Fluxguard Demo:
CDC Content Change Monitoring

—snipped—
* Building Ventilation
* Cleaning, Disinfection, and Hand Hygiene in Schools – a Toolkit for School Administrators
—snipped—

—snipped—
Using Antigen Tests

Interim guidance for SARS-CoV-2 antigen testing forSING ANTIGEN TESTS

Guidance on effective cliniciansal and laboratory professionals. Learn More

CDC DIAGNOSTIC TESTS AND SUPPLIES

* Test for Flu and COVID-19
* Tpublic health use of antigen tests for COVID-19 Only

RESOURCES FOR LABORATORIES

* Using Antigen Tests
* Using Antibody Tests
* Pooling Procedures
* Specimen Collection
* Biosafety for Specimen Handling
* Testing Strategies for SARS-CoV-2
* Guidance for Laboratory Workplace Safety
* Point-of-Care Testing Guidance
* Reporting Laboratory Data
* Laboratory FAQs
* Nucleic Acid Amplification Tests (NAATs)

Search COVID-19 Guidance

CDC LAB WORK

* Diagnosticin different testing situations

Antigen Testing Guidelines

Testing
COVID-19 testing for labs
* Testing Strategies for SARS-CoV-2
* Antibody Testing Guidelines
* Using Antibody Tests
* Nucleic Acid Amplification Tests (NAATs)
* Point-of-Care and Rapid Testing
* SerologyPooling Testing
* Viral Culturing
* Lab Publications

COVID-19 Data Tracker
Testing Data in the US

INTERACTIVE FORECASTING DATA

Fi
CDC COVID-19 Tests
Types of COVID-19 tests and sup-to-date interactive forecasting data on COVID Data Tracker

* SPHERES: SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance
* International Reagent Resource

Advisories and Alerts
* May 18. 2021 05/18/2021: Lab Advisory: CDC Updates Interim Guidance for Antigen Testing for SARS-CoV-2plies
* Multiplex Assay for Flu and SARS-CoV-2
* Test for SARS-CoV-2 Only
* Flu SC2 Multiplex Assay Primers and Probes (Research Use Only)
* Real-time RT-PCR Primers and Probes (Research Use Only)
* FAQs on Distribution of COVID-19 Assays

CDC Lab Work
Biosafety
Data and Reporting
Lab FAQs
Search COVID-19 Guidance

COVID-19 Data Tracker
Testing Data in the US

Advisories and Alerts
* MayDec 140. 2021 0512/140/2021: Lab Update: Join the Next Clinical Laboratory COVID-19 Response Call on Monday, MayDecember 173 at 3:00 PM ET
* MayDec 053. 2021 0512/053/2021: Lab Advisory: SARS-CoV-2 Variants B.1.617, B.1.617.1, B.1.617.2, and B.1.617.3 Classified as Variants of Interestlert: CDC Update on the SARS-CoV-2 Omicron Variant
* Nov 29. 2021 11/29/2021: Lab Advisory: CMS Publishes New FAQ about CLIA and Over-the-Counter Home Testing
—snipped—

—snipped—
Updated Apr. 23May 15, 2021
—snipped—
Updates as of Marchy 195, 2021
* Revised physical distancing recommendations to reflect at least 3 feet between students in classrCDC recommends schoomls and provide clearer guidance when a greater distance (such as 6 feet) is recommended.
* Clarified that ventilation is a component of strategies to clean and maintain healthy facilities.
* Removed recommendation for physical barriers.
* Clarified the role of community transmission levels in decision-making.
* Added guidance on interventions when clusters occucontinue to use the current COVID-19 prevention strategies for the 2020-2021 school year.
—snipped—
* Fully Vaccinated
* Indicators of Community Transmission
—snipped—
FULLY VACCINATED

CDC recently released guidance on the ability of fully vaccinated people to resume pre-pandemic activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and work place guidance. This guidance has raised questions for schools about how to proceed in the current school year. CDC recommends schools continue to use the COVID-19 prevention strategies outlined in the current version of CDC’s Operational Strategy for K-12 Schools for at least the remainder of the 2020-2021 academic school year.

Recommendation for continuation with these prevention strategies is based on

* Students will not be fully vaccinated by the end of the 2020-2021 school year. Youth under the age of 12 are not yet eligible for vaccination. Youth between the ages of 12 and 15 became eligible for vaccination on May 12, 2021. Because people are not fully vaccinated until 2 weeks after their second dose of the Pfizer vaccine, students in this age group will not be fully vaccinated before the end of current school year.
* The time needed for schools to make systems and policy adjustments. Systems and policy adjustments may be required for schools to change mask requirements for students and staff while continuing to ensure the safety of unvaccinated populations.

CDC will update its guidance for schools in the coming weeks. Updated guidance can inform school planning for the 2021-2022 academic year.

INDICATORS OF COMMUNITY TRANSMISSION
—snipped—
As of March 19, 2021

* Revised physical distancing recommendations to reflect at least 3 feet between students in classrooms and provide clearer guidance when a greater distance (such as 6 feet) is recommended.
* Clarified that ventilation is a component of strategies to clean and maintain healthy facilities.
* Removed recommendation for physical barriers.
* Clarified the role of community transmission levels in decision-making.
* Added guidance on interventions when clusters occur.

As of February 26, 2021
—snipped—

—snipped—
Updated May 3June 10, 2022, 12:00 AM
—snipped—
As of 12:01AM ET on June 12, 2022, CDC will no longer require air passengers traveling from a foreign country to the United States to show a negative COVID-19 viral test or documentation of recovery from COVID-19 before they board their flight. For more information, see Rescission: Requirement for Negative Pre-Departure COVID-19 Test Result or Documentation of Recovery from COVID-19 for all Airline or Other Aircraft Passengers Arriving into the United States from Any Foreign Country.

As a result of a court order, effective immediately and as of April 18, 2022, CDC’s January 29, 2021 Order requiring masks on public transportation conveyances and at transportation hubs is no longer in effect. Therefore, CDC will not enforce the Order. CDC continues to recommend that people wear masks in indoor public transportation settings at this time.
—snipped—

STEPS HEALTHCARE FACILITIES CAN TAKE TO STAY PREPARED FOR COVID-19

Steps Healthcare Facilities Can Take to Stay Prepared for COVID-19
Updated Feb. 25, 2021
Print
Minus
Related Pages

SUMMARY OF RECENT CHANGES

Updates as of February 25, 2021:
* Added vaccination information for healthcare personnel.

PROTECT YOUR WORKFORCE:

* Get healthcare personnel vaccinated against COVID-19 to ensuring the health and safety of essential workforce/protect healthcare capacity.
* Screen patients and visitors for fever, respiratory symptoms, or other symptoms before entering your healthcare facility. Keep up to date on the recommendations for preventing spread of COVID-19 on CDC’s website.
* Ensure proper use of personal protection equipment (PPE). Healthcare personnel who come in close contact with confirmed or possible patients with COVID-19 should wear the appropriate personal protective equipment.
* Conduct an inventory of available PPE. Consider conducting an inventory of available PPE supplies. Explore strategies to optimize PPE supplies.
* Encourage sick employees to stay home. Personnel who develop fever, respiratory symptoms, or other symptoms should be instructed not to report to work. Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.

PROTECT YOUR PATIENTS:

* Stay up-to-date on the best ways to manage patients with COVID-19.
* Minus
Related Pages

OOPS!

We can’t seem to find the page you were looking for. Please try our search or A-Z index.

SEARCH CDC.GOV

Separate patients with fever, respiratory symptoms, or other symptoms so they are not waiting among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.
* Get Vaccinated against COVID-19 and maintain other prevention measures for you and your patients.
* Consider the strategies to prevent patients who can be cared for at home from coming to your facility potentially exposing themselves or others to germs, like:
* Using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home.
* Adjusting your hours of operation to include telephone triage and follow-up of patients during a community outbreak.
* Leveraging telemedicine technologies and self-assessment tools.

Top of Pagech

A-Z INDEX

A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
#

—snipped—
* Public Health Recommendations for Community-Related Exposures
* Public Health Recommendations after Travel-Associated COVID-19 Exposure
—snipped—

—snipped—
74,830,4649,611,982
—snipped—
6,633,163873,739
—snipped—

—snipped—
Pregnant and recently pregnant people are also at increased risk for severe illness from COVID-19.
—snipped—

—snipped—
Testing Overview

Summary of cNewOperation Expanded Testing

Operation Expanded Testing (OpET) provides no-cost screening testing for schools, underserved populations, and congregate settings.

About OpET

Testing Overview

Considerations and current CDC recommendations regarding COVID-19 testing strategies
—snipped—
Prepare for broad-based viral testing in facilities after known or suspected SARS-CoV-2 exposure Considerations and practical tips for when there is moderate to substantial transmission in the community.alth departments and healthcare providers
—snipped—
: Social media messaging and fact sheets you can use to communicate about COVID-19 testing in your community.

Testing Communication Toolkit

Testing in Communities, Schools and Workplace

Testing in Community Settings
—snipped—
* Testing Guidance for the Public
* Calculating Percent Positivity
—snipped—
* Laboratory Resources
* Testing Guidance for the Public
—snipped—

—snipped—
* Reinfection
* Multisystem Inflammatory Syndrome in Adults

More Information
* Symptoms
* Symptoms in Children
* TestingGetting Sick Again (Reinfection)
—snipped—

—snipped—
Learn ways to protect yourself and others during the COVID-19 pandemic.

Handwashing is one of the best ways to protect yourself and your family from getting sick. Learn when and how you should wash your hands to stay healthy.
—snipped—

—snipped—
More iInformation
—snipped—

—snipped—
* * Food and Food System Resources During COVID-19 Pandemic

* Disaster Financial Assistance with Food, Housing, and Bills

* Coronavirus Resources for Renters

* US Department of Labor Coronavirus Resources
—snipped—

—snipped—
* English [45284 KB, 1 page]
—snipped—

—snipped—
Updated Apr. 5June 17, 2021
—snipped—
* When Someone is Sick: Disinfect Safely
* When Someone is Sick: Clean and Disinfect Your Home

* When Someone Is No Longer Sick

*: Cleaning and Disinfecting Bedrooms and Bathrooms When Someone Is SickYour Home
—snipped—
* Ask unvisitors who are not fully vaccinated visitors to wear masks.
* Follow guidance for people who are fully vaccinated people before inviting visitors to your home.
—snipped—
CLEAN AND DISINFECT YOUR HOME WHEN SOMEONE IS SICK

In addition to cleaning, dWHEN SOMEONE IS SICK: DISINFECT SAFELY

Disinfect your home when someone is sick or if someone who is positive for COVID-19 has been in your home within the last 24 hours. Disinfecting kills any remaining germs on surfaces and reduces the spread of germs. If you are caring for someone who has COVID-19, detailed instructions for caregivers are available. Keep disinfectants out of the reach of children.
—snipped—
* The label includes instructions on how to use the product and specific instructions to keep you safe. Keep disinfectants out of the reach of children. Many products recommend keeping the surface wet with a disinfectant for a certain period of time (see product labelCheck the label to find out what personal protective equipment (PPE) you need to use your product safely (such as gloves, glasses, or goggles).
—snipped—
* Wear gloves for all tasks Many products recommend keeping the cleaning process.
* Additional personal protective equipment (PPE) (e.g., eye protection) might be required based on the cleansurface wet with a disinfectant for a certain period of time (look at the “contact time” on the product label).

* Ensure adequate ventilation while using orany disinfection products being used and whether there is a risk of splash.

* Want by keeping doors and windows open and using fans to help improve air flow.

* Immediately after disinfecting, wash your hands often with soap and water for 20 seconds. Be sure to wash your hands immediately after removing gloves.
* 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. However, iIf hands are visibly dirty, always wash hands with soap and water for at least 20 seconds.

* Ensure adequate ventilation while using any disinfectant.

Top of Page

Tips for using chemical disinfectants safely

* Always follow the directions on the label of cleaning and disinfection products to ensure safe and effective use. You may need to wear personal protective equipment, such as gloves, goggles, or glasses, depending on the directions on the product label.
* Ensure adequate ventilation (for example, open windows and run fans).
* Use only the amount recommended on the label.
* If diluting with water is indicated for use, use water at room temperature (unless stated otherwise on the label).
* Label diluted cleaning or disinfectant solutions.
* Store and use chemicals out of the reach of children and pets.
* Do not mix products or chemicals.
* Do not eat, drink, breathe, or inject cleaning and disinfection products into your body or apply directly to your skin as they can cause serious harm.
* Do not wipe or bathe people or pets with any surface cleaning and disinfection products.
* Special considerations should be made for people with asthma. Some cleaning and disinfection products can trigger asthma. Learn more about reducing your chance of an asthma attack while disinfecting to prevent COVID-19.

See precautions for household members and caregivers for more information.

Top of Page

WHEN SOMEONE IS SICK: CLEANING AND DISINFECTING BEDROOMS AND BATHROOMS WHEN SOMEONE IS SICK YOUR HOME
—snipped—
* Supplies include tissues, paper towels, cleaners, and EPA List N disinfectants from the EPA List N.
—snipped—
* Wear gloves if needed for your cleaning and disinfection product(s).
—snipped—
After the person who was sick no longer needs to be separated

* Wear a mask when you enter the room to clean.
* Wait as long as possible (at least several hours) before you clean and disinfect. If you can wait 24 hours to clean the areas that the sick person used (such as the bedroom and bathroom), then you only need to clean (disinfection is not needed).
* Use and store cleaning and disinfectant products safely and correctly.
* Store these products securely and use personal protective equipment, like gloves and masks, that is appropriate for the cleaning and disinfection products.
* Use products from EPA List N according to the instructions on the product label.

See precautions for household members and caregivers for more information.

Alternatively, wait a period of 3 days after the person who was sick was in the space; after 3 days, no additional cleaning (aside from regular cleaning procedures) is needed.

After eating

* Wear gloves when handling dishes and utensils for the person who is sick.
* Wash dishes and utensils with soap and hot water or in the dishwasher.
* Clean hands after taking off gloves or handling used items.

Handling trash

* Use a dedicated, lined trash can for the person who is sick.
* Use gloves when removing garbage bags and handling and disposing of trash.
* Wash hands after disposing of the trash.

Tips for using chemical disinfectants safely

* Always follow the directions on the label of cleaning and disinfection products to ensure safe and effective use.
* Wear gloves and consider glasses or goggles for potential splash hazards to eyes.
* Ensure adequate ventilation (for example, open windows).
* Use only the amount recommended on the label.
* If diluting with water is indicated for use, use water at room temperature (unless stated otherwise on the label).
* Label diluted cleaning or disinfectant solutions.
* Store and use chemicals out of the reach of children and pets.
* Do not mix products or chemicals.
* Do not eat, drink, breathe, or inject cleaning and disinfection products into your body or apply directly to your skin as they can cause serious harm.
* Do not wipe or bathe people or pets with any surface cleaning and disinfection products.
* Special considerations should be made for people with asthma. Some cleaning and disinfection products can trigger asthma. Learn more about reducing your chance of an eating

* Wear gloves when handling dishes and utensils for the person who is sick.
* Wash dishes and utensils with soap and hot water or in the dishwasher.
* Clean hands after taking off gloves or handling used items.

Handling trash

* Use a dedicated, lined trash can for the person who is sick.
* Use gloves when removing garbage bags and handling and disposing of trash.
* Wash hands after disposing of the trash.

Top of Page

WHEN SOMEONE IS NO LONGER SICK: CLEANING AND DISINFECTING YOUR HOME

After the person who was sick no longer needs to be separated

Wait as long as possible (at least several hours) before you clean and disinfect.

* Less than 24 hours: Follow the guidance for cleaning and disinfecting when someone is sick. Clean and disinfect surfaces in the areas that the sick person used (such as the bedroom and bathroom) if you enter these areas less than 24 hours after the person is no longer sick. Wear a mask when you enter the room, open windows and use fans to help increase airflow, and always use disinfectants safely.
* Between 24 hours and 3 days: Clean surfaces (disinfection is not needed) in the areas that the sick person used if you enter these areas between 24 hours and 3 days after the person is no longer sick.
* After 3 days: No additional cleaning (aside from routine cleaning) is needed in the areas thma attack while disinfecting to prevent COVID-19.

See EPA’s Six Stepat the sick person used if you enter these areas fmor Safe and Effective Disinfectant Usee than 3 days after the person is no longer sick.
—snipped—

—snipped—
Español | Other Languages
—snipped—

—snipped—
As of 12:01AM ET on June 12, 2022, CDC will no longer require air passengers traveling from a foreign country to the United States to show a negative COVID-19 viral test or documentation of recovery from COVID-19 before they board their flight. For more information, see Rescission: Requirement for Negative Pre-Departure COVID-19 Test Result or Documentation of Recovery from COVID-19 for all Airline or Other Aircraft Passengers Arriving into the United States from Any Foreign Country.

As a result of a court order, effective immediately and as of April 18, 2022, CDC’s January 29, 2021 Order requiring masks on public transportation conveyances and at transportation hubs is no longer in effect. Therefore, CDC will not enforce the Order. CDC continues to recommend that people wear masks in indoor public transportation settings at this time.
—snipped—

—snipped—
Updated Apr. 9Sept. 16, 2021
—snipped—
Healthcare facilities should stop purchasing non-NIOSH -approved respirators for use as respiratory protection and consider using any that have been stored for source control where respiratory protection is not needed. Respirators that were previously used and decontaminated should not be stored. We do not know the long -term stability of non-NIOSH -approved respirators and respirators that have been decontaminated, and if these will be recommended for use in the future. Healthcare facilities should return to using only NIOSH-approved respirators where needed.
—snipped—
Updates as of April 9September 16, 2021

As of April 9, 2021

* Acknowledged that the supply and availability of NIOSH-approved respirators have increased significantly over the last several months
* For conventional capacity strategies
* Added language on extended use of N95 respirators as source control
* Added language on use of respirators with exhalation valves
* For contingency capacity strategies
* Added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control
* For extended use of N95 respirators as PPE, clarified that N95 respirators should be discarded immediately after being removed
* For crisis capacity strategies
* Removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders
* Highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP to ensure an adequate respirator performance
* RSeptember 16, 2021

* For contingency capacity strategies
* Beyond anticipated shortages, added that increased feasibility and practicality may also be considered in decisions to implement extended use for healthcare personnel (HCP) who are sequentially caring for a large volume of patients with suspected or confirmed SARS-CoV-2, including those cohorted in a SARS-CoV-2 unit, those placed in quarantine, and residents on units impacted during a SARS-CoV-2 outbreak.
* For crisis capacity strategies
* Added information about FDA’s reissuance of the Emergency Use Authorization (EUA) in July 2021. FDA removed filtering facepiece respirators that are NIOSH-approved but have since passed the manufacturers’ recommended shelf life and removed decontamination ofed respirators as a strategy with limited re-use
* Emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited
* Removed the table “Suggested well-fitting facemafrom the scope of authorization.
* Added clarification and example scenarios for limited re-use.
* Deleted the strategy, to exclude HCP at increased risk for respirator use, based upon distance from asevere illness from SARS-CoV-2 infection from contact with patients with known or suspected or confirmed SARS-CoV-2 infection and use of source control”.
—snipped—
SELECTIVE USE OF AIRBORNE INFECTION ISOLATION ROOMS

Aerosol-generating procedures performed on patients with suspected or confirmed SARS-CoV-2 infection should take place in an airborne infection isolation room (AIIR), if possible. The AIIR should be constructed and maintained in accordance with current guidelines, as recommended in CDC’s COVID-19 interim prevention and control recommendations in healthcare settings. Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
—snipped—
USE OF PHYSICAL BARRIERS

Barriers such as glass or plastic windows can be an effective solution for reducing exposures among HCP to potentially infectious patients. This approach can be effective in reception areas (e.g., intake desk at emergency department, triage station, information booth, pharmacy drop-off/pick-up windows) where patients may first report upon arrival to a healthcare facility. Other examples include the use of curtains between patients in shared areas and closed suctioning systems for airway suctioning for intubated patients.
—snipped—
Another cornerstone of engineering controls areis ventilation systems that provide air movement from a clean (HCP workstation or area) to contaminated (sick patient) flow direction (along with. It is important that ventilation systems also have appropriate filtration, and exchange rate) that ars and be installed and properly maintained.
—snipped—
Extended use of N95 respirators can be considered for source control while HCP are in the healthcare facility, to cover one’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. When used for this purpose, N95s may be used until they become soiled, damaged, or hard to breathe through. They should be immediately discarded after removal. Extended use of N95 respirators as PPErespiratory protection is a contingency capacity strategy.
—snipped—
Many healthcare systems already use qualitative fit test methods for fit testing HCP. For those using quantitative fit test methods, considerations can be made to use qualitative fit test methods to minimize the destruction of an N95 respirator used in fit testing and allow for the re-use of the same N95 respirator by the HCP. In March 2020, OSHA recommended healthcare employers consider changing from a quantitative fit testing method to a qualitative fit testing method. Qualitative fit methods may also allow for rapid fit testing of larger numbers of HCP. Any switch in methods should be assessed to ensure proficiency of the fit testers in carrying out the test.
—snipped—
Use NIOSH -approved alternatives to N95 respirators where feasible. These include other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, and powered air purifying respirators (PAPRs). All of these alternatives will provide equivalent or higher protection than N95 respirators when properly worn. NIOSH maintains a searchable, online version of the certified equipment list identifying all NIOSH-approved respirators.

Every other NIOSH -approved filtering facepiece respirators is at least as protective as the N95. These include N99, N100, P95, P99, P100, R95, R99, and R100 (with or without an exhalation valve). On March 2, 2020, FDA issued an Emergency Use Authorization (EUA)external icon authorizing the use of certain NIOSH-approved respirator models in healthcare settings.

As source control, findings from NIOSH research suggest that all NIOSH -approved filtering facepiece respirators with exhalation valves, even without covering the valve, perform the same or better than surgical masks, procedure masks, cloth masks, or fabric. If there is a risk that the worker may be exposed to splashes, sprays, or splatters of blood or body fluids, then a faceshield or surgical facemask should be worn over the standard N95 respirator. Care should be taken not to compromise the fit of the respirator if a facemask is placed over the respirator.

Elastomeric respirators are half-facepiece or full-facepiece, tight-fitting respirators that are made of synthetic or rubber material permitting them to be repeatedly disinfected, cleaned, and reused. They are equipped with a replaceable filter cartridges. Similar toparticulate filter (N95, N99, N100, P95, P99, P100, R95, R99, or R100) and provide the same protection level as N95 respirators, e. Elastomeric respirators require annual fit testing. Elastomeric respirators with unfiltered exhalation valves should not be used in surgical settings due to concerns that air coming out of the exhalation valve may contaminate the sterile field. The NIOSH Certified Equipment List identifies the elastomeric respirators without exhalation valves or with filtered exhalation valves that may be used in surgical settings.

PAPRs are reusable respirators that are typically loose-fitting hoods or helmets. These respirators are battery-powered with a blower that pulls air through attached filters or cartridges. TWhe filter is typically a high-efficiency particulate air (HEPA) filtern equipped with a high-efficiency (HE) filter, they provide a higher level of protection than N95 respirators, as they are 99.97% efficient against 0.3 micron particles. Loose-fitting PAPRs do not require fit-testing and can be worn by people with facial hair. However, PAPRs should not be used in surgical settings due to concerns that the blower exhaust and exhaled air may contaminate the sterile field.

On March 28, 2020, FDA issued an update to address NIOSH-Approved Air Purifying Respirators for Use in Health Care Settings During Response to the COVID-19 Public Health Emergency. Facilities using elastomeric respirators and PAPRs should have up-to-date cleaning/ and disinfection procedures, which are an essential part of use for protection against infectious agents.
—snipped—
Facilities can consider temporarily suspending annual fit testing of HCP in times of expected shortages. In March 2020, OSHA issued new temporary guidance regarding the enforcement of OSHA’s Respiratory Protection Standard. The guidance gave OSHA field offices enforcement discretion concerning the annual fit testing requirement as long asmportant conditions include the HCP haves undergone an initial fit test with the same model, style, and size. Other conditions include explaining to HCP and the HCP has been explained the importance of conducting a user seal check each time the respirator is put on and conducting a fit test if there are visual changes to the employee’s physical condition. In June 2021, OSHA published a COVID-19 Emergency Temporary Standard, including a Mini Respiratory Protection Program, which applies to situations in which respirators are not required. The Mini Respiratory Protection Program emphasizes the importance of conducting a user seal check each time the respirator is donned.
—snipped—
Prioritize respirators for HCP who are using them as PPErespiratory protection

In times of anticipated shortages, surgical N95 respirators should be prioritized for those HCP who are recommended to wear them as PPErespiratory protection when caring for patients. RSurgical N95 respirators should not be used by HCP who are only using them for source control.
—snipped—
Extended use of N95 respirators as respiratory protection

Practices allowing extended use of N95 respirators as PPErespiratory protection, when acceptable, can also be considered. The decision to implement policies that permit extended use of N95 respirators should be made by the professionals who manage the institution’s respiratory protection program, in consultation with their occupational health and infection control departments with input from the state/local public health departments. Beyond anticipated shortages, increased feasibility and practicality may also be considered in decisions to implement extended use for HCP who are sequentially caring for a large volume of patients with suspected or confirmed SARS-CoV-2, including those cohorted in a SARS-CoV-2 unit, those placed in quarantine, and residents on units impacted during a SARS-CoV-2 outbreak.

Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several different patients, without removing the respirator between patient encounters. Extended use is well suited to situations wherein multiple patients with the same infectious disease diagnosis, whose care requires use of a respirator, are cohorted (e.g., housed on the same hospital unit such as a COVID-19 unit). It can also be considered to be used for care of patients with tuberculosis, varicella, measles, and other infectious diseases where use of an N95 respirator or higher respirator is recommended.

When practicing extended use of N95 respirators over the course of a shift, considerations should include 1) the ability of the N95 respirator to retain its fit, 2) contamination concerns, 3) practical considerations (e.g., meal breaks), and 4) comfort of the user. N95 respirators should be discarded immediately after being removed. If removed for a meal break, the respirator should be discarded and a new respirator put on after the break. If it is necessary to re-use N95 respirators in addition to extended use, please see the re-use section under crisis capacity strategies below. N95 respirators should be discarded when contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. HCP can consider using a face shield or surgical facemask over the respirator to reduce contamination of the respirator, especially during aerosol generating procedures or procedures that might generate splashes and sprays. Care should be taken not to compromise the fit of the respirator if a mask is placed over the respiratorIt is not known how facemasks placed over the respirator can affect the fit so caution should be used.
—snipped—
Consideration can be made to use N95 respirators beyond the manufacturer-designated shelf life for care of patients with diseases for which a respirator is recommended during their care (e.g., COVID-19, tuberculosis, measles, and varicella). Many models found in U.S. stockpiles and stockpiles of healthcare facilities have been found to continue to perform in accordance with NIOSH performance standards. However, fluid resistance and flammability were not assessed. Use of the N95 respirators recommended in Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 ResponseNIOSH’s Beyond Shelf Life/Stockpiled Assessment Results can be considered. It is optimal to use these respirators in the context of a respiratory protection program that includes medical evaluation, training, and fit testing. If used in healthcare delivery, it is particularly important that HCP perform the expected seal check, prior to entering a patient care area. CDC does not recommend using N95s beyond the manufacturer-designated shelf life in surgical settings. On March 2, 2020, FDA issued an Emergency Use Authorization (EUA) authorizing the use of certain NIOSH-approved respirator models in healthcare settings. Thise EUA includes respirator units that are past their designatwas reissued on July 12, 2021. Due to the increased availability of NIOSH-approved respirators, the FDA removed filtering facepiece respirators that were NIOSH-approved but have since passed the manufacturers’ recommended shelf life.
—snipped—
Non-NIOSH approved products developed by manufacturers who are not NIOSH approval holders are expected to meet the performance requirements if they have been issued a certificate of approval by an authorizccredited test laboratory indicating they conform to the standards below. Non-NIOSH-approved products developed by manufacturers who are not NIOSH approval holders should not be used when an N95 respirator is recommended to be worn. FDA issued updates to its emergency use authorizations concerning non-NIOSH-approved respirators that have been approved in other countries on October 15, 2020 (Non-NIOSH Approved Disposable FFRs Manufactured in China) and March 24, 2021 (Imported, Non-NIOSH Approved Disposable FFRs). Visit Factors to Consider When Planning to Purchase Respirators from Another Country and the NIOSH Science Blog for additional information on understanding the use of imported Non-NIOSH-approved respirators.
—snipped—
These respirators approved under standards used in other countries are no longer authorized under the FDA EUAs for use in healthcare settings, and they are no longer authorized by OSHA in occupational settings under the OSHA Emergency Temporary Standard effective in June 2021. However, these respirators may be used for source control.

