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Law Enforcement, Correctional & Detention Facilities

B73 COVID-19 - Procedural Guidance for DPH Staff



REPORTING PROCEDURES

Outbreak Definitions:

Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.

Definition of Outbreak:

  1. At least two or more epidemiologic linked laboratory confirmed cases (symptomatic or asymptomatic) of COVID-19 among incarcerated/detained individuals within a 14-day period, OR
  2. At least three or more epidemiologic linked laboratory confirmed cases (symptomatic or asymptomatic) of COVID-19 among staff within a 14-day period, OR
  3. A sudden increase of acute febrile respiratory illness (e.g. Fever measured or reported as >100.0° F and either a cough, sore throat, or shortness of breath) in the setting of community transmission of COVID-19—a minimum of two Person Under Investigation (PUI).

LAC DPH will be requiring that all incarcerated/detained persons who have symptoms consistent with COVID-19 in a housing unit with other known cases, but who have not been tested, be considered a “presumed case.” Presumed cases should meet the following criteria:

  1. At least two of the following symptoms/signs: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s), OR
  2. At least one of the following symptoms: cough, shortness of breath, or difficulty breathing, OR
  3. Severe respiratory illness with at least one of the following:
    1. Clinical or radiographic evidence of pneumonia, OR
    2. Acute respiratory distress syndrome (ARDS) AND
  4. No alternative more likely diagnosis.

COVID-19 core information:

For up-to-date information on symptoms, transmission, period of infectiousness, contacts, and fully vaccinated person please refer to the B73 homepage.

Epidemiologic Data for Outbreaks

  1. Establish a case definition (i.e., fever [measured or reported] and either cough, sore throat, or stuffy nose): include pertinent clinical symptoms and laboratory data.
  2. Confirm etiology of outbreak using laboratory data. All symptomatic residents or staff are recommended to be tested for COVID-19. Testing methods outline below.
  3. Determine the onset date of the outbreak. The onset date of the outbreak is the date of symptom onset or date of laboratory-confirmed case for the first case or PUI, whichever comes first. Given the incubation period of SARS CoV2s is 14-days, the outbreak investigation should include investigation of cases occurring 14 days prior to onset date.
  4.  If earlier cases are found, investigation of prior cases should continue until a first index case can be determined, and the outbreak onset date should be updated to reflect the new findings.
  5. Create a line list and contact information following the COVID-19 template above.
  6. Maintain surveillance for new cases until no new cases for at least 2 weeks.
  7. Create an epi-curve, by date of onset (see CDC Quick Learn Lesson: Create an Epi Curve for guidance). Only put those that meet the case definition on the epi-curve. (Optional)

 

CONTROL OF CASE, CONTACTS & CARRIERS

Case

See detailed instructions below for single cases and multiple cases in incarcerated/detained persons, as well as cases in facility staff.

CONTACTS

Contacts are defined as HCWs or incarcerated/detained persons who have:

  1. Been within approximately 6 feet of a person with COVID-19 for a prolonged period (greater than 2 minutes) per CDC criteria; OR
  2. Had unprotected direct contact with infectious secretions or excretions of the resident (e.g., coughed on, touched used tissues with a bare hand).

Healthcare Personnel (HCP):

Facility to identify all close contact HCP (includes clinical and ancillary staff), and determine risk status using the guide outlined in LAC DPH Guidance for Monitoring Healthcare Personnel and a companion guidance, CDC Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (InterimGuidance).

Document the contacts on the COVID-19 Contact Information Form (see Report Forms section) and submit it to DPH as requested by DPH

  1. Monitor and follow-up for symptoms with HCP contacts during or at the end of monitoring period to check-in and respond to concerns.

Visitors:

Correctional/detention facilities to identify any close contact visitors that may have been exposed to a confirmed case and instruct to self-quarantine and self-monitor for symptoms for 14 days after last exposure.

