Author: COVID-19 NEWS

Epidemiology of SARS-CoV-2 in Pregnancy and Infancy (ESPI) Network
The ESPI Electronic Cohort study is collecting information from the medical records of women who receive prenatal care at three participating sites and reach the end of their pregnancy between March 2020 and February 2021. Data collection will include information about the following:
Demographic and maternal characteristics
Medical conditions
Prenatal care
Pregnancy complications, including ambulatory care visits and hospitalizations for acute illness
Postpartum care
Laboratory test results for SARS-CoV-2 and influenza
Pregnancy outcomes
Selected infant outcomes through 6 months of age
This study aims to understand the characteristics of SARS-CoV-2 infection during pregnancy and the six months after the end of pregnancy, including among infants up to six months of age. It also aims to identify risk factors for severe COVID-19 disease, describe use of investigational and off-label therapeutics, and evaluate effects of COVID-19 on pregnancy and infant outcomes.
The ESPI Community Cohort study is a multisite collaboration designed to estimate the incidence of asymptomatic and symptomatic SARS-CoV-2 infection and understand the characteristics of SARS-CoV-2 infection in pregnant women. This includes the spectrum of disease, conditions, and risk factors for infection and developing severe illness. As a secondary objective, this study will examine the effect of COVID-19 during pregnancy on pregnancy and newborn outcomes. The study enrolls pregnant women at less than 28 weeks of pregnancy and follows them through the end of their pregnancies with weekly surveillance for SARS-CoV-2 infection and symptoms of COVID-19-like illness. Information is also collected two to four weeks after the end of their pregnancies, on end-of-pregnancy, infant, and postpartum outcomes.

CDC Science Agenda for COVID-19: Building the Evidence Base to Inform the Ongoing Public Health Response, 2020-2023The agenda guides the development of the evidence base needed to strengthen the public health actions, guidance, and policy essential to limit the spread and impact of SARS-CoV-2 and end the COVID-19 pandemic.
Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2CDC recommends community use of masks, specifically non-valved multi-layer cloth masks, to prevent transmission of SARS-CoV-2.
Scientific Brief: SARS-CoV-2 and Potential Airborne TransmissionThe principal mode by which people are infected with SARS-CoV-2 (the virus that causes COVID-19) is through exposure to respiratory droplets carrying infectious virus.

Until we know more about how this virus affects animals, CDC encourages pet owners to treat pets as you would other human family members to protect them from possible infection. This means limiting contact between your pets and people outside your household as much as possible and avoiding places where large numbers of people gather.
Some areas are allowing groomers and boarding facilities such as dog daycares to open. If you must take your pet to a groomer or boarding facility, follow any protocols put into place at the facility, such as wearing a mask and maintaining at least 6 feet of space between yourself and others if possible.
Limit pet items brought from home to the groomer or boarding facility, and disinfect any objects that are taken into a facility and returned home (such as leashes, bowls, and toys). Use an EPA-registered disinfectantexternal icon to clean items and rinse thoroughly with clean water afterwards. Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or other products, such as hand sanitizer, counter-cleaning wipes, or other industrial or surface cleaners. If you have questions about appropriate products for bathing or cleaning your pet, talk to your veterinarian.
Do not put masks on pets, and do not take a sick pet to a groomer or boarding facility. Signs of sickness in dogs may include fever, coughing, difficulty breathing or shortness of breath, lethargy, sneezing, discharge from the nose or eyes, vomiting, or diarrhea. If you think your pet is sick, call your veterinarian. Some veterinarians may offer telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet’s treatment and care.
See more information on pets and COVID-19 and recommendations for how to help keep your pet safe.