Show More
—snipped—
It is important to consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model. If no manufacturer guidance is available, data suggest limiting the number of reuses to no more than five total uses (five total donnings) per device by the same HCP to ensure an adequate respirator performance.3 Example scenario: a HCP wears a respirator to care for a patient, removes it after exiting the room, and then later returns to care for the patient and puts the same respirator on again. This would count as two uses or donnings. HCP should always inspect the respirator and perform a seal check upon donning a re-used respirator. N95 and other disposable respirators should not be shared by multiple HCP.

During times of crisis, practicing limited re-use while also implementing extended use can be considered. If limited re-use is practiced on top of extended use, caution should be used to minimize self-contamination and degradation of the respirator. If no manufacturer guidance is available, a reasonable limitation should continue to be five total donnings regardless of the number of hours the respirator is worn. Example scenario: An HCP wears a respirator during the first 3 hours of his or her shift, removes the respirator to eat lunch, and puts it back on after lunch. This would count as two uses or donnings.
—snipped—
Respirators soiled or grossly contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients should be discarded. HCP can consider using a face shield or facemask over the respirator to reduce/prevent contamination of the N95 respirator, especially during aerosol generating procedures or procedures anticipated to generate splashes and sprays. It is important to perform hand hygiene before and after the previously worn N95 respirator is donned or adjusted.
—snipped—
Decontamination or bioeburden reduction of NIOSH-approved N95 respirators is no longer a strategy to conserve supplies as the availability to NIOSH-approved respirators has significantly increased. In July 2021, the FDA removed the EUA of decontaminated respirators from the scope of authorization.
—snipped—
Use of additional N95 respirators beyond the manufacturer-designated shelf life for care of patients for whom a respirator is recommended during their care (e.g., SARS-CoV-2 infection, tuberculosis, measles, varicella) can be consideredis no longer authorized as part of an FDA EUA. Some models have been found NOT to perform in accordance with NIOSH performances standards, and previous consideration may bewas given to use these respirators as identified in ReleaUse of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response. In addition, consideration can be given to use N95 respirators that have not been evaluated bythe N95 respirators recommended in NIOSH b’s Beyond the manufacturer-designated sShelf lLife. These respirators should ideally be used in the context of a respiratory protection program that includes medical evaluation, training, and fit testing. It is particularly important that HCP perform the expected seal check, prior to entering a patient care area/Stockpiled Assessment Results.
—snipped—
Source control (i.e., masking of patients) and maintaining physical distance from the patient are particularly important to reduce the risk of transmission. This prioritization approach to conservation is intended to be used when N95 respirators are so limited that routinely practiced standards of care for all HCP wearing N95 respirators when caring for a patient with SARS-CoV-2 infection are no longer possible. N95 respirators beyond their manufacturer-designated shelf life, when available, are preferable to use of well-fitting facemasks. The use of N95s or elastomeric respirators or PAPRs should be prioritized for HCP with the highest potential exposures including being present in the room during aerosol generating procedures performed on persons with SARS-CoV-2 infection.
—snipped—
ADMINISTRATIVE CONTROLS

Exclude HCP at increased risk for severe illness from SARS-CoV-2 infection from contact with patients with known or suspected SARS-CoV-2 infection.

During severe resource limitations, consider excluding HCP who may be at increased risk for severe illness from SARS-CoV-2 infection, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected SARS-CoV-2 infection. Any HCP who are assigned to care for patients with suspected or confirmed SARS-CoV-2 infection should wear a well-fitting facemask.

ENGINEERING CONTROLS
—snipped—
As of April 9, 2021

* Acknowledged that the supply and availability of NIOSH-approved respirators have increased significantly over the last several months
* For conventional capacity strategies
* Added language on extended use of N95 respirators as source control
* Added language on use of respirators with exhalation valves
* For contingency capacity strategies
* Added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control
* For extended use of N95 respirators as PPE, clarified that N95 respirators should be discarded immediately after being removed
* For crisis capacity strategies
* Removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders
* Highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP to ensure an adequate respirator performance
* Removed decontamination of respirators as a strategy with limited re-use
* Emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited
* Removed the table “Suggested well-fitting facemask or respirator use, based upon distance from a patient with suspected or confirmed SARS-CoV-2 infection and use of source control”

As of February 10, 2021
—snipped—

—snipped—
Updated Apr.May 270, 2021
—snipped—
Updates as of AprilMay 270, 2021
* Updates to definitions for Small and Large Gatheringd cleaning and disinfection information

----------------------------------------

View Previous Updates
—snipped—
Event planners should consider implementing severalthese strategies to maintain healthy environments.

* Cleaning and Disinfection
* Develop a schedule for increased, routine cleaning.
* Clean and disinfect frequentlyWhen to Clean
* Cleaning with products containing soap or detergent reduces germs on surfaces and objects by removing contaminants and may weaken or damage some of the virus particles, which decreases risk of infection from surfaces.
* Cleaning high touched surfaces within the venue before the event, at least daily, and as much as possible—for example, door handand shared objects once a day is usually enough to sufficiently remove virus that may be on surfaces unles,s sink handles, grab bars, hand railings, and cash registers.
* When choosing disinfectants, use proomeone with confirmed or suspected COVID-19 has been in your facility. Disinfecting (using disinfectants on U.S. Environmental Protection Agency (EPA)’s List Nexternal icon) removes any remaining germs on surfaces, which further reductes from EPA-approved disinfectants against COVID-19.
* Clean shared objects frequently, based on level of use—for example, payment terminals, tables, countertops, bars, and condiment holders.
* Consider closing areas such as drinking fountains that cannot be adequately cleaned during an event.
* Plan for and enact these clany risk of spreading infection. For more information on cleaning your facility regularly and cleaning your facility when someone is sick, see Cleaning and Disinfecting Your Facility.
* When to Disinfect
* You may want to either clean more frequently or choose to disinfect (in addition to cleaning) in shared spaces if certain conditions apply that can increase the risk of infection from touching surfaces.
* High transmission of COVID-19 in your community
* Low number of people weanring routines when renting event space and ensure that other groups who may use your facilities follow these routines.
* Ensure safe and correct use and storage of cleaning and disinfection products to avoid harm to staff and other people. Always read and follow label instructions for each product, and store products securely away from children.
* Cmasks
* Infrequent hand hygiene
* The space is occupied by people at increased risk for severe illness from COVID-19
* If there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean AND disinfect the space.
* Use Disinfectants Safely
* Always read and follow the directions on how to use and store cleaning and disinfectiong products should not be used near children. Staff should ensure that there is adequate ventilation when using these products to prevent attendees or themselves from inhaling toxic vapors.
* Use disposable gloves when removing garbage bag. Ventilate the space when using these products.
* Always follow standard practices and appropriate regulations specific to your facility for minimum standards for handlcleaning and disposing of trash.
* After using disposable gloves, throw them out in a lined trash can.
* Do not disinfect or reuse the gloves.
* Wash hands after removing glovesinfection. For more information on cleaning and disinfecting, see Cleaning and Disinfecting Your Facility.
—snipped—

PREVIOUS UPDATES

Updates from Previous Content

As of April 27, 2021

* Updated cleaning and disinfection information

Top of Page

—snipped—
* Don’t Delay: Test Soon and Treat Early | Spanish Version
—snipped—

—snipped—
* Hand Sanitizer Use
* Quarantine and Isolation
—snipped—

—snipped—
People who have symptoms of respiratory or gastrointestinal infections, such as cough, fever, sore throat, vomiting, or diarrhea, should stay home. Testing is recommended for people with symptoms of COVID-19 as soon as possible after symptoms begin. People who are at risk for getting very sick with COVID-19 who test positive should consult with a healthcare provider right away for possible treatment, even if their symptoms are mild. Staying home when sick can lower the risk of spreading infectious diseases, including COVID-19, to other people. For more information on staying home when sick with COVID-19, including recommendations for isolation and mask use for people who test positive or who are experiencing symptoms consistent with COVID-19, see Isolate If You Are Sickion and Precautions for People with COVID-19.
—snipped—

—snipped—
OPTIMIZING SUPPLY OF PPE AND OTHER EQUIPMENT DURING SHORTAGES

Optimizing Supply of PPE and Other Equipment during Shortages

Updated July 16, 2020

Print

Minus
Related Pages

Personal protective equipment (PPE) is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from many hazards encountered in healthcare facilities.

The greatly increased need for PPE caused by the COVID-19 pandemic has caused PPE shortages, posing a tremendous challenge to the U.S. healthcare system. Healthcare facilities are having difficulty accessing the needed PPE and are having to identify alternate ways to provide patient care.

Surge capacity refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. While there are no commonly accepted measurements or triggers to distinguish surge capacity from daily patient care capacity, surge capacity is a useful framework to approach a decreased supply of PPE during the COVID-19 response. To help healthcare facilities plan and optimize the use of PPE in response to COVID-19, CDC has developed aPERSONAL PROTECTIVE EQUIPMENT (PPE) SUPPLIES

Optimizing Personal Protective Equipment (PPE) Supplies

Updated July 16, 2020

Print

Minus
Related Pages

General PPE Information * Using Personal Protective Equipment
* FAQS: Personal Protective Equipment (
* PPE) Burn Rate Calculator . Three general strata have been used to describe surge capacity and can be used to prioritize measures to conserve

Strategies for Optimizing PPE sSupplies along the continuum of care.

* Conventional capacity: measures consisting of engineering, administrative, and PPE controls that should already be implemented in general infection prevention and control plans in healthcare settings.
* Contingency capacity: measures that may be used temporarily during periods of anticipated PPE shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies. While current supply may meet the facility’s current or anticipated utilization rate , there may be uncertainty if future supply will be adequate and, therefore, contingency capacity strategies may be needed.
* Crisis capacity: strategies that are not commensurate with U.S. standards of care but may need to be considered during periods of known PPE shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies. Facilities can consider crisis capacity strategies when the supply is not able to meet the facility’s current or anticipated utilization rate .

CDC’s optimization strategies for PPE offer a continuum of options for use when PPE supplies are stressed, running low, or exhausted. Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and implemented sequentially . As PPE availability returns to normal, healthcare facilities should promptly resume standard practices.

Decisions to implement contingency and crisis strategies are based on these assumptions:

1. Facilities understand their current PPE inventory and supply chain
2. Facilities understand their PPE utilization rate
3. Facilities are in communication with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional supplies
4. Facilities have already implemented conventional capacity measures
5. Facilities have provided HCP with required education and training, including having them demonstrate competency with donning and doffing, with any PPE ensemble that is used to perform job responsibilities, such as provision of patient care

HCP and facilities—along with their healthcare coalitions, local and state health departments, and local and state partners—should work together to develop strategies that identify and extend PPE supplies , so that recommended PPE will be available when needed most. When using PPE optimization strategies, training on PPE use, including proper donning and doffing procedures , must be provided to HCP before they carry out patient care activit

Quick Reference: Optimizing PPE Supplies during Shortages

This quick reference summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies.

N95 Respirators Facemasks Isolation Gowns Eye Protection Gloves Powered Air Purifying Respirators Elastomeric Respirators Ventilators

Stockpiled N95 Respirators Decontamination and Reuse of Filtering Facepiece Respirators Factors to Consider When Planning to Purchase Respirators from Another Country Personal Protective Equipment Burn Rate Calculator Using PPE
EMERGENCY USE AUTHORIZATION (EUA) OF RESPIRATORY PROTECTIVE DEVICES

On February 4, 2020, the HHS Secretary declared that circumstances exist to justify the authorization of emergency use of additional respiratory protective devices in healthcare settings during the COVID-19 outbreak. The FDA is providing frequent updates for manufacturers, facilities, and local/state jurisdictions about Emergency Use Authorizations (EUA) for respirators and other types of personal protective equipment. The FDA has issued EUAs to authorize all NIOSH approved particulate-filtering air purifying respirators (APRs) to be used in healthcare settings, including all NIOSH approved filtering facepiece respirators, elastomeric APRs, powered air purifying respirators, expired NIOSH-approved filtering facepiece respirators, and respirators that have been decontaminated pursuant to the terms and conditions of an authorized decontamination system. The authorized decontamination systems are listed on the FDA EUA website. In addition, non-NIOSH-approved disposable filtering facepiece respirators within the context of the posted EUA are permitted for use as well.

More on FDA Website More Resources * NIOSH Science Blog: Imported Respirators
* NIOSH Hospital Respiratory Protection Program Toolkit
* NIOSH Healthcare Respiratory Protection ResourcQuick Reference

* General Optimization Strategies
* N95 and Other Respirators
* Facemasks
* Eye Protection
* Gowns
* Gloves

—snipped—
COVID-19 VIDEOS
—snipped—
CDC Briefing Room: COVID-19 Update: March 14, 2020

CDC BRIEFING ROOM: COVID-19 UPDATE: MARCH 14, 2020

Get the latest information from the CDC about COVID-19

DEMONSTRATION OF DONNING (PUTTING ON) PERSONAL PROTECTIVE EQUIPMENT (PPE)

DEMONSTRATION OF DOFFING (TAKING OFF) PERSONAL PROTECTIVE EQUIPMENT (PPE)

COVID-19: ARE YOU AT HIGHER RISK FOR SEVERE ILLNESS?

10 THINGS YOU CAN DO TO MANAGE COVID-19 AT HOME

6 STEPS TO PREVENT COVID-19

COVID-19: WHAT OLDER ADULTS NEED TO KNOW

SYMPTOMS OF CORONAVIRUS DISEASE 2019

COVID-19 AND THE ROLE OF COMMUNITY HEALTH WORKERS

hand paper solid icon American Sign Language YouTube Videos play circle icon View more videos about coronavirus disease 2019 (COVID-19) on CDC’s YouTube Channel

play circle icon COVID-19 en Español YouTube Playlist youtube icon Ad Council COVID-19 VideosDownload video instructions for different browsers.

loading... Download Instructions Explorer: Right-click on the link, choose “Save target as…”, save file in desired location.

Firefox/Chrome: Right-click on the link, choose “Save link as…”, save file in desired location.

Safari: Right-click or command-click on the link, choose “Download Linked File As…”, save file in desired location.

—snipped—
* Post- Vaccine Considerations for Healthcare WorkerWorkplaces
—snipped—

—snipped—
Find the Latest Information:

* Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

This guidance applies to all medical first responders, including fire services, emergency medical services, and emergency management officials, who anticipate close contact with persons with suspected or confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in the course of their work.
—snipped—

—snipped—
Updated Jan. 14Aug. 31, 2022
—snipped—
CDC is reviewing this page to align with updated guidance.

CDC’s COVID-19 Community Levels recommendations do not apply in healthcare settings, such as hospitals and nursing homes. Instead, healthcare settings should continue to use community transmission rates and continue to follow CDC’s infection prevention and control recommendations for healthcare settings.

This page is forintended for use by healthcare professionals who are caring for people in the community setting under isolation with laboratory-confirmed COVID-19. See Quarantine and Isolation fCOVID-19. For more information for the general population in the community, please see Isolation and Precautions for People with COVID-19.

These recommendations do not apply to healthcare personnel in the healthcare setting, and do not supersede state, local, tribal, or territorial laws, rules, and regulations. For healthcare settings, please see Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Interim Infection Prevention and Control Recommendations for Healthcare Personnel. For more details, including details on certain non-healthcare settings, please review Setting-Specific Guidance.
—snipped—
Updates as of January 14, 2022

As of January 14August 31, 2022

* Updated guidance to reflects new recommendations for isolation and precautions for people with COVID-19.
* Added new recommendationsRemoved Assessment for dDuration of iIsolation for people with COVID-19 who are moderately or severely immunocompromised.

----------------------------------------

View Previous Updates

KEY POINTS FOR HEALTHCARE PROFESSIONALS

* Children and adults with mild, symptomatic COVID-19: Isolation can end at least 5 days after symptom onset and after fever ends for 24 hours (without the use of fever-reducing medication) and symptoms are improving, if these people can continue to properly wear a well-fitted mask around others for 5 more days after the 5-day isolation period. Dand Key Findings From Transmission Literature sections so page provides most current information.

----------------------------------------

View Previous Updates

KEY POINTS

* People who are infected but asymptomatic or people with mild COVID-19 should isolate through at least day 5 (day 0 is the first day of symptoms.
* People who are infected but asymptomatic (never develop symptoms): Isolation can end at least 5 days after the first positive test (with day 0 being appeared or the date their specimen was collected for the positive test), if these people can continue to wear a properly well-fitted for people who are asymptomatic). They should wear a mask athround others for 5 more days after the 5-day isolation period. However, if symptoms develop after a positive test, their 5-day isolation period should start over (day 0 changes to the first day of symptoms)gh day 10. A test-based strategy may be used to remove a mask sooner.
* People who haveith moderate or severe COVID-19 illness: Isolate for 10 days.
* People who are severely ill (i.e., requiring hospitalization, intensive care, or ventilation support): Extending the duration of isolation and precaushould isolate through at least day 10. Those with severe COVID-19 may remain infectionus to at leastbeyond 10 days and up to 20 days after symptom onset, and after fever ends (without the use of fever-reducing medication) and symptoms are improving, may be warranted.
* People who are moderately or severely immunocompromised might have a longer infectious period: Extend isolation to 20 or more days (day 0 is the first day of symptoms or a positive viral test). Use a test-based strategymay need to extend isolation for up to 20 days.
* People who are moderately or severely immunocompromised should isolate through at least day 20. Use of serial testing and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions.
* Recovered patients: Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset. However, replication-competent virus has not been reliably recovered from such patients, and they are not likely infecis recommended in these patients prior to ending isolatiousn.
—snipped—
* Assessment for Duration of Isolation
* Key Findings from Transmission Literature

* Limitations of Current Evidence
* References
* Previous Updates
—snipped—
For people who are mildly ill with a laboratory-confirmed SARS-CoOV-2 infection and not moderately or severely immunocompromised:

* Isolation can be discontinued at least 5 days after symptom onset (day 1 through day 5 after symptom onset, with day 0 being the first day of symptoms), and after resolution of fe0 is the day symptoms appeared, and day 1 is the next full day thereafter) if fever has resolverd for at least 24 hours (without the use ofaking fever-reducing medications) and with improvement of other symptoms are improving.
—snipped—
* These people should continue to properly wear a well-fitted mask around others at home and in public for 5 additional days (day 6 through day 10 after symptom onset) after the 5-day isolation periodA high-quality mask should be worn around others at home and in public through day 10. A test-based strategy may be used to remove a mask sooner.
* If symptoms recur or worsen, the isolation period should restart at day 0.
* People who cannot properly wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days.
* In certain high-risk congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people, CDC recommends a 10-day isolation period for residents.

More details: What We Know About Quarantine and IsolationIsolation and Precautions for People with COVID-19
—snipped—
* Isolation can be discontinued at least 5 days after the first positive viral test (day 0 through day 5, with day 0 beingis the date their specimen was collected for the positive test).
* These people should continue to properly wear a well-fitted mask around others at home and in public for 5 additional days (day 6 through day 10) after the 5-day isolation period. Day 0 is the date their specimen was collected for the positive test and day 1 is the first full day after the specimen was collected for the positive test, and day 1 is the next full day thereafter).
* A high-quality mask should be worn around others at home and in public through day 10. A test-based strategy may be used to remove a mask sooner.
* If a person develops symptoms afterwithin 10 days of testing positive, their 5-day isolation period should start over (day 0 changes to the first day of symptoms).
* People who cannot properly wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days.
* In certain high-risk congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people, CDC recommends a 10-day isolation period for residents.

More details: What We Know About Quarantine and IsolationIsolation and Precautions for People with COVID-19
—snipped—
* Isolation and precautions can be discontinued 10 days after symptom onset (day 1 through day 10, with day 0 being the first day of symptoms0 is the day symptoms appeared, and day 1 is the next full day thereafter).
—snipped—
* A test-based strategy can be considered in consultation with infectious disease expertsIsolation should continue for at least 10 days after symptom onset (day 0 is the day symptoms appeared, and day 1 is the next full day thereafter).
* Some people with severe illness (e.g., requiring hospitalization, intensive care, or ventilation support) may produce replication-competent virremain infectious beyond 10 days that. This may warrant extending the duration of isolation and precautions for up to 20 days after symptom onset (with day 0 being the first day of symptomsday symptoms appeared) and after resolution of fever for at least 24 hours (without the use oftaking fever-reducing medications) and improvement of other symptoms.
* Serial testing prior to ending isolation can be considered in consultation with infectious disease experts.
—snipped—
* Moderately or severely immunocompromised patients may produce replication-competent virremain infectious beyond 20 days. For these people, CDC recommends an isolation period of at least 20 days, and ending isolation in conjunction with a test-based strategyserial testing and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions.
* The criteria for the test-based strategyserial testing to end isolation are:
—snipped—
* Also, if a moderately or severely immunocompromised patient with COVID-19 was symptomatic, there should be resolution of fever for at least 24 hours (without the use oftaking fever-reducing medication) and improvement of other symptoms. Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation .
* Re-testing for SARS-CoV-2 infection is suggested if symptoms worsen or return after ending isolation and precautions based on this test-based strategy for moderately or severely immunocompromised people.(1).
—snipped—
More details: COVID-19 Quarantine and Isolation and What We Know About Quarantine and Isolation

Top of Page

ASSESSMENT FOR DURATION OF ISOLATION

Available data suggest that patients with mild-to-moderate COVID-19 remain infectious no longer than 10 days after symptom onset. More information is available at What We Know About Quarantine and Isolation.

Most patients with more severe-to-critical illness likely remain infectious no longer than 20 days after symptom onset.

There have been numerous reports of moderately or severely immunocompromised people shedding replication-competent virus beyond 20 days.(examples: 1-33) A higher SARS-CoV-2 viral load and longer duration of infection among moderately or severely immunocompromised people may favor emergence of SARS-CoV-2 variants.(5,14,19,30,34,35) Strategies that reduce SARS-CoV-2 transmission to and from people at increased risk of long-term infections could slow the emergence and spread of new variants.(34,35)

Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset in concentrations considerably lower than during illness; however, replication-competent virus has not been reliably recovered from such patients, and they are not likely infectious. The circumstances that result in persistently detectable SARS-CoV-2 RNA have yet to be determined. Studies have not found evidence that clinically recovered adults with persistence of viral RNA have transmitted SARS-CoV-2 to others. These findings strengthen the justification for relying on a symptom-based rather than test-based strategy for ending isolation of most patients.

Top of Page

KEY FINDINGS FROM TRANSMISSION LITERATURE

1. Concentrations of SARS-CoV-2 RNA in upper respiratory specimens decline after onset of symptoms.(36-39, 40-43) Infectiousness peaks around one day before symptom onset and declines within a week of symptom onset, with an average period of infectiousness and risk of transmission between 2-3 days before and 8 days after symptom onset.(42,44)
2. Several studies have found similar concentrations of SARS-CoV-2 RNA in upper respiratory specimens from children and adults.(45-52)
* To date, most studies of SARS-CoV-2 transmission have found that children and adults have a similar risk of transmitting SARS-CoV-2 to others.
* One study reported that children were more likely to transmit SARS-CoV-2 than adults >60 years old.(53)
3. Certain SARS-CoV-2 variants of concern are more transmissible than the wild type virus or other variants, resulting in higher rates of infection. For example, people infected with the Delta variant, including people who are up to date with their vaccines with symptomatic breakthrough infections, can transmit infection to others. However, like other variants, the amount of virus produced by Delta breakthrough infections in people who are up to date with their vaccines decreases faster than in people who are not up to date with their vaccines.
4. The likelihood of recovering replication-competent (infectious) virus is very low after 10 days from onset of symptoms, except in people who have severe COVID-19 or who are moderately or severely immunocompromised.
* For patients with mild COVID-19 who are not moderately or severely immunocompromised, replication-competent virus has not been recovered after 10 days following symptom onset for most patients.(38,39,54-58) With the recommended shorter isolation period for asymptomatic and mildly ill people with COVID-19, it is critical that people continue to properly wear well-fitted masks and take additional precautions for 5 days after leaving isolation.(59,60) Modeling data suggest that close to one-third of people remain infectious after day 5 and can potentially transmit the virus.(61) Outliers exist; in one case report, an adult with mild illness provided specimens that yielded replication-competent virus for up to 18 days after symptom onset.(62)
* Recovery of replication-competent virus between 10 and 20 days after symptom onset has been reported in some adults with severe COVID-19; some of these people were immunocompromised.(37) However, in this series of patients, it was estimated that 88% and 95% of their specimens no longer yielded replication-competent virus after 10 and 15 days, respectively, following symptom onset.
* Detection of sub-genomic SARS-CoV-2 RNA or recovery of replication-competent virus has been reported in moderately or severely immunocompromised patients beyond 20 days, and as long as >140 days after a positive SARS-CoV-2 test result.(examples: 1-33) Immunocompromising conditions that have been associated with shedding of replication-competent virus beyond 20 days include active treatment for solid tumor and hematologic malignancies, solid organ transplant and taking immunosuppressive therapy, receipt of CAR-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppression therapy), moderate or severe primary immunodeficiency, and active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, and other biologic agents that are immunosuppressive or immunomodulatory.(examples: 1-33)
* Prolonged detection of replication-competent virus may be associated with other factors. For example, a 13-year-old immunocompetent male was hospitalized for injuries received in a motor vehicle crash. He required intubation, developed pulmonary infiltrates, and tested positive for SARS-CoV-2. Viral cultures of upper and lower respiratory tract specimens were positive for SARS-CoV-2 on days 47 and 54 of his hospitalization.(63)
5. The risk of SARS-CoV-2 transmission to others varies based upon several factors including time after symptom onset, virus variant, virus levels in the upper respiratory tract, and disease status (asymptomatic, pre-symptomatic, or symptomatic).
* In a large contact tracing study, no contacts developed SARS-CoV-2 infection if their exposure to a COVID-19 case patient occurred 6 days or more after the case patient’s symptom onset.(64)
* One study reported that 59% of SARS-CoV-2 transmission originated from index cases that were asymptomatic or pre-symptomatic.(65)
* A meta-analysis found that the secondary attack rate for asymptomatic (never develop symptoms) index cases was 1.9%, but was 9.3% for pre-symptomatic and 13.6% for symptomatic index cases.(66) Therefore, people with SARS-CoV-2 infection without symptoms pose a transmission risk and should isolate based upon CDC’s quarantine and isolation recommendations.
6. People who have recovered from COVID-19 may have prolonged detection of SARS-CoV-2 RNA.(67) However, prolonged detection of viral RNA does not necessarily mean that such people are a transmission risk.(68) Studies of patients who were hospitalized and recovered indicate that SARS-CoV-2 RNA can be detected in upper respiratory tract specimens for up to 3 months (12 weeks) after symptom onset.(58,62,69)
* Investigation of 285 “persistently SARS-CoV-2 RNA positive” adults, which included 126 adults who had developed recurrent symptoms, found no secondary infections among 790 contacts. Efforts to isolate replication-competent virus were attempted for 108 of these 285 case patients, and SARS-CoV-2 was not recovered in viral culture from any of the 108 specimens.(58)
7. The probability of SARS-CoV-2 reinfection may increase with time after recovery, consistent with other human coronaviruses, because of waning immunity and the possibility of exposure to viral variants.(70-78) The risk of reinfection also depends on host susceptibility, vaccination status, and the likelihood of re-exposure to infectious cases of COVID-19. Continued widespread transmission makes it more likely that reinfections will occur.
8. Loss of taste and smell may continue for weeks or months after recovery.(79) The presence of these symptoms does not mean that the isolation period must be extended.

