City Council - Emergency Meeting

(AMENDED AGENDA) (ADDING AN ADDITIONAL TELECONFERENCE LOCATION) TWENTYNINE PALMS CITY COUNCIL EMERGENCY MEETING AGENDA 6136 Adobe Road Twentynine Palms, CA 92277 www.29palms.org TELECONFERENCE: Viola Klink Residence 74668 Twilight Drive Twentynine Palms, CA 92277 Morongo Basin Community Healthcare Center 6380 Split Rock Avenue Twentynine Palms, CA 92277 Thursday, March 12, 2020 NOTICE IS HEREBY GIVEN, that the City Council will hold an Emergency Meeting on Thursday, March 12, 2020 at City Hall, 6136 Adobe Road, Twentynine Palms, CA 92277 to consider the following: PUBLIC GATHERING EVENTS CLOSING AS A RESULT OF COVID-19 2:30 P.M. CALL TO ORDER 1. Roll Call ANNOUNCEMENTS PUBLIC COMMENTS This is the time for the public to address the City Council on issues within the jurisdiction of the City Council that are NOT on this agenda. All comments are to be directed to the City Council and shall not consist of any personal attacks. Members of the public are expected to maintain a professional, courteous decorum during their comments. There is a time limitation of three minutes per person. If you haven’t already done so, please fill out name and address slips and give them to the City Clerk. The City Council is prohibited by State law from taking action or discussing items not included on the printed agenda. Public comments on specific agenda items will be deferred until consideration of the item on the agenda. Page 1 of 30 DISCUSSION AND POTENTIAL ACTION ITEMS 2. In Consideration of Public Health, Discussion on Cancelling Public Gatherings within the City, per 3- the “Guidance” of Governor Newsom. 30 SBCO - Country orders cancellation of Large Gathering CA Department of Public Health - Gatherings Postponed or canceled the remainder of the month of March. State of CA - Mass gatherings should be postponed or canceled statewide. CDC - Implementation of Mitigation Strategies for communities with local COVID-19 transmissions ADJOURNMENT It is the intention of the City of Twentynine Palms to comply with the Americans with Disabilities Act in all respects. If you are a person with a disability who requires a disability-related modification or accommodation in order to participate in a meeting, including auxiliary aids or services, please request such modification or accommodation from the City Clerk at (760) 367-4890 (facsimile). Notification at least 48 hours prior to the meeting will enable the City to make reasonable arrangements to assure accessibility to the meeting. Please advise us at the time whether you will require accommodations to participate in meetings on a regular basis. Any person affected by any application on this agenda may submit their concerns in writing prior to the meeting or appear in person and be heard in support or opposition to the proposal at the time the matter is considered on the agenda. The staff reports, applications and environmental documents may be viewed at either the office of Community Development or the office of the City Clerk, 6136 Adobe Road, from 7:00 a.m. until 6:00 p.m. Monday through Thursday, except legal holidays. The Invocation is given per Policy 10-01 and does not reflect the views of the City but rather is an expression of speech by a private citizen making the presentation. Telephone inquiries may be made at (760) 367-6799. If you challenge any agenda issue in court, you may be limited to raising only those issues that you or someone else raised at the public meeting described in this notice, or in written correspondence delivered to the City of Twentynine Palms at, or prior to, the public meeting. This notice of agenda is hereby certified to have been posted on or before 2:30 p.m., March 12, 2020. Cindy Villescas CMC, City Clerk Time/Date Page 2 of 30 lmplementation of Mitigation Strategies for Communities with local COUID-l9 Transmission Eackground When a novel yirr.rs with pandemic potential emerges, nonpharmaceutical interventions, which will be called communiry mitigation strategies in this document, often are the most readily available interventions to help slow transmission of the virus in communities. Community mitigation is a set of actions that persons and communities can take to help slow the spread of respiratory virus infections. Community mitigation is especially important before a vaccine or drug becomes widely available. The following is a framewotk for actions which local and state health departments can recommend in their community to both prepare for and mitigate community transmission o( COVID 19 in the United States. Selection and implementation of these actions should be guided by the local characteristics of disease transmission, demographics, and public health and hea.lthcare system capacity. Guiding principles . Each community is unique, and appropliate mitigation strategies wiII vary based on the level of community Goals transmission, charaateristics of the community and their The goals for using mitigation strategies in communities witl populations, and the local capacity to implement strategies local COVID 19 transmission are to slow the transmission of (Table 1). disease and in partiaular to protect: . Consider all aspects of a community that might be impacted, . tndividuals at increased risk for severe illness, irtcluding including populations most lrrlnerable to severe illness and older adu.lts and persons ofany age with underlying health those that may be more impacted socially or economically, conditions (See Appendix A) and select appropriate actions. . The healthcare and clitical inflastructure workforces . Mitigation strategies can be scaled up or down depending on the evolving local situation. These approaches are used to minimize morbiility and mortality and the social and economic impacts of COVID-19. Individuals, . When developing mitigation plans, communities should communities, businesses, and healthcare organizations are identify ways to ensure the safety and social well-being ofgroups that may be especially impacted by mitigation all part of a community mitigation strategy. These strategies strategies, including individuals at increased risk for severe should be implemented to prepare for and when there is illness. evidence of community transmission. Signals of ongoing community transmission may include detection of conErmed . Activation of community emergency plans is critical for the implementatioh of mitigation strategies. These plans may cases of COVID 19 with no epidemiologic link to travelers or provide additional authorities and coordination needed for known cases, or more than three generations of transmission. interventions to be implemented (Table 2). Implementation is based on: . Activities in Table 2 may be implemented at any time . Emphasizing individual responsibility for implementing regardless of the Ievel of community transmission based on recomrnended personal-level actions guidance on from local and state health ofhcials. . Empowering businesses, schools, and community . The level of activities implemented may vary across the organizations to implement recommended actions, settings described in Tabte 2 (e.g., they may be at a minimal/ particularly in ways that protect persons at increased risk of moderate level for one setting and at a substantial level for severe illness another setting in order to meet community response needs). . Focusing on settings that provide critical infrastructure or . Depending on the level of community spread, Iocal and state services to individuals at increased risk of severe illness public health departments may need to impl€ment mitigation . Minimizing disruptions to dai.ly life to the extent possible strategies for public health functions to identify cases and conduct contact tracing (Table 3). When applied, community mitigation efforts may help facilitate public health activities ,& Iike contact traciog For more information: www.