COVID-19

This website is intended to provide an overview and key documents, resources, tools and links to websites for the current outbreak of a 2019 novel coronavirus in Wuhan City, Hubei Province, China. On Jan. 30, 2020, the World Health Organization (WHO) opens in a new tab declared 2019-nCoV a global health emergency. On March 11, it upgraded status to a global pandemic opens in a new tab.

In the U.S., Alex Azar, Secretary of Health and Human Services, pursuant to authority vested to him under section 319 of the Public Health Service Act, announced that a public health emergency exists effective Jan. 31, 2020. The determination was renewed on April 21. On July 20, the Secretary officially announced another 90-day extension of the emergency opens in a new tab, effective July 25.

Effective Feb. 11, the WHO renamed 2019-nCoV to COVID-19 opens in a new tab.  The CDC opens in a new tab has followed suit and updated its website with the new name.

• Coronaviruses are common around the world and cause a range of illnesses in humans, from the common cold to SARS and MERS. Viruses of this family also cause disease in animals. CDC confirmed person-to-person transmission in the U.S on Jan. 30. opens in a new tab On Feb. 26, they confirmed a possible instance of community-spread opens in a new tab of the virus that causes COVID-19.
• Complete CDC information and recommendations to date are available here opens in a new tab . The situation is unfolding dynamically; guidance will evolve.
• CDC COVIDView opens in a new tab (April 5). A weekly COVID-19 surveillance report of U.S. cases. The report summarizes and interprets key indicators including information related to COVID-19 outpatient visits, emergency department visits, hospitalizations and deaths, as well as laboratory data.
• CDC Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission opens in a new tab (April 3).Given what is now known about asymptomatic transmission, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission. The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders.
• CDC Coronavirus “Self-Checker” opens in a new tab. The purpose of the Coronavirus Self-Checker is to help you make decisions about seeking appropriate medical care. This system does not replace the judgment of healthcare professionals or the performance of any clinical assessment.
• The WHO COVID-19 opens in a new tab outbreak website contains excellent videos on topics, such as, proper use, removal and disposal of PPE, and infographics for download. It also houses up-to-date facts and global statistics on the disease.
• The U.S. Environmental Protection Agency (EPA) released a list of EPA-registered disinfectants that are qualified for use against COVID-19 opens in a new tab on March 5. The SARS-CoV-2, is a coronavirus that causes COVID-19. Coronaviruses are enveloped viruses, meaning they are one of the easiest types of viruses to kill with the appropriate disinfectant product. Follow manufacturer’s direction for use of the product; pay close attention to the contact time (how long product must remain on the surface). Disinfect high touch surface areas frequently.
• The Centers for Medicare and Medicaid Services (CMS) just released a memoon CMS website opens in a new tab stating, effective immediately, that all hospital inspections will focus solely on infection prevention and control procedures. This is a call to action for HCWs to ensure they are actively implementing comprehensive infection prevention and control practices. CMS provided a checklist PDF opens in a new tab to guide facilities how to prepare for potential inspection.

PPE/Masks

• AHRQ – Masks for Prevention of COVID-19 in Community and Healthcare Settings opens in a new tab. Rapid Evidence Product Version 1.0 (June 18).
• Annals of Internal Medicine^®– Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points from the American College of Physicians (Version 1) opens in a new tab (Accessed June 19)
• CDC – On July 9, CDC clarified that the recommendations for universal use of eye protection (in addition to a facemask opens in a new tab) for HCP working in facilities located in communities with moderate to sustained SARS-CoV-2 transmission is intended to ensure HCP eyes, nose and mouth are all protected during patient care encounters.
• CDC – Strategies to Optimize the Supply of PPE and Equipment (May 18, 2020) opens in a new tab
• CDC – Decontamination and Reuse of Filtering Facepiece Respirators Using Contingency and Crisis Capacity Strategies opens in a new tab Decontamination and reuse of disposable filtering facepiece respirators (FFRs) may be considered as a crisis capacity strategy. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide and moist heat showed the most promise as potential methods to decontaminate FFRs.
• CMS – Update – Key Protective Mask Guidance for Healthcare Workers – March 10, 2020 opens in a new tab In a March 10 memo issued to State Survey Agencies, CMS is expanding the allowable types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infection. CMS also alerted state surveyors they are not required – on a temporary basis – to validate the date of a facility’s last annual test of the fit of N95 masks worn by workers in Medicare- and Medicaid-certified facilities. CMS took this step to minimize the discarded masks associated with such testing. Only annual fit testing validation is being waived.
• IDSA – In a July 8 statement, opens in a new tab the Society called on the public to wear a mask to help slow the spread of COVID-19.

