Author: COVID-19 NEWS

Key PointsAdult Day Services Centers (ADSCs) provide social or health services to community-dwelling adults aged 65 and over and adults of any age living with disability.
Older adults and persons with disabilities are at highest risk for severe illness from COVID-19 including hospitalization, intensive care, and death.
ADSC administrators and staff can help protect themselves and program participants (that is, adults attending ADSCs) from COVID-19 by promoting and engaging in preventive behaviors that reduce spread and maintain healthy operations and environments at ADSC facilities.
Top of PageIntroduction
Adult Day Services Centers (ADSCs) are professional care settings where community-dwelling adults receive social or health services for some part of the day. (For further information about ADSCs, visit National Adult Day Services Association [NADSAexternal icon] and Regulatory Review of Adult Day Services: Final Reportexternal icon). ADSCs often serve adults age 65 years or older who may require supervised care and adults (of any age) living with dementia, cognitive decline, or disability. ADSCs are designed to provide a safe, community-based group setting where specific needs are addressed and individualized therapeutic, social, or health services are delivered. These centers provide needed services to participants and also support caregiver employment and provide respite, which benefits the mental health of both participants and caregivers.
ADSCs provide important services for participants and caregivers, but some ADSC characteristics – such as frequent social activities, group dining facilities, communal spaces, and shared transportation – may increase the risk of COVID-19 spread.
Administrators, staff, and volunteers at ADSCs should use the following guidance to plan for and implement prevention strategies to prevent COVID-19 spread at their facilities. This guidance is meant to supplement—not replace—any Federal, state, tribal, local, or territorial public health and safety laws, rules, and regulations with which adult day services center programs must comply. CDC has also developed recommendations for participants at ADSCs and their caregivers. For additional information on steps for reducing risk and other prevention strategies visit extra precautions for older adults and how to protect yourself and others.
Top of PagePromote behaviors that reduce spread
Encourage COVID-19 vaccination

Stay home when appropriate
Educate staff and participants about when they should stay home and when they can safely return to the ADSC.

If staff and participants are unsure whether they should stay home, they or their caregiver can use the coronavirus self-checker to help them decide.
Staff and participants should not enter the ADSC from the screening area if they:
Have symptoms of COVID-19, including:
Fever of 100.4o F (38.0o C) or higher or report feeling feverish
Presence of signs of illness, which could include flushed cheeks, sweating inappropriately for ambient temperature, or difficulty with ordinary tasks

Are undergoing evaluation for COVID-19 (such as pending viral test)
Have been diagnosed with COVID-19 in the prior 10 days (or longer if individual had severe or critical illness or if they are immunocompromised).
Have had close contact to someone with COVID-19 during the prior 14 days

Provide education on COVID-19 related symptoms and reminders to notify center staff if anyone is feeling symptoms of COVID-19. This is critical to provide timely assistance
Wear a mask and assist participants in wearing theirs
Staff should wear a mask when in the presence of others. Masks protect the wearer, as well as those around them. Masks work best when everyone wears one.
Masks should cover your nose and mouth, fit snugly, and have multiple layers.
Wearing masks may be difficult for people with sensory, cognitive, or behavioral issues; people with some disabilities; or people with dementia. Staff members should pay close attention and provide necessary support to participants who have trouble remembering to put on a mask, keeping it on, and removing it when needed.
Masks should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
Masks should not be worn by a person with a disability who cannot wear a mask, or cannot safely wear a mask.
Masks should not be worn by a person for whom wearing a mask would create a risk to workplace health, safety, or job duty as determined by the workplace risk assessmentexternal icon.

A mask is not a substitute for physical distancing. Continue to keep at least 6 feet between yourself and others, when possible, even when wearing a mask.
More information on masks is available at Guidance on Wearing Masks
Wash your hands often, and ensure participants can wash their hands appropriately
Staff and participants should wash hands often with soap and water for at least 20 seconds, especially after you have been in a public place or common area or after blowing your nose, coughing, or sneezing.
If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
Staff members should assist people with sensory, cognitive, or behavioral issues, and people with a disability or dementia, who may have challenges washing their hands properly and as frequently as recommended.

Visit CDC’s Life is Better with Clean Hands page to download resources to help promote handwashing.
Top of PageMaintain healthy operations

Reinforce prevention strategies using signs and messages throughout the facility
Display visual posters with instructions for maintaining 6-ft physical distancing, wearing masks, taking daily temperatures, and monitoring for other COVID-19 symptoms. Find free print and digital resources on CDC’s COVID-19 communications page.
Develop signs and plain language messages in alternative formats (for example, large print, Braille for people who have low vision or are blind).
Develop signs and messages in the preferred language(s) of staff and participants. Use COVID-19 easy to read resources, if applicable.
Use tape markings on floors to help people to maintain distancing.
Place directional arrows to establish the flow of traffic.
Designate different doors for entering and exiting center/rooms, if possible.
Post signs in highly visible locations (e.g., at building entrances, in restrooms) that promote everyday protective measures and describe how to stop the spread of germs by properly washing hands and properly wearing masks.
Use reminders for staff and participants to monitor for COVID-19 symptoms.
Broadcast regular announcements on reducing the spread of COVID-19 on public address system, if available.
Include messages (for example, training videos for staff, periodic guidance letters for participants to take home) about behaviors that prevent spread of COVID-19 when communicating with staff, participants, and others who may be in your center.
Please visit CDC’s Toolkit for Older Adults & People at Higher Risk for population specific posters and messaging to be used as reminders to wear a mask.
Health screening
Make employee health screenings as private as possible to prevent stigma and discrimination in the workplace. Do not make determinations of risk based on race or ethnicity and be sure to maintain confidentiality of each individual’s medical status and history. If screening in person, participants, screening staff and employees being screened should wear masks and maintain physical distancing.
Consider virtual health checks for employees and participants (for example, symptom and temperature screening) before they arrive at the center, in accordance with state and local public health authorities and your occupational health services (if applicable).
Before collecting health-related information from staff or participants, center administrators should comply with requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Remember that symptom and temperature screening cannot identify people with COVID-19 who are asymptomatic (do not have symptoms) or are pre-symptomatic (have not developed signs or symptoms yet but will later). Therefore, wearing masks, physical distancing, hand hygiene, cleaning, and other prevention strategies should still be used to reduce transmission.
Refer the individual to their primary care provider immediately or, in case of emergency, call 911, if you think someone is exposed to COVID-19 or may be exhibiting symptoms.
For more information, visit Interim Guidance for SARS-CoV-2 Testing in Non-Healthcare Workplaces.
Isolate and transport staff and participants who have symptoms while at the ADSC
Plan to have an isolation room or area (preferably with access to a dedicated restroom) you can use to isolate a sick participant or staff member. Ensure that isolated participants are wearing masks, are at a distance of 6 feet or greater from others, and remain under supervision.
Staff should isolate people who begin to have these symptoms from others. Prepare a list of all individuals who have been in close contact with sick participant(s) or staff member(s).
Notify an emergency contact regarding the sick person’s symptoms and arrange safe and accessible transportation home. Arrange emergency transport to a healthcare facility for participants or staff with severe symptomspdf icon.
Close off areas used by a sick person and do not use these areas until after cleaning and disinfecting them; this includes surfaces or shared objects in the area, if applicable.
Wait as long as possible (at least several hours) before cleaning and disinfecting. You should ensure safe and proper use of cleaning and disinfection productsexternal icon.
Close off areas used by the person who is sick.
Open outside doors and windows to increase air circulation.
Increase ventilation and wear a mask (in addition to other protection needed for safe use of cleaning and disinfection products) while cleaning and disinfecting.
Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas.

