Guidance for Healthcare Workers about COVID-19 (SARS-CoV-2) Testing
If a passenger is sick with COVID and being transported for medical care
Tribal members who have tested positive for COVID-19, who are sick, or who have recently had a close contact (closer than 6 feet) to a person with COVID-19 should not transport others in their vehicle or ride in a shared vehicle. They should stay home except to seek medical care.
Whenever possible, tribal members seeking medical care for COVID-19 should transport themselves in vehicles with no passengers. If unable to transport themselves, drivers can do the following when transporting a sick passenger suspected or confirmed as having COVID-19 for medical care.
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Remember, only use chlorine-based hand washing solutions when soap and water or alcohol-based hand rub are not available.
Making handwashing solution from 5% liquid bleach
Use the MILD chlorine water to wash hands. Make new mild chlorine water every day.
- Mix 14 tablespoons of 5% bleach into 20 liters of clear water every day. Stir well.
Label plastic bucket for handwashing only / MILD 0.05%. Do not drink or use for cooking.
- Make sure the bucket is covered. Use the MILD chlorine water to wash hands.
Making handwashing solution from HTH chlorine powder
Use the MILD chlorine water to wash hands. Make new mild chlorine water every day.
- Mix 1 tablespoon of HTH chlorine powder into 20 liters of water every day. Stir well. Label plastic bucket for handwashing only / MILD 0.05%. Do not drink or use for cooking.
- Stir well and wait 30 minutes.
- Use the MILD chlorine water to wash hands.
Call out box
Do NOT drink chlorine water.
Do NOT put chlorine water in mouth or eyes.
Since May 18, 2020, CDC has been conducting seroprevalence surveys of antibodies against SARS-CoV-2 among healthcare workers, first responders and public safety personnel in New York City, the Detroit metropolitan area and Rhode Island in response to the COVID-19 pandemic.
These surveys are designed to assess the presence of antibodies against SARS-CoV-2 among healthcare workers, first responders, and public safety personnel to gain a better understanding of their risk for infection with future exposures while continuing to participate in the COVID-19 pandemic response. The assessment will also determine factors that increase the risk of getting SARS-CoV-2 infection among these target populations. Knowing this information may inform recommendations for staff protection during future COVID-19 response activities.
Guidance for Health Departments about COVID-19 Testing in the Community
In the face of an infectious disease outbreak without a vaccine or known treatment, communicating prevention messages is critical to slowing the spread of the pandemic.
Recommended protective measures like social distancing, cloth face coverings, and frequent handwashing are the same for everyone. But some people face more barriers when it comes to taking these actions, and some are harder to reach with messaging.
In late April, as New York and other major cities faced devastating surges of COVID-19 cases, millions stayed in their homes and left only for necessary items like medicine and food. But the pandemic also reached beyond the cities, to the small rural towns where much of that food gets packaged. Meat and poultry plant workers continued to go into work, where social distancing was a challenge. Outbreaks in meat and poultry plants could affect entire towns. And some of these towns are in areas where healthcare services and testing are hard to access.
Maggie Silver, a health communication specialist at CDC’s office in Fort Collins, Colorado, recalls seeing an uptick in cases among workers at a leading beef processing plant in nearby Weld County. The plant closed for 10 days to put a hold on the spread of COVID-19 in the facility and to come up with a strategy to reopen and stay open, as the federal government announced that the food production industry was an essential service.
Maggie’s co-worker in Fort Collins, Dr. Marc Fischer, was dispatched to work with the plant’s management, the county health department, and the workers’ union to develop a mitigation strategy. The team quickly recognized that containing the outbreak would depend on effective communication with employees, the community, and partners. That’s when Marc called on Maggie to develop a risk communication plan.
Recognizing the value of communication
“I really appreciated the team’s understanding of the importance of communication in this situation,” Maggie says. “For many of the plant workers, English is a second language, and the health and financial risks involved complicate the situation further.”
Getting workers safely back to the plant and maintaining the food supply required communicating messages that would promote behavior changes among workers and supervisors. In two days, Maggie developed a risk communication plan for the plant and got buy-in from the company and county health department. It included main prevention messages and outreach strategies such as texting workers, posting signs around the facility, and sharing messages through trusted sources like the union and community organizations.
A few weeks later, a CDC team deployed to Pierre, South Dakota, asked Maggie to support their efforts. In a state that has more cows than people, meat and poultry production is a big part of South Dakota communities, and COVID-19 spread in facilities was an ongoing concern.
