CDC | Testing Guidelines for Nursing Homes

On June 13, the Centers for Disease Control and Prevention issued updated guidance for COVID-19 testing in nursing homes. Thank you to the many  member organizations  providing this vitally important care to our nation’s vulnerable populations. Changes are summarized below:

  • Reorganized recommendations to address:
    • Viral testing of healthcare personnel (HCP)
    • Viral testing of residents
    • Viral testing in response to an outbreak
  • Changed “baseline” testing to “initial” testing, although these terms are interchangeable
  • Added the following recommendations:
    • Testing the same individual more than once in a 24-hour period is not recommended.
    • Clinicians are encouraged to consider testing symptomatic residents for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2.

CDC Nursing Home Testing

Race Gaps in COVID-19 Deaths Are Even Bigger Than They Appear

From the Brookings Institute  on June 16

The COVID-19 pandemic has been like the flash of an X-ray, exposing the deep fractures in U.S. society – not least by race. New data from CDC shows that the death rates among Black and Hispanic/Latino people are much higher than for white people, in all age categories…

Stark inequalities in COVID outcomes exist for the American Indian and Alaska Native population as well, however information on death rates for these groups is incomplete. Here, we focus on the three largest racial/ethnic groups, white, Black, and Hispanic/Latino, for which data are more reliable and which account for 93% of all COVID deaths reported by the CDC (through June 6).

Continue reading►

NYT | Low-Cost Drug Reduces Coronavirus Deaths, Scientists Say

From the New York Time on June 16, 2020

LONDON — Scientists at the University of Oxford said on Tuesday that they had identified what they called the first drug proven to reduce coronavirus-related deaths, after a 6,000-patient trial in Britain showed that a low-cost steroid prevented the deaths of some hospitalized patients.

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Politico | Nursing Homes Go Unchecked As Fatalities Mount

From Politico on June 15, 2020 by Rachel Roubein and Maggie Severns

Thousands of nursing homes across the country have not been checked to see if staff are following proper procedures to prevent coronavirus transmission, a form of community spread that is responsible for more than a quarter of the nation’s Covid-19 fatalities.

Only a little more than half of the nation’s nursing homes had received inspections, according to data released earlier this month, which prompted a fresh mandate from Medicare and Medicaid chief Seema Verma that states complete the checks by July 31 or risk losing federal recovery funds.

Continue reading►

KHN | EMTs Facing A Pandemic And Protests At Once

For EMTs, There’s No ‘Rule Book’ For Facing A Pandemic And Protests At Once

By Carmen Heredia Rodriguez | From Kaiser Health News

Emergency medical services across the country, already burdened by the high demands of COVID-19, have faced added pressure in the past week as they responded to protests ignited by the death of George Floyd in the custody of Minneapolis police.

The need to protect themselves against the coronavirus adds another complication to emergency crews’ efforts in these dangerous conditions. Their personal protective equipment (PPE) can be difficult to wear in a crowd, said emergency medical services officials. Plus, switching from that gear to equipment needed to shield medics from bullets, rocks or tear gas can be challenging.

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MIT | What Does and Does Not Correlate With COVID-19 Death Rates

From the Massachusetts Institute of Technology Center for Energy and Environmental Policy Research

What Does and Does Not Correlate With COVID-19 Death Rates
Christopher R. Knittel and Bora Ozaltun
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Abstract
We correlate county-level COVID-19 death rates with key variables using both linear regression and negative binomial mixed models, although we focus on linear regression models. We include
four sets of variables: socio-economic variables, county-level health variables, modes of commuting, and climate and pollution patterns. Our analysis studies daily death rates from April 4, 2020 to May 27, 2020. We estimate correlation patterns both across states, as well as within states. For both models, we find higher shares of African American residents in the county are correlated with higher death rates. However, when we restrict ourselves to correlation patterns within a given state, the statistical significance of the correlation of death rates with the share of African Americans, while remaining positive, wanes. We find similar results for the share of elderly in the county. We find that higher amounts of commuting via public transportation, relative to telecommuting, is correlated with higher death rates. The correlation between driving into work, relative to telecommuting, and death rates is also positive across both models, but statistically significant only when we look across states and counties. We also find that a higher share of people not working, and thus not commuting either because they are elderly, children or unemployed, is correlated with higher death rates. Counties with higher home values, higher summer temperatures, and lower winter temperatures have higher death rates. Contrary to  past work, we do not find a correlation between pollution and death rates. Also importantly, we do not find that death rates are correlated with obesity rates, ICU beds per capita, or poverty rates. Finally, our model that looks within states yields estimates of how a given state’s death rate compares to other states after controlling for the variables included in our model; this may be interpreted as a measure of how states are doing relative to others. We find that death rates in the Northeast are substantially higher compared to other states, even when we control for the four sets of variables above. Death rates are also statistically significantly higher in Michigan, Louisiana, Iowa, Indiana, and Colorado. California’s death rate is the lowest across all states.