(d(.gov/C0vl Dl 9 Page 3 of 30 Table 1. Local Factors to Consider for Determining Mitigation Strategies Factor Characteristics Epidemiology . Level of commu nity transmission (seeTable 3) . Number and type of outbreaks (e.9., nursing homes, schools, etc.) . lmpact ofthe outbreaks on delivery of healthrare or other critical infrastructure or services . Epidemiology in sunounding jurisdictions Community . Size of community and population density I Chararteristics . Level of community engagement/support ] | j . Size and characteristics ofvulnerable populations . access to tr_eatth |. Transportation (e.9., public, walking) | . Planned larqe events l. Relationship of community to other communities (e.9., transportation hub, tourist destination, etc.) Healthcare capacity . Healthcare workforce . Number of healthcare facilities (including ancillary healthcare facilities) . Testing capacity . lntensive care capacity . Availability of person al protective equipment (PPE) Public health capacity . Pu blic health workforce and availability of resources to implem ent strateg ies . Available support from other state/localgovernment agencies and partner organizations 2 Page 4 of 30 Table 2. (ommunity mitigation strategies by retting and by level of community transmisrion or impa<t ofCOV|D- 19 Potential mitigation adivities a((ording t0 level of (0mmunity transmission or impad of (0VlD'19 by setting [actor one (preparcdners phase) Minimal to moderate 5ubstantial lndividu.li.nd tamili€t . Knowwhere tofnd local Information on . Continue to monrtor loca I inform dtion about Conrinue to monitor o(al informdrion atlloms CoVID l9 and localtr€nd5 ofCOV|D l9cases. COVID-19 in your community. (onnnu€ to pra(tr(e personal prote(t v€ . Know the rign5 and lymptomr ofCOV|D l9 . Continuelopradicep€rlonal protective prepare, jf you or a family and \,!hat to do lfrymplom.ric: (onl nue to put hous€ho d plan nio p a(e membergets ill, or ityour , Stay home when you are sr.k . Continue lo put hourehold plan ioto adion. All individual5 shouid limit (ommunity (ommunlty erperien(es rp re.d of COVID-I 9" , Callyour health c.re prcvide/5 office in . lndividualsatincreated ritkof 5evereillner5 movemenl and adapt to dirruptionr rn routine advance of a virit should coo5ider staying.t home and avoiding aclivities (e.9., !chool a nd/or wo rk (loiurer) gathering5 or other situationr ofpotential ac(odlng to guldance from localoffi(leh. , L mit movementinthe(omm!nity exposu rer. including travel. , Know what additional m€asure! tho5e at hiqh ri5k and who are vulnerable should take. . lmplemenl persona prote.lrve mea5ures (e.9, stay home when sr(k, handwashinq, respiratory etiquetle, clean frequently touched surfa(er daily). ' Cr€atea hourehold planola(ion in (aseof rllness in lhe household or dirruption ofdaily activrti€s due ro covlD-19 in the (ommunity. 2'week supply ol prescriptron ' Consider and over lhe counter medications. food andother e55enli.Le. Know how to qetfood de iv€r€d ifpossible. r Establish ways to communlcate with othe6 {e 9., fam y, fri€nds, co-worker'). r Ertablsh pldnr to telework, what to do about (hildcar€ needt. how to adapt to canceLlation of €ventt . Know about emerge ncy operation s plans for r(ho01s/workplaces of household members. l Page 5 of 30  Potential mitigation adivities a((ording to level of @mmunity tranrmission or impad of(oVlD-19 by setting [ador None (preparednes phare) f/inimal to moderate Substantial td,look/rhild.are . Knowwhere tofind local information on lmplement social distan(ing measurer: Eroader and/or longer term s(hool dismissals, "what childcare COVID l9 and lo(al lrends of COVID-1 9 cases. either asa preventive measure or because of D Red!ce the frequency oflarce gatherings facil tres, K-12 schoois, . (nowthe signsand symproms ofCOV|D l9 (e.9., arremblier, and limit the number of it.ff and/or 5tudent abeente€ism. and colleges and and what to do ifstudents or staffbecome attendee5 per gathering. C.ncellation of 5chool associated univerrilre5 can do to symptomalk al school/chi dcare site. r Aller schedules to redu(e mixing (e.9.. conqreqations, particularly thore wilh prepire for COVID-19, pa i(ipation of high-rhk individuale. if lhe school or fd(ility ' Rev ew and updale emergency operat ons st.qqer recerr, entry/d i5mis 5al timer) pl.n (nc Lrd ng implemenlat on ofsoca r [imit inter-rchool interactions lmplementdirt.nce learning if fea!ible. has(ares of COVIO 19. di(ancing m€a5ure5, dinan(e learning if oriflhecommunityig feasibLe)or develop plan ifon€ 5 not available r Consider dittan(e orelearning in gome expe en(in9 spredd of settingt (0vlo-r9)" . Evaluate whetherthereare rtudentr or 5taff !!hoare atincr€as€d nskof5evere llness and Con5ider .e9u la r health (hecks (e.9., develop plansfor them tocont nuetowork temperature and respiratory symptom or re.e ve edu.ationa rervi.e! ifrherels rcreen lng) of students, rtaft and vlritoR (if moderate levels ofCOV|D l9 transmiision or featible) sho( lerm di5mirgah for schooland , Parents ofch ldr€n al incre.sed ri5k for extraaLrrricular activities as needed (e.9., severc illness 5hould drscuss with their if(asei ln rtaffAtudent!) for cleaning.nd healih (are prov der whether those students contad va(in9. should elay home rn (are of school or Studenttat ancrea5ed ritk of severe illners communrty spre.d. thould (on5ider impl€menting indivdu.l plant in(reated rirl for severe rllnest for distance learning, e-leamin9. ' Staffat 5hould have a plan to 5tay home ifthereare 5.hool-based cases or (ommunity 5pr€ad. . Encoulage naffand nudentr to stay home when sick and notify 5chool .dm nistrators of illness (schoole thould provide non punitlve rickleave option5 to allow rtaffto rtay home when il) . Encourage persondl protectiv€ measures among staff/student5 (e.9.5tay honre when s ck, handwashing, respiralory etiquelte). . Clean and diiinte.l freqLr€ntly to!ched . Ensure hand hyqi€ne 5!pp e5 dre readily available rn burldrngr. 4 Page 6 of 30  Potential mitigation adivities a(@rdin9 to level ofcommunity tranrmisrion or impad ofC0V|D-19 by [ador Minimalto moderdte Sub5tantial Arrirt.d living f idlltioi, . Xnow wherc to 6nd lo<.1 information on lmplement !o(ial d i5tan cing measureri . [ong€r-le.m (lorure or qua6nline offacility. ,.nioi living L.ililier.nd fovtD-19. , Reduce largegathering5 (e.9, groupso(ial . Rejtri(torlimitvisitora(cesr(e,g.,maximum .dult &, pDgr.ltE . l(nowtherignsand symptomsof COVID'19 of 1 perday). nvhat fa(llatiet (an and what to do ifclientyrelidentt or itafi r Altersahedules to reduce mixing {e.9,, do to prep.rc for b€come symptomaiic. 5lagger meal, activity, anival/departure lime, covlD-19, if the fadlity . R€view and update eme rgef cy o peration t I Limat programr with extemalstaff h.t (a5er of COVID-19, plan (in(ludinq implementation of soCial or ifthe aommunity l! expe en(lng 5p€ad of distancing measures)or develop a plan ifone ' Consider having reridents stay in facility and general is notavailable. limlt exposure to the community covlD-19r , timit vhitors, implement screenifig . Encourage per50nal protectrve mea5ure5 among steff, retidents and cllentrwho llve Temperature and respiratory !ymptom €lsewhere (e.q., ,tay home or in residen(e! t(Ieening ofattendeer, statr, and vi5lto6. when sick, handwashiflg, respiralory Short-t€rm clorure, a5 n€eded (e.9.. ifcaser in etiquette). naff, re5idenls or dientr who liveel5ewherel ' Clean frequently touched surfa(es darly. fo. cleaning and conta(t tra(inq. ' En5ure h.nd hygiene tupphe5 are readily available in all buildingr. 