologists work with other scientists to find who has it, why they have it, and what CDC can do about it. There are four areas of focus for epidemiologists:
- Identify the source of the outbreak
- Monitor and track the disease
- Study the disease
- Develop guidance for actions to slow the spread of the disease and lessen its impact
Visiting Beaches and Pools
CDC updated guidance for visiting beaches and pools. There is no evidence that SARS-CoV-2 virus can spread to people through water in oceans, lakes, and other natural bodies of water, pools, water playgrounds and hot tubs. However, droplet transmission is still possible. Recommendations include the usual 5 steps:
- Stay home if ill
- Cloth face coverings, it is suggested to bring two in case one gets wet
- Social distancing in and out of the water
- Respiratory etiquette and hand hygiene
- Clean and disinfect regularly
Public Service Announcements
Organizations with the ability to communicate to large groups of people are encouraged to use CDC developed Public Service Announcement in both Audio and/or written form. All PSA are available in both English and Spanish, and some in other languages. Topics include these and others:
- Everyday prevention actions
- COVID-19 readiness
- Cleaning and disinfection
- People who need extra precautions
- For areas with stay at home or shelter in place orders
- International travelers returning home
Guidelines for the Implementation and Use of Digital Tools to Augment Contact Tracing
CDC released a document that refers to case management tools and proximity and exposure notification tools. Case management tools make the traditional contact tracing process faster and more efficient:
- These tools can streamline the electronic capture and management of data on patients and contacts by enabling automation of contact notification and follow-up, and by allowing patients and contacts to electronically self-report (e.g. demographic and clinical data, contacts, services needed).
- Workflows may integrate with surveillance systems or other workforce management tools (e.g., virtual call centers, test scheduling, support services).
Proximity exposure and notification tools help identify more contacts and notify them of exposure faster than traditional contact tracing alone.
- Voluntary, opt-in tools using Bluetooth or GPS technologies (most commonly via smartphone apps) can be used to estimate the proximity and duration of an individual’s exposure to patient(s) diagnosed with COVID-19.
- More data (from pilots and limited implementations) are needed to quantify the public health value of these tools.
Testing in K-12 and Higher Education Institutions
CDC has suggested testing regimens for learning institutions. While K-12 schools play a role in identifying students, faculty, and staff who have COVID-19 symptoms or who have had recent known or potential exposure to SARS-CoV-2, school staff are not expected to directly administer SARS-CoV-2 tests. In some circumstances, school-based healthcare providers (e.g., school nurses, physicians) may conduct SARS-CoV-2 testing in their capacity as healthcare providers, such as in school-based health centers. Not every school-based healthcare provider will have the resources or training to conduct testing, and accordingly, should not feel compelled to do so; these providers can help link students and their families and staff to other opportunities for testing in the community.
In institutions of higher education, individuals with COVID-19 signs or symptoms should be referred to a healthcare provider for evaluation on whether testing is needed. In some locations, individuals can also visit their state or local health department’s website to look for the latest local information on testing.
Training for Healthcare Professionals
CDC set up a single resource page for health care professionals to receive training. Topics include:
- Clinical care and infection control
- Outreach and communication activity calls
- Prevention in long-term care facilities
- Prevention in hemodialysis facilities
- Research update
- Nursing home infection preventionist training course
- Donning and doffing PPE
- Optimization strategies for healthcare PPE
- Respiratory protection resources
- Nonpharmaceutical interventions
- Application and integration to planning, preparedness and response
- The science of social distancing
- Emergency preparedness and response
- Hurricane Preparedness in the context of COVID-19
- Psychological first aid
- Crisis and emergency risk communication
- Public health emergency law
- Reproductive health in emergency preparedness and response
- National Incident Management System
- Additional topics
- Workplace violence prevention for nurses
- COVID-19 in animals
CDC updated guidance to the general public regarding antibody testing to include an updated guidance document on interpreting COVID-19 test results. Decisions about testing are made by state or local health departments or healthcare providers. Antibody tests are available through healthcare providers and laboratories.
Animal Testing Guidance
CDC collaborated with US Dept. of Agriculture to update guidance on animal testing or SARS-CoV-2. Overall guidance includes:
- Routine testing of animals for SARS-CoV-2 is not recommended.
- The decision to test an animal, including companion animals, livestock, and wild or zoo animals, should be agreed upon using a One Health approach with the appropriate local, state, and/or federal public health and animal health officials.
- This document provides recommendations to guide priorities for animal SARS-CoV-2 testing given limited resources.
- Veterinarians are strongly encouraged to rule out other, more common causes of illness in animals before considering SARS-CoV-2 testing.
Preventing Spread of COVID-19 in Retirement Communities and Independent Living Facilities
CDC updated considerations for ways in which administrators of retirement communities and independent living facilities can help protect residents, workers, visitors, and communities and slow the spread of COVID-19.
Actions are to be taken in collaboration with state and local health officials and tailored to the needs of each community. These considerations are meant to supplement—not replace—any state, local, territorial, or tribal health and safety laws, rules, and regulations with which retirement communities and independent living facilities must comply. The following guiding principles were suggested:
- Risk increases with age, and/or
- They may have underlying health conditions such as heart disease, diabetes, or lung disease.
Further, risk increases based on activity and setting as follows:
- Lower Risk for this Setting: Residents do not spend time in each other’s individual living spaces, and most communal areas (e.g., cafeteria, activity room) are closed. Workers and residents remain at least 6 feet apart at all times, undergo daily health screenings, and wear cloth face coverings correctly. Non-essential volunteers and visitors are not permitted.
- More Risk for this Setting: Residents do not spend time in each other’s individual living spaces. Individual residents may use properly ventilated communal areas (e.g., dining room) or participate in small group outdoor activities, but they remain at least 6 feet apart at all times. Workers, residents, volunteers, and visitors remain at least 6 feet apart at all times, undergo daily health screenings, and wear cloth face coverings correctly. Non-essential volunteers and visitors are permitted, but limited.
- Higher Risk for this Setting: Residents spend significant time indoors together, possibly in each other’s living spaces as well as in communal areas. They may not consistently remain at least 6 feet apart, nor wear cloth face coverings. They also frequently spend time in the larger community (e.g., traveling together to attend public events). Non-essential volunteers and visitors are not restricted.
Strategies for Optimizing the Supply of N95 Respirators, Face Masks, Eye Protection and Isolation Gowns
CDC has updated 4 of its guidance pages to provide guidance on rationing various PPE, especially in healthcare settings where a shortage may occur. Strategies are based on three strata of surge capacity and can be used to prioritize measures to conserve PPE.
- Conventional capacity: measures consist of providing patient care without any change in daily contemporary practices. This set of measures, consisting of engineering, administrative, and personal protective equipment (PPE) controls should already be implemented in general infection prevention and control plans in healthcare settings.
- Contingency capacity: measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare personnel (HCP). These practices may be used temporarily during periods of expected facemask shortages.
- Crisis capacity: strategies that are not commensurate with U.S. standards of care. These measures, or a combination of these measures, may need to be considered during periods of known facemask shortages.
Information is given for each level of capacity based on the PPE:
- For facemasks: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
- For isolation gowns: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html
- For eye protection: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/eye-protection.html
- For respirators: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html
Considerations for Bank Employees
CDC released guidance for bank employees to prevent the spread of infection. Exposures may happen by:
- Being in close contact (within 6 feet) with customers or coworkers.
- Sharing common workplace equipment such as computers or phones.
- Touching or handling items, cash, or paperwork and then touching your mouth, nose, or eyes.
Prevention strategies include the well published steps of social distancing (or barriers if not possible), self-isolating if ill, face coverings, hand hygiene and frequent cleaning and disinfection of the work environment.
Care for Patients at Home
CDC released interim guidance for staff at entities who are coordinating the home care and isolation of people with confirmed or suspected COVID-19 infection, including persons under investigation. Staff are to:
- Assess the suitability of the residential setting for home care
- Provide guidance for precautions to implement during home care
Protecting Children During a COVID-19 Outbreak
Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. These steps are suggested:
- Hand hygiene, cleaning and disinfection of environment, social distancing
- Face coverings for children over 2 years old
- Limit time with other children
- Avoid people who are ill or showing symptoms
- Be aware of Multisystem inflammatory syndrome in children
Toolkit for State Public Health Veterinarians
CDC published a toolkit that provides recommendations for public health and animal health officials involved in managing companion animals diagnosed with SARS-CoV-2, including those that require hospitalization and those that may be isolated or monitored at home. Tools include steps for:
- Preparing and planning for test-positive animals
- Considerations for service animals
- Establish flow of information with state public and animal health officials
- Establish a plan for treating a test-positive animal
- Determine animal hospitalization or in-patient care
- PPE guidelines
- Isolating a test-positive animal at home
- Repeat testing and epidemiological investigation
Restaurants and Bars Communications
Testing in Congregate Settings
CDC has published an Overview of Testing for SARS-CoV-2, the virus that causes COVID-19, and provided interim considerations for facility-wide testing in specific settings. This document is intended to help public health departments and healthcare providers prepare for broad-based viral testing in facilities after known or suspected SARS-CoV-2 exposure or when there is moderate to substantial transmission in the community, based on guidance for specific settings.
COVID-19 Considerations for Animal Activities at Fairs, Shows, and Other Events
CDC released guidance for the general public and event organizers to reduce the risk of spread at fairs and agricultural shows indicating the steps of contact tracing. Fairs and agricultural shows pose unique health risks because they bring together crowds of people and animals with opportunities for close contact among them and mixing of different animals from different places. Fair and agricultural show organizers should consider the potential for COVID-19 to spread from person to person, person to animal, and possibly from animal to animal. The risk of animal-to-person spread is considered low.
Safe Watering Points Guidance
CDC released guidance for tribal communities to set up and maintain safe watering points. Key points and printable poster include:
- Posting operating hours
- Using signage to encourage handwashing, physical distancing and face coverings
- Provide protective gloves for operators who disinfect commonly touched areas at watering points
- Provide a handwashing station
- Provide disinfectant wipes or spray
- Provide lined trash bin
- Place visual cues for social distancing
Guidance for Pet Stores, Pet Distributors, and Pet Breeding Facilities
Guidance for operators to prevent the spread in these facilities was released. In addition to the usual hand hygiene, social distancing, cleaning and disinfection, and face coverings, facilities are encouraged to ensure they review and adhere to established state and industry biosafety and biosecurity practices. Some simple steps to reduce the spread include:
- Workers exposed to sick people or animals may need to self-monitor for temperature or other symptoms
- Limit the number of people in the facility, time spent there, and increase distance between people
- Consider a 2-week quarantine period for new animals or groups of animals
- Treat a bite, scratch or abrasion by washing exposed area of skin immediately with soap and warm water for at least 20 seconds, alert supervisor and contact a healthcare provider
- If an animal is suspected to have SARS-CoV-2 infection:
- Consult with facility veterinarian
- Contact state Public Health Veterinarian or State Animal Health Official immediately
- Isolate the animal and avoid contact with people or other animals in the facility
- Testing may or may not be completed with the sick animal
Contact Tracing Steps for the General Public
CDC released guidance for the general public indicating the steps of contact tracing. The steps involve:
- Interviewing people with COVID-19 to identify everyone they had close contact with during the time they may have been infectious
- Notifying contacts of their potential exposure
- Referring contacts for testing
- Monitoring contacts for signs and symptoms of COVID-19
- Connecting contacts with services they might need during the self-quarantine period
And the contact tracing steps are:
- Case investigation: Public health staff work with a patient to help them recall everyone they have had close contact with during the time they may have been infectious.
- Contact tracing: Public health staff begin contact tracing by notifying exposed people (contacts) of their potential exposure as rapidly and sensitively as possible, not revealing the infected patient’s identity.