Notify health officials and close contacts

Modify layouts
Arrange tables and chairs to allow for physical distancing. People from the same household can be in groups together. Space seating at least 6 feet apart. Provide visual cues such as tape or chalk to guide spacing.
Increase access to handwashing stations or hand sanitizer dispensers at key locations.
Minimize traffic in enclosed spaces, such as elevators and stairwells. Consider limiting the number of individuals in an elevator at one time and designating one-directional stairwells, if possible.
Ensure the facility entry door and exit door are separate to avoid interaction between incoming and outgoing traffic to ADSC.
Ensure that limiting the number of participants and physical distancing can be maintained in shared rooms, such as television, game, or exercise rooms, or rooms for shared worship services.
Physical barriers and guides
Install plexiglass barriers in reception and other face-to-face interaction areas.
Install physical barriers, such as sneeze guards and partitions, particularly in areas where it is difficult for individuals to remain at least 6 feet apart (for example, reception areas).
Provide physical guides, such as tape on floors or sidewalks and signs on walls, to ensure that individuals remain at least 6 feet apart.
Activities
Alter schedules, such as staggering meal and activity times, and creating pods (that is, forming small groups that regularly participate at the same times) and do not mix with individuals in other groups.
Practice physical distancing and wear masks whether indoors or outdoors, for both staff and participants.
Prioritize outdoor activities over indoor activities when possible. Staff should ensure sun safety for all participants and staff of ADSC.
Clean tools, materials, and computer or other equipment before and after the participant has finished using them, or at least daily.
Postpone musical activities and performances that include playing wind instruments, singing, chanting, or shouting during events, especially when participants are in close proximity to each other.
Avoid holding any in-person events that include people who are not staff in the ADSC. If an event is held, follow COVID-19 event considerations, and consider not serving food or having prepackaged boxes or bags instead of a buffet or family-style meals.
Transportation
Schedule and stagger drop off or pick up times for participants to avoid crowding.
Encourage physical distancing among staff and participants at the entrance and exit during these drop off and pick up times with use of visual cues like tapes and signs.
Transport and bus drivers should practice all safety actions and protocols as indicated for other workers (for example, hand hygiene, masks).
Follow guidance for bus transit operators to clean buses or other transport vehicles.
Seat participants at least 6 feet apart while in transport vehicles.
Drivers should provide ventilation by opening the windows or setting the air ventilation/air conditioning on non-recirculation mode when the vehicle is in service.
Paratransit drivers should take extra care in transporting patients with special needs and take all necessary safety precautions to prevent COVID-19. Please visit What Paratransit Operators Need to Know about COVID-19 for more information.
Create participant pods (keeping small groups together) to limit mixing and create distance between passengers on buses, vans and other transport vehicles (for example,  skip rows) when possible.

Encourage participants, workers, and other people at the ADSC who use public transportation to consider using alternatives that minimize close contact with others (for example, walking, biking, driving, or riding by car—alone or with household members only), if feasible. Those who use public transportation should follow CDC mandate on wearing a mask on public transportation and other ways to protect themselves when using transportation.
Top of PageMaintaining healthy environments
Ventilation
Make sure indoor spaces are well-ventilated (for example, open windows or doors when doing so does not pose a safety or health risk to building occupants) and large enough to accommodate physical distancing.
Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible both in the facility as well as any vehicles used by the ADSC.
Consider improving the engineering controls using the building ventilation system.
Cleaning and disinfecting
Reduce risk of transmission of the virus on frequently touched surfaces and in common areas of the facility through routine cleaning.
Clean and disinfect the facility when someone is sick or has a COVID-19 diagnosis.
If more than 3 days have passed since the person who is sick visited or used the center, additional cleaning and disinfection is not necessary. Continue routine cleaning.
Restrooms
Limit the number of people occupying restrooms at one time to prevent long lines or crowds. Remember to maintain a distance of at least 6 feet.
Stock restrooms with enough supplies such as soap, tissues, paper towels or hand dryer, no touch trash cans (preferably covered), and EPA approved hand sanitizer with at least 60% alcohol.
Ensure restrooms are fully functional and that high-touch surfaces such as doorknobs, countertops, faucets, light switches, and toilets have been cleaned every day before the facility opens.
Staff should assist participants in following proper masking and hand hygiene protocols
Visit CDC’s Handwashing Campaign: Life is Better with Clean Hands page to download resources to help promote handwashing in your facility.
When changing a participant’s briefs or diapers, staff should wash their hands and the participant’s hands before they begin and wear gloves. Follow safe brief changing procedures. Procedures should be posted in all brief changing areas. Steps include:
Prepare (includes putting on gloves)
Clean the participant
Remove trash from the immediate area (soiled brief or diaper and wipes)
Replace briefs or diaper
Wash participant’s hands
Clean diapering area – sanitize the changing area with a fragrance-free product appropriate for the surface. If the surface is visibly soiled, it should be cleaned with detergent or soap and water prior to sanitizing.
Remove gloves and then wash hands.

Shared kitchens and dining rooms
Staff can serve food and drinks to participants when wearing a mask and gloves.
Avoid offering any self-serve food or drink options, such as buffets, salad bars, and drink stations. Serve grab-and-go items or individually plated meals instead. For individually plated meals, identify one staff per meal service station to serve food so that multiple staff are not handling the same serving utensils.
Restrict the number of people allowed in the kitchen and dining room at one time so that everyone can stay at least 6 feet apart.
Modify layouts to reduce crowding and encourage physical distancing of at least 6 feet apart.
Make sanitizing wipes available for anyone who uses a microwave and similar food preparation appliances (for example, waffle maker). Sanitize high-touch surfaces of appliances after each use.
Wash, rinse, and sanitize used or dirty food contact surfaces with an EPA-approved food contact surface sanitizer. If a food-contact surface must be disinfected for a specific reason, such as a bodily fluid cleanup or deep clean in the event of likely contamination with COVID-19, use the following procedure: wash, rinse, disinfect according to the label instructions with a product approved for food contact surfaces, rinse, then sanitize with a food-contact surface sanitizer.
Discourage sharing of items that are difficult to clean or sanitize.
Limit any sharing of food, tools, equipment, or supplies by staff members.
Ensure adequate supplies to minimize sharing of high-touch materials (for example, serving spoons) to the extent possible; otherwise, limit use of supplies and equipment to one group of workers at a time and clean and sanitize between use.
Avoid items that are reusable, such as menus, condiments, and any other food containers. Instead, use disposable or digital menus, single serving condiments, and no-touch trash cans and doors.
Clean frequently touched surfaces such as counters, tables, or other hard surfaces between use.