5 Page 7 of 30  Potential mitigation adivities a(rording to level 0f(0mmunity transmission or impa(t 0fC0VID-19 by setting fador Minimalto moderate Substantial l{o,lIl... Xnow where to fnd lo(al lnform.tlon on ' En(ourage rtafftotelewo* (when f€a3lbla), lmplement exlended teleworl anangemenls COVID t 9 and lo(al trend 5 of COVID- I 9 (.rer. paticularly individuals atincreased risk of (when tuarible). 'What wo*pla(er (.n do severe illnegs. to prepare for COVID-19, Know the rigos and symptomr of(0V10-l9 Ensure flexible l€ave policier for 5taff {rho if lhe workpla(€ har and what to do ifstaff become rymptom.ti( al . lmplement so(ial distancing measuree: need to rtay home due to school/dildca e (.ses olCOVID-19, or lhe worksite. ditmirsalt r ln(reasing physical rpace between workerg Review, update, or develop workplace plans to (ancel non-essential work travel, erperiercinq !pread of include: covtD-r9)" , Staggering wo* rchedulet Ca ncel work-9pon sored (onferences, ' Liberal leave and lelework policies , oecreasing social contacts in the workpla(e , fonsider T-day leave policies for people with (e.9.,limit in person meetings, meeting for COVID-19 symptom5 lun(h in a br€ak room, elc.) r Congider altemate team approa(hes for . Limit l.r9e wo*-related gatherings (e.g., staff meetinq!. after work fundion5). E nco urage employees lostay hom€ and . Limit non -esse ntia I work travel. notify workpla(e adminrstrators when si(k . Consider regular health checkr (e.9., (wodplaces should provrde non-punitive temperature and respiratory rymptom rick leave optionr to allow st.ff to 5tay home screening) of ltaff and virito6 €ntering when ill). buildinqs (if fersible). En(ourage personal protective measures among staff(e.9., nay home when rick, handwashinq, reepiratory etiquette). Cl€an and d isinfect freq!ently lou(hed 5urfa(e5 daily. En5ure hand hyqiene supplie5 arc readily available in building. 6 Page 8 of 30  Potential mitigation adivities a(ording t0level of(ommunity kansmirsion or impad of (0VlD-19 by setting [a(tor ilone (pnpandness phare) Minimal to moderate Subnantial (omnlnlt, d f.lth- Knowwhere tofnd lo(alinform.l on on lmplement tocial dist.n (jng measurer: Ce n.el (ommun ity and faith-based gathering! batad oryanhationt COV|o.l9 and lo(alnefds of COV|D.l9 ca5e5 , Reduce aclivities (€.9.. group congreqation, 'What organ irationt Know lhe siqfls and symptomsofCovlO l9 religiou! rervi(es), espe(ially tor can do to prepare and whatto do iforganization members/n.ff oEanrzalionr with individual! nt in(r.ated fo, COVID'l9,ifthe be(om€ symptomdiic. risk of severe illness. organizatronr has ld€ntify lafew.ye to serve thore that.re.t (.res of COV|D.l9, or h qh riskorvulnerable (outre.ch, arristance, et..) ' Condder offering video/audio ofeveflts. iflhe communaty is Determinp ways to continue providing suppolt Revrew, update, ordevelop emergen(y plan! service5 to individualr at increased ritk of expeien(ing 5pre.d of for the orgaaization, especially consideranon severe disease (service!, meal5, che(Iing in) covr0-19)' for individual5 at increased risk ofsever€ while limiting group spttings and exp05ures. lner5. Cancel larg€ gathering5 (e.9., >250 people, En(ourage staff and member! to itay home thouqh threrhold ie ar the di5(retion ofthe and notify orqrnizalion adminirtrators of (ommunity) or move to smallpr groupingr. tor organizdtion5 that serve hiqh ri5k Encourage perronal protective m€a5ure! populationr, cancel g.thering5 ol more than among organization/m€mberr.nd sl.ff 10 people. (€.g., rtay home wh€n rick, h.ndwaehrng, respiratory etiquette). Cl€an freqrently to!ched 5urfaces al organization gathering point, daily. Enture hand hyqipne supplips are readily available in building. 1 Page 9 of 30  Potential mitigation adiviti€j to level transmission or impad of(0VlD-19 by retting tador Minimalto moderate 5ubstantial ll..hl(rr. r.ttl.g..nd ' Provide heallh(are personoel ( IHC Pl, including . lmplement(hangertovisitorpoli(iesto . Restri.t orlimitvisitoG (e.9., m.ximum of 1 per t..ldtcn proridlt rtaff at nuEing homeJ and lonq-term care further limitexposures to H(e retidentr, end day) to reduce f a(ility-bared tranrmisrion. (ind{d.r o.S.ti.{rL facilities) aod syrtems with tools.nd guid.nce patients. thanges (ould in(lude temperature/ . ldentifyareat of operatione that may be n(Blnrionarlong.urrr needed lo support theiade(i9jon9 to care ror rymplom decks for viralorr. lim iting visitor rubiect to altemalive standards of(are and (ri. hallili.,, inr.ti.ot, palients at home (or in nursinq homer/lon9- movement in the fadlity, etc, implement necesrary changes (e,9., allowing tc.h..ht) term carefacilities). . lmplementtriagebeforeenteringfa(ilitiet mildly tymptomatic HCP to work while "what healthcare settingt (e.9., pa*ing lottriage, fiontdoor), phone ' Develop systems for phone triage and wearing afacemask). including nu6in9 home, telemedi(ine to reduce unnecersary healthcare triage, and telemedicine to limit unnecessary . Can(elelective and non-urgent prccedures longlem care fa(ilitier, visits. healthcare visitr. cnn do to preparcfor . Establhh coholt units orfa(ilities for large . Assessfa(ility infe(tion contro I p rogram ri . Actively monitor absenteeism and regpiratory CoVID-19, lf the f.cilitier n umberr of patieflts. asse5s persona I prote(tive eq uipmeflt (PPt) illness among HCP and patients. has casei of CovlD-l9, . Consider requirinq all HCP to wear a facemark or ifthe community i5 supplies and optimi2e PPE use. . A(tively monitor PPE ruppliet. when in thefacility dependinq on supply. experien(ing rpre.d of . Assess plans for monitoring ofHCP and plafls . Establish procerses to evaluate and tes! large covtD-19r for increasing numbers of HCP if needed. numbers ofpatients and HtP with respiratory . Asressviritor policies. rymptoms (e.9., designated (linic, surge tent). . Assess HCP sick leave poli(ie5 (health(are . Consider allowing asymptomati( erposed HCP facilitiee thould provide non-pu nitive 5i(k leave to work while wearing a facemat[ options toallow HCP tonayhomewhen ill) . 8egi,r tocrots trai. HCPtorworking in other . Encouraqe HCPto rtayhome and notify unils in anticipataon ofstaffing shortager. health(are facility adminirtraro15 when !r(k. ' ln conjundion with lo(alhealth department, identify exposed HCP, and implemenl recommended monitoring and work restrictions, . lmplementtriagep ortoenteringf.cilitie5 to rapldly identiry and isolate patient5 with respiratory illness (e.9., phone triag€ before patient arrival, triage upon arrival). 8 Page 10 of 30 Table 3. Potential mitigation strategies for publi( health functions Public health control activities by level of (OVlD-'19 community transmission None/minimal Moderate Substantial Evidence ofisolated cases or limited Widespread and/or sustained Large scale community transmission, comm unity transm ission, case transmission with high likelihood or healthcare staffi ng signifi cantly investigations underway, no evidence confirmed exposure within communal impacted, multiple cases within ofexposure in large communal setting, settings with potentialfor rapid in(rease communal settings like healthcare e.9., healthcare facility, s(hool, mass in suspected cases. facilities, schools, mass gatherings etc. gathering. . Continue contact tracing, monitor . May reduce contact tracing if . May reduce contact tracing if and observe contacts as advised in resources dictate, prioritizing to those resources dictate, prioritizing to those guidance to maximize containment in high-risk settings (e.9., healthcare in high+isk settings (e.9., healthcare around cases. professionals or high-risk settings professionals or high-risk settings . lsolation ofconfirmed COVID-19 cases based on vulnerable populations or based on vulnerable