This time, Maggie had a more hands-on approach on the ground while the facilities remained open. She was able to visit a facility with rising numbers of COVID-19 cases when the plant manager invited a multidisciplinary team of the state health and agricultural departments and CDC staffers to tour the facility and provide recommendations.
“Employees in these facilities are in constant motion when working,” Maggie says. “They are quickly changing for their shift or doing their job on the floor. Lunch is their only down time.”
Posting messages where workers pause
Maggie recommended placing signs with prevention messages in areas where the employees might pause, like around the lunchroom, time clocks, and bathrooms, and suggested sending reading materials home with workers. She learned that, as in Colorado, the employees and members of the surrounding community come from many different ethnic backgrounds and many speak and read limited English. Picture-based signs with little text would help broaden effective outreach.
“One thing that struck me when working with the production company was how much management cared for their employees,” Maggie says. “When touring the facility, they stopped and greeted many of the employees by name and asked about their families. They were very concerned about the health of workers and the community.”
The risk communication plan that Maggie developed for these two companies has been adapted and used in other meat and poultry production facilities. Strong partnerships and tailored risk communication messaging continue to be essential tools in protecting workers and communities.
Getting the word out meant first truly understanding the community interactions and daily lives of the workers. Trusted community groups, like refugee organizations, helped get messaging to the workers and their families.
“The first step to coming up with any plan to support these facilities is to get to know all of the partners involved and their roles and goals,” says Maggie. “Workers’ unions, community groups, health departments, and facility managers all play an important part in keeping the facilities open.”
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Antibody against SARS-CoV-2
Serology, or antibody, testing checks a sample of a person’s blood to look for antibodies against SARS-CoV-2, the virus that causes COVID-19. Antibodies usually become detectable in the blood 1-3 weeks after someone is infected.
Person infected à 1-3 weeks à person has detectable level of antibodies*
*Some people may take longer than 3 weeks to develop antibodies, and some people may not develop antibodies. It is currently unknown how long antibodies are detectable after infection.
A positive result from this test may mean that a person was previously infected with the virus.
Positive (sample positive for SARS-CoV-2 antibodies)
Negative (Sample negative for SARS-CoV-2 antibodies)
The percentage of individuals in a population who have antibodies to an infectious agent is called seroprevalence.
A seroprevalence survey uses antibody tests to estimate the percentage of people in a population who have antibodies against SARS-CoV-2.
This can tell us how many people in a specific population may have been previously infected with SARS-CoV-2.
A small sample of people participating in the survey represents a larger population, which could be a community, state, or special population (like healthcare workers or pregnant women).
Coronaviruses are a large family of viruses that can cause illness in animals or humans. In humans there are several known coronaviruses that cause respiratory infections. These coronaviruses range from the common cold to more severe diseases such as SARS, MERS, and COVID-19.
Coronavirus Disease 2019
Coronavirus disease 2019 (COVID-19) was identified in Wuhan, China in December 2019. COVID-19 is caused by the virus SARS-CoV-2 which is a new virus in humans causing respiratory illness which can be spread from person-to-person. Early in the outbreak, many patients were reported to have a link to a large seafood and live animal market, however, later cases with no link to the market confirmed person-to-person transmission of the disease. Additionally, travel-related exportation of cases has occurred.
The primary transmission of COVID-19 is from person-to-person through respiratory droplets. These droplets are released when someone with COVID-19 sneezes or coughs. COVID-19 can also be spread when you are in close contact with someone who is sick (e.g., shaking hands or talking). A physical distance of at least 1 meter (3 ft) between persons is suggested by the World Health Organization (WHO) to avoid infection, although some WHO member states have recommended maintaining greater distances whenever possible. Respiratory droplets can land on objects or surfaces around the person when they cough or talk, and people can then become infected with COVID-19 from touching these objects or surfaces and then touching their eyes, nose or mouth. Recent data suggests that there can be transmission of COVID-19 through droplets of those with mild symptoms or those who do not feel ill1.
A wide range of symptoms for COVID-19 have been reported2. These include:
- Shortness of breath or difficulty breathing
- Nasal congestion
- Muscle pain
- Sore throat
- Loss of smell or taste
- Diarrhea may be present in some patients
The estimated incubation period is between 2 and 14 days with a median of 5 days. It is important to note that some people become infected and do not develop any symptoms or feel unwell.
Illness Severity – China (through February 11, 2020)3
Despite the important concerns about case fatality rates, most COVID-19 illnesses are – and we expect will continue to be – mild, and most patients will recover spontaneously with some supportive care, especially children and middle-aged adults. An analysis of all cases diagnosed in China as of February 11, 2020 is described below with a total of 44,672 confirmed cases.