Download Full Paper

WEBINAR: Patient Care and Operations | Monday, June 15

Our partners at the HHS Office of the Assistant Secretary for Preparedness and Response are hosting a COVID-19 Clinical Rounds webinar next week. See below for more information and links to register. And be sure to access the latest COVID-19 information for EMS at the updated COVID-19 Resources for EMS.

EMS: Patient Care and Operations

Monday, June 15, 2020
12:00 PM EDT / 9:00 AM PDT

Register Now

Webinar Agenda

Welcome and Introductions

Jon R. Krohmer, MD, FACEP, FAEMS, Director, Office of EMS, National Highway Traffic Safety Administration

Patient Care and Operations

Kristi L. Koenig, MD, FACEP, FIFEM, FAEMS, Medical Director, Emergency Medical Services, County of San Diego Health & Human Services Agency; Professor Emerita of Emergency Medicine & Public Health, University of California, Irvine

Will Smith, MD, Paramedic, FAEMS, Medical Director, Grant Teton National Park, Teton County Search and Rescue, Jackson Hole Fire/EMS, USFS-BTNF; Clinical Assistant Professor, University of Washington School of Medicine; Emergency Medicine, St. John’s Health, Jackson, WY; Colonel, MC, US Army Reserve – 62A, Emergency Medicine

Q & A and Discussion

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

WEBINAR: EMS Response to COVID-19 and Protests | Monday, June 8

Our partners at the HHS Office of the Assistant Secretary for Preparedness and Response are hosting a COVID-19 Clinical Rounds webinar next week. See below for more information and links to register. And be sure to access the latest COVID-19 information for EMS at the updated COVID-19 Resources for EMS.

EMS Response to COVID-19 and Protests

Monday, June 8, 2020
12:00 PM EDT / 9:00 AM PDT

Register Here

Webinar Agenda

Welcome and Introductions

Richard C. Hunt, MD, FACEP, HHS/ASPR National Healthcare Preparedness Programs

EMS Response to COVID-19 and Protests

Jeffrey D. Ho, MD, Chief EMS Medical Director, Hennepin EMS & Professor of Emergency Medicine, University of Minnesota, Minneapolis

Michael R. Sayre, MD, Medical Director, Seattle Fire Department & Professor, Department of Emergency Medicine, University of Washington

Q & A and Discussion

 

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

WEBINAR: EMS: Patient Care and Operations | Monday, June 1

Our partners at the HHS Office of the Assistant Secretary for Preparedness and Response are hosting a COVID-19 Clinical Rounds webinar next week. See below for more information and links to register. And be sure to access the latest COVID-19 information for EMS at the updated COVID-19 Resources for EMS.

EMS: Patient Care and Operations

Monday, June 1, 2020
12:00 PM EDT / 9:00 AM PDT

Register Here

Webinar Agenda
Welcome and Introductions

Jon R. Krohmer, MD, FACEP, FAEMS, Director, Office of EMS, National Highway Traffic Safety Administration

Patient Care and Operations

Lekshmi Kumar, MD, MPH, FACEP, Associate Professor, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine; Medical Director, Grady EMS

Bill Salmeron, Chief, New Orleans EMS

Q & A and Discussion

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

Contact Us

1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

NYT | Fear of Covid Leads Other Patients to Decline Critical Treatment

Psychologists say anxiety and uncertainty prompt irrational decisions — like turning down a transplant when an organ becomes available.

…In Newark, emergency medical services teams made 239 on-scene death pronouncements in April, a fourfold increase from April 2019. Fewer than half of those additional deaths could be attributed directly to Covid-19, said Dr. Shereef Elnahal, president and chief executive of Newark’s University Hospital…

From the New York Times►

The Hill | Coronavirus crisis squeezes ambulance operators

From May 19, 2020’s The Hill article by Reid Wilson

…The coronavirus crisis is putting an unexpected financial squeeze on ambulance operators, ratcheting up costs and tanking revenue even as they audibly remind people of the virus’s proliferation throughout the county…

Read the full article featuring interviews with many AAA members, including Bell Ambulance, Empress EMS, Great Falls Emergency Services, and REMSA!