- Contact support: Contacts are provided with education, information, and support to help them understand their risk, what they should do to separate themselves from others who are not exposed, and how to monitor themselves for illness. In addition, they are informed of the possibility that they could spread the infection to others even if they do not feel ill.
- Self-quarantine: Contacts are encouraged to stay home, monitor their health, and maintain social distance (at least 6 feet) from others until 14 days after their last exposure to the infected patient, in case they also become ill.
Youth Sports Program FAQs
CDC released an FAQ page for youth sports programs including guidance on:
- Amount of contact
- Practicing social distancing
- Cleaning and disinfection of equipment & surfaces
- Response when athletes get COVID-19
- Spectator guidance
Nail Salon Employees
CDC released an updated guidance specific to nail salons. Beyond the usual symptom recognition, hand hygiene, face coverings and social distancing, these specifics were offered for cleaning and disinfecting.
- Use single use tools and supplies (like powder vials for dipping nails) where possible. For items that must be used for multiple clients, disinfect after each client (such as nail file, clippers). Or follow the rules of your local board of health if you are supposed to use single-use tools.
- Wear gloves appropriate for the products being used. You may need additional personal protective equipment if you are handling things that need extra protection, like acetone or other chemicals.
- Clean these areas every hour:
- Countertops, doorknobs, toilets, tables, light switches, phones, faucets, sinks, keyboards, etc.
- Clean credit card devices, foot basins, curing lamps, keypads, etc. between clients.
- Follow the directions on the cleaning product’s label.
Rapid Response Teams
CDC updated training outlines and guidance for the establishment and management of Rapid Response Teams (RRTs) for disease outbreaks. The RRT General Guidance outlines in detail the underlying RRT systems and processes, including the standard operating procedures (SOPs), requisite for an effective and efficient RRT.
Case Investigator Training
CDC has updated and released Case Investigator specific training plan including topics to consider when designing a training plan for those who interview confirmed and probable COVID-19 patients and gather information on their recent close contacts. Investigators completing the training should be able to conduct basic case investigation according to an established protocol.
Food and Coronavirus
COVID-19 is thought to spread mostly person-to-person through respiratory droplets when someone coughs, sneezes or talks. It is possible to contract it by touching a surface or object, including food packaging, that has the virus on it and then touching the mouth, nose, or eyes. However, this is not thought to be the main way the virus spreads. Currently, there is no evidence to suggest that handling food or consuming food is associated with COVID-19. The risk of getting COVID-19 from food or food packaging is very low.
- The risk of getting COVID-19 from food you cook yourself or from handling and consuming food from restaurants and takeout or drive-thru meals is thought to be very low. Currently, there is no evidence that food is associated with spreading the virus that causes COVID-19.
- The risk of infection by the virus from food products, food packaging, or bags is thought to be very low. Currently, no cases of COVID-19 have been identified where infection was thought to have occurred by touching food, food packaging, or shopping bags.
- Although some people who work in food production and processing facilities have gotten COVID-19, there is no evidence of the virus spreading to consumers through the food or packaging that workers in these facilities may have handled.
Monitoring Community Mitigation
CDC developed a framework to evaluate community mitigation strategies and provide overarching considerations to support local health departments, or other organizations in monitoring and evaluating COVID-19 community mitigation strategies. The framework includes a logic model, suggested monitoring and evaluation questions, and potential data sources. The approach considers outcomes that minimize COVID-19 morbidity and associated mortality, effects of community mitigation strategies on long-standing health disparities and social determinants of health, and how communities thrive socially, emotionally, and economically.
Considerations for Casinos & Gaming Operations
As some casinos and gaming operations resume in some areas of the United States, CDC offers the following considerations for ways in which casino and gaming operators can help protect staff and customers and slow the spread of COVID-19. Casinos and gaming operations can determine, in collaboration with local, state, territorial, federal, or tribal health officials, whether and how to implement these considerations, making adjustments to meet the needs and circumstances of the local community. Guiding Principles to keep in mind based on risk of spread:
- Lowest Risk: Gaming activities are only available in virtual or online format.
- More Risk: Casinos are open but with limitations to allow social distancing and disinfection of machines between uses. Activities are limited to gaming machines and equipment that do not require a dealer and that can be played by one customer at a time and disinfected between uses. Individuals remain spaced at least 6 feet apart (2 arms’ length) while seated or standing. Sharing of gaming materials and equipment is not allowed.
- Even More Risk: Casinos are open but with limitations to allow social distancing. Games that require a dealer and that allow multiple players at the same time are offered, but the number of players is limited. Individuals remain spaced at least 6 feet apart while seated or standing. When possible, casino limits customers’ sharing of objects such as dice, card shoes, shufflers, and roulette wheels, Pai Gow tiles, pit podiums, blackjack discard holders, and toke boxes. Casino cleans and disinfects these objects between uses as much as possible. When possible, casino limits sharing of items that are difficult to clean and disinfect, such as cards, and holds items for 72 hours before reuse of these items.
- Highest Risk: Casino and gaming operations are open at full capacity. Games that require a dealer and that allow multiple players at the same time are offered. Individuals are not spaced apart while seated or standing. Sharing of gaming materials and equipment is permitted with no restrictions.
Meat and Poultry Facility Assessment Toolkit
CDC has made updates to the Facility Assessment Checklists which is intended for use by occupational safety and health professionals to assess a facility’s COVID-19 control plan and determine whether control measures in place align with CDC/OSHA guidance. It is suggested these steps are followed.
- Pre-assessment: Inform all parties of the goals of the assessment. Work as a group to review the checklist to determine if each part applies to your company.
- Walkthrough of the facility: While conducting the walkthrough of a facility, use the checklist to document what you find. Observe as much of the plant processes as possible. Limit participation to those familiar with plant processes.
- Post-assessment: After conducting the assessment, discuss observations, develop action items, determine steps to protect workers, and prioritize actions to be taken to control and prevent the spread of COVID-19 within the workplace.
FAQs for Incarceration
Further guidance in the form of FAQs was added for administrators, staff, incarcerated people and family members.
Contact Tracing Workflow
CDC continues to add to its contact tracing training module including this infographic on overall contact tracing workflow.
Forecasts for Hospitalizations
Mathematical models for predicting hospitalizations have been developed and published. Numbers and trends in new COVID-19 hospitalizations per day vary among national forecasts. This week, national forecasts from two models suggest an increase in the number of daily hospitalizations over the next four weeks, while the other four models forecast declines. Near the end of the forecast period, there may be 1,000 to 11,000 new COVID-19 hospitalizations per day. Forecasts estimate the number of new hospitalizations from a variety of data sets of COVID-19 cases or deaths. The use of different data sets, with different limitations—along with the use of different assumptions about social distancing—may result in the high variation among forecasts.
Update to Guidance for Dental Settings
CDC updated these documents to support dental settings complements the following CDC guidance documents:
- Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
- Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic
Summary of Recent Changes
- The recommendation to wait 15 minutes after completion of clinical care and exit of each patient without suspected or confirmed COVID-19 to begin to clean and disinfect room surfaces has been removed to align with CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.
- The time period recommended for patients to inform the dental clinic if they develop symptoms or are diagnosed with COVID-19 following a dental appointment has been changed to 2 days to align with CDC’s Healthcare Personnel with Potential Exposure Guidance.
- Clarifying language has been added to Engineering Controls.
How COVID-19 Spreads
CDC updated information page recognizing the spread of COVID-19 between animals and people. Reminder that the risk is considered low. Nevertheless, social distancing pets from person known or suspected of having COVID-19 is recommended. Further the best methods to prevent the spread are:
- Maintain good social distance (about 6 feet). This is very important in preventing the spread of COVID-19.
- Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- Routinely clean and disinfect frequently touched surfaces.
- Cover your mouth and nose with a cloth face covering when around others.
Open Burning and Wildfire Smoke During the COVID-19 Pandemic
CDC recommends refraining from agricultural burning or backyard burning due to increased health risks. Open burning produces smoke that contains air pollutants. Exposure to these pollutants can worsen existing heart and lung conditions and have other harmful effects, including premature death. People with or recovering from COVID-19 may have diminished lung function and therefore might be at particularly high risk of respiratory health effects after exposure to smoke from open burning. While a community is experiencing community transmission of COVID-19, firefighters and other emergency services may be operating at reduced capacity and have limited resources to respond to uncontrolled fires. Health officials, environmental health professionals, fire managers are to collaborate with local authorities and consider the following actions:
- Temporarily ban open burning
- Promote other waste disposal options
Additional information is posted regarding wildfire smoke in the context of COVID-19.
COVIDTracer Tool 1.0
CDC developed and released a spreadsheet-based tool to allow contact tracing agencies to compare three different tracing/monitoring strategies. The tool is useful in estimating the number of personnel needed to conduct case investigations, contact tracing and case contact monitoring based on entering a set of variables. Download file and instructions here:
COVID-19 Infections in Animals
At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19. However, animal infections have occurred.
- A small number of pet cats and dogs have been reported to be infected with the virus in several countries, including the United States. Most of these pets became sick after contact with people with COVID-19.
- Several lions and tigers at a New York zoo tested positive for SARS-CoV-2 after showing signs of respiratory illness. Public health officials believe these large cats became sick after being exposed to a zoo employee who was infected with SARS-CoV-2. All of these large cats have fully recovered.
- SARS-CoV-2 was recently discovered in mink (which are closely related to ferrets) on multiple farms in the Netherlands.
- In laboratory settings, ferrets, cats, hamsters, and numerous primates have been experimentally infected.
- Animals that do not seem to become infected based on lab studies include mice, pigs, chickens, and ducks.
Considerations for Community-Based Organizations
CBOs can play a vital role in maintaining community morale and cohesion. They include social service agencies, nonprofit organizations, and formal and informal community groups, like neighborhood groups or recreational or special-interest clubs. CBO organizers can take steps to reduce spread of COVID-19 using these guiding principles:
- Lowest risk: Meetings and other activities are conducted virtually. Only essential activities (i.e., provision of essential services) occur in person.
- More risk: Small, in-person gatherings like board meetings or support groups are held. Outdoor activities and meetings are prioritized. Individuals from different households remain spaced at least 6 feet apart and do not share objects. No food is served at meetings or events. Most staff telework and if staff or stakeholders are present in a facility, they are required to wear cloth face coverings (if able) and maintain social distancing. Rigorous cleaning and disinfecting practices are implemented. Attendees at the organization’s meeting and events come from the same local geographic area (e.g., community, town, city, county).
- Higher risk: Indoor activities are held. Medium-sized in-person gatherings are adapted to allow individuals to remain spaced at least 6 feet apart. In CBO facilities, common areas are closed, and staff are encouraged to wear cloth face coverings (if able) and maintain social distancing. Food is served in pre-packaged boxes with disposable utensils to eliminate the need for shared items or congregating around serving tables. For meetings and events, a limited number of attendees come from outside the local geographic area.
- Highest risk: Standard operations and programming are resumed. Large in-person gatherings are held where it is difficult for individuals to remain spaced at least 6 feet apart. Food is served “potluck” or family style. Many event attendees come from outside the local geographic area.
CDC Diagnostic Test Kit
CDC developed a laboratory test kit for use in testing patient specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.
- The test kit is called the “Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel.”
- CDC’s test kit is intended for use by laboratories designated by CDC as qualified and, in the United States, certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity tests. It is intended for use on upper and lower respiratory specimens with the Applied Biosystems 7500 Fast DX Real-Time PCR Instrument with SDS 1.4 software.
- Since distribution of CDC test kits began, high demand for the extraction reagents needed for testing has resulted in global shortages; some public health laboratories have been unable to obtain testing reagents to support their testing volumes, resulting in testing delays. Therefore, on June 12, 2020, FDA approved an amendment to the test’s EUA to allow state public health laboratories and others the flexibility to use alternatives.