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Text Illness Monitoring, or TIM, is a text messaging system that helps public health organizations monitor symptoms of enrolled participants. Public health organizations can use this system at no cost to monitor symptoms consistent with COVID-19.
About TIM            
Text Illness Monitoring (TIM) is a text messaging platform that helps monitor symptoms during an infectious disease outbreak. Public health officials have traditionally done symptom monitoring via telephone calls, which can be a time-consuming process requiring intensive resources. TIM allows for two-way short message service (SMS) text messaging to help public health organizations quickly identify enrolled participants reporting symptoms. TIM can be used to monitor an organization’s workforce or another specified population, such as contacts of an identified case.
TIM is available at no cost and, at this time, is primarily intended for public health organizations at the federal, state, tribal, local, and territorial levels to assist with COVID-19 response activities.
Using TIM for the COVID-19 Response
Since February 2020, multiple federal agencies have used TIM to monitor employees for COVID-19 symptoms. A number of state, tribal, local, and territorial public health authorities are also using TIM to monitor symptoms of enrolled participants in their jurisdictions.
Enrolled participants receive one or more text messages each day asking if they have symptoms consistent with COVID-19. Jurisdictions are immediately alerted when a participant responds YES or when a participant fails to respond to message reminders. A dashboard feature allows jurisdictions to identify and follow up with individuals who are reporting symptoms or those who have been unresponsive.
TIM Features
TIM includes many features to help monitor enrolled participants for symptoms of COVID-19. Organizations using TIM can:
Customize the duration of the monitoring period for an individual
Collect first and last names of participants within the platform
View a dashboard with summary information on the status of participants and symptom reporting
Remove/withdraw participants from monitoring
Designate when follow-up for YES responses or non-responses are in progress and complete
Keep track of who is working on a YES response or non-response
Edit text in messages to make them specific for the population being monitored
Use a Spanish workflow version
Allow participants to self-enroll by texting a keyword to the campaign phone number
Frequently Asked Questions
Access
How do I get access to TIM?
State, tribal, local, and territorial public health authorities may request access to TIM by completing the form at the bottom of this page. The TIM support team will work with the requesting organization to provide access to TIM.
Can local public health jurisdictions use TIM?
Yes, local jurisdictions can use TIM for COVID-19 symptom monitoring.
Who will be able to access the information in TIM?
TIM allows access to information by two tiers. Public health administrators at the state, tribal, or territorial level (tier 1) will have access to all data within their jurisdiction, including local data. Jurisdictions assigned at the local level (tier 2) will only have access to the data for the jurisdiction to which they are assigned.
Dashboard and Notifications
What information is included in the dashboard?
The TIM system includes a dashboard with multiple visualizations, including detailed and summary information on monitored individuals and alerts that require attention (e.g., those who reply YES to a text indicating symptoms or those who have not responded to reminder texts). For alerts, jurisdictions can view the name and mobile phone number associated with the alert and the content of the text message.
How will I know if someone responds that they have symptoms?
TIM creates an alert when an enrolled participant:
Responds with a text that they have symptoms
Does not respond to the daily message after a reminder
Sends a text message to opt out
Administrators may log into TIM to view all alerts for participants. Each organization may also set up one email address to receive alert notifications via email.
Are there any reports available in TIM?
There are several reports and data extracts available in TIM.
Campaign Report (PDF document): Graphics on participant status, campaign status, and alerts at the time the report was generated
Participant Report (PDF document): History of all the text responses received and alerts over a specified time period for a participant
Participant download extract (CSV file): Detailed information on all enrolled participants
Responses download extract (CSV file): List of participant responses and time stamps over a specified time period
In addition to the reports and extracts, TIM includes a dashboard with summary information about participants, texting campaigns, and alerts as graphs and tables. The data in these graphs and tables can be exported as a CSV file.
Enrollment and Messaging
What messages will participants receive?
Organizations using TIM can personalize the text message workflow template available in the system based on their needs. Figure 1 below shows a sample of a text message template available in TIM. After the organization adds a participant’s mobile phone number to TIM, the participant will immediately receive a welcome message notifying them of their enrollment. Participants will receive a daily message asking whether they have symptoms consistent with COVID-19 and will be prompted to reply ‘Yes’ or ‘No.’ If a participant does not respond to the daily message, the TIM system will send a reminder. At the end of the monitoring period, participants will receive a final message informing them that they have completed monitoring and will be unenrolled from TIM.

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Revisions were made on November 3, 2020 to reflect the following:
Clarification on language for the collection of anterior nasal specimens.
Revisions were made on October 8, 2020 to reflect the following:
Clarification on language for the collection of specimens and to include the addition of saliva language.

Healthcare providers* and health department staff considering ordering testing of people with possible infection of SARS-CoV-2 should work with their state, tribal, local, and territorial (STLT) health departments to coordinate testing through public health laboratories, or work with commercial or clinical laboratories using molecular and antigen tests. The type of specimen collected is based on the test you’re using and its manufacturer’s instructions. Some of the specimen types listed below will not be appropriate for all tests.
CDC has guidance for who should be tested, but decisions about who should be tested are at the discretion of STLT health departments and/or healthcare providers. Testing for other pathogens by the provider should be done as part of the initial evaluation, as indicated, but should not delay testing for SARS-CoV-2, the virus that causes COVID-19.
All SARS-CoV-2 test results, including positives, negatives and inconclusive findings, should be reported to the STLT health department. Read CDC’s Data and Reporting FAQ for Laboratories.
Clinical laboratories should NOT attempt viral isolation from specimens collected from people suspected to have COVID-19 unless this is performed in a BSL-3 laboratory.
*Pharmacists are considered healthcare providers in this guidance.
Specimen Type and Priority
All testing for SARS-CoV-2 should be conducted in consultation with a healthcare provider. Specimens should be collected as soon as possible once a decision has been made to pursue testing, regardless of the time of symptom onset. The guidance below addresses options for collection of specimens.
For initial diagnostic testing for SARS-CoV-2, CDC recommends collecting and testing an upper respiratory specimen. Please contact the testing laboratory to confirm accepted specimen types. Please note that nasopharyngeal and oropharyngeal specimens are not appropriate for self-collection. The following are acceptable specimens depending on the authorized SARS-CoV-2 viral test used:
A nasopharyngeal (NP) specimen collected by trained healthcare personnel; or
An oropharyngeal (OP) specimen collected by trained healthcare personnel; or
A nasal mid-turbinate swab collected by trained healthcare personnel or by a supervised onsite self-collection (using a flocked tapered swab); or
An anterior nares (nasal swab) specimen collected by trained healthcare personnel, or self-collected and observed by healthcare personnel, or by home or onsite self-collection (using a flocked or spun polyester swab); or
Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by trained healthcare personnel; or
A saliva specimen collected by the person being tested, either at home or at a testing site under supervision.
Swabs should be placed immediately into a sterile transport tube containing 2-3mL of either viral transport medium (VTM), Amies transport medium, phosphate buffered saline, or sterile saline, unless using a test designed to analyze a specimen  directly, (i.e., without placement in VTM), such as some point-of-care testsexternal icon. If VTM is not available, see the standard operating procedure for public health labs to prepare viral transport mediumpdf icon in accordance with CDC’s protocol.
The NW specimen and the non-bacteriostatic saline used to collect the specimen should be placed immediately into a sterile transport tube.
Testing lower respiratory tract specimens is also an option. For patients who develop a productive cough, sputum can be collected and tested when available for SARS-CoV-2. However, the induction of sputum is not recommended. When under certain clinical circumstances (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen.
Collecting and Handling Specimens Safely
For healthcare personnel collecting specimens or working within 6 feet of patients suspected to be infected with SARS-CoV-2, maintain proper infection control and use recommended personal protective equipment (PPE), which includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown, when collecting specimens.
For healthcare personnel who are handling specimens, but are not directly involved in collection (e.g. self-collection) and not working within 6 feet of the patient, follow Standard Precautions. Healthcare personnel are recommended to wear a form of source control (face mask) at all times while in the healthcare facility.
PPE use can be minimized through patient self-collection while the trained healthcare personnel maintains at least 6 feet of separation.
Handling Bulk-Packaged Sterile Swabs Properly for Upper Respiratory Sample Collection
Sterile swabs for upper respiratory specimen collection may be packaged in one of two ways:
Individually wrapped (preferred when possible)
Bulk packaged
Bulk-packaged swabs may be used for sample collection; however, care must be exercised to avoid SARS-CoV-2 contamination of any of the swabs in the bulk-packaged container.
Before engaging with patients and while wearing a clean set of protective gloves, distribute individual swabs from the bulk container into individual sterile disposable plastic bags.
If bulk-packaged swabs cannot be individually packaged:
Use only fresh, clean gloves to retrieve a single new swab from the bulk container.
Close the bulk swab container after each swab removal and leave it closed when not in use to avoid inadvertent contamination.
Store opened packages in a closed, airtight container to minimize contamination.
Keep all used swabs away from the bulk swab container to avoid contamination.

As with all swabs, only grasp the swab by the distal end of the swab, using gloved hands only.
When patients are self-collecting their swabs under clinical supervision:
Hand a swab to the patient only while wearing a clean set of protective gloves.
The patient can then self-swab and place the swab in transport media or sterile transport device and seal.
If the patient needs assistance, you can help the patient place the swab into transport media or a transport device and seal it.

General Guidelines
Proper collection of specimens is the most important step in the laboratory diagnosis of infectious diseases. A specimen that is not collected correctly may lead to false negative test results. The following specimen collection guidelines follow standard recommended procedures. For more information, including illustrations and step-by-step guidance, see the CDC Influenza Specimen Collectionpdf icon instructions. Note that these instructions are applicable for respiratory viruses in general, and not specific for only influenza virus.
I. Respiratory Specimens
A. Upper respiratory tract
Nasopharyngeal specimen collection /Oropharyngeal (throat) specimen collection