JEMS | Paramedicine Strategic Planning

By Brian J Maguire, Dr.PH, MSA, EMT-P, Scot Phelps, JD, MPH, Paul Maniscalco, PhD(c), MPA, MS, EMT/P, LP, Daniel R. Gerard, MS, RN, Andy Gienapp, NRP, Kathleen A. Handal, MD and Barbara J. O’Neill, PhD, RN

… Many of the system deficiencies can be traced to three main factors. First, there is no single U.S. federal agency solely charged with supporting paramedicine operations. Second, no legislative mandate exists to engage in paramedicine operational research. Third, there is no paramedicine-specific financial support to advance core initiatives at the federal, state, tribal and local levels…

Read full article►

John Hopkins | How to better protect EMS personnel from infectious disease?

Download PDF Report

Emergency medical services systems and providers are on the front lines of the health response to large-scale disasters, including COVID. EMS professionals in the United States have provided medical care and transportation during pandemic influenzas, importations of Ebola, and other high-consequence pathogens, but none have had the widespread systemic effects of COVID. Because of the unpredictable and, at times, chaotic nature of EMS practice, EMS providers face different occupational health risks compared with hospital-based clinicians. Infection control and prevention practices in EMS rely primarily on the provision and proper use of PPE and on universal precautions, such as hand hygiene. However, like other healthcare workers, EMS providers have been facing serious shortages of PPE. EMS agencies chronically struggle with inadequate funding, which limits their ability to stockpile appropriate PPE.51 As such, COVID is taking a dramatic toll on the EMS workforce in the hardest-hit areas. Amid record-high call volumes, it was reported that 1 in every 4 New York fire department EMS providers had called in sick and that roughly 10% of the workforce had tested positive for COVID.52 A similar but perhaps less dramatic strain on EMS is expected in other states with increasing COVID transmission. It is not clear what role infected EMS personnel may play in the spread of COVID.

The highly fragmented nature of EMS practice in the United States makes achieving systemic reforms challenging. However, recent years have seen some qualified successes. HHS’s Hospital Preparedness Program (HPP) provides a grant mechanism to enable hospitals, public health departments, EMS agencies, and other stakeholders in a given locality to conduct joint planning for large-scale emergencies, an investment that we believe has paid dividends. However, additional resources and creative thinking will be needed to more fully integrate EMS systems and providers into the larger healthcare response to high-consequence epidemic and pandemic diseases. To that end, we recommend the following:

Recommendations

  • Federal, state, and local governments should prioritize and fund EMS systems and providers to receive PPE, particularly N95 respirators, on par with hospitals.
  • States should integrate EMS data into COVID surveillance systems to better understand disease transmission, especially in large cities.
  • In the longer term, CMS should reconsider the reimbursement process for EMS, and state and local governments should reassess the baseline funding needs of EMS.”

 

 

CDC: Guidance for Institutions of Higher Education

Read as a PDF

Who is this guidance for?

This interim guidance is intended for administrators of public and private institutions of higher education (IHE). IHE includes a diverse set of American colleges and universities: 2- or 4-year; public, private non-profit, or private for-profit; and comprehensive, research-focused, or special mission. IHE administrators (e.g., presidents, deans, provosts) are individuals who make policies and procedures, set educational aims and standards, and direct programming of institutions of higher education.

Why is this guidance being issued?

This guidance will help IHE and their partners understand how to help prevent the transmission of COVID-19 among students, faculty, and staff. It also aims to help IHE react quickly should a case be identified in the IHE or if there is spread within the community in which the IHE is located. The guidance includes considerations to help administrators plan for the continuity of teaching, learning, and research if there is community spread of COVID-19 and address concerns related to COVID-19 associated stigma.

What is the role of IHE in responding to COVID-19?

IHE, working together with local health departments, has an important role in slowing the spread of disease. IHE’s efforts will help ensure students, staff, and faculty have safe and healthy environments in which to learn and work. IHE welcomes students, staff, faculty, and visitors from throughout the community. All of these people may have close contact in IHE settings, often sharing spaces, equipment, and supplies. Some individuals are experiencing stigma and discrimination in the United States related to COVID-19. This includes people of Chinese and Asian descent, as well as some returning travelers and emergency responders who may have been exposed to the virus. It is important for IHE to provide accurate and timely information
about COVID-19 to students, staff, and faculty to minimize the potential for stigma on college and university campuses. It is also important to provide mental health support to promote resilience among those groups affected by stigma regarding COVID-19. CDC has information IHE can share to reduce COVID-19 associated fear and stigma.

How should IHEs prepare for, and respond to, COVID-19?