Other Resources

• CDC – Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings. opens in a new tab Interim Guidance (July 20). Key updates include:
  • A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances.
  • Symptom-based criteria were modified to “at least 24 hours” have passed since last fever without the use of fever-reducing medications.
  • “Improvement in respiratory symptoms” was changed to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.
• CDC – Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings. Interim Guidance opens in a new tab (July 17).
  • Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue Transmission-Based Precautions opens in a new tab.
  • Other symptom-based criteria were modified as follows:
    • Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications.
    • Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.
  • A summary of current evidence and rationale for these changes is described in a decision memo opens in a new tab.
• CDC – COVID-19 Rapid Response Team Guidance opens in a new tab (Updated June 23). Provides recommendations and resources for the establishment and management of Public Health Rapid Response Teams for disease outbreaks.
• CDC – Interim Guidance for General Population Disaster Shelters During the COVID-19 Pandemic opens in a new tab (Accessed June 23).
• FDA – On July 2, FDA alerted consumers and healthcare personnel to methanol contamination opens in a new tab in some hand sanitizers. Methanol is not an acceptable ingredient and can be toxic when absorbed through the skin or ingested.
• FDA – COVID-19 Response At-A-Glance Summary as of June 18, 2020. opens in a new tab The summary features highlights of FDA activities to date:
  • Ensuring timely availability to accurate and reliable tests
  • Accelerating availability of medical equipment and products for treatment
  • Actively monitoring the medical product and food supply chains to address imbalances
  • Halting the sale of products with fraudulent claims related to COVID-19
• CDC – Clinician Outreach and Communication Activity (COCA) COVID-19 Calls/Webinars.opens in a new tab
  Recent topics include: Updates for Infection Prevention and Control; Long Term Care Facilities; and Caring for Children and Pregnant Women.
• CDC – On March 5, CDC held a Clinician Outreach and Communication Activity (COCA) webinar: Coronavirus Disease 2019 (COVID-19) Update – What Clinicians Need to Know to Prepare for COVID-19 in the United States. Listen here opens in a new tab At present, there is no vaccine or specific treatment for COVID-19 infection; care is supportive. Symptomatic patients should wear a surgical mask and be placed in a single occupancy room; the ideal location is an airborne infection isolation room. Healthcare workers should adhere to standard precautions, contact precautions and use eye protection (e.g., goggles or face shield).
• CDC – Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings (Updated July 9) opens in a new tab
• CDC – (Updated June 18) interim guidance for risk assessment and public health management of HCWs with potential COVID-19 exposure opens in a new tab.
  • If you are sick, stay home; do not go to work. Reach out to your employer for guidance on options and resources.
  • As always, hand hygiene and cough etiquette (cover the cough – not with your hand) are invaluable prevention tactics.
  • In general, be prepared for the possibility of a COVID-19 outbreak in your community. Take measures to reduce the spread of COVID-19. CDC has made resources, guidance and communication materials available for individuals and communities, opens in a new tab including nonpharmaceutical interventions (NPIs).
• CMS – Current Emergencies Website: COVID-19 opens in a new tab This site includes clinical/technical, coding/billing and survey/certification guidance.

• FDA – Enforcement Policy for Viral Transport Media During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency opens in a new tab. Guidance for Commercial Manufacturers, Clinical Laboratories and Food and Drug Administration Staff. FDA also issued a FAQ opens in a new tab to accompany the Policy. (Updated July 20)
• FDA – First Emergency Authorization for Sample Pooling in Diagnostic Testing for COVID-19 opens in a new tab issued July 18. The American Association for Clinical Chemistry has provided an explanation of what pooled testing opens in a new tab is, including guidance on when it should and should not be used.
• On June 13, the CDC released consolidated, updated recommendations for COVID-19 testing opens in a new tab. Included are interim testing guidelines for nursing home residents and healthcare personnel, as well as testing strategy options for high-density critical infrastructure workplaces after a COVID-19 case is identified.
• The CDC updated its interim guidelines opens in a new tab for clinical lab specimens on May 22. Recommendations regarding Persons Under Investigation (PUIs) opens in a new tab and lab biosafety were made on May 3. Providers should contact their local/state health department immediately to notify them of patients with fever and lower respiratory illness who live in or have traveled to an area with sustained transmission OR who have been in close contact (within six feet for at least 10 minutes) with a confirmed COVID-19 patient.
• CDC – Test for Past Infection (Antibody Test) opens in a new tab (Updated May 23)
• CDC – Serology Testing for COVID-19 opens in a new tab (Updated May 23)
• Organizations with Premier^® Clinical Surveillance technology and services opens in a new tab, powered by TheraDoc^®, can deploy real-time alerts or set population flags to identify and track patients with suspected or confirmed illness, giving Infection Preventionists back precious time they need to stem the spread of COVID-19.