Use gloves when removing garbage bags and handling and disposing of trash. After removing gloves, wash hands with soap and water for at least 20 seconds.
Water systems
The temporary shutdown or reduced operation of a building and reductions in normal water use can create hazards for returning occupants. To minimize the risk of Legionnaires’ disease and other diseases associated with water, take steps to ensure that all water systems, water-using devices, and water features (for example, ice machines, drinking fountains, decorative fountains) are safe to use after a prolonged shutdown or reduced operation.
Drinking fountains, like all high-touch surfaces, should be cleaned, but encourage participants, staff, volunteers, and visitors to bring their own water to minimize use and sharing of water fountains.
Top of PageMental health resources
Staff and participants along with their caregivers may be experiencing feelings of sadness, worry, or stress. Visit How Right Nowexternal icon to find out how to help. How Right Now is an initiative to address people’s feelings of grief, loss, and worry during COVID-19.
If you or someone you know are feeling overwhelmed with emotions like sadness, depression, or anxiety:

If you need to find treatment or mental health providers in your area:
Substance Abuse and Mental Health Services Administration (SAMHSA) Find Treatmentexternal icon
If you are in crisis, get immediate help:

If you feel you or someone in you know may harm themselves or someone else:

Other mental health resources

Top of PageAdditional COVID-19 resources
Vaccine resources

Testing resources

Resources to share with ADSC participants and their family members or caregivers

Additional information and resources for people providing care

Key PointsAdult Day Services Centers (ADSCs) provide social or health services to community-dwelling adults aged 65 and over and adults of any age living with disability.
Older adults and persons with disabilities are at highest risk for severe illness from COVID-19 including hospitalization, intensive care, and death.
ADSC administrators and staff can help protect themselves and program participants (that is, adults attending ADSCs) from COVID-19 by promoting and engaging in preventive behaviors that reduce spread and maintain healthy operations and environments at ADSC facilities.
Top of PageIntroduction
Adult Day Services Centers (ADSCs) are professional care settings where community-dwelling adults receive social or health services for some part of the day. (For further information about ADSCs, visit National Adult Day Services Association [NADSAexternal icon] and Regulatory Review of Adult Day Services: Final Reportexternal icon). ADSCs often serve adults age 65 years or older who may require supervised care and adults (of any age) living with dementia, cognitive decline, or disability. ADSCs are designed to provide a safe, community-based group setting where specific needs are addressed and individualized therapeutic, social, or health services are delivered. These centers provide needed services to participants and also support caregiver employment and provide respite, which benefits the mental health of both participants and caregivers.
ADSCs provide important services for participants and caregivers, but some ADSC characteristics – such as frequent social activities, group dining facilities, communal spaces, and shared transportation – may increase the risk of COVID-19 spread.
Administrators, staff, and volunteers at ADSCs should use the following guidance to plan for and implement prevention strategies to prevent COVID-19 spread at their facilities. This guidance is meant to supplement—not replace—any Federal, state, tribal, local, or territorial public health and safety laws, rules, and regulations with which adult day services center programs must comply. CDC has also developed recommendations for participants at ADSCs and their caregivers. For additional information on steps for reducing risk and other prevention strategies visit extra precautions for older adults and how to protect yourself and others.
Top of PagePromote behaviors that reduce spread
Encourage COVID-19 vaccination

Stay home when appropriate
Educate staff and participants about when they should stay home and when they can safely return to the ADSC.

If staff and participants are unsure whether they should stay home, they or their caregiver can use the coronavirus self-checker to help them decide.
Staff and participants should not enter the ADSC from the screening area if they:
Have symptoms of COVID-19, including:
Fever of 100.4o F (38.0o C) or higher or report feeling feverish
Presence of signs of illness, which could include flushed cheeks, sweating inappropriately for ambient temperature, or difficulty with ordinary tasks

Are undergoing evaluation for COVID-19 (such as pending viral test)
Have been diagnosed with COVID-19 in the prior 10 days (or longer if individual had severe or critical illness or if they are immunocompromised).
Have had close contact to someone with COVID-19 during the prior 14 days

Provide education on COVID-19 related symptoms and reminders to notify center staff if anyone is feeling symptoms of COVID-19. This is critical to provide timely assistance
Wear a mask and assist participants in wearing theirs
Staff should wear a mask when in the presence of others. Masks protect the wearer, as well as those around them. Masks work best when everyone wears one.
Masks should cover your nose and mouth, fit snugly, and have multiple layers.
Wearing masks may be difficult for people with sensory, cognitive, or behavioral issues; people with some disabilities; or people with dementia. Staff members should pay close attention and provide necessary support to participants who have trouble remembering to put on a mask, keeping it on, and removing it when needed.
Masks should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
Masks should not be worn by a person with a disability who cannot wear a mask, or cannot safely wear a mask.
Masks should not be worn by a person for whom wearing a mask would create a risk to workplace health, safety, or job duty as determined by the workplace risk assessmentexternal icon.

A mask is not a substitute for physical distancing. Continue to keep at least 6 feet between yourself and others, when possible, even when wearing a mask.
More information on masks is available at Guidance on Wearing Masks
Wash your hands often, and ensure participants can wash their hands appropriately
Staff and participants should wash hands often with soap and water for at least 20 seconds, especially after you have been in a public place or common area or after blowing your nose, coughing, or sneezing.
If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
Staff members should assist people with sensory, cognitive, or behavioral issues, and people with a disability or dementia, who may have challenges washing their hands properly and as frequently as recommended.

Visit CDC’s Life is Better with Clean Hands page to download resources to help promote handwashing.
Top of PageMaintain healthy operations

Reinforce prevention strategies using signs and messages throughout the facility
Display visual posters with instructions for maintaining 6-ft physical distancing, wearing masks, taking daily temperatures, and monitoring for other COVID-19 symptoms. Find free print and digital resources on CDC’s COVID-19 communications page.
Develop signs and plain language messages in alternative formats (for example, large print, Braille for people who have low vision or are blind).
Develop signs and messages in the preferred language(s) of staff and participants. Use COVID-19 easy to read resources, if applicable.
Use tape markings on floors to help people to maintain distancing.
Place directional arrows to establish the flow of traffic.
Designate different doors for entering and exiting center/rooms, if possible.
Post signs in highly visible locations (e.g., at building entrances, in restrooms) that promote everyday protective measures and describe how to stop the spread of germs by properly washing hands and properly wearing masks.
Use reminders for staff and participants to monitor for COVID-19 symptoms.
Broadcast regular announcements on reducing the spread of COVID-19 on public address system, if available.
Include messages (for example, training videos for staff, periodic guidance letters for participants to take home) about behaviors that prevent spread of COVID-19 when communicating with staff, participants, and others who may be in your center.
Please visit CDC’s Toolkit for Older Adults & People at Higher Risk for population specific posters and messaging to be used as reminders to wear a mask.
Health screening
Make employee health screenings as private as possible to prevent stigma and discrimination in the workplace. Do not make determinations of risk based on race or ethnicity and be sure to maintain confidentiality of each individual’s medical status and history. If screening in person, participants, screening staff and employees being screened should wear masks and maintain physical distancing.
Consider virtual health checks for employees and participants (for example, symptom and temperature screening) before they arrive at the center, in accordance with state and local public health authorities and your occupational health services (if applicable).
Before collecting health-related information from staff or participants, center administrators should comply with requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Remember that symptom and temperature screening cannot identify people with COVID-19 who are asymptomatic (do not have symptoms) or are pre-symptomatic (have not developed signs or symptoms yet but will later). Therefore, wearing masks, physical distancing, hand hygiene, cleaning, and other prevention strategies should still be used to reduce transmission.
Refer the individual to their primary care provider immediately or, in case of emergency, call 911, if you think someone is exposed to COVID-19 or may be exhibiting symptoms.
For more information, visit Interim Guidance for SARS-CoV-2 Testing in Non-Healthcare Workplaces.
Isolate and transport staff and participants who have symptoms while at the ADSC
Plan to have an isolation room or area (preferably with access to a dedicated restroom) you can use to isolate a sick participant or staff member. Ensure that isolated participants are wearing masks, are at a distance of 6 feet or greater from others, and remain under supervision.
Staff should isolate people who begin to have these symptoms from others. Prepare a list of all individuals who have been in close contact with sick participant(s) or staff member(s).
Notify an emergency contact regarding the sick person’s symptoms and arrange safe and accessible transportation home. Arrange emergency transport to a healthcare facility for participants or staff with severe symptomspdf icon.
Close off areas used by a sick person and do not use these areas until after cleaning and disinfecting them; this includes surfaces or shared objects in the area, if applicable.
Wait as long as possible (at least several hours) before cleaning and disinfecting. You should ensure safe and proper use of cleaning and disinfection productsexternal icon.
Close off areas used by the person who is sick.
Open outside doors and windows to increase air circulation.
Increase ventilation and wear a mask (in addition to other protection needed for safe use of cleaning and disinfection products) while cleaning and disinfecting.
Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas.