IHE should be prepared for COVID-19 outbreaks in their local communities and for individual exposure events to occur in facilities, regardless of the level of community transmission, for example, a case associated with travel.

When a confirmed case has been on campus, regardless of community transmission

Any IHE in any community might need to implement short-term building closure procedures regardless of community spread if an infected person has been on campus. If this happens, CDC recommends the following procedures, regardless of level of community spread:

  • Coordinate with local health officials. Once learning of a COVID-19 case in someone who has been on the campus, immediately reach out to local public health officials. These officials will help administrators determine a course of action for their IHE.
  • Work with local public health officials to determine cancellation of classes and closure of buildings and facilities. IHE administrators should work closely with their local health officials to determine if a short-term closure (for 2-5 days) of all campus buildings and facilities is needed. In some cases, IHE administrators, working with local health officials, may choose to only close buildings and facilities that had been entered by the individual(s) with COVID-19. This initial short-term class suspension and event and activity (e.g., club meetings; on-campus sport, theater, and music events) cancellation allows time for the local health officials to gain a better understanding of the COVID-19 situation impacting the IHE. This allows the local health officials to help the IHE determine appropriate next steps, including whether an extended duration is needed to stop or slow further spread of COVID-19.
    • Local health officials’ recommendations for the duration and extent of class suspensions, building and facility closures, and event and activity cancellations should be made on a case-by-case basis using the most up-to-date information about COVID-19 and the specific cases in the community.
    • Discourage students, staff, and faculty from gathering or socializing anywhere. This includes group childcare arrangements, as well as gathering at places like a friend’s house, a favorite restaurant, or the local coffee shop.
    • Communicate with students, staff, and faculty. Coordinate with local health officials to communicate dismissal decisions and the possible COVID-19 exposure.
    • This communication to the IHE community should align with the communication plan in the emergency operations plan.
    • Plan to include messages to counter potential stigma and discrimination.
    • In a circumstance where there is a confirmed COVID-19 case that has been on campus, it is critical to maintain confidentiality of the student or staff member as required by the Americans with Disabilities Act and the Family Education Rights and Privacy Act, as applicable.
  • Clean and disinfect thoroughly.
    •  Close off areas used by the patient. Open outside doors and windows to increase air circulation in the area and then begin cleaning and disinfection.
    • Cleaning staff should clean and disinfect all areas (e.g., offices, bathrooms, and common areas) used by the COVID-19 patient focusing especially on frequently touched surfaces.
    •  If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
    •  For disinfection most common EPA-registered household disinfectants should be effective. A list of products that are EPA-approved for use against the virus that causes COVID-19 is available here. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
    • Additional information on cleaning and disinfection of community facilities such as schools can be found on CDC’s website.
  • Make decisions about extending the class suspension and event and activity cancellation. Temporarily suspending classes is a strategy to stop or slow the further spread of COVID-19 in communities.
    • When classes are suspended, IHE administrators should work closely with local public health officials to determine if some buildings and facilities may stay open for staff or faculty that are not ill while students temporarily stop attending in-person classes.
    • IHE administrators should work in close collaboration with local public health officials and the IHE’s university system to make class suspension and large event and activity cancellation decisions. IHE are not expected to make decisions about suspending classes or canceling events on their own. IHE can seek specific guidance from local health officials to determine if, when, and for how long to take these steps. The nature of these actions (e.g., geographic scope, duration) may change as the local outbreak situation evolves.
    • Administrators should seek guidance from local health officials to determine when students, staff, and faculty should return to campus and what additional steps are needed for the IHE community. In addition, students, staff, and faculty who are well but are taking care of or share a home with someone with a case of COVID-19 should follow instructions from local health officials to determine when to return to campus.
  • Implement strategies to continue education and other related supports for students.
    • Ensure continuity of education and research.
      •  Review continuity plans, including plans for the continuity of teaching, learning, and research. Implement e-learning plans and distance learning options as feasible and appropriate.
      • Ensure continuity plans address how to temporarily postpone, limit, or adapt research-related activities (e.g., study recruitment or participation, access to labs) in a manner that protects the safety of researchers, participants, facilities, and equipment.