LIMITATIONS OF CURRENT EVIDENCE

* Studies referenced in this document may have differences compared to the current epidemiology of COVID-19 in the United States. Specifically, many of these references involve non-US populations, homogenous populations, virus transmission prior to the availability of vaccination for COVID-19, and infection prior to the known circulation of SARS-CoV-2 current variants of concern, such as the Delta or Omicron variant. More studies are needed to fully understand virus transmission related to the Delta variant, Omicron variant, and other SARS-CoV-2 variants among people who are up to date with their vaccines.
* Studies have used viral culture to attempt to grow SARS-CoV-2 from clinical samples from patients who tested positive for SARS-CoV-2 to determine infectiousness. Because viral culture must be done in very specialized laboratories, these studies are more limited in number compared to studies using other test methods to detect SARS-CoV-2 infection.
* Many studies that assessed the duration of SARS-CoV-2 infectiousness have been conducted in adults. More studies are needed, especially in children with SARS-CoV-2 infection.
* More data are needed to understand the frequency and duration of infectious SARS-CoV-2 shedding among the spectrum of mild to severely immunocompromised people, including both asymptomatic and symptomatic people.
* More data are needed to fully understand the risk of recovery of replication-competent virus in people with severe COVID-19. There was variation in how studies defined severe illness with COVID-19. Some studies defined severe disease as cases requiring hospitalization or mechanical ventilation while other researchers used the definition of severity from the COVID-19 Treatment Guidelines published by National Institutes of Health (NIH).

Top of Page

REFERENCES

See All References
1. Helleberg M, Niemann CU, Moestrup KS, et al. Persistent COVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses of Remdesivir Therapy. J Infect Dis. Sep 1 2020;222(7):1103-1107. doi:10.1093/infdis/jiaa446
2. Aydillo T, Gonzalez-Reiche AS, Aslam S, et al. Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer. New England Journal of Medicine. 2020;383(26):2586-2588. doi:10.1056/NEJMc2031670
3. Avanzato VA, Matson MJ, Seifert SN, et al. Case Study: Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer. Cell. 2020/12/23/ 2020;183(7):1901-1912.e9. doi:https://doi.org/10.1016/j.cell.2020.10.049
4. Baang JH, Smith C, Mirabelli C, et al. Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient. The Journal of Infectious Diseases. 2020;223(1):23-27. doi:10.1093/infdis/jiaa666
5. Choi B, Choudhary MC, Regan J, et al. Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host. New England Journal of Medicine. 2020;383(23):2291-2293. doi:10.1056/NEJMc2031364
6. Tarhini H, Recoing A, Bridier-nahmias A, et al. Long-Term Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectiousness Among Three Immunocompromised Patients: From Prolonged Viral Shedding to SARS-CoV-2 Superinfection. The Journal of Infectious Diseases. 2021;223(9):1522-1527. doi:10.1093/infdis/jiab075

7. Ferrari A, Trevenzoli M, Sasset L, et al. Prolonged SARS-CoV-2-RNA Detection from Nasopharyngeal Swabs in an Oncologic Patient: What Impact on Cancer Treatment? Curr Oncol. Feb 8 2021;28(1):847-852. doi:10.3390/curroncol28010083
8. Abdul-Jawad S, Baù L, Alaguthurai T, et al. Acute Immune Signatures and Their Legacies in Severe Acute Respiratory Syndrome Coronavirus-2 Infected Cancer Patients. Cancer Cell. Feb 8 2021;39(2):257-275.e6. doi:10.1016/j.ccell.2021.01.001
9. Leung WF, Chorlton S, Tyson J, et al. COVID-19 in an immunocompromised host: persistent shedding of viable SARS-CoV-2 and emergence of multiple mutations: a case report. Int J Infect Dis. Jan 2022;114:178-182. doi:10.1016/j.ijid.2021.10.045
10. Truong TT, Ryutov A, Pandey U, et al. Increased viral variants in children and young adults with impaired humoral immunity and persistent SARS-CoV-2 infection: A consecutive case series. EBioMedicine. May 2021;67:103355. doi:10.1016/j.ebiom.2021.103355
11. Martinot M, Jary A, Fafi-Kremer S, et al. Emerging RNA-Dependent RNA Polymerase Mutation in a Remdesivir-Treated B-cell Immunodeficient Patient With Protracted Coronavirus Disease 2019. Clin Infect Dis. Oct 5 2021;73(7):e1762-e1765. doi:10.1093/cid/ciaa1474
12. Truffot A, Andréani J, Le Maréchal M, et al. SARS-CoV-2 Variants in Immunocompromised Patient Given Antibody Monotherapy. Emerging infectious diseases. Oct 2021;27(10):2725-2728. doi:10.3201/eid2710.211509
13. Karataş A, İnkaya A, Demiroğlu H, et al. Prolonged viral shedding in a lymphoma patient with COVID-19 infection receiving convalescent plasma. Transfus Apher Sci. Oct 2020;59(5):102871. doi:10.1016/j.transci.2020.102871
14. Kemp SA, Collier DA, Datir RP, et al. SARS-CoV-2 evolution during treatment of chronic infection. Nature. 2021/04/01 2021;592(7853):277-282. doi:10.1038/s41586-021-03291-y
15. Khatamzas E, Rehn A, Muenchhoff M, et al. Emergence of multiple SARS-CoV-2 mutations in an immunocompromised host. medRxiv. 2021:2021.01.10.20248871. doi:10.1101/2021.01.10.20248871
16. Yasuda H, Mori Y, Chiba A, et al. Resolution of One-Year Persisting COVID-19 Pneumonia and Development of Immune Thrombocytopenia in a Follicular Lymphoma Patient With Preceding Rituximab Maintenance Therapy: A follow-up Report and Literature Review of Cases With Prolonged Infections. Clin Lymphoma Myeloma Leuk. 2021;21(10):e810-e816. doi:10.1016/j.clml.2021.07.004
17. Hueso T, Pouderoux C, Péré H, et al. Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19. Blood. Nov 12 2020;136(20):2290-2295. doi:10.1182/blood.2020008423
18. Nakajima Y, Ogai A, Furukawa K, et al. Prolonged viral shedding of SARS-CoV-2 in an immunocompromised patient. J Infect Chemother. Feb 2021;27(2):387-389. doi:10.1016/j.jiac.2020.12.001
19. Nussenblatt V, Roder AE, Das S, et al. Year-long COVID-19 infection reveals within-host evolution of SARS-CoV-2 in a patient with B cell depletion. medRxiv. Oct 5 2021;doi:10.1101/2021.10.02.21264267
20. Jassem J, Marek-Trzonkowska NM, Smiatacz T, et al. Successful Treatment of Persistent SARS-CoV-2 Infection in a B-Cell Depleted Patient with Activated Cytotoxic T and NK Cells: A Case Report. Int J Mol Sci. Oct 10 2021;22(20)doi:10.3390/ijms222010934
21. Drouin AC, Theberge MW, Liu SY, et al. Successful Clearance of 300 Day SARS-CoV-2 Infection in a Subject with B-Cell Depletion Associated Prolonged (B-DEAP) COVID by REGEN-COV Anti-Spike Monoclonal Antibody Cocktail. Viruses. Jun 23 2021;13(7)doi:10.3390/v13071202
22. Hensley MK, Bain WG, Jacobs J, et al. Intractable Coronavirus Disease 2019 (COVID-19) and Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Replication in a Chimeric Antigen Receptor-Modified T-Cell Therapy Recipient: A Case Study. Clin Infect Dis. Aug 2 2021;73(3):e815-e821. doi:10.1093/cid/ciab072
23. Malsy J, Veletzky L, Heide J, et al. Sustained Response After Remdesivir and Convalescent Plasma Therapy in a B-Cell-Depleted Patient With Protracted Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. Dec 6 2021;73(11):e4020-e4024. doi:10.1093/cid/ciaa1637
24. Gibson EG, Pender M, Angerbauer M, et al. Prolonged SARS-CoV-2 Illness in a Patient Receiving Ocrelizumab for Multiple Sclerosis. Open Forum Infect Dis. Jul 2021;8(7):ofab176. doi:10.1093/ofid/ofab176
25. Lacson E, Jr., Weiner D, Majchrzak K, et al. Prolonged Live SARS-CoV-2 Shedding in a Maintenance Dialysis Patient. Kidney Med. Mar-Apr 2021;3(2):309-311. doi:10.1016/j.xkme.2020.12.001
26. Marinelli T, Ferreira VH, Ierullo M, et al. Prospective Clinical, Virologic, and Immunologic Assessment of COVID-19 in Transplant Recipients. Transplantation. Oct 1 2021;105(10):2175-2183. doi:10.1097/tp.0000000000003860
27. Shingare A, Bahadur MM, Raina S. COVID-19 in recent kidney transplant recipients. Am J Transplant. Nov 2020;20(11):3206-3209. doi:10.1111/ajt.16120
28. Wei L, Liu B, Zhao Y, Chen Z. Prolonged shedding of SARS-CoV-2 in an elderly liver transplant patient infected by COVID-19: a case report. Ann Palliat Med. Jun 2021;10(6):7003-7007. doi:10.21037/apm-20-996
29. Theodore DA, Greendyke WG, Miko B, et al. Cycle Thresholds Among Solid Organ Transplant Recipients Testing Positive for SARS-CoV-2. Transplantation. Jul 1 2021;105(7):1445-1448. doi:10.1097/tp.0000000000003695
30. Weigang S, Fuchs J, Zimmer G, et al. Within-host evolution of SARS-CoV-2 in an immunosuppressed COVID-19 patient as a source of immune escape variants. Nat Commun. Nov 4 2021;12(1):6405. doi:10.1038/s41467-021-26602-3
31. Zhu L, Gong N, Liu B, et al. Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan, China. Eur Urol. Jun 2020;77(6):748-754. doi:10.1016/j.eururo.2020.03.039
32. Keitel V, Bode JG, Feldt T, et al. Case Report: Convalescent Plasma Achieves SARS-CoV-2 Viral Clearance in a Patient With Persistently High Viral Replication Over 8 Weeks Due to Severe Combined Immunodeficiency (SCID) and Graft Failure. Front Immunol. 2021;12:645989. doi:10.3389/fimmu.2021.645989
33. Delgado-Fernández M, García-Gemar GM, Fuentes-López A, et al. Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency – Three consecutive cases and review of the literature. Enferm Infecc Microbiol Clin (Engl Ed). Feb 11 2021;doi:10.1016/j.eimc.2021.01.013
34. Van Egeren D, Novokhodko A, Stoddard M, et al. Controlling long-term SARS-CoV-2 infections can slow viral evolution and reduce the risk of treatment failure. Scientific Reports. 2021/11/19 2021;11(1):22630. doi:10.1038/s41598-021-02148-8
35. COVID-19 Science Update released: December 3, 2021 Edition 115. https://www.cdc.gov/library/covid19/12032021_covidupdate.html
36. Kujawski SA, Wong KK, Collins JP, et al. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nature Medicine. 2020/06/01 2020;26(6):861-868. doi:10.1038/s41591-020-0877-5
37. van Kampen JJA, van de Vijver DAMC, Fraaij PLA, et al. Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19). Nature Communications. 2021/01/11 2021;12(1):267. doi:10.1038/s41467-020-20568-4

38. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020/05/01 2020;581(7809):465-469. doi:10.1038/s41586-020-2196-x
39. Owusu D, Pomeroy MA, Lewis NM, et al. Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: A Cohort Study of Individuals With COVID-19. The Journal of Infectious Diseases. 2021;doi:10.1093/infdis/jiab107
40. Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020;323(15):1488-1494. doi:10.1001/jama.2020.3204
41. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. New England Journal of Medicine. 2020;382(12):1177-1179. doi:10.1056/NEJMc2001737
42. Meyerowitz EA, Richterman A, Gandhi RT, Sax PE. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. Annals of internal medicine. Jan 2021;174(1):69-79. doi:10.7326/m20-5008
43. Weinbergerova B, Mayer J, Hrabovsky S, et al. COVID-19’s natural course among ambulatory monitored outpatients. Sci Rep. May 12 2021;11(1):10124. doi:10.1038/s41598-021-89545-1
44. Peeling RW, Heymann DL, Teo Y-Y, Garcia PJ. Diagnostics for COVID-19: moving from pandemic response to control. The Lancet. 2021/12/20/ 2021;doi:https://doi.org/10.1016/S0140-6736(21)02346-1
45. Madera S, Crawford E, Langelier C, et al. Nasopharyngeal SARS-CoV-2 viral loads in young children do not differ significantly from those in older children and adults. Sci Rep. Feb 4 2021;11(1):3044. doi:10.1038/s41598-021-81934-w
46. Hurst JH, Heston SM, Chambers HN, et al. SARS-CoV-2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study. Clin Infect Dis. Nov 3 2020;doi:10.1093/cid/ciaa1693
47. Maltezou HC, Magaziotou I, Dedoukou X, et al. Children and Adolescents With SARS-CoV-2 Infection: Epidemiology, Clinical Course and Viral Loads. Pediatr Infect Dis J. Dec 2020;39(12):e388-e392. doi:10.1097/inf.0000000000002899
48. Singanayagam A, Patel M, Charlett A, et al. Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020. Euro Surveill. Aug 2020;25(32)doi:10.2807/1560-7917.Es.2020.25.32.2001483
49. L’Huillier AG, Torriani G, Pigny F, Kaiser L, Eckerle I. Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents. Emerging infectious diseases. Oct 2020;26(10):2494-2497. doi:10.3201/eid2610.202403
50. Baggio S, L’Huillier AG, Yerly S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral Load in the Upper Respiratory Tract of Children and Adults With Early Acute Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. Jul 1 2021;73(1):148-150. doi:10.1093/cid/ciaa1157
51. Bellon M, Baggio S, Bausch FJ, et al. SARS-CoV-2 viral load kinetics in symptomatic children, adolescents and adults. Clin Infect Dis. May 5 2021;doi:10.1093/cid/ciab396

52. Xu CLH, Raval M, Schnall JA, Kwong JC, Holmes NE. Duration of Respiratory and Gastrointestinal Viral Shedding in Children With SARS-CoV-2: A Systematic Review and Synthesis of Data. Pediatr Infect Dis J. Sep 2020;39(9):e249-e256. doi:10.1097/inf.0000000000002814
53. Li F, Li YY, Liu MJ, et al. Household transmission of SARS-CoV-2 and risk factors for susceptibility and infectivity in Wuhan: a retrospective observational study. Lancet Infect Dis. 2021 May;21(5):617-628. doi: 10.1016/S1473-3099(20)30981-6.

54. Arons MM, Hatfield KM, Reddy SC, et al. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. New England Journal of Medicine. 2020;382(22):2081-2090. doi:10.1056/NEJMoa2008457
55. Bullard J, Dust K, Funk D, et al. Predicting Infectious Severe Acute Respiratory Syndrome Coronavirus 2 From Diagnostic Samples. Clinical Infectious Diseases. 2020;71(10):2663-2666. doi:10.1093/cid/ciaa638
56. Young B, Ong S, Ng L, Anderson D, Chia W, Chia P. Immunological and Viral Correlates of COVID-19 Disease Severity: A Prospective Cohort Study of the First 100 Patients in Singapore (4/15/2020). Available at SSRN 3576846.
57. Lu J, Peng J, Xiong Q, et al. Clinical, immunological and virological characterization of COVID-19 patients that test re-positive for SARS-CoV-2 by RT-PCR. EBioMedicine. 2020/09/01/ 2020;59:102960. doi:https://doi.org/10.1016/j.ebiom.2020.102960
58. Korea Centers for Disease Control and Prevention. Findings from Investigation and Analysis of re-positive cases. May 19, 2020. Accessed May 19, 2020. https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030
59. CDC. Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html
60. Japan National Institute of Infectious Diseases and Disease Control and Prevention Center, National Center for Global Health and Medicine. Active epidemiological investigation on SARS-CoV-2 infection caused by Omicron variant (Pango lineage B.1.1.529) in Japan: preliminary report on infectious period. 2022. https://www.niid.go.jp/niid/en/2019-ncov-e/10884-covid19-66-en.html

61. Bays D, Whiteley T, Pindar M, et al. Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods. medRxiv. 2021:2021.12.23.21268326. doi:10.1101/2021.12.23.21268326
62. Liu W-D, Chang S-Y, Wang J-T, et al. Prolonged virus shedding even after seroconversion in a patient with COVID-19. Journal of Infection. 2020/08/01/ 2020;81(2):318-356. doi:https://doi.org/10.1016/j.jinf.2020.03.063
63. Sahbudak Bal Z, Ozkul A, Bilen M, Kurugol Z, Ozkinay F. The Longest Infectious Virus Shedding in a Child Infected With the G614 Strain of SARS-CoV-2. Pediatr Infect Dis J. Jul 1 2021;40(7):e263-e265. doi:10.1097/inf.0000000000003158
64. Cheng H-Y, Jian S-W, Liu D-P, et al. Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods Before and After Symptom Onset. JAMA Internal Medicine. 2020;180(9):1156-1163. doi:10.1001/jamainternmed.2020.2020
65. Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA Network Open. 2021;4(1):e2035057-e2035057. doi:10.1001/jamanetworkopen.2020.35057
66. Thompson HA, Mousa A, Dighe A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis. Clin Infect Dis. Aug 2 2021;73(3):e754-e764. doi:10.1093/cid/ciab100
67. Quicke K, Gallichotte E, Sexton N, et al. Longitudinal Surveillance for SARS-CoV-2 RNA Among Asymptomatic Staff in Five Colorado Skilled Nursing Facilities: Epidemiologic, Virologic and Sequence Analysis. medRxiv. 2020:2020.06.08.20125989. doi:10.1101/2020.06.08.20125989
68. Rhee C, Kanjilal S, Baker M, Klompas M. Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectivity: When Is It Safe to Discontinue Isolation? Clin Infect Dis. Apr 26 2021;72(8):1467-1474. doi:10.1093/cid/ciaa1249
69. Li N, Wang X, Lv T. Prolonged SARS-CoV-2 RNA shedding: Not a rare phenomenon. Journal of Medical Virology. 2020;92(11):2286-2287. doi:https://doi.org/10.1002/jmv.25952
70. Wibmer CK, Ayres F, Hermanus T, et al. SARS-CoV-2 501Y.V2 escapes neutralization by South African COVID-19 donor plasma. bioRxiv. 2021:2021.01.18.427166. doi:10.1101/2021.01.18.427166
71. Zucman N, Uhel F, Descamps D, Roux D, Ricard J-D. Severe Reinfection With South African Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variant 501Y.V2. Clinical Infectious Diseases. 2021;doi:10.1093/cid/ciab129
72. Harrington D, Kele B, Pereira S, et al. Confirmed Reinfection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variant VOC-202012/01. Clinical Infectious Diseases. 2021;doi:10.1093/cid/ciab014
73. Resende PC, Bezerra JF, Teixeira Vasconcelos RH, et al. Severe Acute Respiratory Syndrome Coronavirus 2 P.2 Lineage Associated with Reinfection Case, Brazil, June-October 2020. Emerging infectious diseases. 2021;27(7):1789-1794. doi:10.3201/eid2707.210401
74. Nonaka CKV, Franco MM, Gräf T, et al. Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil. Emerging infectious diseases. 2021;27(5):1522-1524. doi:10.3201/eid2705.210191
75. Naveca F, da Costa C, Nascimento V, et al. SARS-CoV-2 reinfection by the new Variant of Concern (VOC) P. 1 in Amazonas, Brazil. virological org. 2021
76. Sabino EC, Buss LF, Carvalho MPS, et al. Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence. The Lancet. 2021/02/06/ 2021;397(10273):452-455. doi:https://doi.org/10.1016/S0140-6736(21)00183-5
77. Voloch CM, Silva F Rd, de Almeida LGP, et al. Genomic characterization of a novel SARS-CoV-2 lineage from Rio de Janeiro, Brazil. medRxiv. 2020:2020.12.23.20248598. doi:10.1101/2020.12.23.20248598
78. Galloway SE, Paul P, MacCannell DR, et al. Emergence of SARS-CoV-2 b. 1.1. 7 lineage—united states, december 29, 2020–january 12, 2021. Morbidity and Mortality Weekly Report. 2021;70(3):95.
79. Otte MS, Bork M-L, Zimmermann PH, Klussmann JP, Luers JC. Persisting olfactory dysfunction improves in patients 6 months after COVID-19 disease. Acta Oto-Laryngologica. 2021/06/01 2021;141(6):626-629. doi:10.1080/00016489.2021.1905178

PREVIOUS UPDATES

Updates from Previous Content: Ending Isolation and Precautions WebpageIsolation and Precautions for People with COVID-19

Top of Page

PREVIOUS UPDATES

Updates from Previous Content: Ending Isolation and Precautions Webpage

As of January 14, 2022

* Updated guidance to reflect new recommendations for isolation for people with COVID-19.
* Added new recommendations for duration of isolation for people with COVID-19 who are moderately or severely immunocompromised.
—snipped—

—snipped—
Updated SepOct. 213, 2021
—snipped—
* People who have symptoms of COVID-19.
* People who have had a known exposure to someone with suspected or confirmed COVID-19.
* People who are fully vaccinatedhave come into close contact with someone with COVID-19 should getbe tested 3-5 days after exposure, and wear a mask in public indoor settings for 14 days or until they receive a negative test resultto check for infection:
* Fully vaccinated people should be tested 5–7 days after their last exposure.
* People who are not fully vaccinated should quarantine and beget tested immediately after being identified, and,when they find out they are a close contact. If their test result ifs negative, they should get tested again in 5–7 days after their last exposure or immediately if symptoms develop during quarantine.
—snipped—
* *

For more information on testing, see
—snipped—

—snipped—
COVID-19 Cases are Extremely High. Avoid Events and Gatherings

COVID-19 cases, hospitalizations, and deaths are extremely high across the United States. To decrease your chance of getting and spreading COVID-19, CDC recommends that you do not gather with people who do not live with you at this time. Attending events and gatherings increases your risk of getting and spreading COVID-19. Stay home to protect yourself and others from COVID-19.

CDC offers the following general considerations to help communities of faith discern how best to practice their beliefs while keeping their staff and congregations safe. Millions of Americans embrace worship as an essential part of life. For many faith traditions, gathering together for worship is at the heart of what it means to be a community of faith. But as Americans are now aware, gatherings present a risk for increasing spread of COVID-19 during this Public Health Emergency. CDC offers these suggestions for faith communities to consider and accept, reject, or modify, consistent with their own faith traditions, in the course of preparing to reconvene for in-person gatherings while still working to prevent the spread of COVID-19.
—snipped—

—snipped—
* 714 MayCases in the U.S.
* 714 MayOverall US COVID-19 Vaccine Distribution and Administration Update as of Sat, 0714 May 2022 06:00:00 EST
* 613 MayStay Up to Date with Your VaccineWearing Masks in Travel and Public Transportation Settings
* 613 MayCOVID-19 Vaccine Booster Shot
* 613 MayStaffing Resources
—snipped—

—snipped—
Updated Aug. 24Dec. 30, 2022
—snipped—
Beginning January 5, at 12:01AM ET, there are new requirements for air passengers 2 years of age and older traveling to the United States from China, Hong Kong, or Macau, and those traveling from Seoul, Toronto, and Vancouver who have been in China, Hong Kong, or Macau in the past 10 days. These passengers, regardless of citizenship or vaccination status, are required to show a negative COVID-19 test result taken no more than 2 days before their flight departs. Those who had COVID-19 in the 90 days before their travel to the United States can instead show documentation of recovery from COVID-19. See press release.
—snipped—
* ALL travelers 2 years and older: If you are flying to the U.S. from China, Hong Kong, or Macau, or have been in these areas in the past 10 days and are flying from certain airports, you are required to show a negative COVID-19 test result or documentation of recovery from COVID-19 before you board your flight to the U.S.
* Non-U.S. citizen, non-U.S. immigrants: You must show proof of being fully vaccinated with the primary series of an accepted COVID-19 vaccine before you board your flight to the United States. Only limited exceptions apply.
—snipped—
CONTACT INFORMATION – ALL TRAVELERS

REQUIRED

All air passengersTESTING – ALL TRAVELERS
WHO ARE FLYING FROM CHINA, HONG KONG, OR MACAU, OR HAVE BEEN IN ANY OF THESE AREAS IN THE PAST 10 DAYS AND ARE FLYING FROM ONE OF THESE AIRPORTS: INCHEON INTERNATIONAL AIRPORT IN SEOUL, REPUBLIC OF KOREA, TORONTO PEARSON INTERNATIONAL AIRPORT IN CANADA, OR VANCOUVER INTERNATIONAL AIRPORT IN CANADA

REQUIRED

Before boarding a flight to the United States, you are required to provide contact information to airlines before boarding flights to the United States.

* This strengthens a travel process already in place to rapidly identify and contact people in the U.S.show a negative COVID-19 test result taken no more than 2 days before travel. There is also an option for people who may have been exposed to a communicable disease, such as COVID-19.
* Access to travelers’ contact information will allow U.S. federal, state, territorial and local health departments, and agencies to share appropriate health and public health information necessary to help keep the public safe.

TESTING – ALL TRAVELERS

RECOMMENDEDdocumented recovery from COVID-19 in the past 90 days.

Children under 2 years old do not need to test.

Learn more about these requirements.

TESTING – ALL TRAVELERS

RECOMMENDED

If traveling from locations where the U.S. does not require proof of a negative COVID-19 test result before travel:

—snipped—
CONTACT INFORMATION – ALL TRAVELERS

REQUIRED

All air passengers to the United States are required to provide contact information to airlines before boarding flights to the United States.