Notify health officials and close contacts

Modify layouts
Arrange tables and chairs to allow for physical distancing. People from the same household can be in groups together. Space seating at least 6 feet apart. Provide visual cues such as tape or chalk to guide spacing.
Increase access to handwashing stations or hand sanitizer dispensers at key locations.
Minimize traffic in enclosed spaces, such as elevators and stairwells. Consider limiting the number of individuals in an elevator at one time and designating one-directional stairwells, if possible.
Ensure the facility entry door and exit door are separate to avoid interaction between incoming and outgoing traffic to ADSC.
Ensure that limiting the number of participants and physical distancing can be maintained in shared rooms, such as television, game, or exercise rooms, or rooms for shared worship services.
Physical barriers and guides
Install plexiglass barriers in reception and other face-to-face interaction areas.
Install physical barriers, such as sneeze guards and partitions, particularly in areas where it is difficult for individuals to remain at least 6 feet apart (for example, reception areas).
Provide physical guides, such as tape on floors or sidewalks and signs on walls, to ensure that individuals remain at least 6 feet apart.
Activities
Alter schedules, such as staggering meal and activity times, and creating pods (that is, forming small groups that regularly participate at the same times) and do not mix with individuals in other groups.
Practice physical distancing and wear masks whether indoors or outdoors, for both staff and participants.
Prioritize outdoor activities over indoor activities when possible. Staff should ensure sun safety for all participants and staff of ADSC.
Clean tools, materials, and computer or other equipment before and after the participant has finished using them, or at least daily.
Postpone musical activities and performances that include playing wind instruments, singing, chanting, or shouting during events, especially when participants are in close proximity to each other.
Avoid holding any in-person events that include people who are not staff in the ADSC. If an event is held, follow COVID-19 event considerations, and consider not serving food or having prepackaged boxes or bags instead of a buffet or family-style meals.
Transportation
Schedule and stagger drop off or pick up times for participants to avoid crowding.
Encourage physical distancing among staff and participants at the entrance and exit during these drop off and pick up times with use of visual cues like tapes and signs.
Transport and bus drivers should practice all safety actions and protocols as indicated for other workers (for example, hand hygiene, masks).
Follow guidance for bus transit operators to clean buses or other transport vehicles.
Seat participants at least 6 feet apart while in transport vehicles.
Drivers should provide ventilation by opening the windows or setting the air ventilation/air conditioning on non-recirculation mode when the vehicle is in service.
Paratransit drivers should take extra care in transporting patients with special needs and take all necessary safety precautions to prevent COVID-19. Please visit What Paratransit Operators Need to Know about COVID-19 for more information.
Create participant pods (keeping small groups together) to limit mixing and create distance between passengers on buses, vans and other transport vehicles (for example,  skip rows) when possible.

Encourage participants, workers, and other people at the ADSC who use public transportation to consider using alternatives that minimize close contact with others (for example, walking, biking, driving, or riding by car—alone or with household members only), if feasible. Those who use public transportation should follow CDC mandate on wearing a mask on public transportation and other ways to protect themselves when using transportation.
Top of PageMaintaining healthy environments
Ventilation
Make sure indoor spaces are well-ventilated (for example, open windows or doors when doing so does not pose a safety or health risk to building occupants) and large enough to accommodate physical distancing.
Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible both in the facility as well as any vehicles used by the ADSC.
Consider improving the engineering controls using the building ventilation system.
Cleaning and disinfecting
Reduce risk of transmission of the virus on frequently touched surfaces and in common areas of the facility through routine cleaning.
Clean and disinfect the facility when someone is sick or has a COVID-19 diagnosis.
If more than 3 days have passed since the person who is sick visited or used the center, additional cleaning and disinfection is not necessary. Continue routine cleaning.
Restrooms
Limit the number of people occupying restrooms at one time to prevent long lines or crowds. Remember to maintain a distance of at least 6 feet.
Stock restrooms with enough supplies such as soap, tissues, paper towels or hand dryer, no touch trash cans (preferably covered), and EPA approved hand sanitizer with at least 60% alcohol.
Ensure restrooms are fully functional and that high-touch surfaces such as doorknobs, countertops, faucets, light switches, and toilets have been cleaned every day before the facility opens.
Staff should assist participants in following proper masking and hand hygiene protocols
Visit CDC’s Handwashing Campaign: Life is Better with Clean Hands page to download resources to help promote handwashing in your facility.
When changing a participant’s briefs or diapers, staff should wash their hands and the participant’s hands before they begin and wear gloves. Follow safe brief changing procedures. Procedures should be posted in all brief changing areas. Steps include:
Prepare (includes putting on gloves)
Clean the participant
Remove trash from the immediate area (soiled brief or diaper and wipes)
Replace briefs or diaper
Wash participant’s hands
Clean diapering area – sanitize the changing area with a fragrance-free product appropriate for the surface. If the surface is visibly soiled, it should be cleaned with detergent or soap and water prior to sanitizing.
Remove gloves and then wash hands.

Shared kitchens and dining rooms
Staff can serve food and drinks to participants when wearing a mask and gloves.
Avoid offering any self-serve food or drink options, such as buffets, salad bars, and drink stations. Serve grab-and-go items or individually plated meals instead. For individually plated meals, identify one staff per meal service station to serve food so that multiple staff are not handling the same serving utensils.
Restrict the number of people allowed in the kitchen and dining room at one time so that everyone can stay at least 6 feet apart.
Modify layouts to reduce crowding and encourage physical distancing of at least 6 feet apart.
Make sanitizing wipes available for anyone who uses a microwave and similar food preparation appliances (for example, waffle maker). Sanitize high-touch surfaces of appliances after each use.
Wash, rinse, and sanitize used or dirty food contact surfaces with an EPA-approved food contact surface sanitizer. If a food-contact surface must be disinfected for a specific reason, such as a bodily fluid cleanup or deep clean in the event of likely contamination with COVID-19, use the following procedure: wash, rinse, disinfect according to the label instructions with a product approved for food contact surfaces, rinse, then sanitize with a food-contact surface sanitizer.
Discourage sharing of items that are difficult to clean or sanitize.
Limit any sharing of food, tools, equipment, or supplies by staff members.
Ensure adequate supplies to minimize sharing of high-touch materials (for example, serving spoons) to the extent possible; otherwise, limit use of supplies and equipment to one group of workers at a time and clean and sanitize between use.
Avoid items that are reusable, such as menus, condiments, and any other food containers. Instead, use disposable or digital menus, single serving condiments, and no-touch trash cans and doors.
Clean frequently touched surfaces such as counters, tables, or other hard surfaces between use.