How to Get CDC’s Diagnostic Test and Supplies
The CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects the SARS-CoV-2 virus in upper and lower respiratory specimens. The U.S. Food and Drug Administration (FDA) gave Emergency Use Authorization (EUA) for this test on February 4, 2020. On June 12, 2020, FDA granted an amendment to the EUA for the CDC diagnostic test to address global shortages of materials needed to perform the test. This amendment provides alternatives icon for processing the test:
- Four additional extraction reagents that can be used in the existing extraction methods
- An additional extraction instrument and associated reagents
- A new process that can be used in place of the extraction method when materials for the current method are limited
The International Reagent Resource (IRR) is distributing the diagnostic panel and supplies to registered state and local public health laboratories so they can perform SARS-CoV-2 testing.
Consolidated Testing Recommendations
CDC has released consolidated recommendations for COVID-19 testing based on current evidence. includes a summary of current CDC recommendations for testing people who:
- have signs or symptoms of COVID-19;
- have no symptoms but recently had contact with someone known or suspected to have COVID-19;
- have no symptoms and no known contact with someone known or suspected to have COVID-19 but still may be tested for early identification in special settings;
- have had confirmed COVID-19 but no longer have symptoms; and
- may be tested by public health officials to track spread of the virus that causes COVID-19.
Further recommendations for testing in nursing homes and long term care facilities include:
- recommendation against testing the same individual more than once in a 24-hour period;
- consideration for testing residents with symptoms for other causes of respiratory illness, such as influenza; and
- coordination of repeat testing in response to outbreaks with local, territorial, and state health departments.
Contact Tracing Communication Toolkit
CDC released expanded talking points to promote the public understanding of the importance of contact tracing. Information includes infographics, Public Service Announcement scripts, messaging targeting to the general public, people who have been diagnosed with COVID-19, close contacts of someone with COVID-19, stigma, social media posts. Much of the information is available in alternative languages.
Deciding to Go Out
CDC released considerations and plan for the general public as more of the population looks for ways to resume daily activities as safely as possible. Emphasis is on staying safe personally as well as preventing contact spread of the virus. Topics covered include:
- General consideration such as:
- Does the activity allow for social distancing?
- Cloth face covering
- Regular hand hygiene
- What is the length of time interacting with others?
- Specifics included for going to the bank, dining at a restaurant, hosting gatherings or cook-outs, using gyms and fitness centers, nail salons, libraries, and traveling overnight.
Considerations for Events and Gatherings
As some communities in the United States begin to plan and hold events and gatherings, the CDC offers the following considerations for enhancing protection of individuals and communities and preventing spread. Event planners are to work in collaboration with state and local health officials. These recommendations are meant to supplement, not replace any local laws or rules. Considerations for levels of risk:
- Lowest risk: Virtual-only activities, events, and gatherings.
- More risk: Smaller outdoor and in-person gatherings in which individuals from different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., community, town, city, or county).
- Higher risk: Medium-sized in-person gatherings that are adapted to allow individuals to remain spaced at least 6 feet apart and with attendees coming from outside the local area.
- Highest risk: Large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.
Event planners can find communication resources, posters, and additional guidance here:
Survey of Public Attitudes, Behaviors, and Beliefs Related to COVID-19
During May 5–12, 2020, a survey among adults in New York City and Los Angeles and broadly across the United States found widespread support of stay-at-home orders and nonessential business closures and high degree of adherence to COVID-19 mitigation guidelines. Most respondents reported that they would feel unsafe if restrictions were lifted at the time of the survey.
Wildlife Testing Guidance
For professionals working with free-living wildlife, testing may be called for in certain circumstances:
- Testing wildlife for SARS-CoV-2 may be appropriate for morbidity and mortality event-based surveillance, ensuring the health of threatened or endangered species, or for research purposes.
- For animals to be returned or released to the wild, a risk assessment per the International Union for the Conservation of Nature-World Organisation for Animal Health guidelines (IUCN-OIE) should be conducted to assess the risks and benefits of such a release. This risk assessment should include considerations for testing these animals for SARS-CoV-2. Further information found at OIE Considerations for sampling, testing, and reporting of SARS-CoV-2 in animals.
Checklist for Communities of Faith
Communities of faith are encouraged to use this checklist to protect the health of their staff and congregants during the coronavirus disease 2019 (COVID-19) pandemic. Checklist includes:
- Plan and Prepare
- Update your emergency operations plan with the help of your local public health department, emergency operations coordinator or planning team, and other relevant partners to include COVID-19 planning. Be sure to include plans on how to protect staff and congregants at higher risk for severe illness from COVID-19.
- Designate a staff person to be responsible for responding to COVID-19 concerns. Staff and congregants should know who this person is and how to contact them if they become sick or are around others diagnosed with COVID-19. This person should also be aware of state or local regulatory agency policies related to group gatherings and other applicable state and local public health guidance and directives.
- Identify space that can be used to separate sick people, if needed, and make plans for safely transporting them to their home or a healthcare facility, notifying the health department, and cleaning and disinfecting the facility after they have left.
- Develop an emergency communication plan for distributing timely and accurate information to staff, congregants, and others who use your facility.
- Identify actions to take if you need to temporarily adjust operations, and be sure to account for staff and congregants who need extra precautions.
- Promote the practice of everyday preventive actions such as hand hygiene, frequent cleaning and sanitation.
- Have COVID-19 prevention supplies available for staff and others who come to your facility (e.g., soap, water, hand sanitizer that contains at least 60% alcohol, tissues, no-touch trash cans). Keep a few disposable cloth face coverings in stock for those who need them.
- Plan for staff absences by developing flexible attendance and sick-leave policies, plan for alternative coverage, and monitor and track COVID-19-related staff absences.
- Offer support to groups of people stigmatized by COVID-19 and speak out against negative behaviors to help counter stigma and discrimination.
- Take Action If there are people in your community who have COVID-19:
- Stay informed about local COVID-19 information and updates; check for updates from local health and other authorities.
- Put your emergency operations and communication plans into action, including notifying local health officials and alerting staff and congregants who may have been exposed to COVID-19.
- Communicate with your staff, congregants, and others using your facility if you need to adjust operations.
- Encourage staff and congregants to talk with people they trust about their concerns and how they are feeling. Consider posting signs displaying the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746.
- Emphasize the everyday preventive actions listed above through intensified communications with staff, congregants, and others who use your facility.
- If someone becomes sick while at your facility, separate them into an isolated room and safely transport them home or to a healthcare facility as soon as possible. Notify the health department and follow CDC guidance on cleaning and disinfecting the building where the individual was present.
Updates to Lab FAQs
CDC updated FAQs for labs to include information for:
- Accessing laboratory testing
- Test developers
- Specimen handling
- Specimen packing and shipping
- Anatomic pathology
- Ordering supplies for both public health laboratories and clinical laboratories
Using Telehealth Services
CDC released a guidance document to describe landscape of telehealth services and provide considerations for healthcare systems, practices, and providers using telehealth services to provide virtual care during and beyond the COVID-19 pandemic. Topics include:
- Modalities: Synchronous, Asynchronous, Remote patient monitoring
- Strategies to increase telehealth uptake
- Telehealth reimbursement
- Safeguards & Security
- Potential limitations
Guidance for Pregnant and Breastfeeding Mothers
New information has been released for guiding neonates born to mothers with suspected or confirmed COVID-19. Targeted to inform healthcare providers about the diagnosis, evaluation, infection prevention and control practices, and disposition of neonates with suspected or confirmed COVID-19 or known COVID-19 exposure, including birth to a mother with suspected or confirmed COVID-19.
Guidance for the Establishment and Management of Rapid Response Teams (RRT)
CDC released a guidance document to speed the time from disease detection to public health response. The document details:
- RRT Composition: Discipline and suggested reporting structures
- Pre-deployment processes: Briefing, just in time training and equipping the teams
- Deployment processes: Roles by discipline including objectives, activities, deliverables, and indicators/metrics
- Post deployment processes: Resources for returning team members including mental health and re-entry support
- A compliment of additional resources
Suggestions for Youth and Summer Camp: Sleep Away Camps
CDC added special considerations for overnight camps including:
- Communication with families if accepting campers from various geographic regions
- Align mats or beds so that campers and staff sleep head-to-toe at least 6 feet apart
- Add physical barriers, such as plastic flexible screens, between bathroom sinks, between beds
- Camp administrators, nurses, healthcare providers identify an isolation room or area to separate anyone who exhibits COVID-like symptoms
- Establish procedures for transportation if someone becomes sick or needs to be transported
- Apply frequent hand hygiene, cleaning and disinfection
Contact Tracer’s Guide for Notification of Exposure
CDC provided scripting and action guide for contact tracers who are notifying persons with potential exposure and how to collect needed information. Guidance includes tips on language use and establishing report, extracting information, ensuring confidentiality and follow-up recommendations. Script gives principles for interactions and is broken down as follows:
- Verifying identity
- Reason for Call
- Collecting locating and demographic information
- Demographics, such as gender, alternative names
- Location and other contacts in living situation
- Work and other contacts
- Health information and disease comprehension
- Assess disease comprehension
- Fill in knowledge gap regarding Symptoms of COVID-19
- Underlying health conditions and other risk factors
- Testing for COVID-19 in your area
- Quarantine recommendations and resources
- Home or Self quarantine
- Assessing concerns
- Assessing living situation
- Assessing other supports
- Release from quarantine
- Disclosure coaching
- Health monitoring and responding to changes in health status
- Monitoring and agreement tools
- Responding if symptoms develop
- Medical provider
- Check in agreements
- Contact Tracer’s information for follow-up
The full script is available at:
Interim Lab Biosafety Guidelines Update
CDC added detail to their biosafety guidelines specifically for Anatomic Pathology and Point of Care (POC) Testing.
- Point of Care tests (useful for rapid deployment, critical care sites, etc) that operate POC diagnostic instruments must have a current Clinical Laboratory Improvement Amendments of 1988 certificate. Temporary waivers are possible through Centers for Medicare and Medicate Services
- Labs should consider the following when using POC instruments for SARS-CoV-2 diagnostic purpose
- Perform risk assessments that are site and activity specific.
- Train staff on proper use of the instrument and how to minimize risk of exposures.
- Follow Standard Precautions when handling specimens to include hand hygiene, PPE of lab coats, gowns, gloves and eye protection. If needed additional precautions such as surgical mask or face shield or other physical barriers such as splash shield to work behind.
- When using swabs, minimize contamination of the swab stick and wrapper by widely opening the wrapper prior to placing the swab back into the wrapper.
- Change gloves after adding patient specimens to the instrument.
- Decontaminate the instrument after each run by using an EPA-approved disinfectant for SARS-CoV-2. Following the manufacturer’s recommendations for use, such as dilution, contact time, and safe handling.
- Anatomic Pathology refers to surgical pathology, histotechnology cytology and autopsy.
Additional details available here:
Additionally, the Biosafety FAQs were updated:
Public Health Guidance Update
CDC updated guidance for community related exposure regarding people with confirmed COVID-19 who have not had any symptoms.
Published Gene Sequences for Research
CDC updated the web page to list Real-time RT-PCR Pimers and Probes to be used for viral testing with the CDC 2019-nCoV Diagnostic Panel.
Lab Test Reporting Requirements
CDC released requirements for reporting for data submission to Health and Human Services (HHS)/CDC under the Coronavirus Aid, Relief, and Economics Security Act. Details are in the document (attached), highlights include:
- All entities performing testing must report results within 24 hours of results being known
- Methods for submission through state and local public health departments
- Required data elements include type of test ordered, results, patient demographics. Local public health agencies may collect identifying information, but are not to pass it along to HHS/CDC.
- Data reporting and transmission requires electronic data submission using Health Level 7 laboratory reporting and are in compliance with ONC 2015 Edition certification criteria, and structured in accordance with the US Core Data for Interoperability (USCDI) when available or possible.