* This strengthens a travel process already in place to rapidly identify and contact people in the U.S. who may have been exposed to a communicable disease, such as COVID-19.
* Access to travelers’ contact information will allow U.S. federal, state, territorial and local health departments, and agencies to share appropriate health and public health information necessary to help keep the public safe.

Top of Page
—snipped—
* Requirement for Proof of Negative COVID-19 Test or Documentation of Recovery from COVID-19
* Frequently Asked Questions about Travel and COVID-19
—snipped—

BREASTFEEDING AND CARING FOR NEWBORNS IF YOU HAVE COVID-19

Breastfeeding and Caring for Newborns if You Have COVID-19
Updated JulyAug. 18, 2021
—snipped—
Pregnant and recently pregnant people are at an increased risk for severe illness from COVID-19—including illness that requires hospitalization, intensive care, or a ventilator or special equipment to breathe, or results in death—compared with nonpregnant people. Additionally, pregnant people with COVID-19 are at increased risk for preterm birth and might be at increased risk for other poor pregnancy outcomes.

Learn more about COVID-19 and pregnancy.

On This Page
* Caring for newborns when the mother has COVID-19
* Breastfeeding and COVID-19
* Keeping your baby safe and healthy

CARING FOR NEWBORNS WHEN THE MOTHER HAS COVID-19

While much is still unknown about the risks of COVID-19 to newborns born to mothers with COVID-19, we do know that:

* COVID-19 is uncommon in newborns born to mothers who had COVID-19 during pregnancyOn This Page
* Caring for your newborn in the hospital if you have COVID-19
* Caring for your newborn at home if you have COVID-19
* Breastfeeding and COVID-19

Although we still have much to learn about the risks of COVID-19 for newborns of people with COVID-19, we do know these facts:

* Pregnant and recently pregnant people are more likely to get severely ill from COVID-19 compared with nonpregnant people. Pregnant people with COVID-19 are also more likely to give birth early.
* Most newborns of people who had COVID-19 during pregnancy do not have COVID-19 when they are born.
* Some newborns have tested positive for COVID-19 shortly after birth. It is unWe don’t known if these newborns got the virus before, during, or after birth.
* Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are a few reports ofReports say some newborns withdeveloped severe COVID-19 illness.
—snipped—
CARING FOR YOUR NEWBORN IN THE HOSPITAL IF YOU ARE DIAGNOSED WITH OR TEST POSITIVE FORHAVE COVID-19.

Current evidence suggests that the riskchance of a newborn getting COVID-19 from their motherbirth parent is low, especially when the motherparent takes steps (such as wearing a mask and her washing hands) to prevent spread before and during care of the newborn.
—snipped—
Discuss withTalk to your healthcare provider about the risks and benefits of having your newborn stay in the same room with you. Having your newborn stay in the room with you has the benefit of facilitatmaking breastfeeding and mother-newborn bonding. Start this conversation before the baby is born if possible.

If you are in isolation for COVID-19 and are sharing a room with your newborn wear a mask within 6 feet of your newborneasier, and it helps with parent-newborn bonding.
—snipped—
If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following steps to reduce the riskchance of spreading the virus to your newborn:
—snipped—
* Wear a mask whenever you are within 6 feet of your newborn.
—snipped—
* Discuss withTalk to your healthcare provider ways toabout how you can protect your newborn, such as using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

OnceWhen your isolation period has ended, you should still wash your hands before caring for your newborn, but you do not need to take the other precautions. You most likely will not pass the virus to your newborn or any other close contacts after your isolation period has ended.
—snipped—
* 24 hours with no fever, without fever-reducing medicationsine, and
—snipped—
* 10 days have passed since the dayou tested positive for COVID-19.

These timeframes do not apply if you have a severely weakened immune system of your positive COVID-19 test.r were severely ill with COVID-19. Please refer to “When you can be around others after you had or likely had COVID-19” and consult with your health care professional about when it is safe for you to end your isolation period.

Top of Page

CARING FOR YOUR NEWBORN AT HOME IF YOU ARE DIAGNOSED WITH OR TEST POSITIVE FORHAVE COVID-19.
—snipped—
* Have a healthy caregiver who is not at increasedfully vaccinated and not at higher risk for severe illness provide care for your newborn. newborn (see recommendations below).
* Follow recommended precautions if you must care for your newborn before your isolation period has ended.

RECOMMENDED PRECAUTIONS FOR HEALTHY CAREGIVERS HELPING CARE FOR NEWBORNS:

* Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, they should use a hand sanitizer with at least 60% alcohol.
* If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. and is not yet fully vaccinated for COVID-19, they might have been exposed.
* Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 3-5 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. They should isolate if they test positive.
* They should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation, and during their own quarantine after you complete your isolation.
* If a healthy caregiver is not available, you can care for your newborn if you are well enough.
IF A HEALTHY CAREGIVER IS NOT AVAILABLE, YOU CAN CARE FOR YOUR NEWBORN IF YOU ARE WELL ENOUGH.

—snipped—
* 24 hours with no fever without fever-reducing medicationsine, and
—snipped—
* 10 days have passed since the date of youryou tested positive for COVID-19 test

Top of Page

BREASTFEEDING AND COVID-19

CURRENT EVIDENCE SUGGESTS THAT BREAST MILK IS NOT LIKELY TO SPREAD THE VIRUS TO BABIES.

You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding. Breast milk provides protection against many illnesses and is the best source of nutrition for most babies.

If you are breastfeeding, you can receive a COVID-19 vaccine.

HELPFUL TIPS FOR STARTING OR RESTARTING BREASTFEEDING

You may find it harder to start or continue breastfeeding if you are not sharing a room with your newborn in the hospital. Here are some helpful tips:

* Frequent hand expression or pumping will help you establish and build milk supply if you are separated from your newborn in the hospit.

These timeframes do not apply if you have a severely weakened immune system or were severely ill with COVID-19. Please refer to “When you can be around others after you had or likely had COVID-19” and consult with your health care professional about when it’s safe for you to end your isolation period.

MONITOR YOUR NEWBORN FOR COVID-19 SYMPTOMS.

If your newborn has one or more of these signs or symptoms, they may have early symptoms of COVID-19 or another illness, and you should contact your healthcare professional.

* Pump or feed every 2-3 hours (at least 8-10 times in 24 hours, including at night), especially in the first few days. This helps the breasts to produce milk and prevents blocked milk ducts and breast infections.
* If you are unable to start producing milk in the hospital after birth, or if you have to temporarily stop breastfeeding during your COVID-19 illnesFever (a temperature of 100.4 or higher is considered an emergency)
* Lethargy (being overly tired or inactive)
* Runny nose
* Cough
* Vomiting
* Diarrhea
* Poor feeding
* Increased work of breathing or shallow breathing

See CDC’s webpage on Evaluation and Management Considerations for Neonates At Risk for COVID-19 for more information.

Top of Page

BREASTFEEDING AND COVID-19

CURRENT EVIDENCE SUGGESTS THAT BREAST MILK IS NOT LIKELY TO SPREAD THE VIRUS TO BABIES.

COVID-19 vaccination is brecause you do not feel well enough, get help from a lactation support provider. Learn more about restarting breastfeeding (also called relactation).

ommended for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. You should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don’t have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
—snipped—
* Wear a mask duringas you expression breast milk.
—snipped—
* Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Top of Page

KEEPING YOUR BABY SAFE AND HEALTHY

WHEN TO WEAR A MASK IF YOU ARE NOT FULLY VACCINATED

* If you are not fully vaccinated and aged 2 or older, you should wear a mask in indoor public places.
* In general, you do not need to wear a mask in outdoor settings.
* In areas with high numbers of COVID-19 cases, consider wearing a mask in crowded outdoor settings and for activities with close contact with others who are not fully vaccinated.
* People who have a condition or are taking medications that weaken their immune system may NOT be protected even if they are fully vaccinated. They should continue to take all precautions recommended for unvaccinated people, including wearing a well-fitted mask, until advised otherwise by their healthcare provider.
* If you are fully vaccinated, see When You’ve Been Fully Vaccinated.

DO NOT PUT A FACE SHIELD OR MASK ON YOUR BABY

* Children younger than two should not wear masks.
* A face shield could increase the risk of sudden infant death syndrome (SIDS)or accidental suffocation and strangulation. Babies move around, and their movement can cause the plastic face shield to block their nose and mouth or cause the strap to strangle them.
* CDC does not recommend use of face shields as a substitute for masks.

LIMIT VISITORS TO SEE YOUR NEW BABY

The birth of a new baby is a significant life event that typically brings families together to celebrate and support the baby and new mother. However, before allowing or inviting visitors into your home or near your baby, consider the risk of COVID-19 to yourself, your baby, people who live with you, and visitors (e.g., grandparents or older adults and other people at increased risk of severe illness from COVID-19).

* Bringing people who do not live with you into your home can increase the risk of spreading COVID-19.
* Some people without symptoms can spread the virus.
* Limit in-person gatherings and consider other options, like celebrating virtually, for people who want to see your new baby. If you do plan to have in-person visits, ask guests to stay home if they are sick and ask them to stay 6 feet away from you and your baby, wear a mask, and wash their hands when visiting your home. For more information, please see considerations for attending or hosting a small gathering.

KEEP DISTANCE BETWEEN YOUR BABY AND PEOPLE WHO DO NOT LIVE IN YOUR HOUSEHOLD OR WHO ARE SICK

* Consider the risks of spreadingfeed the expressed breast milk to the baby. The caregiver should be fully vaccinated (at least two weeks after the 2nd dose of a 2-dose vaccine or two weeks after a 1-dose vaccine) and not be at increased risk for severe illness from COVID-19. If the caregiver is living in the same home or has been in close contact with you and is not yet fully vaccinated for COVID-19, to you and your baby before you decide whether to go out for activities other than healthcare visits or child care.
* Keep 6 feet of distance between your baby and people who do not live in your household.
* Ask your child care program about the plans they have in place to protect your baby, family, and their staff from COVID-19.

KNOW POSSIBLE SIGNS AND SYMPTOMS OF COVID-19 INFECTION AMONG BABIES

* Most babies who test positive for COVID-19 have mild or no symptoms.
* Severe illness in babies has been reported but appears to be rare. Babies with underlying medical conditions and babies born premature (earlier than 37 weeks) might be at higher risk of severe illness from COVID-19.
* Reported signs among newborns with COVID-19 include fever, lethargy (being overly tired or inactive), runny nose, cough, vomiting, diarrhea, poor feeding, and increased work of breathing or shallow breathing.
* If your baby develops symptoms or you think your baby may have been exposed to COVID-19:
* Get in touch with your baby’s healthcare provider within 24 hours and follow steps for caring for children with COVID-19.
* If your baby has COVID-19 emergency warning signs (such as trouble breathing), call 911 or call ahead to your local emergency facility.
* Notify the operator that you are seeking care for a baby who has or may have COVID-19.

BRING YOUR BABY FOR NEWBORN VISITS

Ideally, newborn visits are done in person so that your baby’s healthcare provider can:

* Check how you and your baby are doing overall.
* Check your baby’s growth and feeding.
* Check your baby for jaundice (yellow color in the skin or eyes).
* Make sure your baby’s newborn screening tests were done (including a bloodspot, hearing test, and a test for critical congenital heart defects) and do any repeat or follow-up testing, if necessary.

Call and notify your baby’s healthcare provider before visiting if you think you or your baby might have COVID-19.

ENSURE SAFE SLEEP FOR YOUR BABY

During the COVID-19 pandemic, parents may be extra stressed and tired. Making sure parents and babies get enough quality sleep, is very important. Take steps to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths, by doing the following:

* Place your baby on his or her back for all sleep times—for naps and at night.
* Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
* Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
* Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
* Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
* Do not smoke or allow anyone to smoke around your baby.

ENSURE YOUR OWN SOCIAL, EMOTIONAL, AND MENTAL HEALTH

* Call your healthcare provider if you think you are experiencing depression after pregnancy.
* Learn about ways to cope with stress and tips for caring for yourself during the COVID-19 pandemic.

Related Pages
* Things to Know about the COVID-19 Pandemichey might have been exposed.
* Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 3-5 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. They should isolate if they test positive.
* Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Top of Page
Related Pages
—snipped—
* Vaccination Considerations for People who arCOVID-19 Vaccines While Pregnant or Breastfeeding
* Coping with Stress
* Frequently Asked Questions
—snipped—
* Tips to cCare for yYourself one small way each day
—snipped—
* Vaccination Considerations for People who are Pregnant or Breastfeeding
* Coping with Stress
* Frequently Asked Questions
* COVID-19 Toolkit for Pregnant People and New Parents
* Things to Know about the COVID-19 Pandemic
* How to Protect Yourself & Others
* What to Do If You Are SickStress and Coping
—snipped—
* Infant Formula Feeding
—snipped—

—snipped—
Updated NovJan. 290, 20212
—snipped—
Free At-Home COVID-19 Tests: Order 4 free tests now so you have them when you need them.

Protect Family Members
—snipped—
GET VACCINATED

* Authorized COVID-19 vaccines can help protect you from COVID-19.
* You should get a COVID-19 vaccine as soon as you can.
* Once you are fully vaccinated, you may be able to start doing some things that you had stopped doing becaus AND STAY UP TO DATE ON YOUR COVID-19 VACCINES

* COVID-19 vaccines are effective at preventing you from getting sick. COVID-19 vaccines are highly effective at preventing severe illness, hospitalizations, and death.
* Getting vaccinated is the best way to slow the spread of SARS-CoV-2, the virus that causes COVID-19
* CDC recommends that everyone who is eligible stay up to date ofn the pandemicir COVID-19 vaccines, including people with weakened immune systems.
—snipped—
* Everyone ages 2 years or older who is not fully vaccinated should wear a mask in indoor public placeand older should properly wear a well-fitting mask indoors in public in areas of substantial or high community transmission, regardless of vaccination status.
* You might choose to wear a mask regardless of the level of community transmission, if you or someone in your household is at increased risk for severe disease or has a weakened immune system, or if someone in your household is not up to date on their COVID-19 vaccines or not eligible to receive COVID-19 vaccines.
* Improve how well your mask protects you, and learn about how to choose a mask to protect yourself and others.
* In general, youpeople do not need to wear a mask is when outdoor settings.
* In areas with high numbers of COVID-19 cases, considers. In areas of substantial or high transmission, people might choose to wearing a mask in crowded outdoor settings and for activities with closoutdoors when in sustained close contact with other people, particularly if
* They or someone they live with has a weakened immune system or is at increased risk for severe disease.
* They are not up to date contact with others COVID-19 vaccines or live with someone who areis not fullyup to date on COVID-19 vaccinatedes.
* People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fullyup to date on their COVID-19 vaccinatedes. They should continue to take all precautions recommended for unvaccinated people, including properly wearing a well-fitted mask, until advised otherwise by their healthcare provider.
* If you are fully vaccinated, to maximize protection and prevent possibly spreading COVID-19 to others, wear a mask indoors in public if you are in an area of substantial or high transmission.For more information, see COVID-19 Vaccines for Moderately or Severely Immunocompromised People
—snipped—
* Inside your home
*: Avoid close contact with people who are sick.
*, if possible. If possible, maintain 6 feet between the person who is sick and other household members.
* Outside your home
* Remember that some If you are taking care of someone who is sick, make sure you perople without symptoms may be ableerly wear a well-fitting mask and follow other steps to spread virus.
* Stay at least 6 feet (about 2 arm lengths)otect yourself.
* Indoors in public: If you are not up to date on COVID-19 vaccines, stay at least 6 feet away from other people, especially if you are at higher risk of getting very sick.

AVOID CROWDS AN with COVID-19.

AVOID POORLY VENTILATED SPACES

* Being in crowded places like restaurants, bars, fitness centers, or movie theaters puts you at higher risk for COVID-19.
* Avoi AND CROWDS

* If indoors, bring in fresh air by opening windows and doors, if possible.
* If you are at increased risk of getting very sick from COVID-19, avoid crowded places and indoor spaces that do not offerhave fresh air from the outdoors as much as possible.
* If indoors, bring in fresh air by opening windows and doors, if possible.

TEST TO PREVENT SPREAD TO OTHERS

* Testing can give you information about your risk of spreading COVID-19.
* You can choose from many different.

TEST TO PREVENT SPREAD TO OTHERS

* You can choose from many different types of tests.
* Tests for SARS-CoV-2(the virus that causes COVID-19) tell you if you have an infection at the time of the test. This types of tests is called a viral test because it looks for viral infection.
—snipped—
* Over-the-counter self-tests are viral tests that can be used at home or anywhere, are easy to use, and produce rapid results. Anyone can use self-tests, regardless of their vaccination status or whether they have symptoms or not.
* Consider using a self-test before joining indoor gatherings with others who are not in your household.
* A positive self-test result.
* COVID-19 self-tests are one of means that you have an infection and should avoid indoor gatherings to reduce the risk of spreading disease to someone else.
* A negative self-test result means that you may not have an infection. Repeating the test with at least 24 hours between tests will increase the confidence that you are not infected.
* Ask your healthcare provider if you need help intery risk-reduction measures, along with vaccination, masking, and physical distancing, that protect you and others by reducing the chances of spretading your test resultsCOVID-19.
—snipped—
Additional Resources
Help protect yourself and others
[PDF - 263 KB, 1 page]
Slow the Spread of COVID-19
[PDF - 1 page]
How toFOLLOW RECOMMENDATIONS FOR QUARANTINE

* If you come into close contact with someone with COVID-19: follow CDC’s recommendations for quarantine.

FOLLOW RECOMMENDATIONS FOR ISOLATION

* If you test positive for COVID-19 or have symptoms: follow CDC’s recommendations for isolation.

TAKE PRECAUTIONS WHEN YOU TRAVEL

* Follow CDC’s recommendations for domestic and international travel.

Additional Resources

For more information, see:

* Families with vaccinated and unvaccinated members
* Improve How Your Mask Protects Yourself and Others

English
Spanish

Stop the Spread of G
* Information for specific groups of people (link: COVID-19 Information for Specific Groups of People | CDC)

----------------------------------------

Help protect yourself and otherms
[PDF - 537263 KB, 1 page]
—snipped—

—snipped—
* Promega Maxwell® CSC 48 as a specimen extraction option
—snipped—

—snipped—
Pregnant and Recently Pregnant People
—snipped—

BREASTFEEDING AND CARING FOR NEWBORNS IF YOU HAVE COVID-19

Breastfeeding and Caring for Newborns if You Have COVID-19
Updated JulyAug. 18, 2021
—snipped—
Pregnant and recently pregnant people are at an increased risk for severe illness from COVID-19—including illness that requires hospitalization, intensive care, or a ventilator or special equipment to breathe, or results in death—compared with nonpregnant people. Additionally, pregnant people with COVID-19 are at increased risk for preterm birth and might be at increased risk for other poor pregnancy outcomes.

Learn more about COVID-19 and pregnancy.

On This Page
* Caring for newborns when the mother has COVID-19
* Breastfeeding and COVID-19
* Keeping your baby safe and healthy

CARING FOR NEWBORNS WHEN THE MOTHER HAS COVID-19

While much is still unknown about the risks of COVID-19 to newborns born to mothers with COVID-19, we do know that:

* COVID-19 is uncommon in newborns born to mothers who had COVID-19 during pregnancyOn This Page
* Caring for your newborn in the hospital if you have COVID-19
* Caring for your newborn at home if you have COVID-19
* Breastfeeding and COVID-19

Although we still have much to learn about the risks of COVID-19 for newborns of people with COVID-19, we do know these facts:

* Pregnant and recently pregnant people are more likely to get severely ill from COVID-19 compared with nonpregnant people. Pregnant people with COVID-19 are also more likely to give birth early.
* Most newborns of people who had COVID-19 during pregnancy do not have COVID-19 when they are born.
* Some newborns have tested positive for COVID-19 shortly after birth. It is unWe don’t known if these newborns got the virus before, during, or after birth.
* Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are a few reports ofReports say some newborns withdeveloped severe COVID-19 illness.
—snipped—
CARING FOR YOUR NEWBORN IN THE HOSPITAL IF YOU ARE DIAGNOSED WITH OR TEST POSITIVE FORHAVE COVID-19.

Current evidence suggests that the riskchance of a newborn getting COVID-19 from their motherbirth parent is low, especially when the motherparent takes steps (such as wearing a mask and her washing hands) to prevent spread before and during care of the newborn.
—snipped—
Discuss withTalk to your healthcare provider about the risks and benefits of having your newborn stay in the same room with you. Having your newborn stay in the room with you has the benefit of facilitatmaking breastfeeding and mother-newborn bonding. Start this conversation before the baby is born if possible.

If you are in isolation for COVID-19 and are sharing a room with your newborn wear a mask within 6 feet of your newborneasier, and it helps with parent-newborn bonding.
—snipped—
If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following steps to reduce the riskchance of spreading the virus to your newborn:
—snipped—
* Wear a mask whenever you are within 6 feet of your newborn.
—snipped—
* Discuss withTalk to your healthcare provider ways toabout how you can protect your newborn, such as using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

OnceWhen your isolation period has ended, you should still wash your hands before caring for your newborn, but you do not need to take the other precautions. You most likely will not pass the virus to your newborn or any other close contacts after your isolation period has ended.
—snipped—
* 24 hours with no fever, without fever-reducing medicationsine, and
—snipped—
* 10 days have passed since the dayou tested positive for COVID-19.

These timeframes do not apply if you have a severely weakened immune system of your positive COVID-19 test.r were severely ill with COVID-19. Please refer to “When you can be around others after you had or likely had COVID-19” and consult with your health care professional about when it is safe for you to end your isolation period.

Top of Page

CARING FOR YOUR NEWBORN AT HOME IF YOU ARE DIAGNOSED WITH OR TEST POSITIVE FORHAVE COVID-19.
—snipped—
* Have a healthy caregiver who is not at increasedfully vaccinated and not at higher risk for severe illness provide care for your newborn. newborn (see recommendations below).
* Follow recommended precautions if you must care for your newborn before your isolation period has ended.

RECOMMENDED PRECAUTIONS FOR HEALTHY CAREGIVERS HELPING CARE FOR NEWBORNS:

* Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, they should use a hand sanitizer with at least 60% alcohol.
* If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. and is not yet fully vaccinated for COVID-19, they might have been exposed.
* Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 3-5 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. They should isolate if they test positive.
* They should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation, and during their own quarantine after you complete your isolation.
* If a healthy caregiver is not available, you can care for your newborn if you are well enough.
IF A HEALTHY CAREGIVER IS NOT AVAILABLE, YOU CAN CARE FOR YOUR NEWBORN IF YOU ARE WELL ENOUGH.

—snipped—
* 24 hours with no fever without fever-reducing medicationsine, and
—snipped—
* 10 days have passed since the date of youryou tested positive for COVID-19 test

Top of Page

BREASTFEEDING AND COVID-19

CURRENT EVIDENCE SUGGESTS THAT BREAST MILK IS NOT LIKELY TO SPREAD THE VIRUS TO BABIES.

You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding. Breast milk provides protection against many illnesses and is the best source of nutrition for most babies.

If you are breastfeeding, you can receive a COVID-19 vaccine.

HELPFUL TIPS FOR STARTING OR RESTARTING BREASTFEEDING

You may find it harder to start or continue breastfeeding if you are not sharing a room with your newborn in the hospital. Here are some helpful tips:

* Frequent hand expression or pumping will help you establish and build milk supply if you are separated from your newborn in the hospit.

These timeframes do not apply if you have a severely weakened immune system or were severely ill with COVID-19. Please refer to “When you can be around others after you had or likely had COVID-19” and consult with your health care professional about when it’s safe for you to end your isolation period.

MONITOR YOUR NEWBORN FOR COVID-19 SYMPTOMS.

If your newborn has one or more of these signs or symptoms, they may have early symptoms of COVID-19 or another illness, and you should contact your healthcare professional.

* Pump or feed every 2-3 hours (at least 8-10 times in 24 hours, including at night), especially in the first few days. This helps the breasts to produce milk and prevents blocked milk ducts and breast infections.
* If you are unable to start producing milk in the hospital after birth, or if you have to temporarily stop breastfeeding during your COVID-19 illnesFever (a temperature of 100.4 or higher is considered an emergency)
* Lethargy (being overly tired or inactive)
* Runny nose
* Cough
* Vomiting
* Diarrhea
* Poor feeding
* Increased work of breathing or shallow breathing

See CDC’s webpage on Evaluation and Management Considerations for Neonates At Risk for COVID-19 for more information.

Top of Page

BREASTFEEDING AND COVID-19

CURRENT EVIDENCE SUGGESTS THAT BREAST MILK IS NOT LIKELY TO SPREAD THE VIRUS TO BABIES.

COVID-19 vaccination is brecause you do not feel well enough, get help from a lactation support provider. Learn more about restarting breastfeeding (also called relactation).

ommended for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. You should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don’t have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
—snipped—
* Wear a mask duringas you expression breast milk.
—snipped—
* Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Top of Page

KEEPING YOUR BABY SAFE AND HEALTHY

WHEN TO WEAR A MASK IF YOU ARE NOT FULLY VACCINATED

* If you are not fully vaccinated and aged 2 or older, you should wear a mask in indoor public places.
* In general, you do not need to wear a mask in outdoor settings.
* In areas with high numbers of COVID-19 cases, consider wearing a mask in crowded outdoor settings and for activities with close contact with others who are not fully vaccinated.
* People who have a condition or are taking medications that weaken their immune system may NOT be protected even if they are fully vaccinated. They should continue to take all precautions recommended for unvaccinated people, including wearing a well-fitted mask, until advised otherwise by their healthcare provider.
* If you are fully vaccinated, see When You’ve Been Fully Vaccinated.

DO NOT PUT A FACE SHIELD OR MASK ON YOUR BABY

* Children younger than two should not wear masks.
* A face shield could increase the risk of sudden infant death syndrome (SIDS)or accidental suffocation and strangulation. Babies move around, and their movement can cause the plastic face shield to block their nose and mouth or cause the strap to strangle them.
* CDC does not recommend use of face shields as a substitute for masks.

LIMIT VISITORS TO SEE YOUR NEW BABY

The birth of a new baby is a significant life event that typically brings families together to celebrate and support the baby and new mother. However, before allowing or inviting visitors into your home or near your baby, consider the risk of COVID-19 to yourself, your baby, people who live with you, and visitors (e.g., grandparents or older adults and other people at increased risk of severe illness from COVID-19).

* Bringing people who do not live with you into your home can increase the risk of spreading COVID-19.
* Some people without symptoms can spread the virus.
* Limit in-person gatherings and consider other options, like celebrating virtually, for people who want to see your new baby. If you do plan to have in-person visits, ask guests to stay home if they are sick and ask them to stay 6 feet away from you and your baby, wear a mask, and wash their hands when visiting your home. For more information, please see considerations for attending or hosting a small gathering.

KEEP DISTANCE BETWEEN YOUR BABY AND PEOPLE WHO DO NOT LIVE IN YOUR HOUSEHOLD OR WHO ARE SICK

* Consider the risks of spreadingfeed the expressed breast milk to the baby. The caregiver should be fully vaccinated (at least two weeks after the 2nd dose of a 2-dose vaccine or two weeks after a 1-dose vaccine) and not be at increased risk for severe illness from COVID-19. If the caregiver is living in the same home or has been in close contact with you and is not yet fully vaccinated for COVID-19, to you and your baby before you decide whether to go out for activities other than healthcare visits or child care.
* Keep 6 feet of distance between your baby and people who do not live in your household.
* Ask your child care program about the plans they have in place to protect your baby, family, and their staff from COVID-19.

