Author: COVID-19 NEWS
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Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020COVID-19 pandemic control requires a multipronged application of evidence-based strategies while improving health equity: universal face mask use, physical distancing, avoiding nonessential indoor spaces, increasing testing, prompt quarantine of exposed persons, safeguarding those at increased risk for severe illness or death, protecting essential workers, postponing travel, enhancing ventilation and hand hygiene, and achieving widespread COVID-19 vaccination coverage. Read the full report.
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These CDC recommendations are based on the latest public health science to inform safer, more responsible international travel during the COVID-19 pandemic. These recommendations are not intended to be requirements for the travel industry. Follow all destination and airline recommendations or requirements.
Air travel requires spending time in security lines and airport terminals, which can bring you in close contact with other people and frequently touched surfaces. Social distancing is difficult in busy airports and on crowded flights, and sitting within 6 feet of others, sometimes for hours, may increase your risk of getting COVID-19. How you get to and from the airport, such as with public transportation and ridesharing, can also increase your chances of being exposed to the virus.
Testing before and after travel can reduce the risk of spreading COVID-19. Testing does not eliminate all risk, but when paired with a period of staying at home and everyday precautions like wearing masks and social distancing, it can make travel safer by reducing spread on planes, in airports, and at destinations.
Here’s what to know:
Get tested 1-3 days before your flight.
Get tested 3-5 days after travel AND stay home for 7 days after travel.
Even if you test negative, stay home for the full 7 days.
If you don’t get tested, it’s safest to stay home for 10 days after travel.
Always follow state and local recommendations or requirements related to travel.
Delay your travel if you are waiting for test results.
Travelers with a known exposure to COVID-19 should delay travel, quarantine themselves from other people, get tested, and monitor their health.
Get Tested Before Your Flight
Below is what you need to know about getting tested before your international flight.
Get tested with a viral test 1-3 days before you depart and again 1-3 days before you return.
Make sure you get your test results before you travel. If you are waiting for results, delay your travel.
Do not travel if your test result is positive; immediately isolate yourself, and follow public health recommendations.
A negative test does not mean that you were not exposed or that you will not develop COVID-19. Make sure to wear a mask, stay at least 6 feet from others, wash your hands, and watch your health for signs of illness while traveling.
Keep a copy of your test results with you during travel. You may be asked for them.
Plan Ahead
Check if your airline requires any health information, testing, or other documents. Some destinations require testing before travel and/or after arrival. Information about testing requirements for your destination may be available from the Office of Foreign Affairs or Ministry of Health, or the US Department of State, Bureau of Consular Affairs, Country Information webpageexternal icon.
Take steps to reduce higher-risk activities for 14 days before your trip and get tested 1-3 days before you travel. This could help reduce the chance that your travel will be interrupted or delayed by COVID-19.
All travelers with any known exposure to COVID-19 should delay travel, quarantine themselves from other people for 14 days after their last known exposure, get tested, and monitor their health.
Travelers with a known exposure to COVID-19 should delay travel, quarantine themselves from other people, get tested, and monitor their health.
Get Tested & Take Precautions After Your Flight
Get tested 3-5 days after travel AND stay home for 7 days after travel. Even if you test negative, stay home for the full 7 days. If you don’t get tested, it’s safest to stay home for 10 days. Always follow state and local recommendations or requirements related to travel.
A negative test does not mean that you were not exposed; you can still develop COVID-19. Watch for symptoms for 14 days after travel, immediately isolate yourself if you develop symptoms, and learn what to do if you are sick.
If your test is positive for COVID-19, immediately isolate yourself and follow public health recommendations. Do not travel until it is safe for you to be around others; this includes your return trip home.
You may have been exposed to COVID-19 on your travels. You may feel well and not have any symptoms, but you can be contagious without symptoms and spread the virus to others. You and your travel companions (including children) pose a risk to your family, friends, and community for 14 days after you were exposed to the virus.
Regardless of where you traveled or what you did during your trip, take these actions to protect others from getting COVID-19 for 14 days after travel:
Stay at least 6 feet/2 meters (about 2 arm lengths) from anyone who did not travel with you, particularly in crowded areas. It’s important to do this everywhere — both indoors and outdoors.
Wear a mask to keep your nose and mouth covered when you are in shared spaces outside of your home, including when using public transportation.
If there are people in the household who did not travel with you, wear a mask and ask everyone in the household to wear masks in shared spaces inside your home.
Wash your hands often or use hand sanitizer with at least 60% alcohol.
Watch your health: Look for symptoms of COVID-19, and take your temperature if you feel sick.
Frequently Asked Questions:
Where do I get tested?