Guidance for Handlers of Service and Therapy Animals
CDC added guidance for Persons using service animals (such as guide dogs for those with low or no vision) and suggests facilities that normally use therapy animals may not allow them at this time because people within the settings are typically at higher risk for serious illness with COVID-19.
- Maintain social distancing for the animal as well as you would for human contact.
- Cleaning and disinfecting collars, leashes, vest, etc. should be done frequently.
- Do not wipe or bathe service animals with chemical disinfectants, alcohol, hydrogen peroxide, or other products not approved for animal use.
- Do not use cloth face coverings on animals.
- There is no evidence that the virus can spread to people from the skin, fur or hair of pets.
Racial and Ethnic Minority Groups
CDC updated a statement recognizing that racial and ethnic minority are affected in greater numbers, with worse outcomes than the general population. The differences are often due to economic and social conditions that are more common among some racial and ethnic minorities. Including living conditions, work circumstances, underlying health conditions, and lower access to healthcare. Public health professionals and community organizers can reduce the effect by:
- Ensuring communications about COVID-19 is frequent, clear, credible, and in easily understood language
- Work with sectors such as faith community education, business, transportation and housing organizations to share information and strategies.
- Link more people among racial and ethnic minority groups to healthcare services
- Provide information for healthcare professionals and health systems
- Use evidence-based strategies to reduce health disparities
Healthcare systems and providers can support by:
- Implementing standard protocols
- Identify and address implicit bias
- Provide medical interpretation services
- Reduce cultural barriers to care
- Connect patients with community resources
- Learn about social and economic conditions that may put some patients at higher risk
Additional Resources for Contact Tracing
CDC continues to bolster the resources available for contact tracing with the following additional resources for entities performing contact tracing:
- Contact tracing communication toolkit with infographics and social media posts
- Checklists for developing a COVID-19 Case Investigation and Contact Tracing Plan (view here)
- Additional resources external to the CDC are listed such as Contract Tracing playbooks, digital tools, steps to transitioning to less activity restrictions
Updated FAQs for Schools and Childcare Programs
Information regarding the use of breathing treatments, or metered dose inhaler was posted in the Frequently asked questions. Although data is limited, it is suggested that students are permitted to use a personal inhaler instead of a stock inhaler. If personal inhalers are not available, use disposable spacer/smouthpieces and nebulizers with disposable tubing. Cleaning and disinfection between uses is required.
Infographic for Workplace, School, Home Guidance
CDC released an infographic to educate/remind the population on techniques to keep decrease the spread of COVID-19. General information is presented for the workplace, schools, in the home, and commercial establishments.
Agriculture Workers and Employers
CDC and Dept. of Labor issued updated guidance for to reduce the spread of COVID-19 in agriculture workers. The guidance recommends that owners and operators:
- Screen agricultural workers for coronavirus symptoms, manage workers who have symptoms upon arrival at work or who become sick during the day, and address return to work after worker exposure;
- Use touch-free clocks and automatic doors, install plastic barriers when distances of six feet between individuals are not possible, and rearrange chairs and tables in break areas;
- Implement cleaning, disinfection, and sanitation protocols;
- Train workers in a language they understand on the signs and symptoms of coronavirus, proper infection control and social distancing practices, and what to do if they or a coworker experience symptoms;
- Encourage workers to use cloth face coverings in certain circumstances (e.g., when utilizing shared methods of transportation); and
- Provide and train workers on proper use of personal protective equipment through videos or in-person visual demonstrations.
- The guidance also explains what employers should do to prevent transmission of the virus among workers who share housing and transportation to and from the agricultural worksite.
Updated Guidance if You Have Pets
CDC is reporting that a number of pets worldwide, including cats and dogs, have been infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19.
- Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low.
- It appears that the virus that causes COVID-19 can spread from people to animals in some situations.
- Treat pets as you would other human family members – do not let pets interact with people outside the household.
- If a person inside the household becomes sick, isolate that person from everyone else, including pets.
- There is no evidence that the virus can spread to people from the skin, fur, or hair of pets. Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or any other products not approved for animal use.
Clinical symptoms details Updated for Clinicians
CDC updated incubation period and symptom percentages based on evidence as follows:
- The incubation period for COVID-19 is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset. One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.
- The signs and symptoms of COVID-19 present at illness onset vary, but over the course of the disease, most persons with COVID-19 will experience the following:
- Fever (83–99%)
- Cough (59–82%)
- Fatigue (44–70%)
- Anorexia (40–84%)
- Shortness of breath (31–40%)
- Sputum production (28–33%)
- Myalgia (11–35%)
Clinician On-Call Center
The Clinician On-Call Center is a 24-hour hotline with trained CDC clinicians standing by to answer COVID-19 questions from healthcare personnel on a wide range of topics, such as diagnostic challenges, clinical management, and infection prevention and control. To reach this service, call 800-CDC-INFO (800-232-4636) and ask for the Clinician On-Call Center.
Seroprevalence Testing in Georgia
As part of determining population antibody presence, CDC Teams visited randomly selected homes within randomly selected blocks in the Atlanta Metro area in late April and early May 2020. They completed surveys and collected blood samples from consenting household members. Blood samples were sent to the CDC laboratory and are being tested for SARS-CoV-2 antibodies.
CDC Summarizes Resources and Support Provided
Two infographics were released showing the category and details of the resources and support provided by the CDC. The first (view here) demonstrates how CDC has taken steps protecting the population in regards to travel, schools, businesses, community, healthcare professionals, healthcare systems, and laboratory diagnostics. The second (view here) highlights some of the people involved in the research and as well as the use of data.
Large-scale Geographic Seroprevalence Surveys
CDC has begun testing the population for antibodies against SARS-CoV-2 in multiple areas starting in Washington state and New York City Metro. Goal of the testing is to determine the level of exposure throughout the population that is not detected through symptomatic virus testing alone. Results will be updated regularly.
Contract Tracing Window Reduced
The contact elicitation window for asymptomatic cases was changed from 10 days before obtaining the specimen that tested positive for COVID-19 to 2 days. Additionally, recent data suggests that asymptomatic persons may have a lower viral burden at diagnosis compared to symptomatic cases. Thus, the longer contact elicitation window (beginning 10 days prior to specimen collection) may have limited impact in identification of new COVID-19 cases. This time period is also now in alignment with WHO, European CDC, and Public Health Canada.
Meat Processing Facility Assessment Toolkit
CDC released tools and resources for safety professionals based on the interim guidance from CDC and OSHA for meat and poultry processing. Two checklists were released:
- A checklist intended for use by occupational safety and health professionals to assess a facility’s COVID-19 control plan (view here).
- A checklist intended for state and local health officials to assess COVID-19 infection prevention and control measures in meat and poultry processing facilities (view here).
Employers with Workers at Higher Risk
As business scale up and resume operations, employers with workers at higher risk may need to take special precautions to reduce exposure risk to these employees. Employers should take particiular care to reduce workers’ risk of exposure to COVID-19, while making sure to be compliant with relevant Americans with Disabilities Act (ADA) and Age Discrimination in Employment Act (ADEA) regulations. These actions are for considerations in a three step scale-up:
- In all steps:
- Protect employees at higher risk for severe illness by supporting and encouraging options to telework.
- Consider offering workers at higher risk duties that minimize their contact with customers and other employees (e.g., restocking shelves rather than working as a cashier), if agreed to by the worker.
- Step 1: Scale up only if business can ensure strict social distancing, proper cleaning and disinfecting requirements, and protection of their workers and customers; workers at higher risk for severe illness are recommended to shelter in place.
- Step 2: Scale up only if business can ensure moderate social distancing, proper cleaning and disinfecting requirements, and protection of their workers and customers; workers at higher risk for severe illness are recommended to shelter in place.
- Step 3: Scale up only if business can ensure limited social distancing, proper cleaning and disinfecting requirements, and protection of their workers and customers.
Guidance for Ending Home Isolation
CDC added guidance for healthcare practitioners regarding management of persons who may have prolonged viral shedding after recovery. Essentially, data are lacking for infectious potential of individuals recovering after symptoms. Even though they may have positive viral RNA Test, the best available evidence suggests that most persons recovered from illness with detectable viral RNA (either persistent or recurrent) are likely no longer infectious, but conclusive evidence is not currently available.
Assisted Care Facilities to Refer to Local Health Authorities
CDC updated guidance for Assisted Living Facilities to refer to guidance from state and local officials when making decisions about relaxing restrictions (e.g. easing visitor restrictions, allowing group activities, or restoring communal dining.)
Sanitation and Wastewater Workers
Recently, SARS-CoV-2 has been found in untreated wastewater. While data are limited there is no information to date that anyone has become sick with COVID-19 because of exposure to wastewater. Standard practices for wastewater treatment plant operations should be sufficient to protect wastewater workers from exposure.
Bars and Restaurants to Consider Legionnaires’ Disease
CDC added guidance for restaurants and bars that are reopening after prolonged facility shutdown to minimize the risk of legionnaires’ disease. Water systems and features at risk include sink faucets, decorative fountains, drinking fountains.
Using Antibody Tests
CDC has developed interim guidance for how healthcare providers, laboratories, and public health staff should use antibody tests. These tests look for the presence of antibodies, which are proteins made in response to infections. Antibodies are detected in the blood of people who are tested after infection; they show the body’s efforts to fight off a specific infection.
And antibody testing at-a-glance recommendations for professionals.
Employer Information for Office Buildings
CDC released guidance steps to prevent spread and exposure to COVID-19 while resuming business operations. Steps include:
- Check the building’s readiness for occupancy
- HVAC functioning properly? Follow procedures for new construction startup if ASHRAE Standard 180-2018 if needed.
- Increase circulation of outdoor air as much as possible.
- Evaluate mechanical and life safety systems.
- Check for hazards such as mold growth, rodents or pests, legionella in stagnant water systems.
- Identify where and how workers might be exposed
- Develop hazard controls using the hierarchy of controls
- Engineering/isolation from the hazard such as barriers, arranging furniture for social distancing.
- Administrative controls such as staggered work shifts, increased cleaning & disinfection schedule.
- Educate employees and supervisors.
Living in Close Quarters
CDC released guidance to reduce the spread for those living in close quarters. Actions include:
- Limiting errands,
- having vulnerable household members avoid caring for children and those who are sick,
- and separating a household member who is sick
When to End Isolation
CDC updated and simplified their recommendations as to when people can be around others after having had (or suspected) COVID-19. A person can be around others after:
- 3 days with no fever AND
- Symptoms improved AND
- 10 days since symptoms first appeared
If a person tested positive for COVID-19 but had no symptoms they can be around others after:
- 10 days have passed since the test
If a person was exposed to another person with COVID-19 they can be around others:
- 14 days after exposure
Case Investigation & Contact Tracing Guidance
CDC released a 56 page document detailing Case Investigation and Contact Tracing Guidance. Sections include:
- Scaling up Staffing and Roles
- Training outlines
- When to initiate an investigation
- Investigating a case
- Contact tracing
- Outbreak investigations
- Building community support
- Data management
- Confidentiality and consent
- Digital contact tracing tools
All content is available on web as well: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/overview.html
Audio PSAs Available
CDC has released a number of Audio Public Service Announcements for those entities that use audio for communications.
Recommendations for Communities of Faith
CDC released a statement regarding re-opening communities of faith. Because there are several published reports of COVID-19 outbreaks sparked by large gatherings, CDC urges faith leaders to work with state, tribal, local, and territorial leaders to provide technical assistance and resources that can support the decisions to protect health and prevent the spread of COVID-19 that is consistent with the free exercise rights of people of faith. FAQs were updated and republished.
The CDC has developed and manufactured a serological based test kit and is evaluating the use of commercial test kits.
- CDC does not recommend using antibody testing to diagnose acute infection as they are designed for population level surveillance to determine the patterns of spread and antibodies most commonly become detectable 1-3 weeks after symptom onset.