Use gloves when removing garbage bags and handling and disposing of trash. After removing gloves, wash hands with soap and water for at least 20 seconds.
Water systems
The temporary shutdown or reduced operation of a building and reductions in normal water use can create hazards for returning occupants. To minimize the risk of Legionnaires’ disease and other diseases associated with water, take steps to ensure that all water systems, water-using devices, and water features (for example, ice machines, drinking fountains, decorative fountains) are safe to use after a prolonged shutdown or reduced operation.
Drinking fountains, like all high-touch surfaces, should be cleaned, but encourage participants, staff, volunteers, and visitors to bring their own water to minimize use and sharing of water fountains.
Top of PageMental health resources
Staff and participants along with their caregivers may be experiencing feelings of sadness, worry, or stress. Visit How Right Nowexternal icon to find out how to help. How Right Now is an initiative to address people’s feelings of grief, loss, and worry during COVID-19.
If you or someone you know are feeling overwhelmed with emotions like sadness, depression, or anxiety:

If you need to find treatment or mental health providers in your area:
Substance Abuse and Mental Health Services Administration (SAMHSA) Find Treatmentexternal icon
If you are in crisis, get immediate help:

If you feel you or someone in you know may harm themselves or someone else:

Other mental health resources

Top of PageAdditional COVID-19 resources
Vaccine resources

Testing resources

Resources to share with ADSC participants and their family members or caregivers

Additional information and resources for people providing care

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For more information on CDC’s web notification policies, see Website Disclaimers.

Links with this icon indicate that you are leaving the CDC website.

The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website’s privacy policy when you follow the link.
CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

For more information on CDC’s web notification policies, see Website Disclaimers.

A Nucleic Acid Amplification Test, or NAAT, is a type of viral diagnostic test for SARS-CoV-2, the virus that causes COVID-19. NAATs detect genetic material (nucleic acids).  NAATs for SARS-CoV-2 specifically identify the RNA (ribonucleic acid) sequences that comprise the genetic material of the virus.NAATs for SARS-CoV-2 test specimens from either the upper or lower respiratory tract. The type of specimen collected when testing for SARS-CoV-2 is based on the test being performed and the manufacturer’s instructions. For initial diagnostic testing for current SARS-CoV-2 infection, CDC recommends collecting and testing an upper respiratory specimen, such as nasopharyngeal, nasal mid-turbinate, or anterior nasal. See CDC’s Collecting and Handling of Clinical Specimens for COVID-19 Testing.
The NAAT procedure works by first amplifying – or making many copies of – the virus’s genetic material that is present in a person’s specimen. Amplifying or increasing the copies of nucleic acids enables NAATs to detect very small amounts of SARS-CoV-2 RNA in a specimen, making these tests highly sensitive for diagnosing COVID-19. In other words, NAATs can reliably detect small amounts of SARS-CoV-2 and are unlikely to return a false-negative result of SARS-CoV-2.
NAATs can use many different methods to amplify nucleic acids and detect the virus, including but not limited to:
Reverse transcription polymerase chain reaction (RT-PCR)
Transcription mediated amplification (TMA)
Loop mediated isothermal amplification (LAMP) tests including:
Nicking endonuclease amplification reaction (NEAR)
Helicase-dependent amplification (HDA)
Clustered regularly interspaced short palindromic repeats (CRISPR)

Strand displacement amplification (SDA)
Since the beginning of the COVID-19 pandemic, both the number and types (methods and technologiesexternal icon) of NAATs authorized for emergency use by the U.S. Food and Drug Administration (FDA) for the detection of SARS-CoV-2 have increased. The FDA will likely authorize additional NAAT methods in the future.
NAATs have been authorized for use in different settings, such as in laboratory facilities by trained personnel (laboratory-based) or in point-of-care (POC) settings. Some NAATs can even be performed at home or in other non-healthcare locations. Some NAATs are considered rapid tests that are performed at or near the place where the specimen is collected and can provide the result within minutes, whereas the time to complete laboratory-based NAATs ranges from less than an hour to more than a day. The level of sensitivity for the detection of SARS-CoV-2 genetic material in a specimen also varies depending on the methods and application of the NAAT. Sensitivity varies by test, but laboratory-based NAATs generally have higher sensitivity than POC tests or tests that can be used anywhere.
Because laboratory-based NAATs are considered the most sensitive tests for detecting SARS-CoV-2, they can also be used to confirm the results of lower sensitivity tests, such as POC NAATs or antigen tests. CDC recommends only laboratory-based NAATs for confirmatory testing. CDC does not recommend NAATs that use oral specimens (e.g., saliva) for confirmatory testing and instead suggests the use of specimens that are considered optimal for detection, such as nasopharyngeal, nasal mid-turbinate, and anterior nasal swabs.

The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to health systems, including large numbers of patients with COVID-19 that can overwhelm health facilities and staff. The World Health Organization (WHO) estimates that about 80% of people with COVID-19 have mild or moderate symptoms1 [1]. Treatment for mildly to moderately ill patients may not require hospitalization, but some people may not be able to isolate safely at home, putting household contacts and, in turn, community members at risk of COVID-19 [2, 3]. Isolation shelters, or community isolation centers (CICs), can provide people with mild to moderate symptoms, who are not at increased risk for severe disease, with a safe space to voluntarily2 isolate until they are no longer considered infectious according to Ministry of Health guidelines [1, 2]. Such centers can reduce household transmission and reserve health facility resources for more seriously ill patients.
People with increased risk for severe disease or severe symptoms should seek care at a health facility or hospital where advanced care and treatment can be provided, if beds are available. If no hospital beds are available, it is preferable for these people to be isolated in a CIC rather than staying at home. People with mild or moderate illness who have been tested and are awaiting a diagnosis should isolate at home until they know their status to avoid becoming infected from other patients at a CIC. However, in cases where safely isolating at home is not possible, people who are awaiting a diagnosis may isolate in a CIC. CICs should ensure that people with suspected COVID-19 (either awaiting test results or unable to be tested due to lack of tests) and those with confirmed cases are placed in separate areas.
This document provides operational considerations for CDC Country Offices, Ministries of Health and partners about establishing and operating CICs for people with suspected or confirmed COVID-19 who are remaining in the CIC voluntarily, and ensuring that people in CICs are safe and have access to adequate healthcare, food, water, sanitation, and hygiene products and services. It is intended for non-US settings. While this document is most relevant for low-resource settings, it may also be applicable to other settings.
Guiding principles:
Each community is unique, and CDC Country Offices, Ministries of Health, and partners may wish to consider local context, local health system capacity, and other factors which may preclude people being able to isolate safely at home.
CICs may be implemented at any time, regardless of the level of community transmission, based on guidance from public health officials, and may be scaled up or down as needed.
While specific considerations may vary by country and location within a country, locating CICs close to the community they are intended to serve may facilitate support from patients’ families and encourage use of these centers.
Footnotes

Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, new loss of smell or taste, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhea, nausea, and vomiting.
Considerations regarding involuntary quarantine can be found hereexternal icon: World Health Organization, Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19), Interim Guidance, March 19, 2020