      • Consider the following approaches:
        • Use of existing infrastructure and services (e.g., Blackboard, Skype, Zoom) to support efficient transition of classes from in-person to distance-based formats. This may include using strategies such as faculty check-ins, recorded class meetings or lectures, and live class meetings.
        • Other student support services such as online library services, print materials available online, phone- or internet-based counseling support, or study groups enabled through digital media.
        •  IHE will need to determine, in consultation with their university system:
        • How to convert face-to-face lessons into online lessons and how to train faculty to do so.
        • How to triage technical issues if faced with limited IT support and staff.
        • How to deal with the potential lack of students’ access to computers and the Internet at home or in temporary housing.
        • Ensure continuity of safe housing.
        • Work in close collaboration with local public health officials to make all decisions related to on-campus housing.
        • If cases of COVID-19 have not been identified among residents of on-campus community housing, students may be allowed to remain in on-campus housing. In this situation, educate housing residents on the precautions they should take to help protect themselves when there is community spread of COVID-19. Residents should follow any more specific recommendations provided by local health officials. Any on-campus resident who may have been in close contact with a confirmed case of COVID-19 should follow instructions provided by local public health officials, including possible temporary relocation to alternate housing for self-quarantine and monitoring for symptoms.
        • If cases of COVID-19 have been identified among residents of on-campus community housing, work with local public health officials to take additional precautions. Individuals with COVID-19 may need to be moved to temporary housing locations. These
          individuals will need to self-isolate and monitor for worsening symptoms according to the guidance of local health officials. Close contacts of the individuals with COVID-19 may also need temporary housing so that they can self-quarantine and monitor for symptoms. Consult with local health officials to determine when, how, and where to move ill residents. Information
          on providing home care to individuals with COVID-19 who do not require hospitalization is available on CDC’s website.
        • Residents identified with COVID-19 or identified as contacts of individuals with COVID-19 should not necessarily be sent to their permanent homes off-campus.Sending sick residents to their permanent homes could be unfeasible, pose logistical challenges,
          or pose risk of transmission to others either on the way to the home or once there. IHE should
          work with local public health officials to determine appropriate housing for the period in which
          they need to self-isolate and monitor for symptoms or worsening symptoms.
          ƒ Remember to consider all types of IHE-affiliated housing when making response plans.
          Distinct housing types (e.g., residence halls, apartments, fraternity and sorority houses) and
          situations (e.g., housing owned and run by the IHE, housing on the IHE campus but not run by
          the IHE) may require tailored approaches.
          ƒ Ensure any staff remaining to support students in on-campus housing receive
          necessary training to protect themselves and residents from spread of COVID-19.
          Staff should also be trained on how to respond if a resident becomes ill. Adequate cleaning and
          personal hygiene supplies should be made available.
          ο Ensure continuity of meal programs.
          ƒ Consult with local health officials to determine strategies for modifying food service offerings to
          the IHE community.
          ƒ Consider ways to distribute food to students, particularly those who may remain on campus,
          while classes or other events and activities are dismissed.
          ƒ If there is minimal to moderate or substantial community spread of COVID-19, design strategies
          to avoid food distribution in settings where people might gather in a group or crowd. Consider
          options such as “grab-and-go” bagged lunches or meal delivery.
          ƒ If on-campus housing residents have been relocated to temporary alternative housing,
          consider how meals can be provided to these students. Work with local public health officials
          to determine strategies for providing meals to residents with COVID-19 or who are being
          monitored because of contact with persons with COVID-19.
          ƒ Ensure any staff remaining on campus to support food services receive necessary training to
          protect themselves and those they serve from spread of COVID-19.
          ο Consider if, and when, to stop, scale back, or modify other support services on campus.
          ƒ Consider alternatives for providing students with essential medical, social, and mental health
          services. Identify ways to ensure these services are provided while classes are dismissed or
          students are in temporary housing.
          ƒ Identify other types of services provided to students, staff, and faculty (e.g., library services,
          cleaning services). Consider ways to adapt these to minimize risk of COVID-19 transmission
          while maintaining services deemed necessary.