KNOW POSSIBLE SIGNS AND SYMPTOMS OF COVID-19 INFECTION AMONG BABIES

* Most babies who test positive for COVID-19 have mild or no symptoms.
* Severe illness in babies has been reported but appears to be rare. Babies with underlying medical conditions and babies born premature (earlier than 37 weeks) might be at higher risk of severe illness from COVID-19.
* Reported signs among newborns with COVID-19 include fever, lethargy (being overly tired or inactive), runny nose, cough, vomiting, diarrhea, poor feeding, and increased work of breathing or shallow breathing.
* If your baby develops symptoms or you think your baby may have been exposed to COVID-19:
* Get in touch with your baby’s healthcare provider within 24 hours and follow steps for caring for children with COVID-19.
* If your baby has COVID-19 emergency warning signs (such as trouble breathing), call 911 or call ahead to your local emergency facility.
* Notify the operator that you are seeking care for a baby who has or may have COVID-19.

BRING YOUR BABY FOR NEWBORN VISITS

Ideally, newborn visits are done in person so that your baby’s healthcare provider can:

* Check how you and your baby are doing overall.
* Check your baby’s growth and feeding.
* Check your baby for jaundice (yellow color in the skin or eyes).
* Make sure your baby’s newborn screening tests were done (including a bloodspot, hearing test, and a test for critical congenital heart defects) and do any repeat or follow-up testing, if necessary.

Call and notify your baby’s healthcare provider before visiting if you think you or your baby might have COVID-19.

ENSURE SAFE SLEEP FOR YOUR BABY

During the COVID-19 pandemic, parents may be extra stressed and tired. Making sure parents and babies get enough quality sleep, is very important. Take steps to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths, by doing the following:

* Place your baby on his or her back for all sleep times—for naps and at night.
* Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
* Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
* Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
* Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
* Do not smoke or allow anyone to smoke around your baby.

ENSURE YOUR OWN SOCIAL, EMOTIONAL, AND MENTAL HEALTH

* Call your healthcare provider if you think you are experiencing depression after pregnancy.
* Learn about ways to cope with stress and tips for caring for yourself during the COVID-19 pandemic.

Related Pages
* Things to Know about the COVID-19 Pandemichey might have been exposed.
* Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 3-5 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. They should isolate if they test positive.
* Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Top of Page
Related Pages
—snipped—
* Vaccination Considerations for People who arCOVID-19 Vaccines While Pregnant or Breastfeeding
* Coping with Stress
* Frequently Asked Questions
—snipped—
* Tips to cCare for yYourself one small way each day
—snipped—
* Vaccination Considerations for People who are Pregnant or Breastfeeding
* Coping with Stress
* Frequently Asked Questions
* COVID-19 Toolkit for Pregnant People and New Parents
* Things to Know about the COVID-19 Pandemic
* How to Protect Yourself & Others
* What to Do If You Are SickStress and Coping
—snipped—
* Infant Formula Feeding
—snipped—

—snipped—
Updated MaJuly 185, 2022
—snipped—
* For initial diagnostic testing for current SARS-CoV-2 infections, CDC recommends collecting and testing an upper respiratory specimen.
—snipped—
For initial diagnostic testing for current SARS-CoV-2 infections, CDC recommends collecting and testing an upper respiratory specimen. Contact the testing laboratory to confirm accepted specimen types and follow the manufacturer instructions for specimen collection. Sterile swabs should be used for the collection of upper respiratory specimens. This is important both to ensure patient safety and preserve specimen integrity. Note that nasopharyngeal and oropharyngeal specimens are not appropriate for self-collection.
—snipped—
Follow the instructions as explicitly described within the test’s Emergency Use Authorization (EUA) Instructions for Use.
—snipped—
The US Department of Health and Human Services (HHS) is directly managing allocation of some swabs and media, including viral transport media (VTM)distributing nasopharyngeal (NP) swabs, based on state and territory testing plans that were submitted in response to the Coronavirus Aid, Relief, and Economic Security (CARES) Act requirements. Allocations were predetermined to maximize state and territory testing using a data-driven algorithm based on population, high incidence areas, and COVID-19 Task Force’s directives. A monthly web-based survey goes out to each state and territory where they can request the number of swabs and media required. As of August 2021, HHS is distributing the following swabs: nasopharyngeal (NP), nasal, foam, and poly swabs. For specificrequired. For swab requests, delivery site changes, or other related requests contact COVID19.TestSupplies@hhs.gov.

Public health and clinical laboratories can also produce their own VTM iHHS is no longer distributing viral transport media (VTM). If it is unavailable for purchase. In response to VTM shortages, CDC has posted a standard operating procedure for the preparation of VTM. Saline is also an acceptable transport medium for some COVID-19 viral assays, including the Influenza SARS-CoV-2 (Flu SC2) Multiplex Assay. Check the Instructions for Use (IFU) to see which transport medium is acceptable.
—snipped—

—snipped—
Updated Apr. 9Sept. 16, 2021
—snipped—
Healthcare facilities should stop purchasing non-NIOSH -approved respirators for use as respiratory protection and consider using any that have been stored for source control where respiratory protection is not needed. Respirators that were previously used and decontaminated should not be stored. We do not know the long -term stability of non-NIOSH -approved respirators and respirators that have been decontaminated, and if these will be recommended for use in the future. Healthcare facilities should return to using only NIOSH-approved respirators where needed.
—snipped—
Updates as of April 9September 16, 2021

As of April 9, 2021

* Acknowledged that the supply and availability of NIOSH-approved respirators have increased significantly over the last several months
* For conventional capacity strategies
* Added language on extended use of N95 respirators as source control
* Added language on use of respirators with exhalation valves
* For contingency capacity strategies
* Added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control
* For extended use of N95 respirators as PPE, clarified that N95 respirators should be discarded immediately after being removed
* For crisis capacity strategies
* Removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders
* Highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP to ensure an adequate respirator performance
* RSeptember 16, 2021

* For contingency capacity strategies
* Beyond anticipated shortages, added that increased feasibility and practicality may also be considered in decisions to implement extended use for healthcare personnel (HCP) who are sequentially caring for a large volume of patients with suspected or confirmed SARS-CoV-2, including those cohorted in a SARS-CoV-2 unit, those placed in quarantine, and residents on units impacted during a SARS-CoV-2 outbreak.
* For crisis capacity strategies
* Added information about FDA’s reissuance of the Emergency Use Authorization (EUA) in July 2021. FDA removed filtering facepiece respirators that are NIOSH-approved but have since passed the manufacturers’ recommended shelf life and removed decontamination ofed respirators as a strategy with limited re-use
* Emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited
* Removed the table “Suggested well-fitting facemafrom the scope of authorization.
* Added clarification and example scenarios for limited re-use.
* Deleted the strategy, to exclude HCP at increased risk for respirator use, based upon distance from asevere illness from SARS-CoV-2 infection from contact with patients with known or suspected or confirmed SARS-CoV-2 infection and use of source control”.
—snipped—
SELECTIVE USE OF AIRBORNE INFECTION ISOLATION ROOMS

Aerosol-generating procedures performed on patients with suspected or confirmed SARS-CoV-2 infection should take place in an airborne infection isolation room (AIIR), if possible. The AIIR should be constructed and maintained in accordance with current guidelines, as recommended in CDC’s COVID-19 interim prevention and control recommendations in healthcare settings. Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
—snipped—
USE OF PHYSICAL BARRIERS

Barriers such as glass or plastic windows can be an effective solution for reducing exposures among HCP to potentially infectious patients. This approach can be effective in reception areas (e.g., intake desk at emergency department, triage station, information booth, pharmacy drop-off/pick-up windows) where patients may first report upon arrival to a healthcare facility. Other examples include the use of curtains between patients in shared areas and closed suctioning systems for airway suctioning for intubated patients.
—snipped—
Another cornerstone of engineering controls areis ventilation systems that provide air movement from a clean (HCP workstation or area) to contaminated (sick patient) flow direction (along with. It is important that ventilation systems also have appropriate filtration, and exchange rate) that ars and be installed and properly maintained.
—snipped—
Extended use of N95 respirators can be considered for source control while HCP are in the healthcare facility, to cover one’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. When used for this purpose, N95s may be used until they become soiled, damaged, or hard to breathe through. They should be immediately discarded after removal. Extended use of N95 respirators as PPErespiratory protection is a contingency capacity strategy.
—snipped—
Many healthcare systems already use qualitative fit test methods for fit testing HCP. For those using quantitative fit test methods, considerations can be made to use qualitative fit test methods to minimize the destruction of an N95 respirator used in fit testing and allow for the re-use of the same N95 respirator by the HCP. In March 2020, OSHA recommended healthcare employers consider changing from a quantitative fit testing method to a qualitative fit testing method. Qualitative fit methods may also allow for rapid fit testing of larger numbers of HCP. Any switch in methods should be assessed to ensure proficiency of the fit testers in carrying out the test.
—snipped—
Use NIOSH -approved alternatives to N95 respirators where feasible. These include other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, and powered air purifying respirators (PAPRs). All of these alternatives will provide equivalent or higher protection than N95 respirators when properly worn. NIOSH maintains a searchable, online version of the certified equipment list identifying all NIOSH-approved respirators.

Every other NIOSH -approved filtering facepiece respirators is at least as protective as the N95. These include N99, N100, P95, P99, P100, R95, R99, and R100 (with or without an exhalation valve). On March 2, 2020, FDA issued an Emergency Use Authorization (EUA)external icon authorizing the use of certain NIOSH-approved respirator models in healthcare settings.

As source control, findings from NIOSH research suggest that all NIOSH -approved filtering facepiece respirators with exhalation valves, even without covering the valve, perform the same or better than surgical masks, procedure masks, cloth masks, or fabric. If there is a risk that the worker may be exposed to splashes, sprays, or splatters of blood or body fluids, then a faceshield or surgical facemask should be worn over the standard N95 respirator. Care should be taken not to compromise the fit of the respirator if a facemask is placed over the respirator.

Elastomeric respirators are half-facepiece or full-facepiece, tight-fitting respirators that are made of synthetic or rubber material permitting them to be repeatedly disinfected, cleaned, and reused. They are equipped with a replaceable filter cartridges. Similar toparticulate filter (N95, N99, N100, P95, P99, P100, R95, R99, or R100) and provide the same protection level as N95 respirators, e. Elastomeric respirators require annual fit testing. Elastomeric respirators with unfiltered exhalation valves should not be used in surgical settings due to concerns that air coming out of the exhalation valve may contaminate the sterile field. The NIOSH Certified Equipment List identifies the elastomeric respirators without exhalation valves or with filtered exhalation valves that may be used in surgical settings.

PAPRs are reusable respirators that are typically loose-fitting hoods or helmets. These respirators are battery-powered with a blower that pulls air through attached filters or cartridges. TWhe filter is typically a high-efficiency particulate air (HEPA) filtern equipped with a high-efficiency (HE) filter, they provide a higher level of protection than N95 respirators, as they are 99.97% efficient against 0.3 micron particles. Loose-fitting PAPRs do not require fit-testing and can be worn by people with facial hair. However, PAPRs should not be used in surgical settings due to concerns that the blower exhaust and exhaled air may contaminate the sterile field.

On March 28, 2020, FDA issued an update to address NIOSH-Approved Air Purifying Respirators for Use in Health Care Settings During Response to the COVID-19 Public Health Emergency. Facilities using elastomeric respirators and PAPRs should have up-to-date cleaning/ and disinfection procedures, which are an essential part of use for protection against infectious agents.
—snipped—
Facilities can consider temporarily suspending annual fit testing of HCP in times of expected shortages. In March 2020, OSHA issued new temporary guidance regarding the enforcement of OSHA’s Respiratory Protection Standard. The guidance gave OSHA field offices enforcement discretion concerning the annual fit testing requirement as long asmportant conditions include the HCP haves undergone an initial fit test with the same model, style, and size. Other conditions include explaining to HCP and the HCP has been explained the importance of conducting a user seal check each time the respirator is put on and conducting a fit test if there are visual changes to the employee’s physical condition. In June 2021, OSHA published a COVID-19 Emergency Temporary Standard, including a Mini Respiratory Protection Program, which applies to situations in which respirators are not required. The Mini Respiratory Protection Program emphasizes the importance of conducting a user seal check each time the respirator is donned.
—snipped—
Prioritize respirators for HCP who are using them as PPErespiratory protection

In times of anticipated shortages, surgical N95 respirators should be prioritized for those HCP who are recommended to wear them as PPErespiratory protection when caring for patients. RSurgical N95 respirators should not be used by HCP who are only using them for source control.
—snipped—
Extended use of N95 respirators as respiratory protection

Practices allowing extended use of N95 respirators as PPErespiratory protection, when acceptable, can also be considered. The decision to implement policies that permit extended use of N95 respirators should be made by the professionals who manage the institution’s respiratory protection program, in consultation with their occupational health and infection control departments with input from the state/local public health departments. Beyond anticipated shortages, increased feasibility and practicality may also be considered in decisions to implement extended use for HCP who are sequentially caring for a large volume of patients with suspected or confirmed SARS-CoV-2, including those cohorted in a SARS-CoV-2 unit, those placed in quarantine, and residents on units impacted during a SARS-CoV-2 outbreak.

Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several different patients, without removing the respirator between patient encounters. Extended use is well suited to situations wherein multiple patients with the same infectious disease diagnosis, whose care requires use of a respirator, are cohorted (e.g., housed on the same hospital unit such as a COVID-19 unit). It can also be considered to be used for care of patients with tuberculosis, varicella, measles, and other infectious diseases where use of an N95 respirator or higher respirator is recommended.

When practicing extended use of N95 respirators over the course of a shift, considerations should include 1) the ability of the N95 respirator to retain its fit, 2) contamination concerns, 3) practical considerations (e.g., meal breaks), and 4) comfort of the user. N95 respirators should be discarded immediately after being removed. If removed for a meal break, the respirator should be discarded and a new respirator put on after the break. If it is necessary to re-use N95 respirators in addition to extended use, please see the re-use section under crisis capacity strategies below. N95 respirators should be discarded when contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. HCP can consider using a face shield or surgical facemask over the respirator to reduce contamination of the respirator, especially during aerosol generating procedures or procedures that might generate splashes and sprays. Care should be taken not to compromise the fit of the respirator if a mask is placed over the respiratorIt is not known how facemasks placed over the respirator can affect the fit so caution should be used.
—snipped—
Consideration can be made to use N95 respirators beyond the manufacturer-designated shelf life for care of patients with diseases for which a respirator is recommended during their care (e.g., COVID-19, tuberculosis, measles, and varicella). Many models found in U.S. stockpiles and stockpiles of healthcare facilities have been found to continue to perform in accordance with NIOSH performance standards. However, fluid resistance and flammability were not assessed. Use of the N95 respirators recommended in Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 ResponseNIOSH’s Beyond Shelf Life/Stockpiled Assessment Results can be considered. It is optimal to use these respirators in the context of a respiratory protection program that includes medical evaluation, training, and fit testing. If used in healthcare delivery, it is particularly important that HCP perform the expected seal check, prior to entering a patient care area. CDC does not recommend using N95s beyond the manufacturer-designated shelf life in surgical settings. On March 2, 2020, FDA issued an Emergency Use Authorization (EUA) authorizing the use of certain NIOSH-approved respirator models in healthcare settings. Thise EUA includes respirator units that are past their designatwas reissued on July 12, 2021. Due to the increased availability of NIOSH-approved respirators, the FDA removed filtering facepiece respirators that were NIOSH-approved but have since passed the manufacturers’ recommended shelf life.
—snipped—
Non-NIOSH approved products developed by manufacturers who are not NIOSH approval holders are expected to meet the performance requirements if they have been issued a certificate of approval by an authorizccredited test laboratory indicating they conform to the standards below. Non-NIOSH-approved products developed by manufacturers who are not NIOSH approval holders should not be used when an N95 respirator is recommended to be worn. FDA issued updates to its emergency use authorizations concerning non-NIOSH-approved respirators that have been approved in other countries on October 15, 2020 (Non-NIOSH Approved Disposable FFRs Manufactured in China) and March 24, 2021 (Imported, Non-NIOSH Approved Disposable FFRs). Visit Factors to Consider When Planning to Purchase Respirators from Another Country and the NIOSH Science Blog for additional information on understanding the use of imported Non-NIOSH-approved respirators.
—snipped—
These respirators approved under standards used in other countries are no longer authorized under the FDA EUAs for use in healthcare settings, and they are no longer authorized by OSHA in occupational settings under the OSHA Emergency Temporary Standard effective in June 2021. However, these respirators may be used for source control.

Show More
—snipped—
It is important to consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model. If no manufacturer guidance is available, data suggest limiting the number of reuses to no more than five total uses (five total donnings) per device by the same HCP to ensure an adequate respirator performance.3 Example scenario: a HCP wears a respirator to care for a patient, removes it after exiting the room, and then later returns to care for the patient and puts the same respirator on again. This would count as two uses or donnings. HCP should always inspect the respirator and perform a seal check upon donning a re-used respirator. N95 and other disposable respirators should not be shared by multiple HCP.

During times of crisis, practicing limited re-use while also implementing extended use can be considered. If limited re-use is practiced on top of extended use, caution should be used to minimize self-contamination and degradation of the respirator. If no manufacturer guidance is available, a reasonable limitation should continue to be five total donnings regardless of the number of hours the respirator is worn. Example scenario: An HCP wears a respirator during the first 3 hours of his or her shift, removes the respirator to eat lunch, and puts it back on after lunch. This would count as two uses or donnings.
—snipped—
Respirators soiled or grossly contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients should be discarded. HCP can consider using a face shield or facemask over the respirator to reduce/prevent contamination of the N95 respirator, especially during aerosol generating procedures or procedures anticipated to generate splashes and sprays. It is important to perform hand hygiene before and after the previously worn N95 respirator is donned or adjusted.
—snipped—
Decontamination or bioeburden reduction of NIOSH-approved N95 respirators is no longer a strategy to conserve supplies as the availability to NIOSH-approved respirators has significantly increased. In July 2021, the FDA removed the EUA of decontaminated respirators from the scope of authorization.
—snipped—
Use of additional N95 respirators beyond the manufacturer-designated shelf life for care of patients for whom a respirator is recommended during their care (e.g., SARS-CoV-2 infection, tuberculosis, measles, varicella) can be consideredis no longer authorized as part of an FDA EUA. Some models have been found NOT to perform in accordance with NIOSH performances standards, and previous consideration may bewas given to use these respirators as identified in ReleaUse of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response. In addition, consideration can be given to use N95 respirators that have not been evaluated bythe N95 respirators recommended in NIOSH b’s Beyond the manufacturer-designated sShelf lLife. These respirators should ideally be used in the context of a respiratory protection program that includes medical evaluation, training, and fit testing. It is particularly important that HCP perform the expected seal check, prior to entering a patient care area/Stockpiled Assessment Results.
—snipped—
Source control (i.e., masking of patients) and maintaining physical distance from the patient are particularly important to reduce the risk of transmission. This prioritization approach to conservation is intended to be used when N95 respirators are so limited that routinely practiced standards of care for all HCP wearing N95 respirators when caring for a patient with SARS-CoV-2 infection are no longer possible. N95 respirators beyond their manufacturer-designated shelf life, when available, are preferable to use of well-fitting facemasks. The use of N95s or elastomeric respirators or PAPRs should be prioritized for HCP with the highest potential exposures including being present in the room during aerosol generating procedures performed on persons with SARS-CoV-2 infection.
—snipped—
ADMINISTRATIVE CONTROLS

Exclude HCP at increased risk for severe illness from SARS-CoV-2 infection from contact with patients with known or suspected SARS-CoV-2 infection.

During severe resource limitations, consider excluding HCP who may be at increased risk for severe illness from SARS-CoV-2 infection, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected SARS-CoV-2 infection. Any HCP who are assigned to care for patients with suspected or confirmed SARS-CoV-2 infection should wear a well-fitting facemask.

ENGINEERING CONTROLS
—snipped—
As of April 9, 2021

* Acknowledged that the supply and availability of NIOSH-approved respirators have increased significantly over the last several months
* For conventional capacity strategies
* Added language on extended use of N95 respirators as source control
* Added language on use of respirators with exhalation valves
* For contingency capacity strategies
* Added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control
* For extended use of N95 respirators as PPE, clarified that N95 respirators should be discarded immediately after being removed
* For crisis capacity strategies
* Removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders
* Highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP to ensure an adequate respirator performance
* Removed decontamination of respirators as a strategy with limited re-use
* Emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited
* Removed the table “Suggested well-fitting facemask or respirator use, based upon distance from a patient with suspected or confirmed SARS-CoV-2 infection and use of source control”

As of February 10, 2021
—snipped—

—snipped—
Updated Feb. 25Mar. 10, 2021
—snipped—
* Testing Strategies for SARS-CoV-2
* General Guidance and Regulatory Requirements
—snipped—
TESTING STRATEGIES FOR SARS-COV-2

What is the difference between diagnostic testing and screening testing for SARS-CoV-2?

Diagnostic testing for SARS-CoV-2 is intended to identify current infection at the individual level and is performed when a person has signs or symptoms consistent with COVID-19, or when a person is asymptomatic but has recent known or suspected exposure to SARS-CoV-2.

Screening testing for SARS-CoV-2 is intended to identify infected persons who are asymptomatic and without known or suspected exposure to SARS-CoV-2. Screening testing is performed to identify persons who may be contagious so that measures can be taken to prevent further transmission.

Any laboratory or testing site that performs diagnostic or screening testing must have a Clinical Laboratory Improvement Amendments (CLIA) certificate and meet all requirements to perform testing. For more information, see the Centers for Medicare & Medicaid Services (CMS) summary of the CLIA regulations. Assays and test systems used for COVID-19 diagnostic or screening testing must have received an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) or be offered under the policies in FDA’s Policy for COVID-19 Tests.

See CDC’s Overview of Testing for SARS-CoV-2, and FDA’s FAQs on Testing for SARS-CoV-2.

Is there any difference in how results are reported for diagnostic testing versus screening testing?

No. Both diagnostic testing results and screening testing results are reported to the persons whose specimens were tested and/or to their healthcare provider or employer.

In addition, both diagnostic testing results and screening testing results (positive and negative) must be reported to the local, state, tribal, or territory health department in accordance with Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act. On June 4, 2020, the Department of Health and Human Services published guidance on COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115 that specifies what additional data laboratories and testing sites should collect and electronically report, in addition to COVID-19 diagnostic or screening test results.

What is the difference between screening testing and surveillance testing?

Screening testing for SARS-CoV-2 is intended to identify infected persons who are asymptomatic and without known or suspected exposure to SARS-CoV-2. Screening testing is performed to identify persons who may be contagious so that measures can be taken to prevent further transmission.

Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice. See CDC’s Introduction to Public Health Surveillance.

Surveillance testing for SARS-CoV-2 is intended to monitor community- or population-level outbreak of disease, or to characterize the incidence and prevalence of disease. Surveillance testing is performed on de-identified specimens, and thus results are not linked to individuals. Surveillance testing cannot be used for individual decision-making.

Any laboratory or testing site that performs screening testing must have a Clinical Laboratory Improvement Amendments (CLIA) certificate and meet all requirements to perform testing. For more information, see the Centers for Medicare & Medicaid Services (CMS) summary of the CLIA regulations. Assays and test systems used for COVID-19 screening testing must have received an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) or be offered under the policies in FDA’s Policy for COVID-19 Tests.

Laboratories that conduct surveillance testing for SARS-CoV-2 are not obligated to comply with the FDA and CLIA requirements for diagnostic and screening testing.

See CDC’s Overview of Testing for SARS-CoV-2, and FDA’s FAQs on Testing for SARS-CoV-2.

Is there any difference in how results are reported for screening testing versus surveillance testing?

Yes. Screening results are a specific person’s test results, whereas surveillance results are reported in aggregate, or as de-identified individual reports.

Screening testing results are reported to the persons whose specimens were tested or to their healthcare provider or employer. In addition, screening testing results (positive and negative) must be reported to the local, state, tribal, or territory health department.

By contrast, surveillance testing results cannot be reported to the persons whose specimens have been tested, nor to their healthcare provider or employer. Surveillance testing results also should not be officially reported to the local, state, tribal, or territory health department as diagnostic or screening test results. If a local, state, tribal, or territory health department, or another institution, requests access to the results of surveillance testing for SARS-CoV-2, those results may only be reported in aggregate to the requesting institution, and a statement should be included that indicates the data are surveillance testing results that do not represent COVID-19 diagnostic or screening test results.

Can you summarize the difference among these testing strategies?

Summary of Testing Strategies for SARS-CoV-2 Diagnostic Screening Surveillance Symptomatic or Known or Suspected Exposure Yes No N/A Asymptomatic without Known or Suspected Exposure No Yes N/A Characterize Incidence and Prevalence in the Community N/A N/A Yes Results may be Returned to Individuals Yes Yes No Results Returned in Aggregate to Requesting Institution No No Yes Results Reported to State Public Health Department Yes Yes Only if requested; must be in aggregate Testing can be performed in a CLIA-Certified Laboratory Yes Yes Yes Testing can be performed in a Non-CLIA-Certified Laboratory No No Yes Test System Must be FDA Authorized or be Offered under the Policies in FDA’s Guidance Yes Yes No

GENERAL GUIDANCE AND REGULATORY REQUIREMENTS
—snipped—

—snipped—
WHAT YOU NEED TO KNOW

* Anyone can have mild to severe symptoms.

* Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.

Coronavirus Self-Checker

A tool to help you make decisions on when to seek testing and medical care

Get Started
About the Tool

WATCH FOR SYMPTOMS

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Anyone can have mild to severe symptoms. People with these symptoms may have COVID-19:
—snipped—
This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

When to seek emergency medical attention Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.

FEELING SICK?

Check Symptoms with Self-Checker Get Tested for COVID-19

WHEN TO SEEK EMERGENCY MEDICAL ATTENTION
—snipped—
CARING FOR YOURSELF OR OTHERS

* How to protect yourself
* How to care for someone who is sick
* What to do if you are sick

WHAT IS THE DIFFERENCE BETWEEN INFLUENZA (FLU) ANDIf You Are Sick
* Check symptoms with Coronavirus Self-Checker
* Get tested
* What to do if you are sick
* Isolate if you are sick
* When to quarantine
* How to care for someone who is sick

DIFFERENCE BETWEEN COVID-19? & FLU
—snipped—
DIGITAL RESOURCEHANDOUTS & VIDEOS
—snipped—
* * Older AdultsSeasonal Allergies FAQ
—snipped—
* Travelers
* Healthcare Professionals
* COVID-19 and Seasonal Allergies FAQs
* COVID-19 in Children and Teens

—snipped—
CDC is reviewing this page to align with updated guidance.

SUMMARY OF RECENT CHANGES
—snipped—

CONSIDERATIONS FOR INSTITUTIONS OF HIGHER EDUCATION

Considerations for Institutions of Higher Education
Updated Apr. 27, 2021
Languages
Español简体中文Tiếng Việt한국어

Other Languages
Print
Minus
Related Pages

SUMMARY OF RECENT CHANGES

Updates as of December 31, 2020
* Updated considerations on cleaning and disinfection for clarity.