Community Engagement
Establishing connections at the community level in the early stages of planning may facilitate adequate resources, community buy-in, and support, which may help ensure that operations are sustainable. Arrangements and organization of CICs may vary according to the local context, so local adaptations should be considered.
CDC Country Offices, Ministries of Health, and partners may wish to consider setting up a community advisory board focused on COVID-19 planning and response early in the planning process. This group may include:
Local, state, provincial, or regional health departments
Local government and community leaders
Healthcare workers
Religious leaders
Traditional healers
Emergency management
Law enforcement
Nonprofit organizations
Collaboration with the community advisory board may help to identify sites (e.g., schools, hotels, gymnasiums, convention centers, other large covered structures) that can be converted to CICs to safely isolate and manage people with mild or moderate COVID-19. A community advisory board can help draft plans to ensure that the CICs will be safe and secure, appropriately staffed, and stocked with the necessary supplies. These advisory boards can continue to meet to address any challenges or issues in the implementation and use of CICs, make operational decisions, and provide advice as needed.
Depending on the specific setting, the community advisory board may prefer to set up fewer, larger CICs, as this will likely be easier to manage than many smaller CICs and require fewer staff members to run. Rural areas may require a larger number of smaller CICs to ensure that facilities are close to the communities they serve, so that patients’ families can help provide support. Densely populated settlements and displaced persons camps may require multiple, smaller CICs, as no suitable, larger spaces may exist. Security may be of particular concern in these areas, and facilities should consider employing a full-time guard to ensure safety of patients and staff.
Establishing a Community
The physical set-up of a CIC takes time, planning, and specific resources to meet the needs of both patients and staff. A variety of settings can be adapted to support a CIC, including a hotel, school, church, or other area able to host groups of people; the size of space needed will depend on the size of the community the CIC is meant to support and the number of active COVID-19 cases in the community [3]. If no suitable buildings exist, it may be necessary to use a tent, construct one, or convert shipping containers to be used as a CIC.
Communities should consider locating the CIC next to a COVID-19 designated health facility to facilitate transfer in case a patient develops more severe symptoms or complications. If this is not possible, the community should consider the availability of mobile telephone service to enable the use of telemedicine [1]. Other considerations include: ensuring good access and guaranteed security for those at the CIC, avoiding flood areas or areas with a danger of landslides, and choosing locations with the option to connect to basic services such as water and electricity [2].
In the process of preparing a CIC, some adaptations to the space are needed to reduce the risk of spread of SARS-CoV-2 (the virus that causes COVID-19) among staff, patients, and visitors. These include
Designating areas for the following purposes:
Intake and patient assessment.
Area for staff to don and doff personal protective equipment (PPE; equipment, such as masks, gloves, goggles, gowns designed to protect the wearer from exposure to or contact with infectious agents).
Staff respite area separate from the patient care area with a bathroom for staff use only; an area where staff can store personal belongings, take breaks, and eat. PPE should not be worn in this area, but masks should be worn whenever possible. If more than one staff member is using the area, there should be at least 2 meter distance between staff.
Patient care area or rooms with access to patient bathrooms/shower areas.
If the facility has shared rooms, consider a private changing area for patients next to the bathrooms, or ensure that the bathrooms are big enough to allow patients to change.
Designated area in the patient care area where staff monitor patients and document key vital signs; depending on the size of the CIC, it may be reasonable to use the same area for intake and routine monitoring.
Clean supply storage area.
Dirty utility area.

Using physical barriers to protect staff who will interact with patients. For example, placing an additional table between staff and patients at reception or marking the ground with tape may help maintain a distance of at least 2 meters between them. Clear plastic sheeting can be used to separate areas for staff and patients, allowing staff to provide oversight but preserving PPE.
Patient housing areas
Women and men should have separate rooms, while children/families should either be housed in private rooms (one per family) or a third room that is only for mixed gender families, with at least 2 meters of space between family units.
In shared spaces, keep mats/beds of people who are not part of a family unit at least 2 meters apart [2].
Patients can be housed in individual rooms, if that is an If individual rooms are not available, multiple patients can be housed in a large, well-ventilated room [4].
If limited individual rooms are available, specific considerations should be given to placing patients with suspected COVID-19 (i.e., never tested or waiting on test results) or families in individual rooms.
If patients with suspected COVID-19 (i.e., never tested or waiting on test results) are admitted to the facility, they should be housed in areas that are physically separated from confirmed cases (and ideally in individual rooms), and keep 2 meters distance between themselves and other patients.

Ensuring adequate potable water (25 liters/patient per day).
Ensuring adequate toilet facilities.
One per 20 patients, with at least one for females and one for males, in addition to a designated staff toilet.
Toilets have convenient handwashing facilities close by.
Toilets are easily accessible (i.e., no more than 30 meters from all users).
There is a cleaning and maintenance routine in operation that ensures that clean and functioning toilets are available at all times [5].

The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to health systems, including large numbers of patients with COVID-19 that can overwhelm health facilities and staff. The World Health Organization (WHO) estimates that about 80% of people with COVID-19 have mild or moderate symptoms1 [1]. Treatment for mildly to moderately ill patients may not require hospitalization, but some people may not be able to isolate safely at home, putting household contacts and, in turn, community members at risk of COVID-19 [2, 3]. Isolation shelters, or community isolation centers (CICs), can provide people with mild to moderate symptoms, who are not at increased risk for severe disease, with a safe space to voluntarily2 isolate until they are no longer considered infectious according to Ministry of Health guidelines [1, 2]. Such centers can reduce household transmission and reserve health facility resources for more seriously ill patients.
People with increased risk for severe disease or severe symptoms should seek care at a health facility or hospital where advanced care and treatment can be provided, if beds are available. If no hospital beds are available, it is preferable for these people to be isolated in a CIC rather than staying at home. People with mild or moderate illness who have been tested and are awaiting a diagnosis should isolate at home until they know their status to avoid becoming infected from other patients at a CIC. However, in cases where safely isolating at home is not possible, people who are awaiting a diagnosis may isolate in a CIC. CICs should ensure that people with suspected COVID-19 (either awaiting test results or unable to be tested due to lack of tests) and those with confirmed cases are placed in separate areas.
This document provides operational considerations for CDC Country Offices, Ministries of Health and partners about establishing and operating CICs for people with suspected or confirmed COVID-19 who are remaining in the CIC voluntarily, and ensuring that people in CICs are safe and have access to adequate healthcare, food, water, sanitation, and hygiene products and services. It is intended for non-US settings. While this document is most relevant for low-resource settings, it may also be applicable to other settings.
Guiding principles:
Each community is unique, and CDC Country Offices, Ministries of Health, and partners may wish to consider local context, local health system capacity, and other factors which may preclude people being able to isolate safely at home.
CICs may be implemented at any time, regardless of the level of community transmission, based on guidance from public health officials, and may be scaled up or down as needed.
While specific considerations may vary by country and location within a country, locating CICs close to the community they are intended to serve may facilitate support from patients’ families and encourage use of these centers.
Footnotes

Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, new loss of smell or taste, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhea, nausea, and vomiting.
Considerations regarding involuntary quarantine can be found hereexternal icon: World Health Organization, Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19), Interim Guidance, March 19, 2020

Community Engagement
Establishing connections at the community level in the early stages of planning may facilitate adequate resources, community buy-in, and support, which may help ensure that operations are sustainable. Arrangements and organization of CICs may vary according to the local context, so local adaptations should be considered.
CDC Country Offices, Ministries of Health, and partners may wish to consider setting up a community advisory board focused on COVID-19 planning and response early in the planning process. This group may include:
Local, state, provincial, or regional health departments
Local government and community leaders
Healthcare workers
Religious leaders
Traditional healers
Emergency management
Law enforcement
Nonprofit organizations
Collaboration with the community advisory board may help to identify sites (e.g., schools, hotels, gymnasiums, convention centers, other large covered structures) that can be converted to CICs to safely isolate and manage people with mild or moderate COVID-19. A community advisory board can help draft plans to ensure that the CICs will be safe and secure, appropriately staffed, and stocked with the necessary supplies. These advisory boards can continue to meet to address any challenges or issues in the implementation and use of CICs, make operational decisions, and provide advice as needed.
Depending on the specific setting, the community advisory board may prefer to set up fewer, larger CICs, as this will likely be easier to manage than many smaller CICs and require fewer staff members to run. Rural areas may require a larger number of smaller CICs to ensure that facilities are close to the communities they serve, so that patients’ families can help provide support. Densely populated settlements and displaced persons camps may require multiple, smaller CICs, as no suitable, larger spaces may exist. Security may be of particular concern in these areas, and facilities should consider employing a full-time guard to ensure safety of patients and staff.
Establishing a Community
The physical set-up of a CIC takes time, planning, and specific resources to meet the needs of both patients and staff. A variety of settings can be adapted to support a CIC, including a hotel, school, church, or other area able to host groups of people; the size of space needed will depend on the size of the community the CIC is meant to support and the number of active COVID-19 cases in the community [3]. If no suitable buildings exist, it may be necessary to use a tent, construct one, or convert shipping containers to be used as a CIC.
Communities should consider locating the CIC next to a COVID-19 designated health facility to facilitate transfer in case a patient develops more severe symptoms or complications. If this is not possible, the community should consider the availability of mobile telephone service to enable the use of telemedicine [1]. Other considerations include: ensuring good access and guaranteed security for those at the CIC, avoiding flood areas or areas with a danger of landslides, and choosing locations with the option to connect to basic services such as water and electricity [2].
In the process of preparing a CIC, some adaptations to the space are needed to reduce the risk of spread of SARS-CoV-2 (the virus that causes COVID-19) among staff, patients, and visitors. These include
Designating areas for the following purposes:
Intake and patient assessment.
Area for staff to don and doff personal protective equipment (PPE; equipment, such as masks, gloves, goggles, gowns designed to protect the wearer from exposure to or contact with infectious agents).
Staff respite area separate from the patient care area with a bathroom for staff use only; an area where staff can store personal belongings, take breaks, and eat. PPE should not be worn in this area, but masks should be worn whenever possible. If more than one staff member is using the area, there should be at least 2 meter distance between staff.
Patient care area or rooms with access to patient bathrooms/shower areas.
If the facility has shared rooms, consider a private changing area for patients next to the bathrooms, or ensure that the bathrooms are big enough to allow patients to change.
Designated area in the patient care area where staff monitor patients and document key vital signs; depending on the size of the CIC, it may be reasonable to use the same area for intake and routine monitoring.
Clean supply storage area.
Dirty utility area.