Mild (non-pneumonia and mild pneumonia cases) represented 80.9% of confirmed patients with COVID-19 in China
- NOTE: These cases included a large spectrum of illnesses including but not limited to patients having fevers, cough, chest pain, nausea, body pain, etc. It is important to note that the notation of “mild” illness does not allude to cold-like symptoms. Patients in this category experienced a wide range of illness severity that did not meet the severe or critical categories assigned within the study.
Severe (dyspnea, respiratory frequency ≥ 30/min, blood O2 sat ≤93%, PaO2/FiO2 ratio <300, lung infiltrates >50% within 24–48 hours) represented 13.8% of confirmed patients with COVID-19 in China.
Critical (respiratory failure, septic shock, and/or multiple organ, dysfunction or failure, death) represented 4.7% of confirmed patients with COVID-19 in China. Critical cases reported 1,023 (49%) deaths among the 2,087 critically ill patients.
COVID-19: People at Higher Risk for Severe Illness
It is important to note that COVID-19 is a new disease, therefore there is limited information regarding risk factors for severe disease. In some cases, people who get COVID-19 can become seriously ill and develop difficulty breathing. These severe complications can lead to death. The older population (> 50 years of age) as well as those with underlying medical conditions such as those who are immunocompromised, have serious heart problems, or chronic lung disease are more likely to develop serious illness. As more data becomes available, additional risk factors for severe COVID-19 may be identified.
COVID-19 Prevention and Treatment
COVID-19: Everyday Preventative Actions
There are a number of ways to prevent the spread of COVID-19 infection. These include:
- Avoid touching your eyes, nose and mouth
- Avoid close contact with people who are sick
- Remember that some people without symptoms can still spread the virus
- Stay at home when you are sick
- Cover your cough or sneeze with a tissue, then dispose of it properly
- Clean and disinfect frequently touched objects and surfaces
- Wash your hands often with soap and water or use alcohol-based hand rub with at least 60% alcohol4
- Hand washing should be done for at least 40-60 seconds based on WHO’s recommendations
Currently, care for patients with COVID-19 is primarily supportive. Care is given to patients to help relieve symptoms and manage respiratory, and other organ, failure. There are currently no specific antiviral treatments licensed for COVID-19, however many treatments are under investigation. Remdesivir, which is also an investigational drug, received FDA emergency use authorization for treatment of hospitalized patients. Finally, no vaccine is currently available.
IPC for COVID-19
What is IPC?
Infection prevention and control (IPC) is the practice of preventing or stopping the spread of infections during healthcare delivery in facilities like hospitals, outpatient clinics, dialysis centers, long-term care facilities or traditional practitioners. IPC is a critical part of health system strengthening and must be a priority to protect patients and healthcare workers. In the context of COVID-19, the IPC goal is to support the maintenance of essential healthcare services by containing and preventing COVID-19 transmission within healthcare facilities to keep patients and healthcare workers healthy and safe.
COVID-19: IPC Priorities
- Rapid identification of suspect cases
- Screening/Triage at initial healthcare facility encounter and rapid implementation of source control
- Limiting the entry of healthcare workers and/or visitors with suspected or confirmed COVID-19
- Immediate isolation and referral for testing
- Cohort patients with suspected or confirmed COVID-19 separately
- Discontinue isolation for those clinically improved who are negative by PCR
- Safe clinical management
- Immediate identification of inpatients and HCWs with suspected COVID-19
- Adherence to IPC practices
- Appropriate PPE use
More detailed information regarding the IPC priorities for non-US healthcare settings can be found in the Strategic Priority IPC Activities for Containment and Prevention document.
Standard and Transmission-based Precautions
Standard Precautions are a set of practices that apply to the care of all patients in all healthcare settings at all times. Standard precautions remain the cornerstone of infection prevention. Application of these precautions depends on the nature of the health worker personnel-patient interaction and the anticipated exposure to a known infectious agent. Standard precautions include:
- Hand hygiene
- Personal protective equipment (PPE)
- Reparatory hygiene and cough etiquette
- Cleaning and disinfection of devices and environmental surfaces
- Safe injection practices
- Medication storage and handling
Transmission based precautions are a set of practices specific for patients with known or suspected infectious agents that require additional control measures to prevent transmission. These precautions are used in addition to standard precautions.
COVID-19: Transmission Based Precautions:
Current WHO guidance for healthcare workers caring for suspected or confirmed COVID-19 patients recommends the use of contact and droplet precautions, in addition to standard precautions (unless an aerosol generated procedure is being performed, in which case airborne precautions are needed)5. Disposable or dedicated patient care equipment (e.g., stethoscopes, blood pressure cuffs) should be used; however, if equipment needs to be shared among patients, then it should be cleaned and disinfected between use for each patient (ethyl alcohol of at least 70%).