----------------------------------------

View Previous Updates

On This Page
* Guiding Principles
* General Settings
* On-Campus Settings
* Reduce Spread

* Healthy Environments
* Healthy Operations
* When Someone Gets Sick

Safer Ways to Celebrate Graduations and End of School Events

Attending gatherings to celebrate graduations and end of the school year events increases the risk of getting and spreading COVID-19. The safest way to celebrate this year is virtually, with people who live with you, or outside while taking prevention measures. Here are some tips for schools to encourage students and families to celebrate safely.

* Host a virtual commencement.
* Organize safely distanced drive-in or drive-through celebrations for those who are graduating.

* Create celebration videos to share with family and friends.

* Hang graduation yard signs in the community.
* Organize a home decorating event to honor the graduates.
* Dress up and have a small outdoor celebration with everyone at least 6 feet apart and wearing masks.

These interim considerations are based on what is currently known about COVID-19 as of the date of posting, October 5, 2020.The US Centers for Disease Control and Prevention (CDC) will update these considerations as needed and as additional information becomes available. Please check CDC website periodically for updated interim guidance.

As some institutions of higher education (IHE) prepare to re-open or keep open in-person learning in the United States, IHEs are faced with the challenge of keeping students, faculty, staff, and volunteers safe due to the coronavirus disease 2019 (COVID-19) pandemic. CDC offers the following considerations for ways that IHEs can help protect students and employees (e.g., faculty, staff, and administrators) and slow the spread of COVID-19. This document refers only to risks related to COVID-19.

IHEs vary considerably in geographic location, size, and structure. As such, IHE officials can determine, in collaboration with state and local health officials, whether and how to implement these considerations while adjusting to meet the unique needs and circumstances of the IHE and local community. Implementation should be guided by what is feasible, practical, acceptable, and tailored to the needs of each community. Health facilities managed by the IHE may refer to CDC’s Guidance for U.S. Healthcare Facilities and may find it helpful to reference the Ten Ways Healthcare Systems Can Operate Effectively During the COVID-19 Pandemic. These considerations are meant to supplement—not replace—any state, local, territorial, or tribal health and safety laws, rules, and regulations with which IHEs must comply.

GUIDING PRINCIPLES TO KEEP IN MIND

The more a person interacts with others, and the longer that interaction lasts, the higher the risk of COVID-19 spread in the community. Risk is also affected by factors such as background rates of infection in the community and individuals’ compliance with mitigation strategies, such as use of masking, social distancing, and hand hygiene. IHEs should communicate their selected level of risk so that people can make more informed decisions about attendance, especially those with disabilities and people who are at higher risk of severe illness from COVID. The risk of COVID-19 spread increases in IHE non-residential (i.e., off-campus housing) and residential (i.e., on-campus housing) settings with the level of COVID activity in the community and as follows:

IHE GENERAL SETTINGS

Lowest Risk

* Faculty and students engage in virtual-only learning options, activities, and events.

Some Risk

* Students, faculty, and staff follow all steps to protect themselves and others at all times, including proper use of face masks, social distancing, and hand hygiene.
* Hybrid learning model: Students participate in virtual learning, and in-person learning is limited to courses and laboratory instruction that cannot be delivered remotely.
* Students, faculty, and staff participate in small, in-person classes, activities, and events that allow individuals to remain spaced at least 6 feet apart (e.g., lecture room with individual seating spaced 6 feet apart).
* Students avoid out-of-class social gatherings and events and communications and policies discouraged these activities.
* Apply and support strict adherence to cohorting, alternating schedules, and staggered schedules in residence halls, dining areas, and recreational areas on campus to create small groups of students and minimize their contact with others (e.g., small cohorts of freshmen who live and learn together).
* Students, faculty, and staff do not share objects (e.g., laboratory, art, or recreational equipment and supplies).
* Regularly scheduled (e.g., at least daily or between uses) cleaning and disinfection of frequently touched areas occur as planned (i.e., on-time and consistently).

Medium Risk

* Students, faculty, and staff follow all steps to protect themselves and others such as proper use of face masks, social distancing, and hand hygiene.
* Hybrid learning model: Students participate in a mix of virtual learning and in-person learning for all courses (in-person learning is not limited to specific courses).
* Students, faculty, and staff participate in larger in-person classes, activities, and events that allow people to remain spaced at least 6 feet apart (e.g., classroom with marked seating or seating removed to encourage sitting 6 feet apart).
* Apply cohorting, alternating schedules, and staggered schedules with some exceptions in residence halls, dining areas, and recreational areas on campus.
* Students, faculty, and staff participate in limited, small out-of-class social gatherings and events.
* Students, faculty, and staff dine outside whenever possible, or in well ventilated rooms with social distancing applied.
* Students and faculty share objects minimally (e.g., sharing of objects is limited to one person at a time for laboratory, art, or recreational equipment and supplies that cannot be purchased or assigned individually and that are wiped down with disinfectant, as possible, between uses).
* Regularly scheduled cleaning and disinfection of frequently touched areas occur as planned with few exceptions.

Higher Risk

* Students, faculty, and staff follow some steps to protect themselves and others at all times such as proper use of face masks, social distancing, and hand hygiene.
* Students and faculty engage in in-person only learning, activities, and events.
* Students, faculty, and staff attend several small out-of-class social gatherings and events.
* Students, faculty, and staff dine in indoor dining rooms while maintaining social distancing.
* Students and faculty share some objects (e.g., sharing of objects is limited to one group of students at a time for laboratory, art, or recreational equipment and supplies that cannot be purchased or assigned individually and that are wiped down with disinfectant, as possible, between uses).
* Irregularly scheduled cleaning and disinfection of frequently touched areas.

Highest Risk

* Use of public buses, campus buses/shuttles or other high occupancy enclosed vehicles with limited ventilation and/or that require students, faculty, or staff to have sustained close contact with others. CDC’s Protect Yourself When Using Transportation provides tips for minimizing your risk when using public transportation.
* Students, faculty, and staff do not/are not required to follow steps such as proper use of face masks, social distancing, hand hygiene to protect themselves and others.
* Students and faculty regularly engage in in-person learning, activities, and events.
* Students, faculty, and staff attend large out-of-class social gatherings and events.
* Students and faculty freely share objects.
* Students, faculty, and staff dine in indoor dining rooms without social distancing.
* Irregularly scheduled cleaning and disinfection of frequently touched areas.

COVID-19 is thought to spread mainly by respiratory droplets released when people talk, cough, or sneeze. It is thought that the virus may spread to hands from a contaminated surface and then to the nose or mouth, causing infection. Therefore, personal prevention practices (such as handwashing, staying home when sick) and environmental prevention practices (such as cleaning and disinfection) are important principles that are covered in this document. Fortunately, there are a number of actions IHE administrators can take to help lower the risk of COVID-19 exposure and spread.

PLAN AND PREPARE

Review, update, and implement emergency operations plans (EOPs)

Most importantly, IHE administrators need to plan and prepare for reopening or keeping IHEs open. Regardless of the number of current cases in a community, every IHE should have a plan in place to protect staff and students from the spread of COVID-19. This should be done in collaboration with state, local, tribal, and territorial public health departments, the IHE’s university system (if applicable), and other relevant partners. IHEs should prioritize EOP components that address infectious disease outbreaks and related consequences.

Reference key resources on emergency preparedness while reviewing, updating, and implementing the EOP

* Multiple federal agencies have developed resources on school planning principles and a 6-step process [2.2 MB, 95 pages] for creating plans to build and continually foster safe and healthy school communities before, during, and after possible emergencies.
* Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center’s website has free resources, trainings, and TA for schools, including IHEs, and their community partners. Resources include those on emergency planning and response to infectious disease outbreaks. IHEs might find this guidance for developing a high-quality EOP helpful.
* Workers (faculty and other school staff), students, and other community members should be involved in developing the EOP because broad worker and community involvement is needed.

Planning and strategies should include

* Daily review of official public health data for the community surrounding the IHE to keep track of the current state of COVID-19 spread.
* Development of information-sharing systems with school and community partners. Institutional information systems can be used for day-to-day reporting on number of cases and information, such as absenteeism or changes in student and staff health center traffic to detect and respond to an outbreak.
* Ways to promote healthy behaviors that reduce the spread of COVID-19, maintain healthy campus environments and operations, and outline what to do if someone gets sick.
* Ways to enforce or ensure compliance of healthy behaviors that reduce the spread of COVID-19.
* Assessment of the accessibility of information and resources to reduce the spread of COVID-19 and maintain healthy environments.
* Criteria for IHE suspension of in-person learning to stop or slow the spread of COVID-19, as well as criteria for determining when to resume in-person learning.
* Strategies that ensure residents and staff use practices to reduce the risk of COVID-19 in the event of IHE suspension or need to self-quarantine for the following:
* Continuing education
* Meal programs
* Continuity of housing
* Other services
* Considerations for students, faculty, and staff with disabilities and people who are at higher risk of severe illness from COVID.
* Considerations for students, faculty, and staff with disabilities, including effective communication of the IHE’s COVID-related plans and accessibility of the IHE’s services.
* Considerations for Limited English Proficient (LEP) students, faculty, and staff to ensure meaningful communication with them regarding the IHE’s practices to reduce the risk of COVID-19 and how to continue education, meals, other services, etc. (e.g., use of interpreters and translated materials).

Top of Page

PROMOTING BEHAVIORS THAT REDUCE SPREAD

IHEs may consider implementing several strategies to encourage behaviors that reduce the spread of COVID-19.

Staying Home or Self-Isolating when Appropriate

* If a decision is made to have any version of in-person classes, before returning to campus, actively encourage students, faculty, and staff who have been sick with COVID-19 symptoms, tested positive for COVID-19, or have been potentially exposed to someone with COVID-19 (either through community-related exposure or international travel) to follow CDC guidance to self-isolate or stay home.
* Educate students, faculty, and staff on when they should stay home or self-isolate in their living quarters.
* Actively encourage students, faculty, and staff who are sick or have recently had a close contact with a person with COVID-19 to stay home or in their living quarters (e.g., dorm room). Develop policies that encourage sick individuals to stay at home without fear of reprisals, and ensure students, faculty, and staff are aware of these policies. Offer virtual learning and telework options, if feasible.
* Develop policies that encourage sick people to stay at home without fear of reprisals and ensure students, faculty, and staff are aware of these Offer virtual learning and telework options, if feasible. Establish procedures for how to re-house roommates of those who are sick.
* Develop policies and plans that ensure the continuity of meal programs. Work with local public health officials to determine strategies for providing meals to students living on campus who are sick with COVID-19 or who are being monitored because of contact with persons with COVID-19. If on-campus housing residents have been relocated to temporary alternative housing, consider how meals can be provided to these students.

* Students, faculty, and staff should stay home when they have tested positive for or are showing symptoms of COVID-19.
* IHEs should develop policies to prepare for when someone gets sick
* CDC’s criteria can help inform return to work/school policies:
* If they have been sick with COVID-19
* If they have recently had a close contact with a person with COVID-19
* IHEs should develop a plan for students who develop symptoms of, or test positive for, or have close contact with a person with COVID-19. Students should isolate or quarantine at their current place of residence, or arrange for accommodations on or near campus to isolate and attend virtual classes. This plan should address linking students to any support services offered by their health departments. Sending people with COVID-19 to distant homes is not desirable because it could lead to community spread.

* *

Hand Hygiene and Respiratory Etiquette

* Recommend and reinforce handwashing with soap and water for at least 20 seconds.
* If soap and water are not readily available, hand sanitizer that contains at least 60% alcohol can be used.
* Encourage students, faculty, and staff to cover coughs and sneezes with a tissue or use the inside of your elbow. Used tissues should be thrown in the trash and hands washed immediately with soap and water for at least 20 seconds.
* If soap and water are not readily available, hand sanitizer that contains at least 60% alcohol can be used.
* Ensure availability and access to supplies that promote healthy hygiene practices (e.g., touchless hand sanitizer stations by building doorways; handwashing stations positioned near high touch areas).

Masks

* Recommend and reinforce use of masks among students, faculty, and staff both on and off campus. Many people with COVID-19 are asymptomatic or have only mild symptoms, thus people may not recognize they are infected. The use of masks to prevent spread of respiratory droplets by the wearer is an important mitigation strategy to help prevent the spread of COVID-19. Masks are not personal protective equipment (PPE) (e.g., N95 respirators) intended for use by healthcare workers. Masks should be worn in public settings whenever possible, even when social distancing. People should be reminded frequently not to touch their masks and to wash their hands often. Information should be provided to all students, faculty, and staff on proper use, removal, and washing of masks.
* Masks should not be placed on:
* Babies and children younger than 2 years old
* Anyone who has trouble breathing or is unconscious
* Anyone who is incapacitated or otherwise unable to remove the mask without assistance
* For people with sensory, cognitive, or behavioral issues for whom wearing masks could be difficult, adaptations and alternatives to prevent against spread of COVID-19 should be considered.
* People who are deaf or hard of hearing may be unable to wear a mask if the ear loops of the mask interferes with the use of hearing aids. Those who care for or interact with a person who is hearing impaired may be unable to wear masks if the person they are interacting with relies on lipreading to communicate. This may be particularly relevant for faculty or staff teaching or working with students who may be deaf or hard of hearing. In this situation, consider using a clear face covering. If a clear face covering isn’t available, consider using written communication or closed captioning and decrease background noise to make communication easier while wearing a mask.

Adequate Supplies

Ensure you have accessible sinks and enough supplies for people to clean their hands and cover their coughs and sneezes. Supplies include soap, a way to dry hands (e.g., paper towels, hand dryer), tissues, hand sanitizer containing at least 60 percent alcohol, disinfectant wipes, masks (as feasible), and no-touch /foot pedal trash cans (preferably covered).

Signs and Messages

* Post signs in highly visible locations (e.g., building entrances, restrooms, dining areas) that promote everyday protective measures [290 KB, 2 pages] and describe how to stop the spread [468 KB, 1 page] of germs (such as by properly washing hands, social distancing at least 6 feet, and wearing a mask). Signs should include visual cues.
* Use simple, clear, and effective language (for example, in videos) about behaviors that prevent spread of COVID-19 when communicating with faculty, staff, and students (such as on IHE websites, in emails, and on IHE social media accounts).
* Use communication methods that are accessible for all students, faculty and staff, and other essential visitors, including parents or guardians. Ensure materials can accommodate diverse audiences, such as people who speak languages other than English, and people with disabilities.
* Find freely available CDC print and digital resources on CDC’s communication resources main page. CDC also has American Sign Language videos related to COVID-19.

Top of Page

MAINTAINING HEALTHY ENVIRONMENTS

IHEs may consider implementing several strategies to maintain healthy environments.

WHEN TO CLEAN

Cleaning with products containing soap or detergent reduces germs on surfaces and objects by removing contaminants and may weaken or damage some of the virus particles, which decreases risk of infection from surfaces.

Cleaning high touch surfaces and shared objects once a day is usually enough to sufficiently remove virus that may be on surfaces unless someone with confirmed or suspected COVID-19 has been in your facility. Disinfecting (using disinfectants on U.S. Environmental Protection Agency (EPA)’s List N) removes any remaining germs on surfaces, which further reduces any risk of spreading infection. For more information on cleaning your facility regularly and cleaning your facility when someone is sick, see Cleaning and Disinfecting Your Facility

WHEN TO DISINFECT

You may want to either clean more frequently or choose to disinfect (in addition to cleaning) in shared spaces if certain conditions apply that can increase the risk of infection from touching surfaces.

* High transmission of COVID-19 in your community
* Low number of people wearing masks
* Infrequent hand hygiene
* The space is occupied by people at increased risk for severe illness from COVID-19

If there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean AND disinfect the space.

USE DISINFECTANTS SAFELY

Always read and follow the directions on how to use and store cleaning and disinfecting products. Ventilate the space when using these products.

Always follow standard practices and appropriate regulations specific to your facility for minimum standards for cleaning and disinfection. For more information on cleaning and disinfecting, see Cleaning and Disinfecting Your Facility.

Ventilation

* Consider ventilation system upgrades or improvements and other steps to increase the delivery of clean air and dilute potential contaminants in campus buildings. Consult experienced heating, ventilation, and air conditioning (HVAC) professionals when considering changes to HVAC systems and equipment. Some of the recommendations below are based on the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Guidance for Building Operations During the COVID-19 Pandemic. Review additional ASHRAE guidelines for schools and universities for further information on ventilation recommendations for different types of buildings and building readiness for occupancy. Not all steps are applicable for all scenarios.
* Improvement steps may include some or all of the following activities:
* Increase outdoor air ventilation, using caution in highly polluted areas.
* When weather conditions allow, open windows and doors to increase fresh outdoor air. Do not open windows and doors if doing so poses a safety or health risk (e.g., risk of falling, triggering asthma symptoms) to people using the facility.
* Use fans to increase the effectiveness of open windows. Position fans securely and carefully in or near windows so as not to create potentially contaminated airflow directly from one person to another. The fan position should also not create potentially contaminated airflow to people outside of the room (e.g., pedestrians using walkways outside the window). Strategic window fan placement in exhaust mode can help draw fresh air into room via other open windows and doors without generating strong room air currents.
* Decrease occupancy in areas where outdoor air ventilation cannot be increased.
* Ensure ventilation systems operate properly and provide acceptable indoor air quality for the current occupancy level for each space.
* Increase total airflow supply to occupied spaces, when possible.
* Disable demand-controlled ventilation controls that reduce air supply based on occupancy or temperature during occupied hours.
* Further open minimum outdoor air dampers to reduce or eliminate HVAC air recirculation. In mild weather, this will not affect thermal comfort or humidity. However, this may be difficult to do in cold, hot, or humid weather.
* Improve central air filtration:
* Increase air filtration to as high as possible without significantly diminishing design airflow.
* Inspect filter housing and racks to ensure appropriate filter fit and check for ways to minimize filter bypass.
* Check filters to ensure they are within service life and appropriately installed.
* Consider running the HVAC system at maximum outside airflow for 2 hours before and after the IHE building is occupied.
* Ensure restroom exhaust fans are functional and operating at full capacity when the IHE building is occupied.
* Inspect and maintain local exhaust ventilation in areas such as restrooms, kitchens, cooking areas, etc.
* Use portable high-efficiency particulate air fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as the IHE health office).
* Inspect and maintain local exhaust ventilation in areas, such as bathrooms, kitchens, cooking areas, etc.
* Generate clean-to-less-clean air movement by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers (especially in higher risk areas, such as the IHE health office).
* Consider using ultraviolet germicidal irradiation as a supplement to help inactivate SARS-CoV-2 (the virus that causes COVID-19), especially if options for increasing room ventilation are limited.
* Ventilation considerations are also important on buses used for IHE activities.

Water Systems

* The temporary shutdown or reduced operation of IHEs and reductions in normal water use can create hazards for returning students and staff. To minimize the risk of lead or copper exposure, Legionnaires’ disease and other diseases associated with contaminated water, take steps such as flushing plumbing to ensure that all water systems and features (e.g., sink faucets, drinking fountains, showers, decorative fountains) are safe to use after a prolonged facility shutdown, and follow EPA’s 3Ts for reducing lead in drinking water. It might be necessary to conduct ongoing regular flushing of all water systems and features after reopening. For additional resources, refer to EPA’s Information on Maintaining or Restoring Water Quality in Buildings with Low or No Use. Drinking fountains should be cleaned and sanitized, but encourage staff and students to bring their own water to minimize use and touching of water fountains.

Modified Layouts

* Space seating/desks at least 6 feet apart when feasible. For lecture halls, consider taping off seats and rows to ensure six-foot distance between seats.
* Host smaller classes in larger rooms.
* Turn desks to face the same direction (rather than facing each other), or have students sit spaced 6 feet apart on only one side of tables.
* Modify learning stations and activities as applicable so there are fewer students per group, placed at least 6 feet apart if possible.
* Offer distance learning in addition to in-person classes to help reduce the number of in-person
* Provide adequate distance between people engaged in experiential learning opportunities (e.g., labs, vocational skill building activities).
* Create distance between students in IHE transport vehicles (e.g., skipping rows) when

Physical Barriers and Guides

* Install physical barriers, such as sneeze guards and partitions, particularly in areas where it is difficult for individuals to remain at least 6 feet apart (e.g., cash registers).
* Provide physical guides, such as tape on floors or sidewalks and signs on walls to ensure that individuals remain at least 6 feet apart in lines and at other times.

Engineering Interventions

* Consider installing automatic doors or doors that can open so that people do not require hands to open a door (e.g., doors can be pushed open with a shoulder).

Communal Spaces

* Close communal use shared spaces such as dining halls, game rooms, exercise rooms, and lounges if possible; otherwise, stagger use and restrict the number of people allowed in at one time to ensure everyone can stay at least 6 feet apart, and clean and disinfect between use.
* Add physical barriers, such as plastic flexible screens, between bathroom sinks and between beds especially when they cannot be at least 6 feet apart.
* For more information on communal spaces in student or faculty housing (e.g., laundry rooms, shared bathrooms and recreation areas) follow CDC’s guidance for Shared or Congregate Housing.

Food Service

* Avoid providing any small appliances (e.g., toasters, waffle makers) and using self-service food or drink options, such as hot and cold food bars, salad or condiment bars, and drink stations. Continue to serve nutritionally balanced meals that are individually plated or pre-packaged. Make soap and water for handwashing available—and where soap and water are not readily available, provide hand sanitizer that contains at least 60% alcohol—for use before and after eating food. Discourage sharing of food, either brought from home or from the food service.
* Provide grab-and-go options. If communal dining halls or cafeterias will be used, ensure that students remain 6 feet apart by placing visual cues in food service lines and at tables. Clean and disinfect tables between use.
* When possible, create options that allow students, faculty, and staff to eat meals outdoors, while maintaining social distance (at least 6 feet apart) as much as possible, instead of in a communal dining hall or cafeteria.
* Ensure students do not share food or utensils to include the safety of students with food allergies. Use disposable food service items (e.g., utensils, trays). If disposable items are not feasible or desirable, ensure that staff handle all non-disposable food service items and equipment with gloves and that those items are washed with dish soap and hot water or in a dishwasher. Staff should wash their hands after removing their gloves or after directly handling used food service
* If food is offered at any event, have pre-packaged boxes or bags for each attendee instead of providing a buffet or family-style service. Review considerations for events and gatherings for additional information about planning and holding events and gatherings that include food service.
* Provide tissues and no-touch or foot-pedal disposal containers for use by faculty, staff, and students.

* If possible, install touchless payment methods (pay without touching money, a card, or a keypad). Provide hand sanitizer that contains at least 60% alcohol near places where people pay so that they can use it right after handling money, cards, or keypads.

Top of Page

MAINTAINING HEALTHY OPERATIONS

IHEs may consider implementing several strategies to maintain healthy operations.

Protections for Students, Faculty, and Staff at Higher Risk for Severe Illness from COVID-19

* Offer options for faculty and staff at higher risk for severe illness (including older adults and people of all ages with certain underlying medical conditions) that limit their exposure risk (e.g., telework and modified job responsibilities).
* Offer options for students at higher risk for severe illness that limit their exposure risk (e.g. virtual learning opportunities).
* Provide inclusive programming for people with special healthcare needs and disabilities that allow on-site or virtual participation with appropriate accommodations, modifications, and assistance (e.g., students with disabilities may have more difficulties accessing and using technology for virtual learning).
* Consistent with applicable law, put in place policies to protect the privacy of people at higher risk for severe illness (e.g., policies to protect the health information of people with underlying medical conditions).

Regulatory Awareness

* Be aware of state or local regulatory agency policies related to group gatherings to determine if events can be held.

Gatherings

* Consider virtual group events, gatherings, or meetings, if possible, and promote social distancing of at least 6 feet between people if events are Limit group size to the extent possible.
* Pursue options to hold sporting events and participate in sports activities in ways that reduce the risk of transmission of COVID-19 to players, families, coaches, and communities.
* Limit any nonessential visitors, volunteers, and activities involving external groups or organizations as possible – especially with individuals who are not from the local geographic area (e.g., community, town, city, or county).

Telework and Virtual Meetings

* Encourage telework for as many faculty and staff as possible, especially employees at higher risk for severe illness from COVID-19.
* Replace in-person meetings with video- or tele-conference calls whenever possible.
* Provide student support services virtually, as feasible.
* When possible, use flexible work or learning sites (e.g., telework, virtual learning) and flexible work or learning hours (e.g., staggered shifts or classes) to help establish policies and practices for social distancing (maintaining distance of approximately 6 feet) between people, especially if social distancing is recommended by state and local health authorities.
* Disability resource centers should review policies and procedures to assess/qualify students for new accommodations, modifications, and assistance that may be needed due to COVID-19 changes.
* Ensure appropriate accommodations, modifications, and assistance are provided for education to remain accessible for students with disabilities or those at higher risk of severe illness from COVID.

Designated COVID-19 Point of Contact

* Designate an administrator or office to be responsible for responding to COVID-19 Provide all IHE students, faculty and staff with the name and contact information for the COVID-19 point of contact.

Travel and Transit

* Consider options for limiting non-essential travel in accordance with state and local regulations and guidance.
* Consider postponing or canceling upcoming student international travel programs planned or hosted by the institution.
* Encourage students, faculty, and staff who use public transportation or ride sharing to use forms of transportation that minimize close contact with others (e.g., biking, walking, driving or riding by car either alone or with household members).
* Ensure options for safe travel on campus for people with disabilities (e.g., drivers should wear a mask and use hand sanitizer before and after providing assistance).
* Encourage students, faculty, and staff who use public transportation or ride sharing to follow CDC guidance on how to protect themselves when using transportation. Additionally, encourage them to commute during less busy times and clean or sanitize their hands as soon as possible after all travel.
* IHEs should develop a plan for students who develop symptoms of, or test positive for, or have close contact with a person with COVID-19. Students should isolate or quarantine at their current place of residence, or arrange for accommodations on or near campus to isolate and attend virtual classes. This plan should address linking students to any support services offered by their health departments. Sending people with COVID-19 to distant homes is not desirable because it could lead to community spread.

Participation in Community Response Efforts

* Consider participating with state, local, tribal, and territorial authorities in broader COVID-19 community response efforts (e.g., sitting on community response committees).

Communication Systems

Put systems in place for:

* Students, faculty, and staff to report to the IHE if they have symptoms of COVID-19, a positive test for COVID-19, or were exposed to someone with COVID-19 within the last 14 days, consistent with applicable law and privacy policies (e.g., health information sharing regulations for COVID-19 and applicable federal and state privacy and confidentiality laws, such as the Family Educational Rights and Privacy Act (FERPA)). See the Notify Health Officials and Close Contacts section below.
* Notifying faculty, staff, students, families, and the public of IHE closures, changes, and any restrictions in place to limit COVID-19 exposure (e.g., limited hours of operation).

Leave (Time Off) and Excused Absence Policies

* Implement flexible sick leave policies and practices that enable faculty, staff, and students to stay home or self-isolate when they are sick, have been exposed, or caring for someone who is sick.
* Examine and revise policies for excused absences and virtual learning (students) and leave, telework, and employee compensation (employees).
* Leave and excused absence policies should be flexible, not be punitive to people for taking time off and should allow sick employees and students to stay home and away from others. Leave and excused absence policies should also account for employees and students who need to stay home with their children if there are school or childcare closures, or to care for sick family members.
* Develop policies for returning to classes and IHE facilities after COVID-19 illness. CDC’s criteria to discontinue home isolation and quarantine can inform these policies.