When there is no community transmission (preparedness phase)

        • The most important thing to do now is plan and prepare. IHE administrators should reinforce healthy practices among their students, staff, and faculty. As the global outbreak evolves, IHE should prepare for the possibility of community-level outbreaks in their communities. IHE need to be ready in the event COVID-19 does appear in
          their communities. Here are some strategies:

          • Review, update, and implement emergency operations plans (EOPs). This should be done in collaboration with local public health departments, the IHE’s university system, and other relevant partners. Focus on components, or annexes, of the plans that address infectious disease outbreaks.
          • Ensure the plan includes strategies to reduce the spread of a wide variety of infectious diseases (e.g., seasonal influenza). This includes strategies for social distancing and IHE dismissal that may be used to stop or slow the spread of infectious disease. The plan should also include strategies for continuing education, meal programs, and other related services in the event of IHE dismissal.
          • Ensure the plan emphasizes preventive actions for students and staff. Emphasize actions individuals can take, including staying home when sick, appropriately covering coughs and sneezes, cleaning
            frequently touched surfaces, and washing hands often.
          • CDC has workplace resources including guidance posters with messages for staff about staying home when sick and how to avoid spreading germs at work.
          • Include procedures in the EOP for how to ensure safe housing for students.
          • Reference key resources while reviewing, updating, and implementing the EOP.
          • Multiple federal agencies have developed resources on school planning principles and a 6-step process for creating plans to build and continually foster safe and healthy school communities before, during, and after possible emergencies. IHE may find this guidance for developing highquality emergency operations plans helpful.
          • Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center’s website contains free resources, trainings, and TA for schools, including IHE, and their community partners, including many tools and resources on emergency planning and response to infectious disease outbreaks.
          • Develop information-sharing systems with partners.
            • Institutional information systems should be used for day-to-day reporting on information such as absenteeism or changes in student health center traffic to detect and respond to an outbreak. Remember that IHE are not expected to screen students, staff, or faculty to identify cases of
              COVID-19.. If a community (or more specifically, an IHE) has cases of COVID-19, local health officials will help identify those individuals and will follow up on next steps.

              • Local health officials should be a key partner in information sharing.
      • Reinforce healthy hygiene practices.
        • Ensure handwashing strategies include washing with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or
          sneezing. If soap and water are not available and hands are not visibly dirty, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
        • CDC offers several free handwashing resources that include health promotion materials and information on proper handwashing technique.
        • Ensure adequate supplies (e.g., soap, paper towels, hand sanitizer, tissue) to support healthy
        • hygiene practices.
  • Intensify cleaning and disinfection efforts.
    • Routinely clean and disinfect surfaces and objects that are frequently touched. This may include cleaning objects/surfaces not ordinarily cleaned daily (e.g., doorknobs, light switches, classroom sink handles, countertops). Clean with the cleaners typically used. Use all cleaning products according to the directions on the label. For disinfection most common EPA-registered household disinfectants
      should be effective.
    • A list of products that are EPA-approved for use against the virus that causes COVID-19 is available here. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
    • Provide disposable wipes to staff and faculty so that commonly used surfaces (e.g., keyboards, desks, remote controls) can be wiped down before use. Ensure adequate supplies to support cleaning and disinfection practices. Monitor and plan for absenteeism. Review attendance and sick leave policies. Students, staff, and faculty should not attend class or work when sick. Allow them to stay home to care for sick household members.