Additionally, adequately ventilated single rooms or wards are suggested. For general ward rooms with natural ventilation, adequate ventilation for COVID-19 patients is considered to be 60 L/s per patient. When single rooms are not available, suspected COVID-19 patients should be grouped together with beds at least 1 meter apart based on WHO’s recommendation, although some member states have recommended maintaining greater distances whenever possible
Additionally, healthcare facilities can also consider cohorting healthcare workers to care for patients with COVID-19 and restrict the number of visitors allowed in the facility.
Transportation of patients with COVID-19 should be avoided unless medically necessary. If it is medically necessary to transport a patient, place a mask on the suspected or confirmed COVID-19 patient. Healthcare workers should also wear the appropriate PPE when transporting patients.
Restricting the number of visitors allowed in the facility and rooms is also suggested.
Contact and droplet precaution PPE are recommended for healthcare workers before entering the room of suspected or confirmed COVID-19 patients. Healthcare workers should be trained on the correct use of PPE, including how to put on and remove PPE. Extended use and re-use of certain PPE items such as masks and gowns can be considered when supply is short. Additional guidance can be found here. Healthcare workers should:
- Use a medical mask (i.e., at least a surgical/medical mask)
- Wear eye protection (goggles) or facial protection (face shield)
- Wear a clean, non-sterile, long-sleeve gown
- Use gloves
There is a higher risk of self-contamination when removing PPE. Instructions for putting on and removing PPE can be found herepdf icon.
Aerosol Generating Procedures:
- Endotracheal intubation
- Non-invasive ventilation
- Manual ventilation before intubation
- Cardiopulmonary resuscitation
For healthcare workers performing any of the following aerosol generating procedures on patients with COVID-19, it is recommended that a fitted respirator mask (N95 respirators, FFP2 or equivalent) is used as opposed to surgical/medical masks. In addition to wearing a fitted respirator mask, healthcare workers should also wear appropriate PPE including gloves, a gown and eye protection.
Infection Prevention and Control Resources for COVID-19 in non-US Healthcare Settings:
Strategic Priority IPC Activities for Containment and Prevention
Identification of Healthcare Workers and Inpatients with Suspected COVID-19
Management of Visitors to Healthcare Facilities
Interim Operational Considerations for Public Health Management of Healthcare Workers Exposed to or Infected with COVID-19
1 Kai-Wang To, K, Tak-Yin Tsang, O, Chik-Yan Yip, C, Chan, KH, Wu, TC, Man-Chun Chan, J…Yuen, KY. Consistent detection of 2019 novel coronavirus in saliva. Clinical Infectious Diseases. 12 February 2020. ciaa149. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa149/5734265external icon
2 WHO. Clinical management of severe acute respiratory infection when COVID-19 is suspected. 13 March 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspectedexternal icon
3 The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) – China 2020. CCDCweekly. 17 February 2020. 10.46234/ccdcw2020.03210.46234/ccdcw2020.032external icon10.46234/ccdcw2020.032external icon 10.46234/ccdcw2020.032external icon
4 WHO. Guide to local production: WHO-recommended handrub formulations. April 2020. https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdfpdf iconexternal icon
5 WHO. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. 19 March 2020. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125external icon
6 WHO. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages. 6 April 2020. https://apps.who.int/iris/bitstream/handle/10665/331695/WHO-2019-nCov-IPC_PPE_use-2020.3-eng.pdfpdf iconexternal icon
Tribal ceremonies such as sweat lodge gatherings and seasonal ceremonies, and larger gatherings such as pow wows and rodeos, are a vital part of cultural identity and traditional practices in tribal communities. CDC offers the following recommendations to help tribal communities, elders, and leaders decide how best to keep their communities safe and work to prevent the spread of COVID-19. These considerations are meant to support—not replace—tribal laws, rules, and regulations aimed at protecting the health of tribal communities.
The more people who attend a ceremony or gathering, the closer they are to one another, and the longer they gather together, the higher the risk of spreading COVID-19. The higher the level of community transmission in the area that the gathering is being held, the risk of COVID-19 spreading during a gathering.
It is important to take steps to protect tribal community members from getting sick before, during, and after participation in tribal ceremonies or other gatherings such as:
- pow wows,
- birthday parties, and
The risk of COVID-19 spreading at events and gathering including tribal ceremonies and gatherings increases as follows: