COVID-19 and Seasonal Influenza: Interim Guidance for Health Care and Public Health Providers
The purpose of this guidance is to provide an integrated approach to preventing, monitoring, and containing outbreaks of acute respiratory infection caused by SARS-CoV-2 (the virus that causes COVID-19), Influenza A and B, and other respiratory pathogens of public health significance. This guidance, which is based on standards and recommendations put forth by the federal Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH), includes information on pharmaceutical and non-pharmaceutical prevention strategies, including infection control, respiratory protection, and vaccination; testing and treatment; and outbreak management strategies including isolation, quarantine and mass testing. For additional information, please see the CDC’s Interim Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities and Information for Health Care Professionals 2020-2021 Flu Season. This guidance is continuously updated; the latest revisions are summarized in the “Record of Changes.”
|AHRQ||Agency for Healthcare Research and Quality|
|AIDS||Acquired Immune Deficiency Syndrome|
|AOD||Administrative Officer of the Day|
|AIIR||Airborne infection isolation room|
|BMI||Body Mass Index|
|CCHCS||California Correctional Health Care Services|
|CDC||Centers for Disease Control and Prevention|
|CDCR||California Department of Corrections and Rehabilitation|
|CDPH||California Department of Public Health|
|CLIA||Clinical Laboratory Improvement Amendments|
|CME||Chief Medical Executive|
|CNE||Chief Nurse Executive|
|COVID-19||Coronavirus Disease 2019|
|DON||Director of Nurses|
|EHRS||Electronic Health Record System|
|EPA||Environmental Protection Agency|
|HCP||Health Care Personnel|
|HCW||Health Care Worker|
|HIV||Human Immunodeficiency Virus|
|HLOC||Higher Level of Care|
|ICN||Infection Control Nurse|
|LHD||Local Health Department|
|NCPR||Nurse Consultant Program Review|
|NIOSH||National Institute for Occupational Safety and Health|
|OSHA||Occupational Safety and Health Administration|
|OEHW||Office of Employee Health and Wellness OEHW|
|PPE||Personal protective equipment|
|PAPR||Powered air purifying respirator|
|PORS||Preliminary Report of Infectious Disease or Outbreak form|
|PHB||Public Health Branch|
|PHN||Public Health Nurse|
|PhORS||Public Health Outbreak Response System|
|RIDT||Rapid Influenza Diagnostic Test|
|RSV||Respiratory syncytial virus|
|RT-PCR||Reverse Transcription Polymerase Chain Reaction|
|RTWC||Return to Work Coordinator|
|URI||Upper Respiratory Infection|
|VCM||Viral Culture Media|
|WHO||World Health Organization|
APPENDIX 18: COVID-19 OPERATIONAL PREPAREDNESS FOR FACILITY LEADERSHIP AND INCIDENT COMMAND
TABLE OF CONTENTS
- OPERATIONAL PREPAREDNESS
- CCHCS GUIDANCE ON EARLY IDENTIFICATION AND LOCATION FOR ISOLATION AND QUARANTINE ROOMS AND FUTURE COHORTS
- CCHCS GUIDANCE ON ASSESSING AND OBTAINING RESOURCES FOR OUTBREAK PLANNING
Please refer to the CCHCS Outbreak Preparedness and Management Toolkit and the COVID-19 Surge Mitigation and Management Strategy Guidance for detailed information and handy materials to assist you in your preparation efforts (CDCR networking is required for access).
The following guidance is excerpted directly from the July 22, 2020 Centers for Disease Control (CDC) Interim Guidance on Management of Coronavirus Disease (COVID-19) in Correctional and Detention Facilities. However, the sections “CCHCS Guidance on Assessing and Obtaining Resources for Outbreak Planning” and the “CCHCS Guidance on Early Identification and Location for Isolation and Quarantine” have been inserted as well as links to the CCHCS Interim Guidance document sections throughout.
Administrators can plan and prepare for COVID-19 by ensuring that all persons in the facility know the symptoms (see our Table 5.1 and the CDC’s listed Symptoms of COVID-19), and the importance of reporting those symptoms, if they develop. Other essential actions include developing contingency plans for reduced workforces due to absences, coordinating with public health and correctional partners, training staff on the proper use of personal protective equipment (PPE) that may be needed in the course of their duties, and communicating clearly with staff and incarcerated/detained persons about these preparations and how they may temporarily alter daily life.
COMMUNICATION AND COORDINATION
- Develop information-sharing systems with partners.
- Identify points of contact in the relevant state, local, tribal, and/or territorial public health departments (CDC) (refer to CCHCS Appendix 11) before SARS-CoV-2 infections develop. Actively engage with the health department to understand which entity has jurisdiction to implement public health control measures for COVID-19 in a particular correctional or detention facility.
- Create and test communication plans to disseminate critical information to incarcerated/detained persons, staff, contractors, vendors, and visitors as the pandemic progresses.
- Communicate with other correctional facilities in the same geographic area to share information, including disease surveillance and absenteeism patterns among staff.
- Where possible, put plans in place with other jurisdictions to prevent individuals with confirmed and suspected COVID-19 and their close contacts from being transferred between jurisdictions and facilities unless necessary for medical evaluation, medical isolation/quarantine, clinical care, extenuating security concerns, release, or to prevent overcrowding.
- Stay informed about updates to CDC guidance via the CDC COVID-19 website and the CCHCS Coronavirus webpage (CDCR networking is required for access) as more information becomes known.
- Review existing plans for influenza, all-hazards, and disasters, and revise for COVID-19.
- Train staff on the facility’s COVID-19 plan. All personnel should have a basic understanding of COVID-19, how the disease is thought to spread, symptoms, and what measures are being implemented and can be taken by individuals to prevent or minimize the transmission of SARS-CoV-2.
- Ensure that separate physical locations (dedicated housing areas and bathrooms) have been identified to 1) isolate individuals with confirmed COVID-19 (individually or cohorted), 2) isolate individuals with suspected COVID-19 (individually – do not cohort), and 3) quarantine close contacts of those with confirmed or suspected COVID-19 (ideally individually; cohorted if necessary). The plan should include contingencies for multiple locations if numerous infected individuals and/or close contacts are identified and require medical isolation or quarantine simultaneously (see Isolation and Quarantine subsections of the CCHCS Interim Guidance for more detailed cohorting considerations).
- Facilities without onsite healthcare capacity should plan for how they will ensure that individuals with suspected COVID-19 will be isolated, evaluated, tested, and provided necessary medical care.
- Make a list of possible social distancing strategies that could be implemented, as needed, at different stages of transmission intensity.
- Designate officials who will be authorized to make decisions about escalating or de-escalating response efforts as the disease transmission patterns change.
- Coordinate with local law enforcement and court officials.
- Identify legally acceptable alternatives to in-person court appearances, such as virtual court, as a social distancing measure to reduce the risk of SARS-CoV-2 transmission.
- Consider options to prevent overcrowding (e.g., diverting new intakes to other facilities with available capacity, and encouraging alternatives to incarceration and other decompression strategies where allowable).
- Encourage all persons in the facility to take the actions below to protect themselves and others from COVID-19. Post signs throughout the facility and communicate this information verbally on a regular basis. Sample CDC signage and other communications materials are available on the CDC website. Ensure that materials can be understood by non-English speakers and those with low literacy, and make necessary accommodations for those with cognitive or intellectual disabilities and those who are deaf, blind, or have low vision. CCHCS signage and communications materials can be found on the Coronavirus webpage under the Internal Resources tab (CDCR networking is required for access).
- For all:
- Practice good cough and sneeze etiquette (CDC): Cover your mouth and nose with your elbow (or ideally with a tissue) rather than with your hand when you cough or sneeze, and throw all tissues in the trash immediately after use.
- Practice good hand hygiene (CDC): Regularly wash your hands with soap and water for at least 20 seconds, especially after coughing, sneezing, or blowing your nose; after using the bathroom; before eating; before and after preparing food; before taking medication; and after touching garbage.
- Wear face coverings, unless specific PPE is indicated.
- Avoid touching your eyes, nose, or mouth without cleaning your hands first.
- Avoid sharing eating utensils, dishes, and cups.
- Avoid non-essential physical contact.
- For incarcerated/detained persons: Educate on the importance of reporting symptoms to staff; social distancing and its importance for preventing COVID-19; and the purpose of quarantine and medical isolation.
- For staff: Stay at home when sick; if symptoms develop while on duty, leave the facility as soon as possible and follow CDC-recommended steps for persons who are ill with COVID-19 symptoms including self-isolating at home, contacting your healthcare provider as soon as possible to determine whether you need to be evaluated and tested, and contacting your supervisor. Refer to the CDCR Office of Employee Health for current CDCR policies.
- For all:
- Review the sick leave policies of each employer that operates within the facility.
- Review policies to ensure that they are flexible, non-punitive, and actively encourage staff not to report to work when sick.
- Determine which officials will have the authority to send symptomatic staff home.
- Identify duties that can be performed remotely. Where possible, allowing staff to work from home can be an effective social distancing strategy to reduce the risk of SARS-CoV-2 transmission.
- Plan for staff absences. Staff should stay home when they are sick. They may also need to stay home to care for a sick household member or care for children in the event of school and childcare dismissals.
- Identify critical job functions and plan for alternative coverage.
- Determine minimum levels of staff in all categories required for the facility to function safely. If possible, develop a plan to secure additional staff if absenteeism due to COVID-19 threatens to bring staffing to minimum levels.
- Review CDC guidance on safety practices for critical infrastructure workers (including correctional officers, law enforcement officers, and healthcare workers) who continue to work after a potential exposure to SARS-CoV-2. Also, see the CCHCS Critical Inmate Workers memo (CDCR networking is required for access).
- Consider increasing keep on person (KOP) medication orders to cover 30 days in case of healthcare staff shortages.
- Consider offering revised duties to staff who are at increased risk for severe illness from COVID-19 (CDC). Persons at increased risk may include older adults and persons of any age with serious underlying medical conditions including lung disease, moderate to severe asthma, heart disease, chronic kidney disease, severe obesity, and diabetes. See CDC’s website for a complete list and regularly check for updates as more data becomes available. Please also refer to the CCHCS Persons at High Risk for Severe Morbidity and Mortality from COVID-19 table (Table 5.2).
- Consult with occupational health providers to determine whether it would be allowable to reassign duties for specific staff members to reduce their likelihood of exposure to SARS-CoV-2.
- Make plans in advance for how to change staff duty assignments to prevent unnecessary movement between housing units during a COVID-19 outbreak.
- If there are persons with COVID-19 inside the facility, it is essential for staff members to maintain a consistent duty assignment in the same area of the facility across shifts to prevent transmission across different facility areas.
- Where feasible, consider the use of telemedicine to evaluate persons with COVID-19 symptoms and other health conditions to limit the movement of healthcare staff across housing units.
- Offer the seasonal influenza vaccine to all incarcerated/detained persons (existing population and new intakes) and staff throughout the influenza season. CDC’s Symptoms of COVID-19 are similar to those of influenza. Preventing influenza in a facility can speed the detection of COVID-19 and reduce pressure on healthcare resources.
- Reference the Occupational Safety and Health Administration (OSHA) website for recommendations regarding worker health.
- Review CDC’s guidance for businesses and employers to identify any additional strategies the facility can use within its role as an employer, or share with others.
OPERATIONS, SUPPLIES, AND PPE PREPARATIONS
- Ensure that sufficient stocks of hygiene supplies, cleaning supplies, PPE, and medical supplies (consistent with the healthcare capabilities of the facility) are on hand and available and have a plan in place to restock as needed. Supplies may include:
- Standard medical supplies for daily clinic needs
- Liquid or foam soap when possible. If bar soap must be used, ensure that it does not irritate the skin and thereby discourage frequent hand washing. Ensure there is a sufficient supply of soap for each individual
- Hand drying supplies
- Alcohol-based hand sanitizer containing at least 60% alcohol (where permissible based on security restrictions)
- Cleaning supplies, including Environmental Protection Agency (EPA)-registered disinfectants effective against SARS-CoV-2
- Recommended PPE (surgical masks, N95 respirators, eye protection, disposable medical gloves, and disposable gowns/one-piece coveralls). See the CCHCS Interim Guidance PPE section and Table 11.2 for more detailed information, including recommendations for extending the life of all PPE categories in the event of shortages, and when surgical masks are acceptable alternatives to N95s. Visit CDC’s website for a calculator to help determine the rate of PPE usage.
- Make contingency plans for possible PPE shortages during the COVID-19 pandemic, particularly for non-healthcare workers.
- Consider relaxing restrictions on allowing alcohol-based hand sanitizer in the secure setting, where security concerns allow. If soap and water are not available, CDC recommends cleaning hands with an alcohol-based hand sanitizer that contains at least 60% alcohol. Consider allowing staff to carry individual-sized bottles for their hand hygiene while on duty, and placing dispensers at facility entrances/exits and in PPE donning/doffing stations.
- Provide a no-cost supply of soap to incarcerated/detained persons, sufficient to allow frequent hand washing. (See CDC’s Hygiene section for additional detail regarding recommended frequency and protocol for handwashing.)
- Provide liquid or foam soap where possible. If bar soap must be used, ensure that it does not irritate the skin, and thereby discourage frequent handwashing, and ensure that individuals do not share bars of soap.
- If not already in place, employers operating within the facility should establish a respiratory protection program (CDC), as appropriate, to ensure that staff and incarcerated/detained persons are fit-tested for any respiratory protection they will need within the scope of their responsibilities.
- Ensure that staff and incarcerated/detained persons are trained to correctly don, doff, and dispose of PPE that they will need to use within the scope of their responsibilities.
- Prepare to set up designated PPE donning and doffing areas outside all spaces where PPE will be used. These spaces should include:
- A dedicated trash can for disposal of used PPE
- A hand washing station or access to alcohol-based hand sanitizer
- A poster (CDC) demonstrating correct PPE donning and doffing procedures
- Review CDC and EPA guidance for cleaning and disinfecting of the facility.
CCHCS GUIDANCE ON EARLY IDENTIFICATION AND LOCATION FOR ISOLATION AND QUARANTINE ROOMS AND FUTURE COHORTS
- It is crucial to be ready for your first cases and contacts of cases.
- Analyze your ventilation systems and staff/inmate traffic patterns.
- If you anticipate the need for tent housing, consult the Department Operations Center (DOC) at DOCCOVID19@cdcr.ca.gov.
- Work with the warden on evaluating and repurposing existing space in collaboration with the DOC.
- Work with custody and supplies from the Office of Emergency Preparedness for physical space assistance. Ensure patients’ ability to access showers, bathrooms, and a path to the exercise yards that will not expose other inmates to the virus.
- Consider what supplies you will need, inventory your current stock, and order accordingly (e.g., testing kits and swabs, PPE, cleansers, trash receptacles, extra tissues, extra soap, portable wash stations, housing tents or canopies, portable showers, duct tape, oxygen, incentive spirometry, nasal cannulas, O2, surgical masks, and tubing, etc.).
- Mobilize your PPE: have it ready and available at the sites where it will be needed, including the Treatment and Triage Area (TTA), all medical and dental clinics, specialized medical housing, and for custody officers who may need to escort a symptomatic patient from the housing area to a site for medical evaluation.
CCHCS GUIDANCE ON ASSESSING AND OBTAINING RESOURCES FOR OUTBREAK PLANNING
For assessing needed supplies, the facility leadership, including the Chief Medical Executive (CME), Chief Nursing Executive (CNE), Warden, and Chief Executive Officer (CEO), should meet to discuss resources and allocation. After a leadership discussion at the institution, if there are needed items, lack of local resources, or concerns about being able to provide needed precautionary or treatment measures, contact the DOC (see below).