- It is not yet clear if the presence of antibodies means an individual is immune from re-infection.
- Individuals wanting testing should communicate with their health care provider. Results can be interpreted in combination with viral testing using this table.
As restaurants have suspended operations, rodents that have relied on their waste for food have begun to search for new sources. There have been reports of unusual or aggressive rodent behavior. Rats and mice can spread over 35 diseases. After natural disasters rodent populations decline, then rebound as commercial activities resume. CDC has a host of rodent control resources and in simple terms recommends these actions:
- Seal up holes inside and outside a residence or structure to prevent entry
- Trap up rodents around the home to reduce the population
- Clean up rodent food sources and nesting sites
Dental Settings Update
CDC updated their recommendations to dental settings:
- Recommendations are provided for resuming non-emergency dental care during the COVID-19 pandemic.
- New information is included regarding facility and equipment considerations, sterilization and disinfection, and considerations for the use of test-based strategies to inform patient care.
- Expanded recommendations for provision of dental care to both patients with COVID-19 and patients without COVID-19.
Media Release of “Opening America” Resources
CDC aggregated resources (all previously reported in this daily update) aggregating decision trees and tools for resuming civic and commercial activities. Resources include:
- CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again
- Standardized way to look at the gating criteria in Opening Up America Again Whitehouse web page
- Set of health considerations to be used by summer camps, schools, youth sports organizations, institutes of higher education, and restaurants and bars, that are open.
Pandemic Planning Scenarios for Mathematic Modeling
CDC and Office of the Assistant Secretary for Preparedness and Response have developed 5 COVID-19 Pandemic Planning. Models developed using the data provided in the planning scenarios can help evaluate the potential effects of different community mitigation strategies (e.g., social distancing). The planning scenarios may also be useful to hospital administrators in assessing resource needs and can be used in conjunction with the COVID-19 Surge Tool.
Travelers Prohibited From Entry into the US
Several Presidential proclamations established restrictions on the entry of certain travelers into the US in an effort to help slow the spread of COVID-19. With specific exceptions, foreign nationals who have been in any of the following countries during the past 14 days may not enter the United States:
- European Schengen Area
- United Kingdom
- Republic of Ireland
Exceptions do apply, and people meeting those exceptions will be allowed to enter through one of 13 airports.
Multisystem Inflammatory Syndrome in Children (MIS-C) Information for Parents
MIS-C is a condition in children where body parts can become inflamed included the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. It seems to be related to same virus that causes COVID-19. Most children recover with medical care.
- Symptoms include fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, fatigue
- Seek emergency care if trouble breathing, pain in chest that does not go away, new confusion, inability to wake or stay awake, bluish lips or face, severe abdominal pain
- Best method to prevent MIS-C is to prevent child from getting COVID-19
How to Report Lab Data
Data collection is critical to the COVID-19 response.
- All state public health labs and select large commercial labs that currently report directly to CDC should continue sending those data.
- Hospital labs should submit their data via electronic message to state or large local health department
- Standardized codes and case definitions are critical to aggregating data
- A standardized case definition has been developed
- Additionally, the CDC has posted a LOINC In-Vitro Diagnostic (LIVD) Test Code Mapping Guide
Publications About COVID-19 for Labs
CDC posted the following studies and publications to assist labs in the processes:
- Severe acute respiratory syndrome coronavirus 2 from patient with 2019 novel coronavirus disease
- An orally bioavailable broad-spectrum antiviral inhibits SARS-CoV-1 in human airway epithelial cell cultures in multiple coronaviruses in mice
- Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility
- Clinical and virologic characteristics of the first 12 patients with COVID-19 in the United States
- Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1
- Multiple respiratory syncytial virus introductions into a neonatal intensive care unit
- Mesoscale reaction-diffusion phenomena governing lignin-first biomass fractionation
- First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 in the USA
Considerations for Restaurants and Bars
These guidelines are not to replace local and state health official recommendations. Transmission risks increasing as follows:
- Lowest risk: Food service limited to drive-through, delivery, take-out, and curbside pick-up.
- More risk: Drive-through, delivery, take-out, and curbside pick-up emphasized. On-site dining limited to outdoor seating. Seating capacity reduced to allow tables to be spaced at least 6 feet apart.
- Even more risk: On-site dining with both indoor and outdoor seating. Seating capacity reduced to allow table to be spaced at least 6 feet apart.
- Highest risk: On-site dining with both indoor and outdoor seating, seating capacity NOT reduced, tables NOT spaced at least 6 feet apart.
Consideration for Youth Sports and Programs
Administrators of programs are to consult with state and local health officials and make adjustments at the local level. Risk of COVID-19 spread increases as follows:
- Lowest risk: Performing skill building drills or conditioning at home
- Increasing risk: Team-based practice
- More risk: Within-team competition
- Even more risk: Full competition between teams from same local geographic area
- Highest risk: Full competition between teams from different geographic areas
Administrators and coaches can assess risk based on the way sports are played, equipment is shared and are advised to consider:
- Physical closeness of the players and length of time players are close to each other
- Amount of necessary touching of shared equipment and gear (i.e. bats, racquets, water bottles, etc.)
- Ability to engage in social distancing while not engaged in play (i.e. during practice, on the sideline)
- Age of the athlete (older may be better able to follow directions for social distancing)
- Team size
Children Schools, Camps and Care Centers
Additional guidance and infographics were released for supporting children’s schools, camps and care centers. The risk for COVID-19 spread increases in youth camp settings as follows:
- Lowest risk: Small groups of campers stay together all day each day and are able to social distance without sharing objects. All campers from local geographic area.
- More risk: Campers mix between groups but able to social distance, still from same geographic area
- Even more risk: Campers mix between groups, do not social distance
- Greatest risk: Campers mix between groups and are NOT from the local geographic area
Considerations for Institutes of Higher Education (IHE)
Administrators are to collaborate with state and local health officials and make use of these guiding principles for general settings:
- Lowest risk: Faculty and students engage in virtual only learning options, activities and events
- More risk: Small in-person classes, activities and events, individuals able to social distance, and do not share objects
- Highest risk: Full-sized in-person classes, activities and events with inability to social distance and sharing materials, supplies, and other objects
For on-campus housing settings risk increases as follows:
- Lowest risk: Residence halls are closed
- More risk: Residence halls are open at lower capacity and shared spaces (kitchens & common areas) are closed
- Highest risk: Residence halls are open at full capacity including shared spaces
Visiting Parks and Recreational Facilities
Released guide for visiting parks and recreational facilities. Recommendations are to:
- Visit parks close to home
- Prepare before the visit (check openings with local authorities/facility managers)
- Stay at least 6 feet away from others
- DO NOT visit parks if you are sick or recently exposed to COVID-19
- DO NOT visit crowded parks
- DO NOT use playgrounds
- DO NOT participate in organized activities or sports
Department of Health and Human Services (HHS) Delivers Funding to Expand Testing Capacity for States, Territories, Tribes
HHS is providing $11B in new funding to support testing for COVID-19. Funding from the Paycheck Protection Program and Health Care Enhancement Act is designed to provide critical support to develop, purchase, administer, process, and analyze COVID-19 tests, conduct surveillance, trace contacts and related activities.
Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the Pandemic
Updated strategies for non-COVID-19 healthcare to minimize chances for exposure with patients with confirmed or suspected COVID-19.
- The prior recommendation that all elective procedures be postponed has been removed
Key considerations for performing non-COVID-19 clinical care during the COVID-19 pandemic, including potential for patient harm if care is deferred and level of community transmission, are summarized in the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic.
COVID-19 Serology Surveillance Strategy
Serology (antibody) testing will be deployed for widespread pandemic surveillance. Serology testing uses blood and can indicate if somebody has previously been infected with the SARS-CoV-2 virus whether they showed symptoms or not. It may take 1-3 weeks after initial infection to show a positive test, so it is not a good measure to determine if an individual has been infected. CDC’s strategy to find how the virus is spreading through the US population. It is not known if the presence of antibodies (positive test) means immunity at this point. CDC will be gathering results in the following patters:
- Large Scale Geographic where CDC will gather results from practitioners who may be sampling blood that was collected for other reasons (e.g. routine cholesterol test) to understand how the virus is spreading in a large area. Sampled individuals remain anonymous.
- Community level surveys where public health practitioners may sample a population at a town or community level.
- Special populations for example pregnant women or healthcare workers maybe sampled.
CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again
Updated report on activities to support the reopening of America.
Updated Research Supporting the Use of Cloth Face Coverings for Asymptomatic or Pre-Symptomatic Individuals
The virus can spread between people interacting in close proximity. Seven published studies support the use of cloth face coverings. The studies are listed here:
Updated Checklist for Homeless Service Providers During Community Re-Opening
- Coordination with local and state health departments
- Placing posters strategically to provide instruction on handwashing, cough etiquette, social distancing, etc.
- Support staff regarding job stress and coping
- Enact prevention strategies for clients and staff
- Continue to connect clients to care
- Continue additional precautions for clients and staff who are at higher risk for severe ill
Guidance for Multisystem Inflammatory Syndrome in Children (MIS-C)*
In rare cases, patients under 21 years may have multiple organ inflammation weeks after SARS-CoV-2 infection. There are currently no specific drugs approved by the FDA therefore treatment is to focus on support and management of complications.
*MIS-C is referred to by ECDC as Pediatric Inflammatory Multisystem Syndrom or PIMS.
Updated Animal Testing Guidance and Recommendations for Priorities
Key points include:
- Routine testing of animals for SARS-CoV-2 is not recommended.
- The decision to test an animal (including companion animals, livestock, and wild or zoo animals) should be agreed upon using a One Health approach between appropriate local, state, and/or federal public health and animal health officials.
- Veterinarians are strongly encouraged to rule out other, more common causes of illness in animals before considering SARS-CoV-2 testing.
Outline takes participants through:
- Identifying strategies to reduce the spread of COVID-19
- Components of COVID-19 case investigation
- Requirements for protecting health information
- COVID-19 case investigation protocol
- Application to real life scenarios
People Who Are at Higher Risk for Severe Illness
Updated list of conditions that are high risk for severe illness, in addition to previously listed conditions, the list now includes:
- People with preexisting serious heart conditions
- And added to examples of immunocompromised conditions; cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, prolonged use of corticosteroids and other immune weakening medications
FAQs for Wildland Firefighters
FAQs for wildland firefighters were added including guidance such as:
- Isolate as a unit if possible
- Allow for social distancing upon arrival to duty station for 14 days if possible
- Encourage self-monitoring for symptoms, consider daily temperature checks and symptom screening
- Many of the CDC’s COVID-19 Guidance for shared or congregate housing applies to fire camps
Financial resources are being made available to support COVID-19 response. New funding added to already existing funding includes:
- $10.25B to state, local and territorial health departments for detection, response and prevention through Paycheck Protection Program
- $631M to 64 jurisdictions distributed through existing network of Epidemiology and Laboratory Capacity cooperative agreement through CARES Act
Video library was updated to include or update content on:
- Prevention and Symptoms (20 videos)
- Nursing Home (1 video)
- Public/Private sector (5 call recordings
- Travel (7 videos)
- Spanish (21 videos)
- American Sign Language (18 videos)
- Ad Council (3 videos)
- CDC Briefing room (3 videos)
Schools and Child Care Programs
Decision tools for child care, youth programs and caps, and school reopening were posted along with other resources for k-12 schools to:
- Plan, prepare and respond
- FAQs for Administrators
- Checklist for teachers & Parents
COVID-19 Testing by Laboratories: Q&A
FAQs for Labs were updated to include information on:
- How to access lab testing
- Specific instructions for test developers
- Ordering supplies such as swabs, regents, PCR assays
CDC Environmental Health Practitioners Webpage
An information page targeting Environmental Health Practitioners was published. Topics include:
- Management at congregate facilities and shelters
- General population disaster shelters
- Correctional and detention facilities
- Retirement and independent living facilities
- Childcare programs that remain open
- Cooling centers
- Cleaner Air shelters and spaces
- Parks and recreational facilities
- Cleaning and disinfection
- Reopening guidance for public spaces, workplaces, businesses, schools, and
- Community facilities
- Food safety
- For grocery & food retail workers
- Meat and poultry processing
- Food poisoning prevention
- Water Safety
- Water & COVID-19 FAQs
- Building water systems
- Public pools, hot tubs, water playgrounds during COVID-19
- Solid Waste & Debris
- Lab waste
- Environmental infection control
CDC Staffing Resources
New staffing resources were added to complement of human resources to assist local health departments with COVID-19 responses. A fact sheet illustrates organizations available to provide staffing support including:
- State Service Commission
- CDC staffing
Additional guidance is posted.