Make accommodations

  • (e.g., extended due dates, electronic submission of assignments), as possible, for individuals who
    may be temporarily unable to attend class due to restrictions placed on them related to possible
    exposure to the virus that causes COVID-19.
  •  Identify critical job functions and positions, and plan for alternative coverage by cross-training staff and faculty. Review the usual absenteeism patterns at your institution and on your campus among students, staff, and faculty. Consider identifying and implementing processes for faculty and IHE leadership to report noticeable changes in absenteeism, even if subjective, to a designated administrator.
  • Alert local health officials about large increases in student, staff, and faculty absenteeism or substantial increases in student health center traffic due to respiratory illnesses (like the common cold or the “flu,” which have symptoms similar to symptoms of COVID-19).
    • Determine what level of absenteeism will disrupt continuity of teaching, learning, and research.
  • Assess group gatherings and events. Consider postponing non-critical gatherings and events.
    • Ensure you have a clear understanding of all upcoming gatherings and large events for your IHE (e.g., special performances, athletic events, award banquets). Give special consideration to events that might put students, staff, or their families in close proximity to others from communities that may have identified cases of COVID-19 or include populations at increased risk of severe illness with
      COVID-19.
    • Consider whether any of these events should be canceled. Speak with local health officials to help determine the best approach.
  • Establish procedures for how to re-house roommates of those that are sick.
    • Ensure IHE health clinics prepare for COVID-19.
    • Review CDC guidance to help healthcare facilities prepare for COVID-19. Guidance includes steps to
      take now and strategies for preparing for community transmission of COVID-19.
  • Create plans to communicate accurate and timely information to the IHE community.
    •  Include strategies for sharing information with staff, students, and faculty without increasing fear and stigma. Keeping the community informed with accurate information can counter the spread of misinformation and reduce the potential for fear and stigma.
    • Include strategies to communicate steps being taken by the IHE to prepare and how additional information will be shared
    •  Include strategies to communicate changes to usual campus schedules or functions.
    • Include strategies to communicate information IHE community members can use to protect themselves from infectious disease, including COVID-19.
  • Review CDC’s guidance for businesses and employers.
  • Review this CDC guidance to identify any additional strategies the IHE can use, given its role as an employer.
    IHE administrators can support their IHE community by sharing COVID-19 informational resources with students, staff, and faculty. Coordinate with local health officials to determine what type of information is best to share with the IHE community. Consider sharing the following fact sheets and information sources:
  • Information about COVID-19 available through state and local health departments
  • General fact sheets to help students, staff, faculty, and their families understand COVID-19 and the steps they can take to protect themselves:
    • What you need to know about coronavirus disease 2019 (COVID-19)
    • What to do if you are sick with coronavirus disease 2019 (COVID-19)
    •  Stop the spread of germs – help prevent the spread of respiratory viruses like COVID-19
    • Share facts about COVID-19 to help prevent stigma
  • CDC information for students, staff, and faculty who have recently traveled back to the United States from areas where CDC has identified community spread of COVID-19:
  • A list of countries where community spread of COVID-19 is occurring can be found on the CDC
    webpage: Coronavirus Disease 2019 Information for Travel
  • Implement multiple social distancing strategies. Select strategies based on feasibility given the unique space and needs on IHE campuses. Not all strategies will be feasible for all IHE. IHE administrators are encouraged to think creatively about all opportunities to increase the physical space between students and limit interactions in large group settings. IHE may consider strategies such as:
    • Cancel large gatherings. Cancel activities and events such as athletic events or practices, or special performances for groups of 250 people or more. Cancel events for groups of 20 people or more if attendees are at increased risk for severe illness from COVID-19
    • Cancel or modify courses where students are likely to be in very close contact, such as lecture courses with close seating, or music or physical activity classes where students are likely to be in close proximity.
    • Increase space between desks. Where possible, rearrange desks to maximize the space between students. Turn desks to face in the same direction (rather than facing each other) to reduce transmission caused from virus-containing droplets (e.g., from talking, coughing, sneezing).
    • Reduce congestion in the health clinic. For example, consider using the health clinic for students with flu-like symptoms and a satellite location for routine clinic visits (e.g., preventive screenings or annual exams).
    • Consider if and how existing dining services should be scaled back or adapted. For example, an IHE may close some of or all its cafeterias/cafes, offering meal delivery or grab-and-go options to discourage students, staff, and faculty from gathering in group settings. Self-serve stations that require multiple students to touch the same equipment (e.g. cereal dispensers, ice cream dispensers) may be scaled back.
  • Consider ways to accommodate the needs of students and staff at higher risk of severe illness with COVID-19. Consider if and how to honor requests of students or staff who may have concerns about being on campus due to underlying medical conditions or those of others in their home.
  • Ensure continuity of safe housing.
    • Work in close collaboration with local health officials to make all decisions related to oncampus housing.
    • If cases of COVID-19 have not been identified among residents of on-campus community housing, students may be allowed to remain in on-campus housing. In this situation, educate housing residents on the precautions they should take to help protect themselves when there is community spread of COVID-19. Residents should follow any more specific recommendations provided by local health officials.
    • Help counter stigma and promote resilience on campus.
    • Share facts about COVID-19 through trusted dissemination channels to counter the spread of misinformation and mitigate fear.
    • Speak out against negative behaviors, including negative statements on social media about groups of people.
    • Develop plans to support students, staff, and faculty who may feel overwhelmed by COVID-19 and associated events on campus.
    • Ensure continuity of mental health services, such as offering remote counseling. Encourage students to call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) if they are feeling overwhelmed with emotions such as sadness, depression, anxiety, or feel like wanting to harm themselves or others.

When there is substantial community transmission

    • Additional strategies should be considered when there is substantial transmission in the local community in
      addition to those implemented when there is no, minimal, or moderate transmission. These strategies include:
  • Continue to coordinate with local public health officials. If local health officials have determined there is substantial transmission of COVID-19 within the community, they will provide guidance to administrators on the best course of action for IHE. Mitigation strategies are expected to extend across organizations (e.g., K-12 schools, business, community and faith-based organizations) within the community, as they are
    not necessarily tied to cases within IHE.
  • Consider extended in-person class suspension. In collaboration with local public health officials, implement extended class suspension and event/activity cancellations (e.g., suspension/cancellations for longer than two weeks). This longer-term, and likely broader-reaching, strategy is intended to slow transmission rates of COVID-19 in the community. During extended class suspensions, also cancel extracurricular group activities and large events. Remember to implement strategies to ensure the continuity of education, research, and housing as well as meal programs and other essential services for students.