populations or critical inf rastructure). critical inf rastructure). until no longer considered infectious accordinq to guidance. . Encourage HCP to more strictly . Encourage HCP to more strictly . For asymptomatic close (ontacts implement phone triage and implement phone triaqe and telemedicine practices. telemedicine practices. exposed to a confirmed COVID-19 case, consideration of movement . Continue COVID-'I9 testing of . Continue COVID 19 testing of restrictions based on risk level, sorial symptomatic persons; however, if symptomatic persons; however, if distancing. testing capacity limited, prioritize testing capacity limited, prioritize . Monitoring close contacts should be testing of high-risk individuals. testing of high-risk individuals. done by jurisdictions to the extent feasible based on local priorities and resources. . Encourage HCP to develop phone triage and telemedicine practices. . Test individuals with signs and symptoms compatible with COVID-19 . Determine methods to streamline contact tracing through simplified data collection and surge if needed (resources including staffi ng through colleges and other first responders, technology etc.). 9 Page 11 of 30  .. ; Appendix A: Underlying medical conditions that may increase the risk ofserious (OVlD-19 for individuals of any age. Blood dirotderu (e.g., sickle cell disease or on blood thinners) Chtonic lddney diaeaae as deFned by you-r doctor. Patient has been told to avoid or reduce the dose of mdications because kidney disease, or is under treatment for kidney disease, including receiving dialysis Chronic liver direace as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease. 'Compromiredimmunesystem(imEunoruppreeaion)(e.g.,seeingadoctorforcancerandtreatmentsuchaschemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HtV or AIDS) . Curr€nt ot recent pregaancy in the last two weeks . Endocrine dicorderc (e.g., diabetes mellitus) . Metabolic dirordera (such as inherited metabolic disorders and mitochondrial disorders) . Heart dicea8€ (such as congenital heart disease, congestive heart failure and coronary artery disease) ' Lung diceaee including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic cond-itions associated with impaired lung function or that require home oxygen ' Neurological and neurologic and leurodevelopment <oaditionc Iincluding disorders of t]re brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscr-rlar dystrophy, or spinal cord injury]. 10 Page 12 of 30  a o o CDPH PublicHealth To protect public health and slow the rate of transmission of COVID-I9, gatherings as described below should be postponed or canceled across the state of California for at least the remainder of the month of March. The Califbrnia Department of Public Health finds the following: r Large gatherings that include 250 people or more should be posponed or canceled. o This includes gatherings such as concerts, conferences, and professional, college, and school sporting events. o Smaller gatherings held in venues that do not allow social distancing of six feet per person should be postponed or canceled. o This includes gatherings in crowded auditoriums, rooms or other venues. . Gatherings of individuals who are at higher risk for severe illness from COVID-I9 should be limited to no more than l0 people. o This includes gatherings such as those at retirement facilities, assisted living facilities, developmental homes, and support groups for people with health conditions. o A "gathering" is any event or convening that brings together people in a single room or single space at the same time, such as an auditorium, stadium, arena, large conference room, meeting hall, cafeteria, or any other indoor or outdoor space. This applies to all non-essential professional, social, and community gatherings regardless of their sponsor. Gatherings that do not meet the aforementioned criteria should only be conducted when they are essential that is, if the activity is essential and could not be postponed or achieved without gathering, meaning that some other means of communication could not be used to conduct the essential function. What will this achieve? The timely implementation ofaggressive strategies that create social distance and those that reduce close contact ofpeople not regularly together, including limiting gatherings, has proven effective in prior pandemics at delaying rates of transmission and reducing illness and death. Page 13 of 30 By decreasing the prevalence of disease across Califomia we will: r Reduce the number of Californians who contract COVID-19 before an effective treatment or vaccine is available. o Protect those most likely to experience severe symptoms, such as older Califomians and those with underlying chronic conditions. o Preserve and protect our health care delivery system, including our health care workforce, so they can care for the least healthy individuals in the community for any medical condition, not just COVID- 19. o Minimize the social and economic impacts of COVID-19 over the long run. How long will these limitations apply? This guidance will remain in place at least through the month of March. As with all guidance that relates to COVID-19 response, authorities will revisit this guidance on a regular basis to evaluate the continued public health need for it and to evaluate ifany elements need to be changed. To stay informed, continue to monitor this link: httos://www.cdoh.ca.uov/Prosrarns/CI D/DC DC/P ages/Guidance.asnx What is Social Distancing and how is it achieved? Social distancing is a practice recommended by public health officials to stop or slow down the spread ofcontagious diseases. [t requires the creation ofphysical space between individuals who may spread certain inlectious diseases. The key is to minimize the number of gatherings as much as possible and to achieve space between individuals uhen events or activities cannot be modified. postponed. or canceled. Although the Department expects most events with more than 250 attendees to be postponed or canceled. we emphasize that the venue space does matter. Achieving space between individuals of approximately six leet is advisable. Additionally. there is a particular focus on creating space between individuals who have come together on a one-time or rare basis and who have very different travel patterns such as those coming from multiple countries. states or counties. What can be done to a make a gathering safer if it is essential or small? Page 14 of 30  o Stagger activities. o Add frequency ofan event to spread out attendance, e.g. hold more, smaller gatherings. o Add distance between where individuals sit or stand around tables. r Add additional hand washing stations and restrooms. o Limit the number of people in lines. o Avoid direct physical contact, such as hand-shaking, holding hands, and hugging. r Extend hours to allow for staggering of attendance or participation. . Use phones, videos or video conferencing to reduce the need for close interactions. r Consider ways to encourage anyone with fever and respiratory symptoms to stay home when sick, such as o Offering refunds or support reselling of tickets for persons who become ill. o Placing messages on websites, tickets, and venue entrances reminding people to protect one another by staying home if sick. Examples of Essential Events this Does Not Apply To The goal ofthis recommendation is to prevent people physically coming together unnecessarily, where people who have the infection can easily spread it to others. This guidance does not apply to activities such as attendance at regular school classes, work, or essential services. Please see the guidance for schools document for additional information. Certain activities are