Visitors should call their primary care provider to discuss testing options and guidance.

Correctional/detention facilities should be encouraged to maintain daily visitor log with date and time of visit as a regular practice.

Steps correctional/detention should take to reduce the spread of COVID-19

(Refer to Guidance for Managing COVID-19 in Correctional and Detention Facilities)

Key recommendations include:

  1. The facility must conduct COVID-19 diagnostic testing for incarcerated/detained persons, which may include those with and without symptoms.
  2. The facility must report all confirmed or suspected COVID-19 cases and deaths to LAC DPH immediately by email at covidcorrections@ph.lacounty.gov.
  3. The facility will comply with state and local guidelines for interfacility transfers.

Visit the LAC DPH COVID-19 website frequently for updated information on COVID-19 testing, infection control, FAQs, and guidance for facilities.

General steps correctional/detention facilities should take to reduce the spread of COVID-19 for incarcerated/detained persons

(Refer to Guidance for Managing COVID-19 in Correctional and Detention Facilities)

Key recommendations include:

  1. The facility should conduct COVID-19 diagnostic PCR testing for incarcerated/detained persons, which may include those with and without symptoms.
    • Perform pre-intake symptom screening and temperature checks for all new entrants in order to identify and immediately place individuals with symptoms under medical isolation. Screening should take place in an outdoor space prior to entry, in the sally port, or at the point of entry into the facility immediately upon entry, before beginning the intake process. Test incoming incarcerated/detained persons and house them individually (when feasible) while waiting for test results. For persons who are not fully vaccinated, testing can be combined with a 14-day observation period before persons are assigned housing with the rest of the  facility's population. In this case, individuals should be quarantined separately from those with confirmed or suspected COVID-19.
  2. If incarcerated/detained person has symptoms of COVID-19:
    • Place the individual under medical isolation regardless of vaccination status, test for SARS-CoV-2, and medically evaluate.
    • All symptomatic incarcerated/detained persons should be presumed infectious pending test results.
    • Require the individual to wear a surgical mask. Anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance should not wear a mask.
    • Ensure that the staff who have direct contact with the symptomatic individual wear recommended PPE.
  3. If an individual is an asymptomatic close contact of someone with COVID-19:
    • Quarantine the individual and monitor for symptoms at least once per day for 14 days.
    • Incarcerated/detained persons who are fully vaccinated and do not have symptoms of COVID-19 do not need to quarantine at intake, after transfer, or following exposure to suspected or confirmed COVID-19.*
    • The facility must report all confirmed or suspected COVID-19 cases and deaths to LAC DPH immediately by email at covidcorrections@ph.lacounty.gov
    • The facility will comply with state and local guidelines for interfacility transfers.

*Regardless of symptoms incarcerated/detained persons who are fully vaccinated should continue to be tested for SARS-CoV-2 following exposure to suspected or confirmed COVID-19 or if they develop any symptoms of COVID-19.

General steps staff should take to reduce spread of COVID-19 in the facility:

  1. Instruct employees with confirmed COVID-19 and any ill employees with symptoms suggestive of respiratory illness to self-isolate at home.

  2. Employer, or site coordinator, should recommend testing for all symptomatic employees even if they have been fully vaccinated (at least 2 weeks have passed since the final dose of their vaccine series).  They can be referred to their primary care provider or 2-1-1 to access county or city testing resources. Testing is not generally available at Public Health Laboratory for congregate settings that are non-residential or non-healthcare.

  3. If the employee came to the site while ill, they should be separated from others with door closed, masked, and directed to go home right away.

  4. Determine when the employee was first symptomatic and when they were tested.

  5. Determine which days or shifts the case was on site.

  6. If ill person has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.

  7. Consider alternative work options like teleworking if employee is well enough to do so.

  8. Instruct employee case to notify all other employers of their illness in order to initiate contact investigations or other necessary infection control measures.