Using physical barriers to protect staff who will interact with patients. For example, placing an additional table between staff and patients at reception or marking the ground with tape may help maintain a distance of at least 2 meters between them. Clear plastic sheeting can be used to separate areas for staff and patients, allowing staff to provide oversight but preserving PPE.
Patient housing areas
Women and men should have separate rooms, while children/families should either be housed in private rooms (one per family) or a third room that is only for mixed gender families, with at least 2 meters of space between family units.
In shared spaces, keep mats/beds of people who are not part of a family unit at least 2 meters apart [2].
Patients can be housed in individual rooms, if that is an If individual rooms are not available, multiple patients can be housed in a large, well-ventilated room [4].
If limited individual rooms are available, specific considerations should be given to placing patients with suspected COVID-19 (i.e., never tested or waiting on test results) or families in individual rooms.
If patients with suspected COVID-19 (i.e., never tested or waiting on test results) are admitted to the facility, they should be housed in areas that are physically separated from confirmed cases (and ideally in individual rooms), and keep 2 meters distance between themselves and other patients.

Ensuring adequate potable water (25 liters/patient per day).
Ensuring adequate toilet facilities.
One per 20 patients, with at least one for females and one for males, in addition to a designated staff toilet.
Toilets have convenient handwashing facilities close by.
Toilets are easily accessible (i.e., no more than 30 meters from all users).
There is a cleaning and maintenance routine in operation that ensures that clean and functioning toilets are available at all times [5].

Screening testingTesting asymptomatic persons without known or suspected exposure to SARS-CoV-2
Viral testing of asymptomatic staff or incarcerated/detained persons without known or suspected exposure to SARS-CoV-2 – known as screening testing – in correctional and detention facilities can detect COVID-19 early and stop transmission quickly, particularly in areas with moderate to high community transmission of COVID-19. Screening testing is a key component of a layered approach to prevent SARS-CoV-2 transmission. Screening testing allows early identification and isolation of persons who are asymptomatic or presymptomatic, or have only mild symptoms and who may be unknowingly transmitting virus. For screening testing in correctional facilities, either NAATs or antigen tests (or both) could be used. Important attributes to consider when selecting the type of test or tests used for screening include availability, costs, and turnaround time. In screening where antigen tests are used, a laboratory-based confirmatory NAAT testing is recommended for individuals who test positive.
Screening testing for staff should be considered in all facilities. This should include:
Testing of all staff before entering the facility every 3–7 days, and
Targeted testing of new staff, those returning from a prolonged absence, travel, or other concerns related to exposure. In some facilities, COVID-19 cases have been initially identified among staff before any cases have been identified among incarcerated/detained persons. If there are barriers to staff testing, facilities can investigate options to work with community partners (e.g. local hospitals or clinics) or state/local health departments to implement staff testing.
Screening testing for incarcerated/detained persons should be implemented and can include the following strategies, listed in order of priority for implementation and described in sections below:
Screening testing based on movement between facilities and between the facility and the community.
Expanded screening testing of all persons in a housing unit, building, or facility regardless of symptoms.
Serial screening testing of all (or a random sample of) incarcerated/detained persons.
Use of point-of-care (POC) tests, such as antigen tests, can play an important role in testing as a mitigation strategy due to the short turn-around time for results. Antigen tests for SARS-CoV-2 are generally less sensitive than real-time reverse transcription polymerase chain reaction (RT-PCR) and other nucleic acid amplification tests (NAATs) for detecting the presence of viral nucleic acid. The decreased sensitivity of antigen tests might be offset if the point-of-care antigen tests are repeated more frequently (i.e., serial testing). Thus, when screening large numbers of persons (e.g., a well-defined cohort) without known or suspected exposure to SARS-CoV-2, a less sensitive test can be appropriate if the test can be performed more frequently and provide rapid results with immediate isolation of infected individuals.
Screening testing based on movement between facilities and between the facility and the community
When implementing screening testing, facilities should prioritize testing to prevent the introduction of the virus into the facility and to prevent transmission to another facility or into the community. Screening testing should include testing for incarcerated/detained persons in the following scenarios.
At intake. Test all incoming incarcerated/detained persons and house them individually (when feasible) while waiting for test results. Testing can be combined with a 14-day observation period (sometimes referred to as “routine intake quarantine”), ideally in single cells, before persons are assigned housing with the rest of the facility’s population. This practice can reduce the risk of transmission from sources outside the facility.
Before transfer to another facility or reassignment in the facility. Test all incarcerated/detained persons before transfer to another correctional/detention facility. Wait for a negative result before transfer. Testing before transfer can be combined with a 14-day observation period (sometimes referred to as “routine transfer quarantine”), ideally in single cells, before an individual’s projected transfer date. If testing and transfer quarantine cannot be performed for security or logistical reasons, then intake quarantine may occur in the receiving facility for 14 days upon arrival. Refer to Interim Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities for more information about transfer and release recommendations.
Before visits or release into the community. Test all persons 1–3 days before visits (e.g. clinics, court appearances, community programs) or release (whether into the community or to a halfway house or other transitional location), particularly if it is known that they will be releasing to other congregate settings (e.g., homeless shelters, group homes, or halfway houses) or to households with persons who are at higher risk of severe illness from COVID-19. Community members that visit the facility, including medical providers, should also be tested as close to the day of the visit (no more than 3 days prior). Testing before release can be combined with a 14-day observation period (sometimes referred to as “routine release quarantine”), ideally in single cells, before a person’s release date. This practice can reduce the risk of transmission from the facility to the community and allows the opportunity for the facility to notify public health authorities for assistance arranging recommended medical isolation upon release for people who test positive.
Expanded screening testing
In correctional and detention facilities, where physical distancing is often impracticable, it can be difficult to determine who has been in close contact with someone with COVID-19. For these situations, options for expanded screening testing are recommended. Expanded screening testing is not intended to replace case investigation or response-based testing.
Expanded screening testing should be considered following a positive test from diagnostic or screening testing when targeted testing of close contacts based on contact tracing is not practicable (e.g., in large dormitory units). If someone tests positive at intake but has not had close contact with other members of the facility’s population and is immediately placed in medical isolation, this person’s positive test result would not trigger expanded screening testing.
The scope of expanded screening testing should be based on the extent of movement (of staff and incarcerated/detained persons) between parts of the facility with and without cases. Examples of expanded screening testing strategies include:
Testing all persons in a single housing unit where someone has tested positive if there has not been contact with other areas of the facility through staff or incarcerated/detained persons.
Testing all persons in an entire building or complex when cases have been identified in multiple parts of the building or complex, or if there has been contact between parts of the building or complex with and without cases. This can happen in situations such as when staff work in multiple units, or through incarcerated/detained persons who have moved through multiple areas of the facility during work detail.