Visit your state, territorial, tribal and localexternal icon health department’s website to look for the latest information on where to get tested.
What kind of test should I get?
You should get a viral test that can determine if you are currently infected with COVID-19. Learn more about testing for a current infection.
What else should I do before I travel to protect myself and others from COVID-19?
For 14 days before you travel, take everyday precautions like wearing masks, social distancing, and handwashing, and avoid the following activities that put you at higher risk for COVID-19:
Going to a large social gathering like a wedding, funeral, or party.
Attending a mass gathering like a sporting event, concert, or parade.
Being in crowds like in restaurants, bars, fitness centers, or movie theaters.
Taking public transportation like trains or buses or being in transportation hubs like airports.
Traveling on a cruise ship or river boat.
Is one test enough to prevent spread during my travel?
CDC recommends getting tested 1-3 days before your flight AND 3-5 days after your trip AND stay home for 7 days. Even if you test negative, stay home for the full 7 days. If you don’t get tested, it’s safest to stay home for 10 days. Getting tested in combination with staying home significantly reduces travelers’ risk of spreading COVID-19.
What if I recently recovered from COVID-19?
CDC does not recommend getting tested again in the three months after a positive viral test, as long as you do not have symptoms of COVID-19. If you have had a positive viral test in the past 3 months, and you have met the criteria to end isolation, travel with a copy of your positive test result and a letter from your doctor or health department that states you have been cleared for travel.
Cleaning and Disinfection
Personal controls: General recommendations for cleaning and disinfection in schools
Intensify cleaning and disinfection by cleaning staff. Frequently touched surfaces should be cleaned and disinfected at least once a day (i.e., before or after school day), and more frequently when possible. Railings, desks and tables, door and window handles, sanitation (restroom/toilet/latrine) surfaces, toys, teaching/learning aids, and materials used/shared by students (e.g., pens, pencils, art supplies, books, electronics) are examples of frequently touched surfaces.
Cleaning refers to the removal of germs, dirt, and impurities from surfaces. It does not kill germs, but by removing them, it lowers their number and the risk of spreading infection. Removing dirt and impurities also helps disinfectant be more effective.
Disinfecting refers to using chemicals, for example, diluted sodium hypochlorite (bleach), to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.
Use a 0.1% solution made from bleach and water (using non-turbid water source) for disinfection. To mix, use the percentage found on the bleach bottle (for example, 5%) and follow these instructions:
Example of making 0.1% solution with 5% liquid bleach:[5% chlorine in liquid bleach / 0.1% chlorine solution desired] – 1 = [5 / 0.1] – 1= 49 parts of water for each part liquid bleachIf you are using a 20 L jerry can or bucket to mix, you will need 400 mL of bleach and should fill the rest of the jerry can with water.20 L / 50 parts = 0.4 L, or 400 mL
[% chlorine in liquid bleach ∕ % chlorine desired] − 1 = Total parts of water for each part bleach
See instructionspdf icon for making 0.1% solution from 0.5% disinfecting solution, 70% high-test hypochlorite (HTH), or 35% chlorine powder.
Cleaning and disinfection procedures:
1) Put on personal protective equipment (rubber gloves, thick aprons, and closed shoes).
2) Mix 0.1% bleach solution using the procedures described above in well-ventilated area.
3) Clean with detergent or soap and water to remove organic matter.
4) Apply the 0.1% solution to the surface with a cloth and allow for a contact time (the amount of time that the disinfectant should remain wet and undisturbed on the surface) of at least 1 minute. Additional disinfectant may need to be applied to ensure it remains wet for 1 minute. After 1 minute has passed, rinse residue with clean water (this will also protect the surface or item from damage).
5) After cleaning and disinfection, carefully remove personal protective equipment (PPE) and wash hands immediately. Re-usable PPE (e.g., aprons) should be laundered immediately.
Cleaning and disinfecting should not take place near children or people with asthma.
Procedures for cleaning and disinfecting various surfaces (hard surfaces, soft surfaces, electronics, and laundry) can be found here.
Administrative and engineering controls: Possibilities for schools
Cleaning staff should clean and disinfect frequently touched surfaces at least once a day, or more frequently if possible. If once daily, cleaning and disinfecting can take place either before the school opens or after it closes.
School administrators, cleaning staff, and select students should walk through the school together and decide which surfaces are touched frequently by students and staff and therefore should be the target of cleaning and disinfection efforts.
Increase ventilation and air flow. Ensure ventilation systems (when present) are working properly. Increase circulation of outdoor air within buildings by opening windows and doors if it is safe to do so.