FEMA | Alternative Care Site Fact Sheet

To address immediate and projected needs from the coronavirus (COVID-19) pandemic, state, local, tribal, and territorial (SLTT) governments may, under certain conditions, be reimbursed through FEMA’s Public Assistance (PA) Program for costs associated with keeping Alternate Care Sites (ACS), including temporary and expanded medical facilities, minimally operational when COVID- 19 cases diminish and the facilities are no longer in use. View on FEMA’s Website

FEMA Public Assistance Program

In accordance with sections 403 and 502 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121 et seq. (the “Stafford Act”), emergency protective measures taken by SLTT governments to respond to the COVID-19 emergency at the direction or guidance of public health officials may be reimbursed under the PA program. Under this authority, FEMA may approve work and costs associated with maintaining minimal operational readiness at ACS facilities when necessary in response to the COVID-19 Public Health Emergency.

Public health experts have warned of the potential for a second wave of COVID-19 cases, the severity and timing of which are uncertain. ACS facilities that are unused but remain operationally ready and available for potential medical surge capacity for COVID-19 response are referred to as “warm sites.”

Work to Eliminate or Lessen an Immediate Threat

FEMA has the authority to provide funding for activities that eliminate or lessen immediate threats to lives, public health, or safety, such as operating an ACS facility. To determine whether work-related to ACS warm sites is necessary to eliminate or lessen an immediate threat, FEMA may consider SLTT assessments of need based on:

  • Public health guidance, including the continued declaration of a Public Health Emergency by the U.S. Department of Health and Human Services (HHS), and other information on the likelihood of a resurgence of COVID-19 cases;
  • Whether the ACS facility is strategically located for areas projected to be most impacted by a resurgence (e.g., if the ACS facility needs to be relocated to better address the most impacted areas, it may not be prudent to maintain the facility as a warm site); and
  • SLTT hospital bed capacity relative to the projected need.

FEMA regions will work with the state, territory, or tribe acting as the Recipient to:

  • Identify ACS warm sites based on SLTT projections of need as supported by predictive modeling or other supporting information and in accordance with federal, state, and/or local public health guidance;
  • Provide support for ACS warm sites to either suspend medical care activities while maintaining minimal operational readiness for future rapid activation, or to demobilize the ACS and store necessary medical equipment and supplies for future rapid activation; and/or
  • Reduce excess capacity by demobilizing and closing ACS facilities that are no longer in use and not anticipated to be required in future planning scenarios based on the projected needs.

Eligible Costs to Maintain ACS Warm Sites

All claimed costs must be necessary and reasonable in order to effectively respond to the COVID-19 Public Health Emergency, in accordance with public health guidance, and are subject to standard program eligibility, the applicable cost share for the declaration, and other federal requirements. Pursuant to Section 312 of the Stafford Act, FEMA is prohibited from providing financial assistance where such assistance would duplicate funding available from another program, insurance, or any other source for the same purpose. FEMA will reconcile final funding based on any funding provided by another agency or covered by insurance or any other source for the same purpose. FEMA will coordinate with HHS to share information about funding from each agency to assist in preventing duplication of benefits. Costs that may be necessary to maintain the minimum operational level of an ACS warm site include:

  • Renting/leasing the space for an ACS facility and/or the necessary equipment to operate the facility and provide adequate medical care in the event of a COVID-19 resurgence;
  • Other facility costs such as utilities, maintenance, and/or security;
  • Keeping the necessary equipment and supplies (including PPE) in stock, including inspection and maintenance of equipment and supplies, and replacement of non-functioning equipment and expired supplies and commodities;
  • Demobilization of ACS facilities when it is more cost effective than maintaining a warm site, and remobilizing in the event of a COVID-19 resurgence based on projected needs;
  • Storage of equipment and supplies for ACS warm sites or demobilized ACS facilities which can be re- deployed for future rapid activation;
  • Wraparound services, as defined in the ACS Toolkit, necessary for minimal operational readiness;
  • Minimal level of medical and/or non-medical staffing, if necessary;
  • Site restoration to allow a facility that was/is being used as an ACS to return to normal operations until such time as the facility is needed as an ACS again in the event of a COVID-19 resurgence; and/or
  • Other costs necessary to maintain a minimum level of operational readiness.

Time Limitations

Funding for ACS warm sites is limited to maintaining the site no longer than is necessary and reasonable based on projected needs and in accordance with public health guidance.

  • The continued need for an ACS warm site should be assessed on a monthly basis by FEMA and SLTTs and based on the latest federal and/or SLTT COVID-19 projections of the likelihood of a COVID-19 resurgence in the area and the subsequent capacity and capability needs.
  • FEMA will not reimburse costs related to maintaining ACS warm sites for more than 30 days after

 

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