essential to the functioning ofour state and must continue. Hence, this does not apply to essential public transportation, airport travel, or shopping at a store or mall. Other specific guidance can be found on the CDPH website to help peopte take actions that can protect them in those settings. This does not apply to congregate living situations, including dormitories and homeless encampments. For more information on what can be done to protect homeless individuals, please see the Guidance for Homeless Assistance Providers on Novel Coronavirus (COVID-19) (PDF). Page 15 of 30 Page 16 of 30  California Public Health Experts: Mass Gatherings Should be Postponed or Canceled Statewide to Slow the Spread of COVID-I9 | California Governor State of California State public health etperts announce that clatherings utith z5o people or rnore should be rescheduled or canceled Snruller gathertngs can proceed if organizers implement 6 feet of social distancing SACRAMENTO - Governor Garin Nervsom announced that California public health officials this evening issued an updated policy on gatherings to protect public health and slorv the spread ofCO\4D-t9. The state's public health expefts have determined that gatherings should be postponed or canceled across the state until at least the end of March. Non-essential gatherings must be limited to no more than z5o people, u'hile smaller e\-ents can proceed only,if the organizers can implement social distancing of 6 feet per person. Gatherings of indi,'tduals who are at higher risk for severe illness from COVID-t9 should be limited to no more than to people, u'hile also follorving social distancing guidelines. "Changing our actions for a short period of time will sar.e the life of one or more people you know," said Governor Neu'som. "That's the choice before us. Each of us has extraordinary pouer to slow the spread of this disease. Not holding that concert or communilv event can have cascading effects - saring dozens oflives and presen'ing critical health care resources that your family may need a month from non'. The people in our lives rvho are most at risk - seniors and those wtth underlying health conditions - are depending on all ofus to make the right choice." The state's updated policy defines a "gathering" as any e\€nt or convening that brings together people in a single room or single space at the same time, such as an auditorium, stadium, arena, large conference room, meeting hall, cafeteria, or any other indoor or outdoor space. This guidance applies to all non-essential professional, social and community gal herings regardless of their sponsor. Essential gatherings should only be conducted if the essential activitl'could not be postponed or achieved without gathering, meaning that some other means of communication could not be used to conduct the essential function. I of 4 hft ps://www.gov.ca. gov/2020/03/ I I /califo 3/ l2i 2020. l:15 PM Page 17 of 30  The full policy can be found here. "These changes will cause real stress especially for families and businesses - least equipped financially to deal r,r'ith them. The state of California is working closely with businesses who will feel the economic shock of these changes, and we are mobilizing every level of government to help families as they persevere through this global health crisis," added Governor Newsom. State Efforts to Assist California Workers California will continue acting swiftly to help workers hurt by COVID-r9. Affected workers can visit the Labor & Workforce Development Agency's r.r,ebsite to review what benefits are available to them. For instance, o If you're unable to rvork because 1'ou are caring for an ill or quarantined family member rvith COVID-I9 you may qualifl, for Paid Family Leave (PFL). . If you're unable to work due to medical quarantine or illness, you may qualify for Disability Insurance. Those who have lost a job or have had their hours reduced for reasons related to COVID-r9 may be able to partially recover their rvages by filing an unemployment insurance claim. . If a worker or a family member is sick or for preventative care rvhen ciril authorities recommend quarantine, workers may use accrued paid sick leave in accordance with the lalr'. . If u'orkers are unable to do their usual job because they were exposed to and contracted COVID-I9 during the regular course of their r,vork, they ma1' be eligible for u.orkers' compensation benefits. All information and resources can be found at l,abor.Ca.Gor'rcarclalqq52A1S AII Community Guidance Released from CDPH: The California Department of Public Health has consolidated state guidance on how to prepare and protect Californians from COVID-r9 in a s!4gle location. This includes guidance for: o Health care facilities, including long-term care facilities . Community care facilities, including assisted living facilities and child care . Schools and institutions of higher education o First responders, including paramedics and EMTs . Employers, health care workers and workers in general industry . Health care plans . Home cleaning h'ith COVID-19 positive individuals . Guidance for Using Disinfectants at Schools and Child Cares . Laboratories . Health care facilities from CaI/OSHA . HomelessnessProviders What to Do if YouThinkYou're Sick: Call ahead: If you are experiencing s-vmptoms of CO\rlD-rg and may have had contact w'ith a person with COVID-19, or recently trar,eled to countries h.ith apparent community spread, call y'our health care provider or local public health department first before seeking medical care so that appropriate precautions can be taken. 2 ofl https://www.gov.ca. gov/2020/03/ I I /califo 3,'12'2020. l: l5 PM Page 18 of 30  California's Response to CO\rID-rg : We have been actir,el)'and extensil'el)' planning with our local public health and health care delivery systems. Here are some of the things we are already doing: o As in any public health event, the California Department of Public Health's Medical and Health Coordination Center has been activated and is coordinating public health response efforts across the state. . California continues to prepare and respond in coordination h.ith federal and local partners, hospitals and physicians. . Governor Newsom declared a State of Emergency to make additional resources available, formalize emergency actions alreadl' underu'ay across multiple state agencies and departments, and help the state prepare for broader spread of CO\rlD-19. . Governor Gavin Newsom requested the Legislature make up to gzo million available for state government to respond to the spread of COVID-r9. o California activated the State Operations Center to its highest level to coordinate response efforts across the state. . z4 million more Californians are nolv eligible for free medically necessary COVID-r9 testing. . California made available some of its emergency planning resen'es of zr million N95 filtering face piece masks for use in certain health care settings to ease shortages of personal protective equipment. . The Public Health Department is providing information, guidance documents, and technical support to local health departments, health care facilities, pror.iders, schools, universities, colleges, and childcare facilities across California . The California Emplol,rnent Derelopment Department (EDD) is encouraging individuals u'ho are unable to lvork due to exposure to COVID-t9 to file a DisabiliS' Insurance claim. o EDD is also encouraging emplol-ers rvho are experiencing a slon'dorm in their businesses or sen ices as a result ofthe Coronavirus impact on the economy to apply for an Unemployment Insurance work sharing program. o California continues to work in partnership with the federal government to aid in the safe return of 962 Californians from the Grand Princess cruise ship. This mission is centered around protecting the health ofthe passengers, and ensuring that when the passengers disembark, the public health of the United States, the State of California, and partner communities is protected. . The Public Health Department is coordinating with federal authorities and local health departments that have implemented screening, monitoring and, in some cases quarantine of returning travelers. o In coordination with the CDC, state and local health departments, we are actively responding to cases of COVID-t9. . The Public Health Department is supporting hospitals and local public health laboratories in the collection of specimens and testing for COVID-Ig. The California Department of Public Health's state laboratory in Richmond and rB other public health department laboratories now have tests for the rirus that causes COVID-19. Eighteen ofthem are currently conducting tests, with the others coming online soon. For more the most up to date information on COMD-I9 and California's 3 of4 hnps://www.gov.ca.gov/2020/03/ I I /califo... 