Provide the cleaning staff with cleaning supplies (soap/detergent, bleach, buckets) and PPE specific for the disinfectant to wear when mixing, cleaning, and disinfecting (for example, rubber gloves, thick aprons, and closed shoes). PPE should be used for COVID-19-related disinfection only (cleaning staff should not bring home PPE – it should be stored at the school in a secure, designated area).
Provide cleaning staff with information (e.g., written or pictorial instructions) about when and how to clean and disinfect and how to safely prepare disinfectant solutionspdf icon, as described in the leftmost column.
If someone becomes sick at school, close off spaces used by the sick person until after they can be cleaned and disinfected. Cleaning staff should wait 24 hours before cleaning and disinfecting, or if 24 hours is not feasible, wait as long as possible.
Materials, activities, and personnel needed for implementation
Stocks of soap, bleach, buckets, and other cleaning supplies (e.g., mops, cloths).
Designated cleaning staff.
PPE for designated cleaning staff (rubber gloves, thick aprons, and closed shoes).
Sufficient access to non-turbid water to meet all cleaning and disinfection needs.
Instructional materials describing the cleaning and disinfection process, including proper mixing of solutions, for use by designated cleaning staff.
Written schedule for increased routine cleaning and disinfection.
Considerations and challenges for schools
If schools use an expanded timetable (e.g., one group of students attends in the morning and another in the afternoon and/or evening), cleaning and disinfection must occur between each session.
There will be costs associated with purchasing the bleach, soap, cleaning supplies, and PPE; printing instructional materials; and possibly having to pay additional staff to clean.
If no rubber gloves are available for cleaning staff, any kind of gloves can be used. If no aprons are available, cleaning staff can wear protective clothing (such as long pants and long-sleeved shirts) that are laundered after each use.
There could be further supply chain constraints on soap, chlorine products, and PPE as demand increases as COVID-19 spreads. Calcium Hypochlorite (HTH) powder or bleaching powder can also be used to mix disinfection solutions if available.
If water supply is not available on site, it will be more challenging and costly to clean and disinfect daily. Water-scarce schools may consider temporary solutions for water provision, such as water trucking.
There is potential for harm to users when making and using disinfection products, so it is important for cleaning staff to be adequately protected when mixing and using disinfectant and trained on how to mix and disinfect.
Note: Large-scale spraying of disinfectant in schools or on school buses is not recommended. There is limited evidence that it is effective. To be effective, disinfectants need to have sufficient contact time and coverage, which is difficult to get when doing large-scale spraying. There is also limited ability to prevent people nearby from the hazards of inhaling disinfectants during large-scale spraying. Additionally, organic matter, like that which is often found on the ground in public places, would need to be removed by cleaning before disinfectants would work effectively
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Note: This document is intended to provide guidance on the appropriate use of testing among nursing home residents and does not address payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency.
Nursing home residents are at high risk for infection, serious illness, and death from COVID-19. Testing for SARS-CoV-2, the virus that causes COVID-19, in respiratory specimens detects current infections (referred to here as viral testing) among residents in nursing homes. Viral testing of residents in nursing homes, with authorized nucleic acid amplification tests or antigen detection assays, is an important addition to other infection prevention and control (IPC) recommendations aimed at preventing SARS-CoV-2 from entering nursing homes, detecting cases quickly, and stopping transmission. This guideline is based on currently available information about COVID-19 and will be refined and updated as more information becomes available.
Testing conducted at nursing homes should be implemented in addition to recommended IPC measures. Facilities should have a plan for testing residents for SARS-CoV-2. Additional information about the components of the testing plan are available in the CDC guidance titled Preparing for COVID-19 in Nursing Homes.
Testing practices should aim for rapid turnaround times (ideally less than 24 hours) of SARS-CoV-2 testing results to facilitate effective interventions. Antibody (serologic) test results generally should not be used as the sole basis to diagnose an active SARS-CoV-2 infection or to inform IPC actions.
While this guidance focuses on testing in nursing homes, several of the recommendations such as testing residents with signs or symptoms of COVID-19 and testing asymptomatic close contacts should also be applied to other long-term care facilities (e.g., assisted living facilities, intermediate care facilities for individuals with intellectual disabilities, institutions for mental disease, and psychiatric residential treatment facilities).
For additional guidance on testing, refer to the Overview of Testing for SARS-CoV-2. Guidance for testing healthcare personnel (HCP) is available in the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2. Additional testing guidance exists for non-healthcare facilities, including critical infrastructure workplaces, select workplaces, correctional and detention facilities, K-12 schools, higher education, congregate settings, and homeless shelters and encampments.
Diagnostic Testing
Testing residents with signs or symptoms of COVID-19
At least daily, take the temperature of all residents and ask them if they have any COVID-19 symptoms. Perform viral testing of any resident who has signs or symptoms of COVID-19.