Back-Up Staffing Plan

* Monitor absenteeism of employees and students, cross-train staff, and create a roster of trained back-up staff.

Staff Training

* Train staff on all safety protocols
* Conduct training virtually or ensure that social distancing is maintained during training.

Recognize Signs and Symptoms

* Note that symptom screenings and health checks do not identify people who are infected but without symptoms (asymptomatic), people who are infected but have not yet developed symptoms (pre-symptomatic), or people with mild non-specific symptoms who might not realize they are infected. As such, screening and health checks are not a replacement for other protective measures, such as social distancing, hand hygiene, and use of masks.
* If an IHE opts to use health checks, the checks should be done safely, respectfully, and in accordance with any applicable federal or state privacy and confidentiality laws and IHE administrators may use examples of screening methods found in CDC’s General Business FAQs.

Testing

* IHEs might test students, faculty, or staff for purposes of surveillance, diagnosis, screening, or in the context of an outbreak. Individuals should be considered for and offered testing if they
* Show signs or symptoms consistent with COVID-19 (diagnostic)
* Have a recent known or suspected exposure to a person with laboratory-confirmed COVID-19 (diagnostic)
* Have been asked or referred to get testing by their healthcare provider or health department (diagnostic)
* Are part of a cohort for whom testing is recommended (in the context of an outbreak)
* Are attending an IHE that requires entry screening (entry testing as part of screening)
* Active surveillance testing to include
* Are in a community where public health officials are recommending expanded testing on a voluntary basis including testing of a sample of asymptomatic individuals, especially in areas of moderate to high community transmission (screening)
* Volunteer to be tested in order to monitor occurrence of cases and positivity rate (surveillance)
* Wastewater monitoring and then active surveillance in identified dorms as a part of comprehensive testing for those living on campus (surveillance).
* Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of people diagnosed with COVID-19 be identified quickly. Identifying and testing close contacts will likely vary by IHE and the local context.
* In addition, in accordance with state and local laws and regulations, IHEs should work with local health officials to inform those who have had close contact with a person diagnosed with COVID-19 to wear masks if they are able, quarantine in their living quarters or a designated housing location, and self-monitor for symptoms for 14 days.
* The best way to protect yourself and others is to stay home for 14 days if you think you’ve been exposed to someone who has COVID-19. Check your local health department’s website for information about options in your area to possibly shorten this quarantine period.

* Additional information on IHE testing considerations can be found at CDC’s Interim Considerations for Institutions of Higher Education Administrators for SARS-CoV-2 Testing.

Contact Tracing

* Contact tracing is the process of notifying people (contacts) of potential exposure to SARS-CoV-2 and discussing information about the virus, symptom history, and other relevant health information. Also discussed are instructions for self-quarantine and monitoring for symptoms, and support and referrals to testing, clinical services, and other essential support services, as indicated.
* The case investigation and contact tracing processes help prevent further transmission of disease by separating people who have (or might have) an infectious disease from people who do not. Prompt identification, voluntary self-quarantine, and monitoring of these contacts exposed to SARS-CoV-2 can break the chain of transmission effectively and prevent further spread of the virus in a community. IHE settings contain a mixed population of students and staff ranging from young to older adults who are highly interconnected in multiple, close-contact networks, such as dormitories, classrooms, lecture halls, sports teams, clubs and fraternities/sororities. As a result, these close settings may cause the IHE population to be more susceptible to increased transmission of SARS-CoV-2.
* Health departments are responsible for leading case investigations, contact tracing, and outbreak investigations. Given the large number of COVID-19 cases reported to health departments, coupled with how easily and quickly SARS-CoV-2 is spreading, health department resources can be overwhelmed. Partnerships between health departments and IHEs are encouraged, as it may aid in limiting the spread of SARS-CoV-2 in these settings and local communities.
* Additional information on contact tracing within an IHE setting can be found at Investigation and Contact Tracing Considerations in IHEs for Health Departments and IHE Administrators.

Sharing Facilities

* Encourage any organizations that share or use IHE facilities to also follow these considerations.

Support Coping and ResilienceGUIDANCE FOR INSTITUTIONS OF HIGHER EDUCATION (IHES)

Guidance for Institutions of Higher Education (IHEs)
Updated June 4, 2021
Languages
Español简体中文Tiếng Việt한국어

Other Languages
Print
Minus
Related Pages

SUMMARY OF RECENT CHANGES

Updates as of June 4, 2021
* Added Introduction language to reflect the latest information relevant to Institutions of Higher Education (IHEs)
* Added guidance on offering and promoting COVID-19 vaccination
* Added guidance on prevention strategies for IHEs where everyone is fully vaccinated and for IHEs where not everyone is fully vaccinated
* Added section on General Considerations for All IHEs
* Added section with Additional Considerations for All IHEs
* Added Key Terms
* Added References section
* Updated Resources section

----------------------------------------

View Previous Updates

Key Points

This guidance supplements and does not replace any federal, state, tribal, local, or territorial health and safety laws, rules, and regulations with which IHEs must comply.

* This guidance provides resources that IHE administrators can use to prevent the spread of COVID-19 among students, faculty, and staff during the COVID-19 pandemic.
* IHE administrators can help protect students, faculty, and staff and slow the spread of COVID-19, by encouraging vaccinations and using CDC’s Guidance for IHEs.
* IHEs can help increase vaccine uptake among students, faculty, and staff by providing information about COVID-19 vaccination, promoting vaccine trust and confidence, and establishing supportive policies and practices that make getting vaccinated as easy and convenient as possible.
* IHEs where all students, faculty, and staff are fully vaccinated prior to the start of the semester can return to full capacity in-person learning, without requiring or recommending masking or physical distancing for people who are fully vaccinated in accordance with CDC’s Interim Public Health Recommendations for Fully Vaccinated People.
* IHEs where not everyone is fully vaccinated will have a mixed population of both people who are fully vaccinated and people who are not fully vaccinated on campus which requires decision making to protect the people who are not fully vaccinated.

On This Page
* Introduction
* Section 1: Offer and Promote COVID-19 Vaccination
* Section 2: Guidance for IHEs Where Everyone is Fully Vaccinated
* Section 3: Guidance for IHEs Where not Everyone is Fully Vaccinated

* Section 4: General Considerations for All IHEs
* Key Terms
* Additional Resources
* References

INTRODUCTION

This guidance is intended for any institution of higher education (IHE) that offers education or instruction beyond the high school level, such as colleges and universities, including community and technical colleges.

To determine your level of community transmission, please see CDC’s COVID Tracker.

This guidance is split into four sections to support IHEs in their decision making:

* Section 1: Offer and Promote COVID-19 Vaccination
* Section 2: Guidance for IHEs Where Everyone is Fully Vaccinated
* Section 3: Guidance for IHEs Where Not Everyone is Fully Vaccinated
* Section 4: General Considerations for All IHEs

IHE administrators can determine, in collaboration with tribal, state, local, and territorial public health officials and in accordance with applicable law, how to implement CDC guidance while considering the needs and circumstances of the IHE within the context of their local community. IHE administrators should take into account health equity considerations for promoting fair access to health. This guidance does not replace any applicable federal, state, tribal, local, or territorial health and safety laws, rules, and regulations with which IHEs must comply.

The Department of Education has a complementary handbook to this guidance ED COVID-19 Handbook Volume 3: Strategies for Safe Operation and Addressing the Impact of COVID-19 on Higher Education Students, Faculty, and Staff found here: https://www2.ed.gov/documents/coronavirus/reopening-3.pdf

SECTION 1: OFFER AND PROMOTE COVID-19 VACCINATION

IHEs can play a critical role in offering and promoting vaccination to help increase the proportion of students, faculty and staff that are vaccinated to help slow the spread of COVID-19 and prevent interruptions to in-person learning.

Vaccination is the leading prevention strategy to protect individuals from COVID-19 disease and end the COVID-19 pandemic. Current COVID-19 vaccines authorized for use in the United States are safe and effective, widely accessible in the U.S., and available at no cost to all people living in the U.S. Learn more about the Benefits of Getting a COVID-19 Vaccine.

IHEs can help increase vaccine uptake among students, faculty, and staff by providing information about and offering COVID-19 vaccination, promoting vaccine trust and confidence, and establishing supportive policies and practices that make getting vaccinated as easy and convenient as possible. IHE administrators may refer to CDC’s Workplace Vaccination Program as instructive to help prepare for campus vaccination.

To increase access to vaccines, IHEs can

* Provide on-site vaccination in IHE facilities or local vaccination sites through partnerships (e.g., existing occupational and student health clinics, IHE-run temporary vaccination clinics, mobile vaccination clinics brought to the IHE, etc.).
* Consider hosting a mass vaccination clinic or setting up smaller vaccine venues on campus to promote vaccination.
* Connect with your local or state health department or health system to learn what might be possible.
* If you are not already working with your local or state health department, consider reaching out for assistance with promoting and implementing vaccinations within the IHE community. The local or state health department can assist with coordination of vaccination clinics and offer local vaccine expertise.
* Refer to CDC guidance for help planning vaccination clinics held at satellite, temporary, or off-site locations.
* Refer to the American College Health Association’s website for a compilation of guidance and resources for hosting a mass vaccination clinic and other best practices.
* Use trusted messengers to promote vaccination, including current and former students.
* Consider offering multiple locations and vaccination times to accommodate student work and academic schedules.
* Facilitate access to off-site vaccination services in the community (e.g., pharmacies, mobile vaccination clinic set up in community locations, partnerships with local health departments, healthcare centers and other community clinics, partnerships with student organizations).
* Visit vaccines.gov to find out where students can get vaccinated in your community and identify locations near to campus.
* Offer free transportation to off-site vaccination sites for students who need assistance.
* Offer flexible, supportive sick leave options (e.g., paid sick leave), in accordance with applicable laws and IHE policies, for employees with side effects after vaccination. See CDC’s post-vaccination Considerations for Workplaces.
* Offer flexible excused absence options for students receiving vaccination and those with side effects after vaccination.

To promote vaccination, IHEs can

* Develop educational messaging for vaccination campaigns to build vaccine confidence and consider utilizing student leaders and athletes as spokespersons.
* Ask student and other organizations who are respected in IHE communities to help build confidence in COVID-19 vaccines and promote the benefits of getting vaccinated.
* Ask students, faculty, and staff to promote vaccination efforts in their social groups and their communities.

Certain communities and groups have been disproportionately affected by COVID-19 illness and severe outcomes, and some communities might have had previous experiences that affect their trust and confidence in the healthcare system. Vaccine confidence may be different among students, faculty, and staff. IHE administrators should tailor communications and involve trusted community messengers, including those on social media, to promote vaccinations among those who may be hesitant to receive COVID-19 vaccination.

IHEs can consider verifying the vaccination status of their students, faculty, and staff. Administrators can determine vaccine record verification protocols, in accordance with state and local laws.

See COVID-19 Vaccine Toolkit for Institutions of Higher Education (IHE), Community Colleges, and Technical Schools for more information.

Top of Page

SECTION 2: GUIDANCE FOR IHES WHERE EVERYONE IS FULLY VACCINATED

This section is intended for IHEs that have a fully vaccinated campus. People who are fully vaccinated are at low risk of symptomatic or severe infection, and a growing body of evidence suggests that people who are fully vaccinated are less likely to have asymptomatic infection or transmit the virus that causes COVID-19 to others. IHEs with fully vaccinated students, faculty, and staff can refer to CDC’s Interim Public Health Recommendations for Fully Vaccinated People. As new information become available, CDC guidance will be updated accordingly.

IHEs should comprehensively engage their IHE networks to establish and promote a vaccination environment that is safe and equitable for all students, faculty, and staff.

Some students, faculty, or staff might not be able to get the COVID-19 vaccine due to medical or other conditions. IHEs will need to determine prevention strategies, accommodations, and policies for any students, faculty, or staff who cannot be vaccinated.

IHEs where all students, faculty, and staff are fully vaccinated prior to the start of the semester can return to full capacity in-person learning, without requiring or recommending masking or physical distancing for people who are fully vaccinated in accordance with CDC’s Interim Public Health Recommendations for Fully Vaccinated People. General public health considerations such as handwashing, cleaning/disinfection and respiratory etiquette should continue to be encouraged regardless of vaccination status (see Section 4). When holding gatherings and events that include individuals who are not fully vaccinated such as campus visitors or others from outside of the IHE, IHEs should utilize appropriate prevention strategies to protect people who are not fully vaccinated.

We are still learning how well the COVID-19 vaccines protect people with weakened immune systems, including people who take immunosuppressive medications. Administrators should advise students, faculty, and staff with weakened immune systems on the importance of talking to their healthcare providers to discuss their activities and precautions they may need to keep taking to prevent COVID-19. Currently, CDC recommends continued masking and physical distancing for people with weakened immune systems.

WEARING A MASK

Students, faculty, and staff who are fully vaccinated do not need to wear masks, except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance. Although fully vaccinated persons do not generally need to wear masks, CDC recommends continued masking and physical distancing for people with weakened immune systems. IHEs can be supportive of students, faculty, or staff who choose to continue to wear a mask for any reason.

PHYSICAL DISTANCING

Physical distancing is not necessary for fully vaccinated students, faculty, and staff on campus for IHEs where everyone is fully vaccinated except indicated in CDC’s Interim Public Health Recommendations for Fully Vaccinated People.

HOUSING AND COMMUNAL SPACES

Shared housing includes a broad range of settings, such as apartments, condominiums, student or faculty/staff housing, and fraternity and sorority housing. People who are fully vaccinated in shared housing should follow CDC’s Interim Public Health Recommendations for Fully Vaccinated People.

HAND HYGIENE AND RESPIRATORY ETIQUETTE

IHEs should continue to facilitate health-promoting behaviors such as hand hygiene and respiratory etiquette to reduce the spread of infectious disease in general.

CLEANING, IMPROVING VENTILATION, AND MAINTAINING HEALTHY FACILITIES

IHEs should continue to follow cleaning, disinfecting, and ventilation recommendations, including routine cleaning of high touch surfaces and shared objects as well as maintaining improved ventilation.

TESTING

People who are fully vaccinated do not need to undergo routine COVID-19 screening testing. If a fully vaccinated person is exposed to someone with COVID-19 they do not need to be tested unless they are experiencing COVID-19 symptoms. Any person who experiences COVID-19 symptoms should get a COVID-19 test. Refer to CDC’s Interim Public Health Recommendations for Fully Vaccinated People for more information.

SYMPTOM SCREENING

Encourage students, faculty, and staff to perform daily health screenings for infectious illnesses, including COVID-19. Encourage students, faculty, and staff with signs or symptoms of infectious illness to stay home when sick and/or seek medical care. A COVID-19 self-checker may be used to help decide when to seek COVID-19 testing or medical care. If symptom screening is conducted, ensure that symptom screening is done safely, respectfully, and in accordance with any applicable federal or state privacy and confidentiality laws.

CONTACT TRACING IN COMBINATION WITH ISOLATION AND QUARANTINE

Prompt collaboration between IHEs and health departments to implement case investigation and contact tracing can effectively break the chain of transmission and prevent further spread of the virus in the IHE setting and the community. All COVID-19 case investigation and contact tracing should be done in coordination with state, local, tribal and territorial public health authorities and in accordance with local requirements and guidance. IHEs should continue to support investigation and contact tracing detailed in CDC’s Guidance for Case Investigation and Contact Tracing in IHEs. People who are fully vaccinated with no COVID-like symptoms do not need to quarantine or be restricted from work following an exposure to someone with suspected or confirmed COVID-19, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.

VARIANTS

Variants of the virus that causes COVID-19 are spreading in the United States. Current data suggest that COVID-19 vaccines authorized for use in the United States offer protection against known variants. CDC has systems in place to monitor how common these variants are and to look for the emergence of new variants. CDC will continue to monitor variants to see if they have any impact on how COVID-19 vaccines work in real-world conditions. For more information see CDC’s COVID-19 Vaccines Work page.

If IHEs experience increases in COVID-19 cases among fully vaccinated persons, administrators should promptly contact their local or state public health department and determine whether they need to re-institute, intensify or implement certain prevention strategies.

Top of Page

SECTION 3: GUIDANCE FOR IHES WHERE NOT EVERYONE IS FULLY VACCINATED

IHEs where not everyone is fully vaccinated will have a mixed population of both people who are fully vaccinated and people who are not fully vaccinated on campus which requires decision making to protect the people who are not fully vaccinated.

GENERAL CONSIDERATIONS

Multiple factors should inform the optimal implementation of layered prevention strategies by IHEs. Ideally, consideration would be given to both the direct campus population as well as the surrounding community. The primary factors to consider include: 1) level of community transmission of COVID-19 ; 2) COVID-19 vaccination coverage, including among students, faculty, and staff; 3) implementation of a robust, frequent SARS-CoV-2 screening testing program with high participation from the unvaccinated campus population; and 4) any local COVID-19 outbreaks or increasing trends. Discussion of these factors should occur in collaboration with local or state public health partners.

PREVENTION STRATEGIES THAT REDUCE SPREAD

IHE administrators should create programs and policies that facilitate the adoption and implementation of prevention strategies to slow the spread of COVID-19 at the IHE and in the local community. Evidence-based prevention strategies, including vaccination, should be implemented, and layered in IHE settings. Key prevention strategies include

* Offering and promoting vaccination
* Consistent and correct use of masks
* Physical distancing
* Handwashing and respiratory etiquette
* Contact tracing in combination with isolation and quarantine
* Testing for COVID-19
* Maintaining healthy environments (increased ventilation and cleaning)
* Maintaining healthy operations (communications, supportive policies and health equity)

These prevention strategies remain critical in IHE and community settings with mixed populations of both people who are fully vaccinated and people who are not fully vaccinated.

Particularly in areas of substantial to high transmission, IHEs in collaboration with their local or state health department may consider maintaining or implementing additional prevention strategies including physical distancing and mask use indoors by all students, faculty, staff, and other people such as visitors, including those who are fully vaccinated.

WEARING A MASK

When people who are not fully vaccinated correctly wear a mask, they protect others as well as themselves. Consistent and correct mask use by people who are not fully vaccinated is especially important indoors and in crowded settings, when physical distancing cannot be maintained. Given evidence of limited transmission of COVID-19 outdoors,1,2,3,4,5,6 CDC has updated its guidance for outdoor mask use among people who are not fully vaccinated.

Administrators should encourage people who are not fully vaccinated and those who might need to take extra precautions to wear a mask consistently and correctly:

* Indoors. Mask use is recommended for people who are not fully vaccinated including children. Children under the age of 2 should not wear a mask.
* Outdoors. In general, people do not need to wear masks when outdoors. However, particularly in areas of substantial to high transmission, CDC recommends that people who are not fully vaccinated wear a mask in crowded outdoor settings or during activities that involve sustained close contact with other people who are not fully vaccinated.

Although people who are fully vaccinated do not need to wear masks, IHEs should be supportive of vaccinated people who choose to wear a mask.

IHEs that continue to require universal mask policies should make exceptions for the following categories of people:

* A person with a disability who cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act (42 U.S.C. 12101 et seq.).
* A person for whom wearing a mask would create a risk to workplace health, safety, or job duty as determined by the relevant workplace safety guidelines or federal regulations.

PHYSICAL DISTANCING

Physical distancing means keeping space of at least 6 feet (about 2 arm lengths) between people who are not from your household in both indoor and outdoor spaces. People who are not fully vaccinated should continue to practice physical distancing.

Promote physical distancing by

* Hosting virtual-only activities, events, and gatherings (of all sizes).
* Holding activities, events, and gatherings outdoors in areas that can accommodate physical distancing, when possible.
* Spacing out or blocking off rows, chairs, and/or table seating positions in communal use shared spaces (such as classrooms, dining halls, locker rooms, laboratory facilities, libraries, student centers, and lecture rooms).
* Limiting occupancy and requiring mask use by people who are not fully vaccinated, including drivers, and on campus buses/shuttles or other vehicles. Alternate or block off rows and increase ventilation (i.e., open windows if possible).

HAND HYGIENE AND RESPIRATORY ETIQUETTE

IHEs should facilitate health-promoting behaviors such as hand washing and respiratory etiquette to reduce the spread of infectious illnesses including COVID-19.

IHEs can place visual cues such as handwashing posters, stickers, and other materials in highly visible areas. They can download and print handwashing materials or order handwashing materials from CDC for free using CDC-INFO on Demand.

HOUSING AND COMMUNAL SPACES

Shared housing includes a broad range of settings, such as apartments, condominiums, student or faculty/staff housing, and fraternity and sorority housing. IHE administrators should refer to CDC’s Guidance for Shared and Congregate Housing.

Additionally consider:

* If the IHE designates fully vaccinated dorms, floors or complexes, those areas should follow CDC’s Interim Public Health Recommendations for Fully Vaccinated People.
* Housing students who are not fully vaccinated in single rooms instead of shared rooms when feasible.7
* Establishing cohorts of people who are not fully vaccinated, such as groups of dorm rooms or dorm floors that do not mix with other cohorts to minimize transmission across cohorts and facilitate contact tracing. All units that share a bathroom should be included in a cohort. Roommates/suite-mates can be considered a household and do not need to use masks or physically distance within the household “unit” (e.g., dorm room or suite) unless someone in the household is ill.
* Close or limit the capacity of communal use shared spaces such as dining areas, game rooms, exercise rooms, and lounges, if possible, to decrease mixing among non-cohort people who are not fully vaccinated. Consider limiting use of communal use shared space to people who are fully vaccinated.

* Limit building access by non-residents, including outside guests and non-essential visitors, to dorms and residence halls.

CONTACT TRACING IN COMBINATION WITH ISOLATION AND QUARANTINE

CASE INVESTIGATION AND CONTACT TRACING

All COVID-19 case investigation and contact tracing should be done in coordination with state, local, tribal and territorial public health authorities and in accordance with local requirements and guidance. IHEs should continue to support investigation and contact tracing detailed in CDC’s Guidance for Case Investigation and Contact Tracing in IHEs. IHE administrators should take a proactive role in preparing for COVID-19 case investigation and contact tracing detailed in CDC’s Guidance for Case Investigation and Contact Tracing in IHEs. It is important that case investigations and contact tracing are conducted in a culturally appropriate manner consistent with applicable privacy, public health, healthcare, and workplace laws and regulations.

* Case investigation and contact tracing are essential interventions in a successful, multipronged response to COVID-19, and should be implemented along with other prevention strategies such as offering and promoting vaccination, consistent and correct use of masks and physical distancing among people who are not fully vaccinated.8
* Contact tracing with students, faculty, and staff associated with the campus should be anticipated as a crucial strategy to reduce further transmission once a case is identified consistent with applicable privacy, public health, healthcare, and workplace laws and regulations.

Consistent with applicable privacy laws, IHE officials should plan to provide information and records to aid in the identification of exposures, and notify close contacts, as appropriate, of exposure as soon as possible after the IHE is notified that someone in the IHE has tested positive or been diagnosed with COVID-19.

QUARANTINE AND ISOLATION

Some students, faculty, and staff might develop symptoms of COVID-19 while on campus. IHE administrators should be prepared for this possibility and should clearly communicate to students, faculty, and staff actions to take when responding to someone who is sick with COVID-19. IHE administrators should collaborate with local public health authorities to create a plan for quarantine and isolation to protect persons by preventing exposure to people who have or might have COVID-19. IHEs should facilitate isolation of students, staff, educators, contractors, or volunteers with suspected or confirmed COVID-19 and prompt reporting to the health department and follow Considerations for Case Investigation and Contact Tracing in K-12 Schools and Institutions of Higher Education.

TESTING FOR COVID-19

Testing can slow and stop the spread of COVID-19. Testing must be carried out in a way that protects individuals’ privacy and confidentiality, is consistent with applicable laws and regulations, and integrates with state, local, and tribal public health systems.

IHEs should conduct diagnostic or screening testing of students, faculty, and staff for purposes of surveillance or in the context of an outbreak; however, the recommendations vary based on whether or not a person is fully vaccinated.

* Diagnostic testing is intended to identify current infection in individuals and is performed when a person has signs or symptoms consistent with COVID-19, or when a person who is not fully vaccinated is asymptomatic but has recent known or suspected exposure to SARS-CoV-2.
* Students, faculty, and staff who are fully vaccinated can refrain from testing following a known exposure if they are asymptomatic. People who are fully vaccinated should continue to get tested if experiencing COVID-19 symptoms.
* Screening testing is intended to identify infected people who are asymptomatic and do not have known, suspected, or reported exposure to SARS-CoV-2. Screening helps to identify unknown cases so that measures can be taken to prevent further transmission.
* Students, faculty, and staff who are fully vaccinated can refrain from routine screening testing, if feasible.

IHE officials should determine in collaboration with local health department officials the nature of any testing strategy to be implemented for purposes of diagnosis, screening, or outbreak response, and if so, how to best do so. Testing strategies implemented should be done as part of a larger COVID-19 prevention plan. IHE testing guidance can be found at CDC’s Interim Guidance for SARS-CoV-2 Testing and Screening at Institutions of Higher Education (IHEs).

IHEs may consider maintaining documentation of individuals’ vaccination status to inform testing, contact tracing efforts, and quarantine/isolation practices. It is recommended that fully vaccinated people with no COVID-19-like symptoms and no known exposure should be exempted from routine screening testing programs. Vaccination information should be obtained with appropriate safeguards to protect personally identifiable information and HIPAA-sensitive information from unlawful release.

SYMPTOM SCREENING

Symptom screening will fail to identify some people who have the virus that causes COVID-19. Symptom screening cannot identify people with COVID-19 who are asymptomatic (i.e., do not have symptoms) or pre-symptomatic (have not developed signs or symptoms yet but will later). Others might have symptoms that are so mild that they might not notice them.

* Encourage students, faculty, and staff to perform daily health screenings at home for infectious illnesses, including COVID-19. Encourage students, faculty, and staff with signs or symptoms of infectious illness, including COVID-19, to stay home when sick and/or seek medical care. A COVID-19 self-checker may be used to help decide when to seek COVID-19 testing or medical care.
* If symptom screening is conducted, ensure that symptom screening is done safely, respectfully, and in accordance with any applicable federal or state privacy and confidentiality laws.

COMMUNICATING PREVENTION STRATEGIES

* Designate staff member(s) or a specific office to be officially responsible for replying to COVID-19 concerns. When students, faculty, or staff develop symptoms of COVID-19, test positive for COVID-19, or are exposed to someone with COVID-19, they should report to the IHE designated staff or office.