3i 12,/1020. l:15 PM Page 19 of 30  response, risit the CDPH n'ebsite ### ..1 of .l https:,'/www.gov.ca. gov/2020/03/ I I /califo 3112/2020. l:15 PM Page 20 of 30 lmplementation of Mitigation Strategies for Communities with local COUID-l9 Transmission Eackground When a novel yirr.rs with pandemic potential emerges, nonpharmaceutical interventions, which will be called communiry mitigation strategies in this document, often are the most readily available interventions to help slow transmission of the virus in communities. Community mitigation is a set of actions that persons and communities can take to help slow the spread of respiratory virus infections. Community mitigation is especially important before a vaccine or drug becomes widely available. The following is a framewotk for actions which local and state health departments can recommend in their community to both prepare for and mitigate community transmission o( COVID 19 in the United States. Selection and implementation of these actions should be guided by the local characteristics of disease transmission, demographics, and public health and hea.lthcare system capacity. Guiding principles . Each community is unique, and appropliate mitigation strategies wiII vary based on the level of community Goals transmission, charaateristics of the community and their The goals for using mitigation strategies in communities witl populations, and the local capacity to implement strategies local COVID 19 transmission are to slow the transmission of (Table 1). disease and in partiaular to protect: . Consider all aspects of a community that might be impacted, . tndividuals at increased risk for severe illness, irtcluding including populations most lrrlnerable to severe illness and older adu.lts and persons ofany age with underlying health those that may be more impacted socially or economically, conditions (See Appendix A) and select appropriate actions. . The healthcare and clitical inflastructure workforces . Mitigation strategies can be scaled up or down depending on the evolving local situation. These approaches are used to minimize morbiility and mortality and the social and economic impacts of COVID-19. Individuals, . When developing mitigation plans, communities should communities, businesses, and healthcare organizations are identify ways to ensure the safety and social well-being ofgroups that may be especially impacted by mitigation all part of a community mitigation strategy. These strategies strategies, including individuals at increased risk for severe should be implemented to prepare for and when there is illness. evidence of community transmission. Signals of ongoing community transmission may include detection of conErmed . Activation of community emergency plans is critical for the implementatioh of mitigation strategies. These plans may cases of COVID 19 with no epidemiologic link to travelers or provide additional authorities and coordination needed for known cases, or more than three generations of transmission. interventions to be implemented (Table 2). Implementation is based on: . Activities in Table 2 may be implemented at any time . Emphasizing individual responsibility for implementing regardless of the Ievel of community transmission based on recomrnended personal-level actions guidance on from local and state health ofhcials. . Empowering businesses, schools, and community . The level of activities implemented may vary across the organizations to implement recommended actions, settings described in Tabte 2 (e.g., they may be at a minimal/ particularly in ways that protect persons at increased risk of moderate level for one setting and at a substantial level for severe illness another setting in order to meet community response needs). . Focusing on settings that provide critical infrastructure or . Depending on the level of community spread, Iocal and state services to individuals at increased risk of severe illness public health departments may need to impl€ment mitigation . Minimizing disruptions to dai.ly life to the extent possible strategies for public health functions to identify cases and conduct contact tracing (Table 3). When applied, community mitigation efforts may help facilitate public health activities ,& Iike contact traciog For more information: www.(d(.gov/C0vl Dl 9 Page 21 of 30 Table 1. Local Factors to Consider for Determining Mitigation Strategies Factor Characteristics Epidemiology . Level of commu nity transmission (seeTable 3) . Number and type of outbreaks (e.9., nursing homes, schools, etc.) . lmpact ofthe outbreaks on delivery of healthrare or other critical infrastructure or services . Epidemiology in sunounding jurisdictions Community . Size of community and population density I Chararteristics . Level of community engagement/support ] | j . Size and characteristics ofvulnerable populations . access to tr_eatth |. Transportation (e.9., public, walking) | . Planned larqe events l. Relationship of community to other communities (e.9., transportation hub, tourist destination, etc.) Healthcare capacity . Healthcare workforce . Number of healthcare facilities (including ancillary healthcare facilities) . Testing capacity . lntensive care capacity . Availability of person al protective equipment (PPE) Public health capacity . Pu blic health workforce and availability of resources to implem ent strateg ies . Available support from other state/localgovernment agencies and partner organizations 2 Page 22 of 30 Table 2. (ommunity mitigation strategies by retting and by level of community transmisrion or impa<t ofCOV|D- 19 Potential mitigation adivities a((ording t0 level of (0mmunity transmission or impad of (0VlD'19 by setting [actor one (preparcdners phase) Minimal to moderate 5ubstantial lndividu.li.nd tamili€t . Knowwhere tofnd local Information on . Continue to monrtor loca I inform dtion about Conrinue to monitor o(al informdrion atlloms CoVID l9 and localtr€nd5 ofCOV|D l9cases. COVID-19 in your community. (onnnu€ to pra(tr(e personal prote(t v€ . Know the rign5 and lymptomr ofCOV|D l9 . Continuelopradicep€rlonal protective prepare, jf you or a family and \,!hat to do lfrymplom.ric: (onl nue to put hous€ho d plan nio p a(e membergets ill, or ityour , Stay home when you are sr.k . Continue lo put hourehold plan ioto adion. All individual5 shouid limit (ommunity (ommunlty erperien(es rp re.d of COVID-I 9" , Callyour health c.re prcvide/5 office in . lndividualsatincreated ritkof 5evereillner5 movemenl and adapt to dirruptionr rn routine advance of a virit should coo5ider staying.t home and avoiding aclivities (e.9., !chool a nd/or wo rk (loiurer) gathering5 or other situationr ofpotential ac(odlng to guldance from localoffi(leh. , L mit movementinthe(omm!nity exposu rer. including travel. , Know what additional m€asure! tho5e at hiqh ri5k and who are vulnerable should take. . lmplemenl persona prote.lrve mea5ures (e.9, stay home when sr(k, handwashinq, respiratory etiquetle, clean frequently touched surfa(er daily). ' Cr€atea hourehold planola(ion in (aseof rllness in lhe household or dirruption ofdaily activrti€s due ro covlD-19 in the (ommunity. 