Contact tracing training, training plans, and digital tools were updated and released. A 64 page contact tracing plan template and guidance was published. Additional tools are provided for non-governmental organizations and academia.
Management of Healthcare Workers Exposed to or with Suspected or Confirmed COVID-19: Non-US Healthcare Settings
Updates were added to managing exposed healthcare workers in non-US healthcare settings. Includes a flow chart for management of healthcare workers with exposure.
Guidance on Unsheltered Homelessness and Coronavirus Disease 2019 (COVID-19) for Service Providers and Local Officials
CDC Provided update to interim guidance on people experiencing unsheltered homelessness. Changes include:
- Emphasis on whole community approach
- Clarification of outreach staff guidance
- Clarification of encampment guidance
COVID-19 National Death Forecast Models
National Death Forecast models were updated.
Resource Page for Manufacturing Workers and Employers
Facilities are to develop infection control plans for continuing operations in the setting of COVID-19 and should:
- Work directly with appropriate state and local public health officials and occupational safety and health professionals
- Incorporate relevant aspects of CDC guidance, including but not limited to CDC’s Critical Infrastructure Guidance; and
- Incorporate guidance from other authoritative sources or regulatory bodies as needed.
Workers exposure risk should be kept to a minimum, factors affecting risk in workplaces include:
- Distance between workers
- Duration of contact
- Type of contact (droplet exposure and contact w/ contaminated surfaces)
Additional resources for employers are available on the page such as guidance for:
- Cloth face coverings
- Educational posters and materials
- Cleaning and disinfection
- Screening workers
- Managing sick workers
List of Respirators Tested by the National Personal Protective Technology Laboratory
Various commercially available Filtering Facepieces were tested for efficiency by NIOSH standard testing procedure (STP) TEB-APR-STP-0059 and found minimum efficiency ranging from 11.2-99.83% and maximum ranging from 33.90-100%. A list showing specific products tested and associated efficiencies can be found here:
Spreadsheet Estimator Tool for COVID-19 Demand for Hospital Based Services
Download COVID-19Surge here, and FAQs can be found here:
FAQs for Healthcare Practitioners
Topics covered include:
- Testing and Diagnosis
- Treatment and Management
- Obstetrical Care
- Drug Therapies
- Patients with Asthma
- Patients with Liver Disease
- Patients with Hypertension
- Waste Management
Pediatrics and Child Healthcare Updates
- It is suggested to maintain vaccinations, and reach out to children who have missed vaccinations due to quarantine.
- Clinics should attempt to separate well baby/child check-ups from sick child care.
- COVID-19 in children is generally mild where in one study of 2000 pediatric patients only 5% had severe symptoms and 0.6% had critical respiratory failure.
Updated Guidance on What To Do If Your Pet Gets Sick
- If your pet tests positive, isolate the pet from everyone else, including other pets.
- Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or any other products not approved for animal use.
- Only a few pets have been confirmed to be infected with the virus that causes COVID-19. Some pets did not show any signs of illness, but those pets that did get sick all had mild disease that could be taken care of at home. None have died from the infection.
- If you suspect COVID-19, call a veterinarian first.
- Pets with confirmed infection with the virus that causes COVID-19 should be restricted to isolation in the home until a veterinarian or public health official has determined that they can be around other pets and people.
Factors to Consider When Planning to Purchase Respirators
Considerations for purchasing respirators from another country guidelines were issued by the CDC. During the current PPE shortage, products are on the market that do not meet FDA standard requirements, or the FDA’s Emergency Use Authorization. Three most common problems are:
- Documents are altered so the Filtering Facepiece Respirators (FFR) appear to comply with a standard, but they do not.
- Certifications marks are counterfeit
- Manufactures’ names, logos, and model numbers are counterfeit
Factors for purchasers
- Evaluate the device, if possible, with samples for filtration, fit, head/harness design
- Evaluate the manufacturer and seller to determine if devices tested in an ISO/IEC 17025 accredited lab, vet all contact information with dated photos and videos of the models being purchased, investigate the financial strength of US intermediary
- Evaluate the contract: KN95 FFRs are approximately $2-$3/unit, if paying more likely overpaying, if paying less product may be suspect. (as of this printing 5/12/2020). Do no pre-pay. Establish provisions to protect your purchase such as financially guarantee the authenticity of the products.
Managing Workplace Fatigue
Tactics for workers and employers to manage workplace fatigue were issued by the CDC. Under regular circumstances adults need 7-9 hours of sleep per night, along with opportunities for rest while awake. Lacking these can lead to fatigue which increases risk for injury, deteriorating health, and effectiveness at job tasks. General strategies for workers:
- Recognize in more stressful circumstances, more sleep may be needed to recover
- Optimal sleep happens in a dark, cool quiet room
- If it takes longer that 15 minutes to fall asleep, then set aside time before bedtime to aid relaxation (such as meditating, deep breathing, progressive muscle relaxation)
- Before beginning a long stretch of shifts try “banking your sleep” by getting extra hours longer than typical
- After a long stretch of shifts, it may take several days of extended sleep to recover
- Avoid sunlight or bright lights 90 minutes before attempting sleep if possible
- Naps of 90 minutes before working a night shift can reduce feeling tired at work
- Eat healthy foods and stay physically active
- Before going to sleep avoid foods and drinks that make sleeping more difficult such as alcohol, heavy meals, caffeine, nicotine.
General strategies for Employers:
- Create culture of safety with clear communication between management and workers.
- Recognize signs of fatigue (e.g. yawning, difficulty keeping eyes open, inability to concentrate)
- The Epworth Sleepiness Scale is a short survey that can be posted for workers to quickly rate their fatigue.
- Create a non-punitive method for reporting when workers or colleagues are too fatigued to work safely.
- Develop a process to relieve a worker from their duties if too fatigued to work safely, such as these if possible:
- Assign workers just starting their shifts safety critical tasks
- Rotate workers or groups through tasks that are repetitive and/or strenuous (clean and disinfect between workers)
- Schedule physically or mentally demanding workloads in shorter shifts and/or during day
- Educate workers on sleep deprivation recognition and remedies
- Allow adequate off-duty time to meeting obligations and sufficient rest and recovery
- Rotating shift work should rotate forward
- Avoid shifts of 12 hours if possible
- Provide alternative transportation
Funeral Guidance for Individuals and Families
CDC Released funeral guidance for individuals and families. People continue to get exposed to COVID-19 at funerals by attendees who were not feeling sick. Considerations when making funeral arrangements:
- People who have died form COVID-19 can be buried or cremated, no need to change the wishes of the deceased.
- No need to delay funeral services due to COVID-19, unless scheduling with funeral service providers requires due to a large number of deaths.
- There is currently no known risk associated with being in same room at a funeral service or visitation with the body of a deceased person who had COVID-19 after the body has been prepared for viewing.
- Some traditional funeral practices that require touching the body may need to be changed.
Considerations for during the funeral:
- Hold modified funerals by limiting attendance to a small number of immediate family members and friends, and an additional memorial service in the future when social distancing guidelines are less restrictive.
- Attempt virtual funeral services, visitations, and memorial tributes by on-line video streaming if possible?
- Hold services and gatherings in a large, well-ventilated area or outdoors, as circumstances and traditions allow
- On-line guestbooks or memory books
- Attendees should nod, bow, or wave instead of holding or shaking hands, hugging, or kissing
- Space seating 6 feed apart for attendees who do not live in the same household
- Those who are sick, or have a household member or close contact who is sick, or at higher risk of severe illness should NOT attend in person
Interim Laboratory Biosafety Guidelines
CDC Updated Lab Biosafety recommendations for point of care testing. Labs are to:
- Perform site specific and activity specific risk assessments
- Follow standard precautions (hand hygiene, PPE of lab coats, gowns, gloves, eye protection), routine lab practices for decontamination
- Test in BioSafety Level 2 lab settings
Healthcare Infection Prevention and Control FAQs
CDC Healthcare Infection Prevention FAQs added recommendations for behavioral health and psychiatric hospitals. Facilities can tailor certain recommendations to their setting (i.e. not using alcohol-based hand sanitizer in drug and alcohol treatment facilities). Challenges and potential solutions on topics include cohorting, group therapy sessions, cloth face coverings, dining, and smoking.
CDC Guidance on Interpreting COVID-19 Test Results
- Viral tests using swaps of the inside of the nose tell if there is a current infection of SARS-CoV-2, the virus that casus COVID-19.
- Not everyone needs to be tested. The CDC has guidance for who should be tested, but decisions about testing are made by state and local health departments or healthcare providers.
- If you have symptoms and want to get tested, call your healthcare provider first.
- If you test positive, take protective steps as outlined on the CDC webpage.
- If you test negative, you probably were not infected, but that does not mean you will not get sick. It is possible you were tested early in your infection, or you could be exposed later and develop the illness.
CDC Released Recommendations for the General Public as to When to Wear Gloves
Gloves should be worn:
- When cleaning
- When caring for someone who is sick
- Be sure to wash hands directly after removing the gloves
Gloves are not necessarily protective from COVID-19 and therefore not needed outside of these two instances. (For example when using a shopping cart, or an ATM). Guidelines and recommendations for glove use in a healthcare or workplace settings will differ from the recommendations for the general public.
CDC Released Document Detailing CDC Activities and Initiatives Supporting the COVID-19 Response
Also includes the President’s plan for opening America up again. The document is a summary of efforts to date, resources developed and deployed, and the overarching strategy and criteria for a phased re-opening. Criteria and phases provided here.
CDC Released Key Resources for Leaders to Contain the Spread of COVID-19 During Reopening Activities
Provides guiding documents for:
- Infection prevention and control
- Laboratory capacity
- Community mitigation
- Surveillance and data analytics
- Contact tracing
- Staffing support
CDC Cruise Ship Crew Disembarkations Were Updated
Includes the following vessels:
- Disney Wonder
- Liberty of the Seas
- Carnival Fantasy
- Norwegian Escape
- Norwegian Epic
- Ociania Marina
- Oceania Sirena
- Norwegian Joy
CDC Released FAQs For All Laboratories
Includes special content for:
- Accessing laboratory testing
- Test developers
- Content regarding serology (antibody testing)
- Ordering supplies
CDC Released Guidance for What to Do If You Are Sick
Details were added to the guidance on what to do if you are sick including an infographic. A Self Checker link provides a quick decision tree on actions to be taken based on location, age, symptoms and exposure. Additional details for steps to prevent the spread if you are sick include:
- Stay home except for medical care
- Separate yourself from other people
- Monitor symptoms
- Call ahead before visiting your doctor
- Wear cloth covering over your nose and mouth
- Cover coughs and sneezes
- Clean hands often
- Avoid sharing personal household items
- Clean all “high-touch” surfaces everyday
- Use the decision tree on when to end home isolation
CDC Considerations for Public Pools, Hot Tubs, and Water Playgrounds
The CDC directs facility managers to make decisions to reopen collaboratively with local health officials.