Facility administrators should strongly consider including staff in expanded screening testing efforts. In some facilities, COVID-19 cases have been initially identified among staff before any cases have been identified among incarcerated/detained persons. Because staff move between the facility and the community daily, the risks of introducing infection into the facility from the community and/or bringing infection from the facility back into the community is ongoing. If there are operational, contractual, and/or legal reasons to refrain from testing staff within the facility or concerns about using facility resources/personnel to test staff, facilities should investigate options to work with community partners or state/local health departments to implement staff testing.
Before conducting expanded screening testing, facilities should make plans for how they will modify their operations based on results and ability to act on those results.
Given the potential for high numbers of asymptomatic infections, ensure that plans include isolation options to house large numbers of infected persons and quarantine options to house large numbers of close contacts. For example, consider how the facility’s housing operations could be modified for multiple test result scenarios (e.g., if testing reveals that 10%, 30%, 50%, or more of a facility’s population is infected with SARS-CoV-2).
Review CDC guidance on Performing Broad-Based Testing for SARS-CoV-2 in Congregate Settings for information on choosing a physical location for testing, ensuring adequate ventilation, planning movement through the testing location, and providing recommended PPE.
Serial screening testing for all or a random sample of incarcerated/detained persons
Facilities should consider implementing serial screening testing among additional incarcerated/detained persons and staff, or among a select group according to criteria it designates. Given the incubation period for COVID-19 (up to 14 days), CDC recommends conducting screening testing every 3-7 days. Screening testing can increase the likelihood of early case identification to prevent widespread transmission. Two strategies for serial screening testing include serial screening testing every 3-7 days for all (or a random selection of) individuals in a facility, or targeted screening testing based on facility- or individual-level factors. The testing interval should be based on the stage of an ongoing outbreak (more frequent testing in the context of an escalating outbreak; less frequent when transmission has slowed) and on the type of test (more frequent for antigen tests).
Serial screening testing can be conducted among all incarcerated/detained persons and among all staff, or by randomly selecting individuals for testing. Facilities using random selection should plan to test at least 25% of incarcerated/detained persons and staff every 3-7 days.
Targeted serial screening testing based on facility-level factors. Within a single facility, an expanded ongoing testing strategy could be designed in several ways.
Testing based on risk. A facility could target certain parts of the facility for serial screening testing based on risk of transmission in the settings. Examples of risk-based testing priorities could include incarcerated/detained people and staff assigned to dorm-based housing units (as opposed to cell-based units).
History of cases in the facility. Consider prioritizing expanded testing in facilities that have had recent cases or outbreaks of COVID-19.
Type of housing in the facility. Consider prioritizing expanded testing in facilities with dormitory-based housing units where physical/social distancing is especially difficult.
In-person visiting. Consider prioritizing expanded testing in facilities where in-person visitation is occurring.
Community movement. Consider prioritizing expanded testing in facilities where incarcerated/detained people make more visits into the community (e.g., off-site medical visits, work release, or court appearances), especially in areas where there are higher levels of community transmission of SARS-CoV-2.
Turnover within the facility. Consider prioritizing expanded testing in facilities that have frequent admissions (newly incarcerated/detained persons or those transferring in from other facilities).
Staff interactions. Consider prioritizing expanded testing in facilities employing staff who work in multiple correctional/detention facilities or in other congregate settings (e.g., homeless shelters, group homes, or schools), or employing staff who are in frequent close contact (e.g., family or household members, carpools) with others who work in different parts of the facility or in other congregate settings.
Populations at higher risk of severe illness from COVID-19. Consider prioritizing expanded testing in facilities with a high proportion of people who are at higher risk for severe illness from COVID-19 (e.g., facilities designated for medical care such as medical facilities, long-term care facilities, or skilled nursing facilities).

Targeted serial screening testing based on person-level factors. Across facilities, there may be certain groups of people who are at higher risk of SARS-CoV-2 infection or at higher risk for severe illness from COVID-19, regardless of the particular facility where they live or work. Some of these person-level factors should be considered when prioritizing categories of people for serial screening testing.
Incarcerated/detained persons and staff who are medically high-risk. Consider serial screening testing for people who are at higher risk of severe illness from COVID-19, including those with medical conditions that increase or may increase risk of severe COVID-19. Identifying infections early can help ensure timely medical attention to prevent severe outcomes.
Incarcerated/detained person assigned to on-site work details. Consider serial screening testing for people who are assigned to critical work duties within the facility (e.g., food service or laundry) that require them to leave their housing unit.
Incarcerated/detained persons participating in work release programs. Consider serial screening testing for people who participate in community-based work release programs.
Staff working in a facility designated for medical care. Consider serial screening testing for staff who must continue to work in a correctional/detention facility designated for medical care (e.g., medical facility, long-term care facility, or skilled nursing facility).
Staff working in multiple areas of the facility. Consider serial screening testing for staff who work in multiple areas of the facility, or who live or spend time with other staff who work in other areas of the facility (e.g., family or household members, carpools).
Staff working in multiple congregate facilities. Consider serial screening testing for staff who work in more than one correctional/detention facility or in another congregate setting (e.g., homeless shelters, group homes, or schools), or those who have frequent close contact (e.g., family or household members, carpools) with others who work in different parts of the facility or in other congregate settings.

Frequency of screening testing
Screening testing approaches may include initial testing described in the screening testing for staff and serial screening testing for incarcerated/detained persons sections above. Facility administrators may find the following factors helpful to consider when determining the interval for periodic testing:
The availability of testing, turnaround time, and cost
The latency time period between exposure and development of a positive SARS-CoV-2 viral test
How many staff or incarcerated/detained persons tested positive during previous rounds of testing
Relevant experience with outbreaks at the facility
Testing any less frequently than once a week is unlikely to be effective in identifying recently infected asymptomatic persons who need to be isolated. Additionally, outbreak control depends largely on the frequency of testing and the speed of returning results for rapid medical isolation.
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Reports of death after COVID-19 vaccinationFDA requires vaccination providers to report any death after COVID-19 vaccination to VAERS.
Reports of death to VAERS following vaccination do not necessarily mean the vaccine caused the death.
CDC follows up on any report of death to request additional information and learn more about what occurred and to determine whether the death was a result of the vaccine or unrelated.
To date, VAERS has not detected patterns in cause of death that would indicate a safety problem with COVID-19 vaccines.
CDC, FDA, and other federal partners will continue to monitor the safety of COVID-19 vaccines.
Over 109 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through March 15, 2021. During this time, VAERS received 1,913 reports of death (0.0018%) among people who received a COVID-19 vaccine. CDC and FDA physicians review each case report of death as soon as notified and CDC requests medical records to further assess reports. A review of available clinical information including death certificates, autopsy, and medical records revealed no evidence that vaccination contributed to patient deaths. CDC and FDA will continue to investigate reports of adverse events, including deaths, reported to VAERS.