2'week supply ol prescriptron ' Consider and over lhe counter medications. food andother e55enli.Le. Know how to qetfood de iv€r€d ifpossible. r Establish ways to communlcate with othe6 {e 9., fam y, fri€nds, co-worker'). r Ertablsh pldnr to telework, what to do about (hildcar€ needt. how to adapt to canceLlation of €ventt . Know about emerge ncy operation s plans for r(ho01s/workplaces of household members. l Page 23 of 30  Potential mitigation adivities a((ording to level of @mmunity tranrmission or impad of(oVlD-19 by setting [ador None (preparednes phare) f/inimal to moderate Substantial td,look/rhild.are . Knowwhere tofind local information on lmplement social distan(ing measurer: Eroader and/or longer term s(hool dismissals, "what childcare COVID l9 and lo(al lrends of COVID-1 9 cases. either asa preventive measure or because of D Red!ce the frequency oflarce gatherings facil tres, K-12 schoois, . (nowthe signsand symproms ofCOV|D l9 (e.9., arremblier, and limit the number of it.ff and/or 5tudent abeente€ism. and colleges and and what to do ifstudents or staffbecome attendee5 per gathering. C.ncellation of 5chool associated univerrilre5 can do to symptomalk al school/chi dcare site. r Aller schedules to redu(e mixing (e.9.. conqreqations, particularly thore wilh prepire for COVID-19, pa i(ipation of high-rhk individuale. if lhe school or fd(ility ' Rev ew and updale emergency operat ons st.qqer recerr, entry/d i5mis 5al timer) pl.n (nc Lrd ng implemenlat on ofsoca r [imit inter-rchool interactions lmplementdirt.nce learning if fea!ible. has(ares of COVIO 19. di(ancing m€a5ure5, dinan(e learning if oriflhecommunityig feasibLe)or develop plan ifon€ 5 not available r Consider dittan(e orelearning in gome expe en(in9 spredd of settingt (0vlo-r9)" . Evaluate whetherthereare rtudentr or 5taff !!hoare atincr€as€d nskof5evere llness and Con5ider .e9u la r health (hecks (e.9., develop plansfor them tocont nuetowork temperature and respiratory symptom or re.e ve edu.ationa rervi.e! ifrherels rcreen lng) of students, rtaft and vlritoR (if moderate levels ofCOV|D l9 transmiision or featible) sho( lerm di5mirgah for schooland , Parents ofch ldr€n al incre.sed ri5k for extraaLrrricular activities as needed (e.9., severc illness 5hould drscuss with their if(asei ln rtaffAtudent!) for cleaning.nd healih (are prov der whether those students contad va(in9. should elay home rn (are of school or Studenttat ancrea5ed ritk of severe illners communrty spre.d. thould (on5ider impl€menting indivdu.l plant in(reated rirl for severe rllnest for distance learning, e-leamin9. ' Staffat 5hould have a plan to 5tay home ifthereare 5.hool-based cases or (ommunity 5pr€ad. . Encoulage naffand nudentr to stay home when sick and notify 5chool .dm nistrators of illness (schoole thould provide non punitlve rickleave option5 to allow rtaffto rtay home when il) . Encourage persondl protectiv€ measures among staff/student5 (e.9.5tay honre when s ck, handwashing, respiralory etiquelte). . Clean and diiinte.l freqLr€ntly to!ched . Ensure hand hyqi€ne 5!pp e5 dre readily available rn burldrngr. 4 Page 24 of 30  Potential mitigation adivities a(@rdin9 to level ofcommunity tranrmisrion or impad ofC0V|D-19 by [ador Minimalto moderdte Sub5tantial Arrirt.d living f idlltioi, . Xnow wherc to 6nd lo<.1 information on lmplement !o(ial d i5tan cing measureri . [ong€r-le.m (lorure or qua6nline offacility. ,.nioi living L.ililier.nd fovtD-19. , Reduce largegathering5 (e.9, groupso(ial . Rejtri(torlimitvisitora(cesr(e,g.,maximum .dult &, pDgr.ltE . l(nowtherignsand symptomsof COVID'19 of 1 perday). nvhat fa(llatiet (an and what to do ifclientyrelidentt or itafi r Altersahedules to reduce mixing {e.9,, do to prep.rc for b€come symptomaiic. 5lagger meal, activity, anival/departure lime, covlD-19, if the fadlity . R€view and update eme rgef cy o peration t I Limat programr with extemalstaff h.t (a5er of COVID-19, plan (in(ludinq implementation of soCial or ifthe aommunity l! expe en(lng 5p€ad of distancing measures)or develop a plan ifone ' Consider having reridents stay in facility and general is notavailable. limlt exposure to the community covlD-19r , timit vhitors, implement screenifig . Encourage per50nal protectrve mea5ure5 among steff, retidents and cllentrwho llve Temperature and respiratory !ymptom €lsewhere (e.q., ,tay home or in residen(e! t(Ieening ofattendeer, statr, and vi5lto6. when sick, handwashiflg, respiralory Short-t€rm clorure, a5 n€eded (e.9.. ifcaser in etiquette). naff, re5idenls or dientr who liveel5ewherel ' Clean frequently touched surfa(es darly. fo. cleaning and conta(t tra(inq. ' En5ure h.nd hygiene tupphe5 are readily available in all buildingr. 5 Page 25 of 30  Potential mitigation adivities a(rording to level 0f(0mmunity transmission or impa(t 0fC0VID-19 by setting fador Minimalto moderate Substantial l{o,lIl... Xnow where to fnd lo(al lnform.tlon on ' En(ourage rtafftotelewo* (when f€a3lbla), lmplement exlended teleworl anangemenls COVID t 9 and lo(al trend 5 of COVID- I 9 (.rer. paticularly individuals atincreased risk of (when tuarible). 'What wo*pla(er (.n do severe illnegs. to prepare for COVID-19, Know the rigos and symptomr of(0V10-l9 Ensure flexible l€ave policier for 5taff {rho if lhe workpla(€ har and what to do ifstaff become rymptom.ti( al . lmplement so(ial distancing measuree: need to rtay home due to school/dildca e (.ses olCOVID-19, or lhe worksite. ditmirsalt r ln(reasing physical rpace between workerg Review, update, or develop workplace plans to (ancel non-essential work travel, erperiercinq !pread of include: covtD-r9)" , Staggering wo* rchedulet Ca ncel work-9pon sored (onferences, ' Liberal leave and lelework policies , oecreasing social contacts in the workpla(e , fonsider T-day leave policies for people with (e.9.,limit in person meetings, meeting for COVID-19 symptom5 lun(h in a br€ak room, elc.) r Congider altemate team approa(hes for . Limit l.r9e wo*-related gatherings (e.g., staff meetinq!. after work fundion5). E nco urage employees lostay hom€ and . Limit non -esse ntia I work travel. notify workpla(e adminrstrators when si(k . Consider regular health checkr (e.9., (wodplaces should provrde non-punitive temperature and respiratory rymptom rick leave optionr to allow st.ff to 5tay home screening) of ltaff and virito6 €ntering when ill). buildinqs (if fersible). En(ourage personal protective measures among staff(e.9., nay home when rick, handwashinq, reepiratory etiquette). Cl€an and d isinfect freq!ently lou(hed 5urfa(e5 daily. En5ure hand hyqiene supplie5 arc readily available in building. 