On March 13, CMS issued Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes opens in a new tab. In brief, the guidance is to adhere to CDC current recommendations opens in a new tab regarding residents, staff and visitors. Long-term care facilities concerned that a resident, visitor or employee may be a COVID-2019 patient under investigation (PUI) opens in a new tab should contact their local or state health department immediately for consultation and guidance.

Centers for Disease Control and Prevention (CDC):

• CDC’s Clinician Outreach and Communication (COCA) webinar: Coronavirus Disease 2019 (COVID-19) Update and Information for Long-term Care Facilities (March 17, 2020) opens in a new tab
• CDC’s Morbidity and Mortality Weekly Report (MMWR) COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020 opens in a new tab
• Guidance for Retirement Communities and Independent Living opens in a new tab. Plan, prepare and respond to coronavirus disease 2019

Centers for Medicare and Medicaid Services (CMS):

• Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes opens in a new tab (May 2020)
• CMS Announces New Measures to Protect Nursing Home Residents from COVID-19 opens in a new tab (March 13, 2020):
  • Restricting all visitors, effective immediately, with exceptions for compassionate care, such as end-of-life situations.
  • Restricting all volunteers and nonessential healthcare personnel and other personnel (i.e., barbers).
  • Cancelling all group activities and communal dining.
  • Implementing active screening of residents and health care personnel for fever and respiratory symptoms.

Illinois Department of Public Health (IDPH)

• COVID-19 – Long Term Care Facilities Guidance opens in a new tab
• Includes:
  • IDPH Long Term Care COVID-19 Guidance
  • Visitor Restriction Guidance
  • Checklist for Long Term Care Facilities opens in a new tab
  • Sample Long Term Care Facility Letter
  • Employee Monitoring Tool opens in a new tab

American Health Care Association (AHCA)

• Coronavirus Resources opens in a new tab: Practical information and resources for providers; friends and family; and residents and patients.

The Society for Post-Acute and Long-Term Care Medicine (AMDA)

• AMDA Update on COVID-19 site opens in a new tab, includes guidance, resources and tools.

Surge capacity, meaning a facility’s or healthcare systems’ ability to handle a sudden increase in volume or demand, is fundamental to disaster preparedness. Surge capability is focused on meeting specialized needs, i.e., need for ICU care or specific care need, such as, isolation. Preparation is key.

• AHRQ  – Northeastern University Hospital Surge Capacity Planning Model: Bed, Ventilator, and PPE 1-30 Day Demand (May 2020) opens in a new tab
• ASPR – Enhancing Medical Surge Capacity (April, 27, 2018) opens in a new tab
• ASPR – Hospital Preparedness Program (HPP): Hospital Surge Evaluation Tool opens in a new tab
• CDC – Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19) opens in a new tab
• NEW: CDC COVID19Surge opens in a new tab (April 21) – A spreadsheet-based tool that can be used to estimate surge in demand for services during the pandemic. A user can generate estimates of needs for hospitalized COVID-19 patients, including the number requiring ICU level care and ventilatory support and compare to current capacity.
• HHS – Medical Surge Capacity Handbook opens in a new tab
• Wisconsin Department of Health Services – Guidelines for Managing Hospital Surge Capacity opens in a new tab. Wisconsin Healthcare Emergency Preparedness Program. Expert Panel on Medical Surge Capacity. (Rev. March 2015)

Communities also have a key role to play as active participants in planning for and responding to local health care crises, such as COVID-19.

• CDC – Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission opens in a new tab

From April 2012 to July 2013, a novel new coronavirus caused respiratory illness in 81 adults (45 fatal) from four countries in the Middle East (Saudi Arabia, Qatar, Jordan and the United Arab Emirates), as well as France, Germany, Tunisia and the United Kingdom. (Updated case counts opens in a new tab). Symptoms included fever, cough and shortness of breath. The new virus was named the Middle East Respiratory Syndrome Coronavirus or (MERS-CoV). There is still limited information on transmission, severity and clinical impact. Thus far, all clusters of cases have occurred in a healthcare setting or among close family contacts. Human-to-human transmission was documented on several occasions in which secondary cases had not traveled to affected areas and is strongly suspected in others. In May 2014, there were two imported cases of MERS in travelers from Saudi Arabia to the US, however the cases were not linked. For more information, visit the CDC website on MERS opens in a new tab.