* Post signs in highly visible locations (such as building entrances, restrooms, and dining areas) and communicate with students, faculty, and staff via email and social media about prevention strategies, such as getting a COVID-19 vaccine, consistent and correct use of masks, physical distancing, handwashing (or use of hand sanitizer), covering their mouths and noses with a tissue or use the inside of their elbow or mask if they cough or sneeze. Signs should include visual cues. Use CDC’s print communication materials developed to support COVID-19 recommendations. Materials are available in multiple languages and free for download and may be printed on a standard office printer.
* Use simple, clear, and effective language (for example, in videos) about behaviors that reduce the spread of COVID-19 when communicating with students, faculty, and staff (such as on IHE websites, in emails, and on IHE social media accounts).
* Students, faculty, and staff should attend a virtual training on all campus prevention strategies, policies, and procedures. This type of training can be useful for incoming students who were not in attendance during the previous academic year.
* Use communication methods that are accessible for all students, faculty, staff, and other essential visitors (such as parents or guardians). Ensure materials can accommodate diverse audiences, such as people who have limited English proficiency (LEP) and people with disabilities. Partnerships to provide public service announcements (PSA) might be useful, such as The Corporation for Public Broadcasting (CPB) PSA to Houston-based tribal and Historically Black Colleges and Universities. The CPB campaign is expected to provide trusted, life-saving information to populations that have been disproportionately affected by the pandemic.9

Top of Page

SECTION 4: GENERAL CONSIDERATIONS FOR ALL IHES

This section is intended for all IHEs regardless of policy on COVID-19 vaccination. The considerations included here will help IHEs to prevent any infectious illness transmission among students, faculty, staff, and visitors.

CLEANING, IMPROVING VENTILATION, AND MAINTAINING HEALTHY FACILITIES

WHEN TO CLEAN

Cleaning with products containing soap or detergent reduces germs on surfaces and objects by removing contaminants and may weaken or damage some of the virus particles, which decreases risk of infection from surfaces.

Cleaning high touch surfaces and shared objects once a day is usually enough to sufficiently remove virus that may be on surfaces unless someone with confirmed or suspected COVID-19 has been in your facility. Disinfecting (using disinfectants on U.S. Environmental Protection Agency [EPA]’s List) removes any remaining germs on surfaces, which further reduces any risk of spreading infection. For more information on cleaning your facility regularly and cleaning your facility when someone is sick, see Cleaning and Disinfecting Your Facility.

WHEN TO DISINFECT

You may want to either clean more frequently or choose to disinfect (in addition to cleaning) in shared spaces if certain conditions apply that can increase the risk of infection from touching surfaces, such as:

* High transmission of COVID-19 in your community
* Infrequent hand hygiene
* The space is occupied by people at increased risk for severe illness from COVID-19

If there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean AND disinfect the space.

USE DISINFECTANTS SAFELY

Always read and follow the directions on how to use and store cleaning and disinfecting products. Ventilate the space when using these products.

Always follow standard practices and appropriate regulations specific to your facility for minimum standards for cleaning and disinfection. For more information on cleaning and disinfecting, see Cleaning and Disinfecting Your Facility.

IMPROVING VENTILATION

Improving ventilation is an important COVID-19 prevention strategy for IHEs. Along with other preventive strategies, protective ventilation practices and interventions can reduce the airborne concentration of viral particles and reduce the overall viral dose to occupants. For more specific information about maintenance and use of ventilation equipment and other ventilation considerations, refer to CDC’s Ventilation in Buildings webpage. CDC’s Ventilation FAQs and Improving Ventilation in Your Home webpage further describe actions to improve ventilation. Additional ventilation recommendations for different types of IHE buildings can be found in the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) schools and universities guidance document.

FOOD SERVICE AND COMMUNAL DINING

Currently, there is no evidence to suggest that COVID-19 is spread by handling or eating food. However, consuming refreshments, snacks, and meals with persons not from the same household may increase the risk of getting and spreading COVID-19 among people who are not fully vaccinated because masks are removed when eating or drinking.

* Promote prevention measures. Require staff and volunteers to wash their hands and encourage diners to wash their hand or use an alcohol-based hand sanitizer (before and after serving or eating). In indoor dining areas, people who are not fully vaccinated should wear a mask when not actively eating or drinking and physically distance.
* Increase airflow and ventilation. Prioritize outdoor dining and improved ventilation in indoor dining spaces.
* Avoid crowding. Particularly in areas with substantial to high levels of community transmission, reduce seating capacity, use markers and guides to ensure that people remain at least 6 feet apart in a mixed campus when waiting in line to order or pick up. Stagger use of dining areas.

* Consider offering to-go options and serve individually plated meals. If traditional self-serve stations are offered, CDC provides recommendations to reduce the risk of getting and spreading COVID-19.
* Clean regularly. For food contact surfaces, continue following all routine requirements for cleaning and sanitization. Non-food contact surfaces should be cleaned at least daily. If someone with COVID-19 has been in the facility in the previous 24 hours, non-food contact surfaces should be disinfected. See CDC’s Food and COVID-19 for more detailed information. Food service operators can find more detailed recommendations relevant to food service establishments in Considerations for Restaurant and Bar Operators and FAQs for Institutional Food Service Operators. For more information on COVID-19 adapted community food serving and distribution models, visit Safely Distributing School Meals during COVID-19.

IHE administrators can also refer to CDC’s Guidance for School Nutrition Professionals and Volunteers for safe operations of food service and communal dining.

WATER SYSTEMS

The temporary shutdown or reduced operation of IHEs and reductions in normal water use can create hazards for returning students, faculty, and staff. Check for hazards such as mold, Legionella (the bacteria that causes Legionnaire’s Disease), and lead and copper contamination from plumbing that has corroded.

* For more information, refer to the ASHRAE Guidance for Building Operations During the COVID-19 Pandemic, CDC Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation and the Environmental Protection Agency’s Information on Maintaining or Restoring Water Quality in Buildings with Low or No Use.

SERVICE ANIMALS AND OTHER ANIMALS IN CAMPUS BUILDINGS

* At this time, there is no evidence that animals play a significant role in spreading SARS-CoV-2, the virus that causes COVID-19, to people. We are still learning about this virus, but we know that it can spread from people to animals in some situations, especially during close contact.
* Refer to CDC’s Guidance for Handlers of Service and Therapy Animals and the American Veterinary Medical Association (AVMA) services, emotional support and therapy animals page when making decisions about allowing therapy animals in campus buildings on a case-by-case basis.

HEALTH EQUITY

Long-standing systemic health and social inequities have put many racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19. American Indian/Alaska Native, Black, and Hispanic persons are disproportionately affected by COVID-19; these disparities exist among all age groups, including school-aged children and young adults. Because of these disparities, in-person instruction on campuses might pose a greater risk of COVID-19 to disproportionately affected populations. For these reasons, health equity considerations related to in-person instruction are an integral part of decision-making.

Addressing social and racial injustice and inequity is at the forefront of public health. Administrators can help to protect people at increased risk for severe COVID-19 and promote health equity by implementing the following strategies:

* Encourage and support people to get vaccinated as soon as they can.
* Offer options for accommodations, modifications, and assistance to students, faculty, and staff at increased risk for severe illness that limit their exposure risk and allow for education and or work opportunities (such as virtual learning, telework, and modified job responsibilities) to remain available to them.
* Provide inclusive programming and make options available for people with special healthcare needs and disabilities that allow on-site or virtual participation with appropriate accommodations, modifications, and assistance (for example, people with disabilities may need additional support to access and use technology for virtual learning).
* Put in place policies to protect the privacy and health information of all people, consistent with applicable laws.
* Train people at all levels of the organization to identify and address all forms of discrimination consistent with applicable laws and IHE policies.
* Work with others to connect people with resources (for example, healthy foods and stable and safe housing) and services to meet their physical, spiritual, and mental health needs.
* Identify students who might be experiencing homelessness or food insecurity, and identify resources and strategies to address these and other needs related to COVID-19.

SUPPORT COPING AND RESILIENCE
—snipped—
* Promote employees and students eating healthy, exercising, getting sleep and findingto eat healthy, exercise, get sleep, and find time to unwind.
—snipped—
* Consider having an employee assistance program (EAP) through which faculty and staff can get counseling.
* Share facts about COVID-19 regularly with students, faculty, and staff through trusted sources of information to counter the spread of misinformation, reduce stigma, and mitigate fear.
* Positive, pro-active messaging, education, and role-modeling is encouraged. Speak out against negative behaviors that stigmatize individuals who test positive for or are exposed to COVID-19, including negative statements on social media, by promoting positive messaging that does not discourage mitigation behaviors and testing.
* Consider posting signs for the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746.
* Ensure continuity of mental health services, such as offering remote counseling.
* Encourage students, faculty, and staff to call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), 1-888-628-9454 for Spanish, or Lifeline Crisis Chat if they are feeling overwhelmed with emotions like sadness, depression, anxiety, or feel like wanting to harm themselves or others.

Top of Page

PREPARE FOR WHEN SOMEONE GETS SICK

IHEs may consider implementing several strategies to prepare for when someone gets sick.

Advise Sick Individuals of Home Isolation Criteria

* Sick faculty, staff, or students should not return to in-person classes or IHE facilities, or end isolation until they have met CDC’s criteria to discontinue home isolation.

Isolate and Transport Those Who are Sick

* Make sure that faculty, staff, and students know they should not come to the IHE if they are sick, and should notify IHE officials (e.g., IHE designated COVID-19 point of contact) if they become sick with COVID-19 symptoms, test positive for COVID-19, or have been exposed to someone with COVID-19 symptoms or a confirmed or suspected case.
* Immediately separate faculty, staff, and students with COVID-19 symptoms (such as fever, cough, or shortness of breath). Individuals who are sick should go home or to a healthcare facility, depending on how severe their symptoms are, and follow CDC Guidance for caring for oneself and others who are sick. IHEs may follow CDC’s Guidance for Shared or Congregate Housing for those that live in IHE housing.
* IHE administrators should immediately provide options to separate people with COVID-19 symptoms by providing distance learning options, self-isolation rooms in dormitories or other housing facilities, and food delivery service for on-campus students in self-isolation.

* IHE administrators and healthcare providers should identify an isolation room, area, or building/floor (for on-campus housing) to separate anyone who has COVID-19 symptoms or tests positive but does not have symptoms. IHE healthcare providers should use standard and transmission-based precautions when caring for sick people. See: What Healthcare Personnel Should Know About Caring for Patients with Confirmed or Possible COVID-19

* Establish procedures for safely transporting anyone who is sick to a place where they can be isolated from students, faculty, and staff or to a healthcare If you are calling an ambulance or bringing someone to the hospital, try to call first to alert them that the person might have COVID-19.
* IHEs should develop a plan for students to stay at their current place of residence or arrange for accommodations outside the campus for isolating and to attend virtual classes. This plan should also address needed services including accommodations and isolation plans for COVID-19 positive students during an outbreak as well as quarantine plans for close contacts.

Clean and Disinfect

* Close off areas used by a sick person and do not use these areas until after cleaning and disinfecting.
* Wait at least 24 hours before cleaning and disinfecting. If 24 hours is not feasible, wait as long as possible. Ensure safe and correct use and storage of cleaning and disinfection products, including storing products securely away from children.

Notify Health Officials and Close Contacts

* In accordance with applicable federal, state and local laws and regulations, IHEs should notify local health officials, faculty, staff, and students immediately of any case of COVID-19 while maintaining confidentiality in accordance with the Americans with Disabilities Act (ADA), FERPA or and other applicable laws and regulations.
* Inform those who have had close contact with a person diagnosed with COVID-19 to stay home or in their living quarters and self-monitor for symptoms, and follow CDC guidance if symptoms develop.
* IHEs might need to implement short-term closure procedures. If this happens, IHEs should work with local public health officials to determine whether in-person classes need to be cancelled or moved to virtual delivery and/or buildings and facilities need to close. An initial short-term suspension of in-person classes and cancellation of events and activities (e.g., club meetings; on-campus sport, theater, and music events) allows time for the local health officials to gain a better understanding of the COVID-19 situation and help the IHE determine appropriate next steps, including whether an extended suspension duration is needed to stop or slow further spread of COVID-19. IHEs should develop a plan for students who develop symptoms of, or test positive for, or have close contact with a person with COVID-19. Students should isolate or quarantine at their current place of residence, or arrange for accommodations on or near campus to isolate and attend virtual classes. This plan should address linking students to any support services offered by their health departments. Sending people with COVID-19 to distant homes is not desirable because it could lead to community spread.
* Local health officials’ recommendations for the duration and extent of suspension of in-person classes, 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 context of local incidence, case-counts, and ongoing transmission in the community.

Additional considerations for students with disabilities or at higher risk for severe illness from COVID-19

Plan for accommodations, modifications, and assistance for students with disabilities and special healthcare needs

* An individualized approach for COVID-19 may be required for some people with disabilities. For example, consider the needs of people who have limited mobility, difficulty accessing information due to visual, hearing or other disabilities, require close contact with direct service providers, have trouble understanding information, have difficulties with changes in routines, or have other concerns related to their disability. This approach should account for the following:
* Wearing masks may be difficult for people with sensory (e.g., visual or hearing) or cognitive disabilities or behavioral issues, or persons with chronic health conditions that cause breathing difficulties. They should consult with their healthcare providers for advice about wearing masks and be particularly attentive to social distancing.
* Persons with a hearing disability may require assistance with understanding those wearing a face mask.
* Students may require assistance or visual and verbal reminders to cover their mouth and nose with a tissue, throw the tissue in the trash, and wash their hands afterwards.
* Where service or therapy animals are used, use guidance to protect the animal from COVID-19.
* Cleaning and disinfecting may affect those with sensory or respiratory issues.
* Handwashing with soap and water for at least 20 seconds or using a hand sanitizer (containing at least 60% alcohol) may require assistance or supervision.

Follow guidance for Direct Service Providers (DSPs)

* Direct Service Providers (personal care attendants, direct support professionals, paraprofessionals, therapists, and others) provide a variety of home- and community-based, health-related services that support individuals with disabilities. Services provided may include activities of daily living, access to health services, and more. DSPs are essential for the health and well-being of the people individuals they serve.
* Ask DSPs before they enter school if they are experiencing any symptoms of COVID-19 or if they have been in contact with someone who has COVID-19. If DSPs provide services in other IHEs, ask specifically whether any of the other IHEs have had positive cases. For guidance related to screening of staff (to include DSPs), please refer to CDC’s Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 and the Prevent Transmission Among Employees section of CDC’s Resuming Business Toolkit [1.1 MB, 22 pages].
* If there is potential that DSPs could be splashed or sprayed by bodily fluids during work, they should use standard precautions. Personal protective equipment (PPE) includes a face mask, eye protection, disposable gloves, and a gown.
* CDC has developed guidance for DSPs. IHE administrators should review the DSP guidance and ensure that DSPs needing to enter the school are aware of those preventive actions.

Other Resources

* Young Adults: Care for Yourself [840 KB, 1 page]
* Interim Considerations for Institutions of Higher Education Administrators for SARS-CoV-2 Testing
* Guidance for Institutions of Higher Education with Students Participating in International Travel or Study Abroad Programs
* Guidance for Direct Service Providers, Caregivers, Parents, and People with Developmental and Behavioral Disorders
* Guidance for Direct Service Providers
* Guidance for Handlers of Service and Therapy Animals
* Latest COVID-19 Information
* Cleaning and Disinfection
* Guidance for Businesses and Employers
* Guidance for Schools and Childcare Centers
* COVID-19 Prevention
* Handwashing Information
* Masks
* Social Distancing
* COVID-19 Frequently Asked Questions
* People at Higher Risk
* Managing Stress and Coping
* HIPAA and COVID-19
* CDC Communication Resources
* Community Mitigation
* OSHA Guidance on Preparing Workplaces for COVID-19 [ 1.3 MB, 35 pages]
* FERPA and the Coronavirus Disease 2019 (COVID-19)

Top of Page

PREVIOUS UPDATES

Updates from Previous ContentOffer an employee assistance program (EAP) through which faculty and staff can get counseling.
* Share facts about COVID-19 regularly with students, faculty, and staff through trusted sources of information to counter the spread of misinformation, reduce stigma, and lessen fear.
* Positive, pro-active messaging, education, and role-modeling is encouraged. Consistent with applicable laws and IHE policies, address negative behaviors that stigmatize individuals who test positive for or are exposed to COVID-19, including negative statements on social media, by promoting positive messaging that does not discourage vaccination, prevention behaviors, and testing.
* Consider posting signs for the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746.
* Ensure continuity of mental health services, such as offering remote counseling.
* Encourage students, faculty, and staff to call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), 1-888-628-9454 for Spanish, or Lifeline Crisis if they are feeling overwhelmed with emotions like sadness, depression, anxiety, or feel like wanting to harm themselves or others.

CONSIDERATIONS FOR STUDENTS, FACULTY, AND STAFF WITH DISABILITIES

* People with disabilities should be highly encouraged to get vaccinated and be fully integrated into the most appropriate learning environment with the proper accommodations.
* Disability resource centers should review policies and procedures to assess/qualify students for new accommodations, modifications, and assistance that might be needed due to changes in response to the COVID-19 pandemic.
* Consider the individualized approaches for COVID-19 prevention that may be needed for some people with disabilities.
* Provide accommodations for people who might have difficulty with mask use, such as some people with disabilities or certain medical conditions. Allow exceptions in the IHEs mask use policy. People concerned about their ability to consistently and correctly use a mask should consult with their healthcare provider or IHE disability resource center, for suggested adaptations and alternatives.
* Ensure education remains accessible for students with disabilities as prevention strategies to reduce cases of COVID-19 are implemented.
* Encourage all students, faculty, and staff to discuss any accommodations they might need with the IHE’s disability resource center.

GATHERINGS, EVENTS, AND VISITORS

Crowded settings still present a greater risk of transmission among people who have not been fully vaccinated, especially when they bring together people of unknown vaccination status from different communities where community transmission is substantial to high. People who are not fully vaccinated should continue to avoid large gatherings, but if they choose to attend, they should wear well-fitting masks that cover the mouth and nose, maintain physical distancing, and practice good hand hygiene. For mixed campus IHEs, in-person instruction should be prioritized over extracurricular activities, including sports and school events, to minimize risk of transmission in schools and to protect in-person learning. Mixed campus IHEs may consider limiting the size of gatherings to maintain physical distance as an additional measure.

SPORTS

People who are fully vaccinated no longer need to wear a mask or physically distance in any setting including while participating in sports. People who are fully vaccinated can also refrain from quarantine following a known exposure if asymptomatic, facilitating continued participation in in-person learning and sports. Due to increased exhalation that occurs during physical activity, many sports put players, coaches, trainers, etc. who are not fully vaccinated at increased risk for getting and spreading COVID-19. Close contact and indoor sports are particularly risky.10

IHEs should follow CDC Guidance for Sports as long as it does not conflict with state, local, tribal, or territorial requirements and guidance. IHE administrators should also:

* Offer and promote vaccination to all athletes, coaches, trainers, etc.
* Prior to traveling, establish testing protocols for sport team members including coaches and support staff who are not fully vaccinated. Physical distancing can be difficult when flying or traveling by bus. Follow CDC guidance for travel during the COVID-19 pandemic.
* Prior to hosting large sporting events, establish policies for athletes, coaches, staff, and spectators.
* Learn more about NCAA’s recommendations to protect health and safety of college athletes from COVID-19: https://www.ncaa.org/sport-science-institute/covid-19-coronavirus

STUDY ABROAD AND TRAVEL

IHEs planning study-abroad programs should check CDC’s destination-specific Travel Health Notices (THN) for information about the COVID-19 situation in the destination or host country. IHEs should postpone programs in destinations with very high COVID-19 levels (Level 4 Travel Health Notice). IHEs should have plans in place to take action if situations in the destination change and COVID-19 levels become very high during the program. IHEs may consider requiring vaccination as a condition of a study-abroad program.

IHEs planning study-abroad programs should advise and strongly encourage students to

* Get fully vaccinated against COVID-19 before traveling.
* Follow CDC guidance for international travel.
* Follow general public health considerations such as handwashing, cleaning/disinfection and respiratory etiquette.

Students may face unpredictable circumstances accessing medical care if they get sick or injured in their host country. Routine healthcare and emergency medical services may be impacted by COVID-19 at the destination.

Study-abroad programs should ensure that students are aware of and follow all airline and destination entry requirements, such as testing, vaccination, mask wearing and quarantine. They should be aware that if they do not follow the destination’s requirements, they may be denied entry and required to return to the United States. Programs and students should check with the Office of Foreign Affairs or Ministry of Health or the US Department of State, Bureau of Consular Affairs, Country Information page for destination-specific entry requirements. Before studying abroad, programs and students should consider obtaining insurance to cover health care and emergency evacuation while abroad.

Programs should advise students who are at increased risk for severe COVID-19 to discuss any study abroad plans with their healthcare provider. For more information and guidance on safety precautions for students before, during, and after travel, please visit CDC’s Studying Abroad webpage or CDC’s Yellow Book section Study Abroad and Other International Student Travel.

INTERNATIONAL STUDENTS

International students vaccinated outside of the United States should refer to Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States for the need for vaccinations upon arrival in the United States.

Top of Page

KEY TERMS

Campus: The grounds and buildings of a university, college, or school (including community colleges and technical schools). The grounds include classrooms, libraries, outdoor and indoor common areas, sports stadiums, auditoriums, dorms and other housing, campus recreation centers, cafeterias, dining halls, etc.

People who are not fully vaccinated: People who are not fully vaccinated are individuals of all ages, including children, that have not completed a vaccination series to protect against COVID-19.

Fully vaccinated people/People who are fully vaccinated: People are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson [J&J]/Janssen)±.

†This guidance applies to COVID-19 vaccines currently authorized for emergency use by the U.S. Food and Drug Administration: Pfizer-BioNTech, Moderna, and Johnson and Johnson (J&J)/Janssen COVID-19 vaccines. This guidance can also be applied to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization (e.g. AstraZeneca/Oxford).

Mixed campus: A mixed campus includes people who have completed their COVID-19 vaccination series and people who have not completed their vaccination series to protect against COVID-19.

Fully vaccinated campus: IHEs where all students, faculty, and staff have completed their vaccination series to protect against COVID-19 prior to returning to campus except those people who are unable to get the COVID-19 vaccine due to medical or other reasons.

Additional Resources
* Coronavirus Disease 2019 (COVID-19) Pandemic
* Resources for Colleges, Universities and Higher Learning
* Health Equity
* Worker Safety and Support
* Communication Resources
* CDC COVID-19 Vaccination Program Provider Requirements and Support
* Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19)
* Workplace Vaccination Program
* Guidance for U.S. Healthcare Facilities about Coronavirus (COVID-19)
* COVID-19 Behaviors Encouraging Protective Among College Students
* The Department of Education COVID-19 Handbook Volume 3: Strategies for Safe Operation and Addressing the Impact of COVID-19 on Higher Education Students, Faculty, and Staff)

References
1. Fouda B, Tram HPB, Makram OM, Abdalla AS, Singh T, Hung IC, Raut A, Hemmeda L, Alahmar M, ElHawary AS, Awad DM, Huy NT. Identifying SARS-CoV2 transmission cluster category: An analysis of country government database. J Infect Public Health. 2021 Apr;14(4):461-467. DOI: 10.1016/j.jiph.2021.01.006. Epub 2021 Jan 18. PMID: 33743366; PMCID: PMC7813483.
2. Belosi F, Conte M, Gianelle V, Santachiara G, Contini D. On the concentration of SARS-CoV-2 in outdoor air and the interaction with pre-existing atmospheric particles. Environ Res. 2021 Feb;193:110603. DOI: 10.1016/j.envres.2020.110603. Epub 2020 Dec 8. PMID: 33307081; PMCID: PMC7833947.
3. Bulfone TC, Malekinejad M, Rutherford GW, Razani N. Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic Review. J Infect Dis. 2021 Feb 24;223(4):550-561. DOI: 10.1093/infdis/jiaa742. PMID: 33249484; PMCID: PMC7798940.
4. Chirizzi D, Conte M, Feltracco M, Dinoi A, Gregoris E, Barbaro E, La Bella G, Ciccarese G, La Salandra G, Gambaro A, Contini D. SARS-CoV-2 concentrations and virus-laden aerosol size distributions in outdoor air in north and south of Italy. Environ Int. 2021 Jan;146:106255. DOI: 10.1016/j.envint.2020.106255. Epub 2020 Nov 12. PMID: 33221596; PMCID: PMC7659514.
5. Qian H, Miao T, Liu L, Zheng X, Luo D, Li Y. Indoor transmission of SARS-CoV-2. Indoor Air. 2021 May;31(3):639-645. DOI: 10.1111/ina.12766. Epub 2020 Nov 20. PMID: 33131151.
6. Sundar V, Bhaskar E. Low secondary transmission rates of SARS-CoV-2 infection among contacts of construction laborers at open air environment. Germs. 2021 Mar 15;11(1):128-131. doi: 10.18683/germs.2021.1250. PMID: 33898351; PMCID: PMC8057850.
7. Borowiak M, Ning F, Pei J, et al. Controlling the Spread of COVID-19 on College Campuses. Mathematical Biosciences and Engineering. 18(1): 551-563. Published 2020 Dec 14. doi:10.3934/mbe.2021030
8. Fox M, Bailey D, Seamon M, Miranda M. Response to a COVID-19 Outbreak on a University Campus — Indiana, August 2020. MMWR Morb Mortal Wkly Rep. 2021;70(4):118-122. Published 2021 Jan 29. doi:10.15585/mmwr.mm7004a3.
9. The Corporation for Public Broadcasting. CPB Funds COVID-19 PSAs for Tribal and HBCU Public Radio Stations. Press Release 2021 Apr 08.
10. Atrubin D, Wiese M, Bohinc B. An Outbreak of COVID-19 Associated with a Recreational Hockey Game — Florida, June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(41):1492-1493. Published 2020 Oct 16. doi:10.15585/mmwr.mm6941a4

PREVIOUS UPDATES

Updates from Previous Content

As of December 31, 2020:

* Updated considerations for Direct Service Providers (DSPs)
—snipped—

—snipped—
Updated May 103, 2021
—snipped—
TYPES OF SPREAD

COVID-19 is spread in three main ways:

1.* Breathing in air when close to an infected person who is exhaling small droplets and particles that contain the virus.
2.* Having these small droplets and particles that contain virus land on the eyes, nose, or mouth, especially through splashes and sprays like a cough or sneeze.
3.* Touching eyes, nose, or mouth with hands that have the virus on them.
—snipped—
The best way to prevent illness is to avoid being exposed to this virus. Protect yourself and others from all ways COVID-19 spreads by taking these prevention actions:

* Get a COVID-19 vaccine as soon as you can.
* Wear a mask that covers your nose and mouth to help protect yourself and others.
* Stay at least 6 feet apart from others who don’t live with you.
* Avoid crowds and poorly ventilated indoor spaces, and improve ventilation.
* Wash your hands often with soap and water. Use hand sanitizer if soap and water aren’t available.

Learn more about what you can do to protect yourself and others and what you can do after you’ve been fully vaccinated.

HOW COVID-19 SPREADS

Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.
—snipped—
* Get vaccinateda COVID-19 vaccine as soon as you can.
—snipped—
* Get vaccinateda COVID-19 vaccine as soon as you can.
—snipped—
* Get vaccinateda COVID-19 vaccine as soon as you can.
—snipped—
Learn more about what you can do to protect yourself and others and what you can do after you’ve been fully vaccinated.

COVID-19 AND ANIMALS
—snipped—

—snipped—
Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–DecemberWaning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 20212
—snipped—
February 411, 2022 (EARLY RELEASE)

* Safety Monitoring of COVID-19 Vaccine Booster Doses Among Adults — United States, September 22, 2021–February 6, 2022
* Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 2022

February 11, 2022

* Genomic Surveillance for SARS-CoV-2 Variants: Predominance of the Delta (B.1.617.2) and Omicron (B.1.1.529) Variants — United States, June 2021–January 2022
* Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021
—snipped—