6 Page 26 of 30  Potential mitigation adivities a(ording t0level of(ommunity kansmirsion or impad of (0VlD-19 by setting [a(tor ilone (pnpandness phare) Minimal to moderate Subnantial (omnlnlt, d f.lth- Knowwhere tofnd lo(alinform.l on on lmplement tocial dist.n (jng measurer: Ce n.el (ommun ity and faith-based gathering! batad oryanhationt COV|o.l9 and lo(alnefds of COV|D.l9 ca5e5 , Reduce aclivities (€.9.. group congreqation, 'What organ irationt Know lhe siqfls and symptomsofCovlO l9 religiou! rervi(es), espe(ially tor can do to prepare and whatto do iforganization members/n.ff oEanrzalionr with individual! nt in(r.ated fo, COVID'l9,ifthe be(om€ symptomdiic. risk of severe illness. organizatronr has ld€ntify lafew.ye to serve thore that.re.t (.res of COV|D.l9, or h qh riskorvulnerable (outre.ch, arristance, et..) ' Condder offering video/audio ofeveflts. iflhe communaty is Determinp ways to continue providing suppolt Revrew, update, ordevelop emergen(y plan! service5 to individualr at increased ritk of expeien(ing 5pre.d of for the orgaaization, especially consideranon severe disease (service!, meal5, che(Iing in) covr0-19)' for individual5 at increased risk ofsever€ while limiting group spttings and exp05ures. lner5. Cancel larg€ gathering5 (e.9., >250 people, En(ourage staff and member! to itay home thouqh threrhold ie ar the di5(retion ofthe and notify orqrnizalion adminirtrators of (ommunity) or move to smallpr groupingr. tor organizdtion5 that serve hiqh ri5k Encourage perronal protective m€a5ure! populationr, cancel g.thering5 ol more than among organization/m€mberr.nd sl.ff 10 people. (€.g., rtay home wh€n rick, h.ndwaehrng, respiratory etiquette). Cl€an freqrently to!ched 5urfaces al organization gathering point, daily. Enture hand hyqipne supplips are readily available in building. 1 Page 27 of 30  Potential mitigation adiviti€j to level transmission or impad of(0VlD-19 by retting tador Minimalto moderate 5ubstantial ll..hl(rr. r.ttl.g..nd ' Provide heallh(are personoel ( IHC Pl, including . lmplement(hangertovisitorpoli(iesto . Restri.t orlimitvisitoG (e.9., m.ximum of 1 per t..ldtcn proridlt rtaff at nuEing homeJ and lonq-term care further limitexposures to H(e retidentr, end day) to reduce f a(ility-bared tranrmisrion. (ind{d.r o.S.ti.{rL facilities) aod syrtems with tools.nd guid.nce patients. thanges (ould in(lude temperature/ . ldentifyareat of operatione that may be n(Blnrionarlong.urrr needed lo support theiade(i9jon9 to care ror rymplom decks for viralorr. lim iting visitor rubiect to altemalive standards of(are and (ri. hallili.,, inr.ti.ot, palients at home (or in nursinq homer/lon9- movement in the fadlity, etc, implement necesrary changes (e,9., allowing tc.h..ht) term carefacilities). . lmplementtriagebeforeenteringfa(ilitiet mildly tymptomatic HCP to work while "what healthcare settingt (e.9., pa*ing lottriage, fiontdoor), phone ' Develop systems for phone triage and wearing afacemask). including nu6in9 home, telemedi(ine to reduce unnecersary healthcare triage, and telemedicine to limit unnecessary . Can(elelective and non-urgent prccedures longlem care fa(ilitier, visits. healthcare visitr. cnn do to preparcfor . Establhh coholt units orfa(ilities for large . Assessfa(ility infe(tion contro I p rogram ri . Actively monitor absenteeism and regpiratory CoVID-19, lf the f.cilitier n umberr of patieflts. asse5s persona I prote(tive eq uipmeflt (PPt) illness among HCP and patients. has casei of CovlD-l9, . Consider requirinq all HCP to wear a facemark or ifthe community i5 supplies and optimi2e PPE use. . A(tively monitor PPE ruppliet. when in thefacility dependinq on supply. experien(ing rpre.d of . Assess plans for monitoring ofHCP and plafls . Establish procerses to evaluate and tes! large covtD-19r for increasing numbers of HCP if needed. numbers ofpatients and HtP with respiratory . Asressviritor policies. rymptoms (e.9., designated (linic, surge tent). . Assess HCP sick leave poli(ie5 (health(are . Consider allowing asymptomati( erposed HCP facilitiee thould provide non-pu nitive 5i(k leave to work while wearing a facemat[ options toallow HCP tonayhomewhen ill) . 8egi,r tocrots trai. HCPtorworking in other . Encouraqe HCPto rtayhome and notify unils in anticipataon ofstaffing shortager. health(are facility adminirtraro15 when !r(k. ' ln conjundion with lo(alhealth department, identify exposed HCP, and implemenl recommended monitoring and work restrictions, . lmplementtriagep ortoenteringf.cilitie5 to rapldly identiry and isolate patient5 with respiratory illness (e.9., phone triag€ before patient arrival, triage upon arrival). 8 Page 28 of 30 Table 3. Potential mitigation strategies for publi( health functions Public health control activities by level of (OVlD-'19 community transmission None/minimal Moderate Substantial Evidence ofisolated cases or limited Widespread and/or sustained Large scale community transmission, comm unity transm ission, case transmission with high likelihood or healthcare staffi ng signifi cantly investigations underway, no evidence confirmed exposure within communal impacted, multiple cases within ofexposure in large communal setting, settings with potentialfor rapid in(rease communal settings like healthcare e.9., healthcare facility, s(hool, mass in suspected cases. facilities, schools, mass gatherings etc. gathering. . Continue contact tracing, monitor . May reduce contact tracing if . May reduce contact tracing if and observe contacts as advised in resources dictate, prioritizing to those resources dictate, prioritizing to those guidance to maximize containment in high-risk settings (e.9., healthcare in high+isk settings (e.9., healthcare around cases. professionals or high-risk settings professionals or high-risk settings . lsolation ofconfirmed COVID-19 cases based on vulnerable populations or based on vulnerable populations or critical inf rastructure). critical inf rastructure). until no longer considered infectious accordinq to guidance. . Encourage HCP to more strictly . Encourage HCP to more strictly . For asymptomatic close (ontacts implement phone triage and implement phone triaqe and telemedicine practices. telemedicine practices. exposed to a confirmed COVID-19 case, consideration of movement . Continue COVID-'I9 testing of . Continue COVID 19 testing of restrictions based on risk level, sorial symptomatic persons; however, if symptomatic persons; however, if distancing. testing capacity limited, prioritize testing capacity limited, prioritize . Monitoring close contacts should be testing of high-risk individuals. testing of high-risk individuals. done by jurisdictions to the extent feasible based on local priorities and resources. . Encourage HCP to develop phone triage and telemedicine practices. . Test individuals with signs and symptoms compatible with COVID-19 . Determine methods to streamline contact tracing through simplified data collection and surge if needed (resources including staffi ng through colleges and other first responders, technology etc.). 9 Page 29 of 30  .. ; Appendix A: Underlying medical conditions that may increase the risk ofserious (OVlD-19 for individuals of any age. Blood dirotderu (e.g., sickle cell disease or on blood thinners) Chtonic lddney diaeaae as deFned by you-r doctor. Patient has been told to avoid or reduce the dose of mdications because kidney disease, or is under treatment for kidney disease, including receiving dialysis Chronic liver direace as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease. 'Compromiredimmunesystem(imEunoruppreeaion)(e.g.,seeingadoctorforcancerandtreatmentsuchaschemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HtV or AIDS) . Curr€nt ot recent pregaancy in the last two weeks . Endocrine dicorderc (e.g., diabetes mellitus) . Metabolic dirordera (such as inherited metabolic disorders and mitochondrial disorders) . Heart dicea8€ (such as congenital heart disease, congestive heart failure and coronary artery disease) ' Lung diceaee including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic cond-itions associated with impaired lung function or that require home oxygen ' Neurological and neurologic and leurodevelopment <oaditionc Iincluding disorders of t]re brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscr-rlar dystrophy, or spinal cord injury]. 10 Page 30 of 30