Use only synthetic fiber swabs with plastic or wire shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and may inhibit molecular tests. CDC is now recommending collecting only the NP specimen, although OP specimen remain an acceptable specimen type. If both NP and OP specimens are collected, they should be combined in a single tube to maximize test sensitivity and limit use of testing resources.
Instructions for collecting an NP specimen: Gently and slowly insert a minitip swab with a flexible shaft (wire or plastic) through the nostril parallel to the palate (not upwards) until resistance is encountered or the distance is equivalent to that from the ear to the nostril of the patient, indicating contact with the nasopharynx. Swab should reach depth equal to distance from nostrils to outer opening of the ear. Gently rub and roll the swab. Leave swab in place for several seconds to absorb secretions. Slowly remove swab while rotating it. Specimens can be collected from both sides using the same swab, but it is not necessary to collect specimens from both sides if the minitip is saturated with fluid from the first collection. If a deviated septum or blockage create difficulty in obtaining the specimen from one nostril, use the same swab to obtain the specimen from the other nostril.
OP specimen: Insert swab into the posterior pharynx and tonsillar areas.  Rub swab over both tonsillar pillars and posterior oropharynx and avoid touching the tongue, teeth, and gums.
Nasal mid-turbinate (NMT) specimen
Use a flocked tapered swab. Tilt patient’s head back 70 degrees. While gently rotating the swab, insert swab less than one inch (about 2 cm) into nostril parallel to the palate (not upwards) until resistance is met at turbinates. Rotate the swab several times against nasal wall and repeat in other nostril using the same swab.
Anterior nasal (nares) specimen
Using a flocked or spun polyester swab, insert the entire absorbent tip of the swab (usually ½ to ¾ of an inch (1 to 1.5 cm) inside the nostril and firmly sample the nasal wall by rotating the swab in a circular path against the nasal wall at least 4 times. Take approximately 15 seconds to collect the sample. Be sure to collect any nasal drainage that may be present on the swab. Sample both nostrils with same swab.
For a visual guide, see the How To Collect Your Anterior Nasal Swab Sample For Covid-19 Testing infographic.pdf icon
Nasopharyngeal wash/aspirate or nasal wash/aspirate
Attach catheter to suction apparatus. Have the patient sit with head tilted slightly backward. Instill 1 mL-1.5 mL of non-bacteriostatic saline (pH 7.0) into one nostril. Insert the tubing into the nostril parallel to the palate (not upwards). Catheter should reach depth equal to distance from nostrils to outer opening of ear. Begin gentle suction/aspiration and remove catheter while rotating it gently. Place specimen in a sterile viral transport media tube.
Saliva
Collect 1-5 ml of saliva  in a sterile, leak-proof screw cap container. No preservative is required.
B. Lower respiratory tract
Bronchoalveolar lavage, tracheal aspirate, pleural fluid, lung biopsy
Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container.
Due to the increased technical skill and equipment needs, collection of specimens other than sputum from the lower respiratory tract may be limited to patients presenting with more severe disease, including people admitted to the hospital and/or fatal cases.
Sputum
Educate the patient about the difference between sputum and oral secretions (saliva). Have the patient rinse the mouth with water and then expectorate deep cough sputum directly into a sterile, leak-proof, screw-cap collection cup or sterile dry container.
Note: This is an aerosol generating procedure and likely to generate higher concentrations of infectious respiratory aerosols. Aerosol generating procedures potentially put healthcare personnel and others at an increased risk for pathogen exposure and infection. Healthcare personnel should apply Standard Precautions and wear an N95 or equivalent or higher-level respirator, instead of a face mask, eye protection, gloves, and a gown, when collecting specimens.
II. Storage
Store specimens at 2-8°C for up to 72 hours after collection. If a delay in testing or shipping is expected, store specimens at -70°C or below.
III. Shipping
If necessary, and with advance approval, samples may be shipped to CDC if repeated testing results remain inconclusive or if other unusual results are obtained. Please contact CDC at respvirus@cdc.gov prior to submitting samples to confirm.
If shipping samples to CDC: If specimens will ship without delay, store specimens at 2-8°C, and ship overnight to CDC on ice pack. If a delay in shipping will result in receipt at CDC more than 72 hours after collection, store specimens at -70°C or below and ship overnight to CDC on dry ice. Additional useful and detailed information on packing, shipping, and transporting specimens can be found at Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19).
Specimens must be packaged, shipped, and transported according to the current edition of the International Air Transport Association (IATA) Dangerous Goods Regulations external iconexternal icon.
Label each specimen container with the patient’s ID number (e.g., medical record number), unique CDC or state-generated nCov specimen ID (e.g., laboratory requisition number), specimen type (e.g., serum) and the date the sample was collected. Complete a CDC Form 50.34 for each specimen submitted. In the upper left box of the form, 1) for test requested select “Respiratory virus molecular detection (non-influenza) CDC-10401” and 2) for At CDC, bring to the attention of enter “Unit 84 (Non-flu Resp Virus)”.
Please refer to our instruction guidance for submitting CDC Form 50.34 found here: Guidelines For Submitting Specimens to CDCpdf icon.
For additional information, consultation, or the CDC shipping address, contact the CDC Emergency Operations Center (EOC) at 770-488-7100.
Additional Resources

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.