These strategies can prevent the spread of COVID-19:
- Promote hand hygiene and ensure adequate supplies of soap, hand sanitizer, paper towels, no-touch trash cans
- Encourage wearing cloth face coverings BUT NOT WHILE IN THE WATER.
- Educate staff patrons and swimmers to stay home if ill
- Provide ample signage to educate on above topics, use PA system with regular announcements, make use of social media and web-pages for messaging
These strategies will clean and maintain a healthy environment:
- Clean and disinfect frequently touched surfaces daily or more
- Consult with the company or engineer that designed the aquatic venue to decide which EPA approved disinfectants are best.
- Establish methods for disinfecting shared furniture, equipment, towels, clothing. Keep cleaned separate from contaminated
- Ensure ventilation systems of indoor spaces operate properly. Increase outdoor air circulation as much as possible without posing safety risk.
- Ensure water systems are safet to use after prolonged shutdown to minimize risk of legionnaires’ disease.
- Modify deck layouts to ensure social distancing. Provide visual cues or barriers as guides for patrons.
- Discourage sharing of equipment (kickboards, noodles, etc) with those they don’t live with
These are strategies to consider for operations of an aquatic venue:
- Life saving or emergency evacuation activities are exceptions to 6 feet social distancing rule.
- Protect vulnerable staff by offering telework. Limit staff and patrons from local area only if feasible. Make use of staggered or rotated shifts
- Lifeguards to remain focused on water safety, not monitoring of handwashing, use of face coverings, etc.
- Adhere to local orders/policy regarding number of people allowed at gatherings. Encourage staggered drop off, parents consider if their children are capable of maintaining social distance, limit nonessential visitors, volunteers and activities.
- Provide staff training for communication methods, signs & symptoms, leave policies, isolation requirements, back up staffing plan.
CDC Released Refined Contact Tracing Training Plan
Topics covered include:
- Boots on the ground foundational epidemiology
- Contact Investigation Training
- Ways to prevent the spread of COVID-19
- Real-time legal response: Focus on quarantine, isolation, and other social distancing
- Infection prevention and control in the household
CDC Released Guidance for Long Haul Truck Drivers
- Maintaining social distance from truck stop attendants, store workers, dock workers, other truck drivers, anybody with symptoms. Avoid touching nose, mouth, eyes after contacting surfaces touched by others.
- Make a plan with employer and family as to what to do if becoming symptomatic while on the road.
- Limit exposure by
- Limiting time spent outside of truck cab during fueling, loading and unloading
- User electronic invoicing for fuel, deliveries, etc.
- Use radio/phone to talk with dock managers or other drivers
- Pack food, water & supplies to limit the number of stops
- Keep truck well ventilated
- Clean and disinfect high touch areas of the truck regularly (door handle, steering wheel, seat belt, turn signal, wiper controls, etc.)
- If a third party must access the interior of truck (mechanic, other driver, inspector for example), request that the third party clean and disinfect before turning it back over.
- Do not share tools or PPE such as hard hats, vests, safety glasses
- Use pre-qualified truck stops or hotels identified by employer as having appropriate COVID-19 protections.
- When team driving, wear cloth face coverings inside the truck and avoid sharing bedding in the sleeper berth.
CDC Decision Tool
CDC Updated Decision Tool for guidance in cleaning and disinfecting public spaces, workplaces, businesses, schools and homes. The tool continues the guidance of:
- Develop a plan
- Implement the plan
- Maintain and revise
And clarifies the cleaning practices based on if the area is indoors, has been occupied in the past 7 days, is a frequently touched object, and if the object is porous or non-porous.
CDC Highlights FAQs from Cybersecurity and Infrastructure Security Agency (CISA)
CDC highlighted previously released guidance and FAQs from CISA for 16 Essential Critical Infrastructure Workers. There are 16 sectors considered critical: Communications, Chemical, Critical Manufacturing, Commercial Facilities, Dams, Defense Industrial Base, Emergency Services, Energy, Financial, Food and Agriculture, Government Facilities, Healthcare and Public Health, Information Technology, Nuclear Reactors, Materials and Waste, Transportation Systems, Water.
CDC Difference Between Quarantine and Isolation
- Quarantine is used to keep someone who might have been exposed to COVID-19 away from others. Quarantine helps prevent spread of disease that can occur before a person knows they are sick or if they are infected with the virus without feeling symptoms. People in quarantine should stay home, separate themselves from others, monitor their health, and follow directions from their state or local health department.
- Isolation is used to separate people infected with the virus (those who are sick with COVID-19 and those with no symptoms) from people who are not infected. People who are in isolation should stay home until it’s safe for them to be around others. In the home, anyone sick or infected should separate themselves from others by staying in a specific “sick room” or area and using a separate bathroom (if available).
CDC Air Travel Toolkit for Airline Partners
Toolkit includes messages, graphics and products to:
- Support timely messaging to travelers and employees
- Share CDC resources with airline partners
- Help airline partners develop additional COVID-19 materials
- Media includes Fact Sheets, PSAs, and sample social media posts, graphics for electronic messaging for Kiosks, printable posters.
CDC General FAQs
Topics include risk, transmission, testing, diagnostics, treatment for COVID-19.
A specialty section on waste management was added:
- Wastewater and sewage companies do not need to take special precautions beyond standard precautions and basic hygiene.
- Medical waste from facilities with COVID-19 is no different than waste coming from facilities without COVID-19 patients.
CDC Infection Prevention FAQs for Healthcare Practitioners
Topic include guidance on:
- Environmental Services (Housekeeping) PPE requirements and the practice of waiting sufficient time based on the number of room air changes per hour.
- PPE supply preservation methods
- Performing nasopharyngeal swabs
- Long term care facility processes and practices
CDC Updated Resources for Management of COVID-19 in Correctional and Detention Facilities
Includes PowerPoint training. Training provides specifics on PPE, employee and intake inmate screening, and strategies to achieve social distancing.
CDC Standardizing How COVID-19 Testing Data is Reported
CDC Suggestions for Employees Coping with Stress and Building Resilience
- Recognizing symptoms of stress such as feeling irritation, anger, uncertaintaty, tired, sad, lacking motivation, trouble sleeping or trouble concentrating.
- Common work-related factors such as fear of virus exposure, familial responsibilities, different workload, lack of access to tools & equipment, uncertainty about the future, technical difficulties with new communication tools, different workspace and/or work schedule.
- Tips to build resilience:
- Communicate with co-workers openly about stressors and identify solutions, remind about mental health resources in workplace such as EAP.
- Identify things over which you do not control, identify resources available.
- Develop a consistent daily routine if possible, including regular sleep schedules, set time to end work (if from home).
- Remind self and others we all have a role to contribute and understanding the facts about COVID-19 and how to protect yourself and others.
- Take breaks from consuming pandemic related news and social media.
- Connect with others, check in with others.
- Continue any current treatment for mental health conditions.
Links to multiple reputable help lines/chats are included in the post:
CDC Updated Recommendations and Priorities for Testing Suspected Cases
- Hospitalized patients with symptoms.
- Healthcare facility workers, workers in congregate living settings, and first responders with symptoms.
- Residents in long-term care facilities or other congregate living settings, including prisons and shelters, with symptoms.
- Persons with symptoms of potential COVID-19 infection, including: fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat.
- Persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans.
Additionally, CDC updated recommendation to nucleic acid or antigen test to diagnose acute infection (not antibody testing).
CDC Cruise Ship Disembarkation Requirements
Compliance with CDC Requirements to Safely Disembark their Crew Members.
CDC FAQ for People with Liver Disease
In some cases, severe COVID-19 infections can appear to cause liver damage.
CDC Staffing Resources
Public Health Staffing Workforce to support return to economic activities are broadening:
- CDC resources include contact tracing staffing, staffing guidance, COVID-19 Response Corps, COVID-19 Job Corps, training resources.
- Additional non-profit organizations from the US Digital Response, Regugee.rescue.org, Medical Reserve Corps, YMCA.
- Staffing agencies providing support include Generation USA, AllSTEM Connections, LevelUP Capital Solutions, Securitas Critical Infrastructure Services.
CDC Updated Web Page with FAQs for General Business
- Handling suspected or confirmed cases of COVID-19 in the workplace, isolating employees immediately until meeting ‘discontinue home isolation’ criteria, and not requiring sick employees to provide a COVID-19 test result or healthcare provider’s note to validate the illness.
- Reducing the spread such as erecting barriers to protect customers, cleaning and disinfecting surfaces, increasing physical distance between people, screening employees,
- Promoting healthy operations by social distancing, drafting/updating non-punative “emergency sick leave” policies, manage meetings and conference to maintain social distancing
- Cleaning and disinfection of the workplace instruction, and chemical usage, HVAC
- Critical infrastructure and management/protection of essential employees.
CDC Released Contact Tracing Training and Guidance
Sample plan may be useful with large employers who have developed their own contact tracing teams/protocols. Content and learning objectives include:
- Primary components of COVID-19 contact tracing
- Requirements for protecting health information
- COVID-19 contact tracing protocol
Toolkit for workers or volunteers with little or no experience conducting contact tracing found here.
In depth training materials contact tracing materials can be found here.
CDC Updates FAQs for Children and COVID-19
FAQs for Children and COVID-19 were updated to cover topics such as:
- Children are at lower risk of severe illness
- Strategies to keep your child healthy such as social distancing, hand hygiene, laundry guidance
- Reminder that children under age 2 should not wear a cloth face covering or mask
- Resources for talking with children about COVID-19 outbreaks
- Managing activities and mental health while school’s out
CDC Updated Guidance for Caring for Someone Sick at Home
Guidance was updated for caring for someone sick at home to include:
- Provide support and help cover basic needs such as pet care, grocery shopping/filling prescriptions
- Treat symptoms with lots of fluid and rest
- Watch for warning signs to escalate care if needed. Call 911 right away if caregivers observe difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to wake up, bluish lips or face.
- Caregivers are to limit contact, eat in separate rooms, avoid sharing personal items, wear face coverings and/or gloves and track their own health
CDC Released a Decision Memo
A decision memo guiding when to end isolation for persons with COVID-19 based on symptoms was released. Due to impracticality of continued testing during community transmission, there is a need to base end of isolation decisions on “time-since-illness-onset” and/or “time-since-recovery.”
- Emerging evidence shows that viable COVID virus are no longer shed by most infected persons 10 days after the onset of symptoms.
- Viable virus are unlikely to be shed from most infected persons 3 days after recovery (recover = no fever without medications)
- It should be noted, these guidelines apply to the typical population and the isolation period will need to be longer for persons in high risk for serious illness
CDC Provided Guidance if a Pet or Service Animal Tests Positive for COVID-19:
- If positive for the virus that causes COVID-19, isolate the pet from everyone else, including other pets.
- Do not wipe or bathe pet with chemical disinfectants, alcohol, hydrogen peroxide, or any other products not approved for animal use.
- Only a few pets have been confirmed to be infected with the virus that causes COVID-19. Some pets did not show any signs of illness, but those pets that did get sick all had mild disease that could be taken care of at home. None have died from the infection.
- If suspected or confirmed COVID-19 infection, call a veterinarian.
- Pets with confirmed infection with the virus that causes COVID-19 should be restricted to isolation in the home until a veterinarian or public health official has determined that they can be around other pets and people.
CDC Updates for Guidance to Dental Clinics to Reduce Non-Symptomatic Transmission
- Implement source control (require facemasks or cloth face coverings) for everyone entering the dental setting (dental healthcare personnel [DHCP][ 1 ] and patients), regardless of whether they have COVID-19 symptoms in order to address asymptomatic and pre-symptomatic transmission.
- Actively screen everyone on the spot for fever and symptoms of COVID-19 before they enter the dental setting.
- Actively screen Dental Healthcare Personnel on the spot for fever and symptoms before every shift.