Testing asymptomatic residents with known or suspected exposure to an individual infected with SARS-CoV-2, including close and expanded contacts (e.g., there is an outbreak in the facility)
Perform expanded viral testing of all residents in the nursing home if there is an outbreak in the facility (i.e., a new SARS-CoV-2 infection in any HCP or any nursing home-onset SARS-CoV-2 infection in a resident).
A single new case of SARS-CoV-2 infection in any HCP or a nursing home-onset SARS-CoV-2 infection in a resident should be considered an outbreak. When one case is detected in a nursing home, there are often other residents and HCP who are infected with SARS-CoV-2 who can continue to spread the infection, even if they are asymptomatic. Performing viral testing of all residents as soon as there is a new confirmed case in the facility will identify infected asymptomatic residents quickly, in order to assist in their clinical management and allow rapid implementation of IPC interventions (e.g., isolation, cohorting, use of personal protective equipment) to prevent SARS-CoV-2 transmission.
When undertaking facility-wide viral testing, facility leadership should expect to identify multiple asymptomatic and pre-symptomatic residents with SARS-CoV-2 infection and be prepared to cohort residents. See Public Health Response to COVID-19 in Nursing Homes for more details.
If viral testing capacity is limited, CDC suggests first directing testing to residents who are close contacts (e.g., on the same unit or floor of a new confirmed case or cared for by infected HCP).
See Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes for additional details.
Residents who are known close contacts should be considered for testing initially, and, if negative, again about 5-7 days after exposure. If testing is negative, residents should remain in quarantine for 14 days. Alternatives to the 14-day quarantine period are described in the Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing. Healthcare facilities could consider these alternatives as a measure to mitigate staffing shortages, space limitations, or PPE supply shortages. However, these alternatives are not a preferred option because of the special nature of healthcare settings (e.g., patients at risk for severe illness, critical nature of healthcare personnel, challenges with social distancing).
Initial (baseline) testing of asymptomatic residents without known or suspected exposure to an individual infected with SARS-CoV-2 is part of the recommended reopening process
Perform initial viral testing of each resident in a nursing home as part of the recommended reopening process pdf icon[180 KB, 11 pages]external icon.
In any nursing home, initial viral testing of each resident (who is not known to have previously been diagnosed with COVID-19) is recommended because of the high likelihood of exposure during a pandemic, transmissibility of SARS-CoV-2, and the risk of complications among residents following infection.
The results of viral testing inform care decisions, infection control interventions, and placement decisions (e.g., cohorting decisions) relevant to that resident.
Testing to determine resolution of infection
A test-based strategy, which requires serial tests and improvement of symptoms, could be considered for discontinuing Transmission-Based Precautions earlier than the symptom-based strategy. However, in most cases, the test-based strategy results in prolonged isolation of residents who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious. A test-based strategy could also be considered for some residents (e.g., those who are severely immunocompromised) in consultation with local infectious diseases experts if concerns exist for the resident being infectious for more than 20 days. In all other circumstances, the symptom-based strategy should be used to determine when to discontinue Transmission-Based Precautions.
Repeat Testing in Coordination with the Health Department
Non-diagnostic testing of asymptomatic residents without known or suspected exposure to an individual infected with SARS-CoV-2 (apart from the initial testing referenced above)
After initially performing viral testing of all residents in response to an outbreak, CDC recommends repeat testing to ensure there are no new infections among residents and HCP and that transmission has been terminated as described below. Repeat testing should be coordinated with the local, territorial, or state health department.
Continue repeat viral testing of all previously negative residents, generally every 3 days to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. This follow-up viral testing can assist in the clinical management of infected residents and in the implementation of infection control interventions to prevent SARS-CoV-2 transmission.
If viral test capacity is limited, CDC suggests directing repeat rounds of testing to residents who leave and return to the facility (e.g., for outpatient dialysis) or have known exposure to a case (e.g., roommates of cases or those cared for by a HCP with confirmed SARS-CoV-2 infection). For large facilities with limited viral test capacity, testing only residents on affected units could be considered, especially if facility-wide repeat viral testing demonstrates no transmission beyond a limited number of units.
Healthcare personnel (HCP): HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, feeding assistants, students and trainees, contractual HCP not employed by the healthcare facility, and persons not directly involved in patient care but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.
Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated in the nursing home. It does not refer to the following:
Residents who were known to have COVID-19 on admission to the facility and were placed into appropriate Transmission-Based Precautions to prevent transmission to others in the facility.
Residents who were placed into Transmission-Based Precautions on admission and developed SARS-CoV-2 infection within 14 days after admission.
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