For requested items not available locally, a Form 213 Resource Request Message (CDCR networking is required for access) needs to be filled out and e-mailed to the DOC (e-mail address below). Form 213 can be sent by the Warden, CEO, or CME.
Form 213 is available through Lifeline. (Entering ‘213’ in the search space gives you the form below, entering ‘213 resource request’ gives both the form and the Clarification Regarding Utilization of Resource Request Message, Incident Command System, 213 RR; CAL-Cards; and General Procurement Methods in Response to COVID-19 memo (CDCR networking is required for access).
Note: A separate form should be submitted for each item (e.g., N95 respirators on one form, tents on another form). Needed items are obtained from another institution that currently has extra or from the state Office of Emergency Services (OES).
For questions, please contact the respective CDCR chain of command, or e-mail the DOC at DOCCOVID19@cdcr.ca.gov.
Detailed information on prevention can be found in the Primary Prevention section of the CCHCS guidance document.
Cases of COVID-19 have been documented in all 50 states. Correctional and detention facilities can prevent the introduction of SARS-CoV-2 and reduce transmission if it is already inside by reinforcing good hygiene practices among incarcerated/detained persons, staff, and visitors (including increasing access to soap and paper towels), intensifying cleaning/disinfection practices, and implementing social distancing strategies.
Because many individuals infected with SARS-CoV-2 do not display symptoms, the virus could be present in facilities before infections are identified. Good hygiene practices, vigilant symptom screening, wearing cloth face coverings (CDC) (if able), and social distancing are critical in preventing further transmission.
Testing (CDC) symptomatic and asymptomatic individuals and initiating medical isolation for suspected and confirmed cases and quarantine for close contacts can help prevent the spread of SARS-CoV-2. See the CCHCS Testing and Control Strategies for Suspect and Confirmed COVID-19 Cases sections, and the Movement Matrix.
Set up an Incident Command Center with appropriate leadership representation (e.g., the CEO, medical, nursing, custody, the warden, pharmacy, dental, mental health, etc.). Make use of the Daily Institution Command Report (access permissions are required).
- Stay in communication with partners about your facility’s current situation.
- State, local, territorial, and/or tribal health departments
- Other correctional facilities
- Communicate with the public about any changes to facility operations, including visitation programs.
- Limit transfers of incarcerated/detained persons to and from other jurisdictions and facilities unless necessary for medical evaluation, medical isolation/quarantine, clinical care, extenuating security concerns, release, or to prevent overcrowding.
- Consider postponing non-urgent outside medical visits. Use telehealth to the extent possible as a social distancing measure within the facility and help minimize movement between the facility and the community.
- If a transfer is absolutely necessary, perform verbal screening and a temperature check before the individual leaves the facility. If an individual does not clear the screening process, delay the transfer and follow the protocol for suspected COVID-19 infection – including giving the individual a surgical mask, if not already wearing one, immediately placing them under medical isolation, and evaluating them for SARS-CoV-2 testing.
- Ensure that the receiving facility can properly quarantine or isolate the individual upon arrival.
- See the Transportation subsection for information on precautions to use when transporting an individual with confirmed or suspected COVID-19.
- Make every possible effort to modify staff assignments to minimize movement across housing units and other areas of the facility. For example, ensure that the same staff are assigned to the same housing unit across shifts to prevent cross-contamination from units where infected individuals have been identified to units with no infections.
- Consider suspending work release and other programs that involve the movement of incarcerated/detained individuals in and out of the facility, especially if the work release assignment is in another congregate setting, such as a food processing plant.
- Implement lawful alternatives to in-person court appearances where permissible.
- Where relevant, consider suspending co-pays for incarcerated/detained persons seeking medical evaluation for possible COVID-19 symptoms.
- Limit the number of operational entrances and exits to the facility.
Where feasible, consider establishing an onsite laundry option for staff to change out of their uniforms, launder them at the facility, and wear street clothes and shoes home. If onsite laundry for staff is not feasible, encourage them to change clothes before leaving the worksite, and provide a location for them to do so. This practice may help minimize the risk of transmitting SARS-CoV-2 between the facility and the community.