CDC Released Guidance for Veterinary Clinics’ Usage of PPE
Updates for guidance to Veterinary Clinics’ usage of PPE during animal care were released. The guidelines use a cautious approach and Veterinarians should be aware of the current shortage of PPE from high demand in human healthcare settings.
- Veterinarians should consider their current PPE supply and rate of PPE use and review Strategies for Optimizing the Supply of PPE. Consider using reusable PPE where possible.
- Veterinarians and their staff should review the concepts in the NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel, which outlines routine infection prevention practices to minimize transmission of zoonotic pathogens from animals to veterinary personnel.
CDC Updated Resources for Community and Faith-Based Leaders
Resources for community and faith-based leaders were updated including:
- A checklist for leaders & administrators
- Cleaning and disinfecting public spaces: everyday steps
- Video describing the role of the community health worker in the Latino community
CDC Updated Mathematical Models for Projected COVID-19 Deaths
Mathematical models for projected COVID-19 deaths were updated. There are now 9 institutions generating models predicting numbers of deaths for the next 30 days. Individual states models are also available.
CDC Updated Guidance for Mail, Parcel, Food, and Grocery Delivery Drivers
Guidance for mail, parcel, food, and grocery delivery drivers was updated to educate this group of essential workers.
- Primary mode of virus transmission is from person to person.
- It may be possible that a person can become infected by touching a surface that has the virus on it and then touching their own mouth, nose, or eyes. However, this is not thought to be the main way the virus spreads.
- Workers can protect themselves and others by
- Stay home when sick
- Wear a cloth face covering in public settings
- Limit contact, maintain distance of 6 feet, do not share scanners, pens, tools with customers, do not touch face, if using machine washable gloves at the end of use store them for washing and then wash hands
- Clean and disinfect high touch surfaces, pens, clipboards, electron signature pads
- Exercise proper hand hygiene
- Before, during and after food prep
- Before eating
- After using the toilet
- After blowing your nose
- Before and after work shifts, work breaks, making a delivery
- After putting on, touching, or removing cloth face covering
- After touching frequently touched surfaces such as doorbells or door handles
- Before wearing and after removing cold-weather gloves
- Before and after pumping gas
CDC Released Guidance for Cleaning and Disinfecting a Non-Emergency Vehicle
- If transporting people with known or suspected COVID-19 infection N95 respirator and eye protection is recommended to be worn by the driver. Passenger should wear cloth face covering. Contact should be limited, and hand hygiene should be practices
- At a minimum, clean & disinfect commonly touched surfaces at the beginning and end of each shift and between transporting passengers who are visibly sick.
- Keep doors/windows open for adequate ventilation when cleaning with chemicals. Use of disposable gloves and gown for cleaning activities are recommended.
- For hard non-porous surfaces inside the vehicle (such as arm rests, door handles, seat belt buckles) clean with detergent or soap & water if visibly dirty. Then disinfect using EPA registered Antimicrobial products, diluted household bleach solutions, or Alcohol solution of 70%.
- For soft or porous surfaces such as fabric seats, remove any visible contamination, use EPA approved products that are compatible with soft surfaces.
- Gloves and gown should be removed after cleaning, immediately followed by proper hand hygiene. If gown not available, work clothes or uniform worn during cleaning and disinfecting should be laundered using the warmest appropriate water setting and dry items completely.
CDC Clinical Tips for Healthcare Providers
Clinical tips for healthcare providers including specifics for:
- Treatment and Prophylaxis: The NIH is providing guidance and updates on efficacy of drugs and therapeutics, there is currently no FDA approved post exposure treatment.
- Symptoms and Diagnosis: Non-respiratory symptoms might appear before fever and lower respiratory tract symptoms. Children may have fever and cough at symptom onset as often as adult patients. CT scans should not be used to screen for COVID-19 or as a first-line test to diagnose COVID-19. CT should be used sparingly, reserved for hospitalized, symptomatic patients with specific clinical indications for CT.
- Co-Infections in people with COVID-19 have been reported. Several patients with COVID-19 have been reported presenting with concurrent community-acquired bacterial pneumonia. Antibiotics are to be used appropriately.
- Severe Illness: There is potential for some patients to rapidly deteriorate one week after illness onset, an average time to acute respiratory distress syndrome (ARDS) ranges from 8 to 12 days. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels, elevated lactate dehydrogenase, high CRP, and high ferritin levels may be associated with greater illness severity.
CDC Provides Change in Return to Work Criteria for Healthcare Providers
- Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for those with symptoms and the ‘time-based strategy’ for those without symptoms and updated these to extend the duration of exclusion from work to at least 10 days since symptoms first appeared. This update was made based on evidence suggesting a longer duration of cultural viral shedding and will be revised as additional evidence becomes available.
- Based on this extension of the symptom-based and time-based strategies, language about the test-based strategy being preferred was removed.
CDC Genome Sequencing Effort
Genome sequencing effort being coordinated by the CDC is leveraging a network of clinical and public health laboratories, academic institutions and the private sectors. Goal is to generate information about the virus that will strengthen COVID-19 mitigation strategies.
CDC Issues Guidance Document and Decision Tool for Re-Opening Facilities
Includes guidance to:
- Develop, implement, revise plan
- Actions based on area characteristics such as
- Indoor v. outdoor
- Occupied within the last 7 days
- Frequently touched surfaces/objects
- Types of Materials in the space
- Considerations for custodial staff exposure and PPE needs are to be included in the plan
- Include mitigation strategies for communities in the re-opening plan
CDC Contact Tracing Guidance Was Released
Contact tracing is a critical disease control measure implemented by health authorities to prevent the spread. These key concepts were highlighted.
- Contact tracing is a specialized skill, includes interviewing patients, educations of contacts, adherence to confidentiality, understanding of medical and disease processes
- Time is of the essence when identifying contacts who may have been exposed to begin isolation to stop the spread
- Contact tracing in co-housing or congregate living settings is a priority
CDC Provided Communication Tool Kit
Communication tool kit for domestic travel was provided for SMS, social media, even roadway signage is provided for groups involved in educating travelers.
CDC Updated Downloadable Video Training Library
Video topics include:
- Prevention & Symptoms (19 videos)
- Travel (8 videos)
- In Spanish (14 videos)
- In American Sign Language (18 videos)
- Recorded calls for public/private sector organizations (5 recordings)
- Recorded CDC briefings (3 recordings)
Updates Were Made to Alternative Disinfection Methods of Cleaning and Disinfecting a Building
Updates add to the existing guidance on how to clean & disinfect typical buildings including soft surfaces, electronics, surfaces, outdoor areas, laundering. Alternative Disinfection Methods:
- Efficacy of alternative disinfection methods, such as ultrasonic waves, high intensity UV radiation and LED blue light against COVID-19 virus is not routinely reviewed by the EPA, therefore EPA cannot confirm whether, or under what circumstances such products might be effective against the spread of COVID-19
- CDC does not recommend the use of sanitizing tunnels. There is no evidence that they are effective and chemicals used could cause skin, eyey, or respiratory irritation or damage
- CDC only recommends use of the surface disinfectants identified on List Nexternal icon against the virus that causes COVID-19.
Updates Made to Timing for Cleaning and Disinfecting a Community Facility
Timing and location of cleaning and disinfection of surfaces
At a school, daycare center, office, or other facility that does not house people overnight:
- Close off areas visited by the ill persons. Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours or as long as practical before beginning cleaning and disinfection.
- Cleaning staff should clean and disinfect all areas used by the ill persons, focusing especially on frequently touched surfaces.
At a facility that does house people overnight:
- Follow Interim Guidance for US Institutions of Higher Education on working with state and local health officials to isolate ill persons and provide temporary housing as needed.
- Close off areas visited by the ill persons. Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours or as long as practical before beginning cleaning and disinfection.
- In areas where ill persons are being housed in isolation, follow Interim Guidance for Environmental Cleaning and Disinfection for US Households with Suspected or Confirmed Coronavirus Disease 2019. This includes focusing on cleaning and disinfecting common areas where staff/others providing services may come into contact with ill persons but reducing cleaning and disinfection of bedrooms/bathrooms used by ill persons to as-needed.
- In areas where ill persons have visited or used, continue routine cleaning and disinfection as in this guidance.
- If it has been more than 7 days since the person with suspected/confirmed COVID-19 visited or used the facility, additional cleaning and disinfection is not necessary.
Care for Breastfeeding Women and Infants
- It is unknown do not know whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission.
- Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.
- A mother with confirmed COVID-19 should be counseled to take all possible precautions to avoid spreading the virus to her infant, including hand hygiene and wearing a cloth face covering.
- Breastfeeding mothers working in high exposure risk settings such as healthcare or first responders, ideally would be provided a private, non-bathroom space for milk expression, which are then cleaned and disinfected between uses.
CDC Updated COVID-19 Symptoms
The COVID-19 symptom set was updated indicating people with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.
Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms or combinations of symptoms may have COVID-19:
- Shortness of breath or difficulty breathing
Or at least two of these symptoms:
- Repeated shaking with chills
- Muscle pain
- Sore throat
- New loss of taste or smell
People should seek medical attention immediately if they have any of these emergency warning signs:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
*This list is not all-inclusive.
Meat & Poultry processing facilities are considered essential workers and have experienced multiple outbreaks in the US. Meat and poultry processing employers are to follow the previously issued Guidance on preparing workplaces for COVID-19, in addition to the recommendations below.
- A qualified workplace coordinator should be identified who will be responsible for COVID-19 assessment and control planning.
- Configure workstations and communal work environments so the alignment of workers should follow recommendations for distancing and/or partitioning (See image).
- Heating, ventilation, and A/C should minimize workers’ exposure by avoiding directing blowing air from one worker to another. Personal fans should be removed. Heat hazards need to be kept in consideration with these changes in air flow.
- Handwashing stations or hand sanitors should be placed at multiple locations. Touch free options are optimal.
- Add clock-in / clock-out stations that are spaced apart if possible.
- Arrange breakrooms or identify alternative areas to accommodate adequate spacing for breaks and lunches.
- A list of work practices includes; single file spaced lines, stagger schedules and break-times, mark floors to remind social distancing, discourage carpooling, educating workers on symptom recognition and reporting and encourage cloth face coverings.
- Employers should consider screening workers before entry into the workplace based on a written program developed in coordination with local public health authorities and may include:
- Verbal symptom check
- Temperature check by trained personnel who wear proper PPE
- Issue PPE per OSHA standards
Dental Settings guidance was revised and updated as follows:
- To address asymptomatic and pre-symptomatic transmission, implement source control (require facemasks or cloth face coverings) for everyone entering the dental setting (dental healthcare personnel [DHCP] and patients), regardless of whether they have COVID-19 symptoms.
- Actively screen everyone on the spot for fever and symptoms of COVID-19 before they enter the dental setting.
- Actively screen DHCP on the spot for fever and symptoms before every shift.
The CDC COVID-19 Response Corps is supplying staffing for local health authorities in three main ways:
- CDC’s COVID-19 Response Corps. The COVID-19 Response Corps is a nationwide community-focused initiative to provide surge staffing and resources in state, tribal, local, and territorial health departments on the frontlines of the fight against COVID-19.
- CDC Foundation: COVID-19 Corps Jobs. In support of CDC’S COVID-19 Response Corps, the CDC Foundation is urgently recruiting candidates for critical positions nationwide. Interested parties should go to the
- CDC Foundation website and apply directly for positions.
- COVID-19 Training Resources. CDC’s COVID-19 trainings are available on TRAIN, a national learning network that provides training opportunities to professionals who protect and improve the public’s health.
- Imbedded field staff are distributed as indicated in the map below.
Therapeutic options for clinicians were released in summary.
Currently, there are no drugs or other therapeutics approved by the US Food and Drug Administration to prevent or treat COVID-19. Clinical management at this time includes:
- Infection Prevention and Control
- Supportive care including supplemental oxygen
- Mechanical ventilatory support when indicated