  9. Document suspected and confirmed cases, regardless of prior testing or vaccination status, on the Case Line List in the COVID-19 Line List.

  10. Even if COVID-19 testing is negative for a symptomatic employee, utilize the symptom-based clearance strategy in bullet 1 for return to work.

General and Administrative Considerations during an Outbreak

  1. Identify a mechanism for your facility to obtain SARS CoV-2 samples and to send these specimens from your facility to a lab.
  2. Review and follow the CDC’s guidance for Correctional and Detention Facilities and use CDC guidance on conservation of personal protective equipment (PPE). Develop a surge plan for emerging infectious diseases, particularly suspected or confirmed COVID-19 patients.
  3. Plan for ways to continue essential services if on-site operations are reduced temporarily.
  4. Plan for employee absences and create a back-up/on-call system.
  5. Discontinue group activities, field trips, and communal dining.
    1. All meals are to be served within individual rooms unless it is unsafe for incarcerated/detained persons to eat unsupervised.
    2. Staff may eat together in staff break rooms or a separate designated area, but physical distancing of six feet or more between persons must be enforced at all times while eating.
  6. Immediately implement symptom screening for all staff, incarcerated/detained persons, and visitors—including temperature checks. Incarcerated/detained persons should have their temperature taken every 12 hours if it is a medical facility. If there are no medical staff at the facility, incarcerated/detained persons should self-monitor their temperature every 12 hours.
    1. Every individual, regardless of reason, entering the correctional facility (including incarcerated/detained persons, staff, visitors, outside healthcare workers, vendors, etc.) should be asked about COVID-19 symptoms and they must also have their temperature checked. An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need. They do not have to be screened, as they are typically screened separately.
    2. Records are to be kept of staff and incarcerated/detained persons temperature checks.
    3. Facilities should limit access points and ensure that all accessible entrances have a screening station.
    4. Anyone with a fever (100.0° F or 37.8° C) or symptoms (fever, chills, sore throat, cough, sneezing, shortness of breath, gastrointestinal symptoms, or not feeling well) may not be admitted entry.
  7. Prohibit visitors from entering the facility unless compassionate care situations, such as end-of-life.
    1. Those with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
    2. Post signs explaining visitor restrictions.
    3. Set-up alternative methods of visitation such as through videoconferencing through skype or FaceTime
    4. Those visitors that are permitted must follow DPH visitation guidance
  8. Restrict all volunteers and non-essential staff.
  9. All facility personnel should wear a surgical mask or non-medical face covering while they are in the facility.
    1. Staff must wear either an N95 respirator (if not fully vaccinated) or a surgical mask (if fully vaccinated) when in patient care areas.
    2. Masks and respirators are not required for staff working alone in closed areas unless they are moving through common spaces where they may interact with other staff or incarcerated/detained persons.
    3. All staff should follow physical distancing and hand hygiene guidance.
  10. All incarcerated/detained persons must wear a face mask when outside their room. This includes persons who must regularly leave the facility for care (e.g. hemodialysis patients). Surgical masks are required for any resident that is COVID-19-positive or assumed to be COVID-19-positive.
    1. The facility is required to provide each resident with a clean non-medical face covering and replace them if damaged.
  11. Provide education and job-specific training to staff regarding COVID-19, including:
    1. Signs and symptoms
    2. Modes of transmission of infection
    3. Correct infection control practices and personnel protective equipment (PPE) use
    4. Staff sick leave policies and recommended actions for unprotected exposures (e.g., not using recommended PPE, an unrecognized infectious patient contact)
    5. How and to whom COVID-19 cases should be reported
  12. Establish a COVID-19 area within the facility:
    1. Ensure that separate physical locations (dedicated housing areas and bathrooms) have been identified to 1) isolate individuals with confirmed COVID-19 (individually or cohorted), 2) isolate individuals with suspected COVID-19 (individually – do not cohort), and 3) quarantine close contacts of those with confirmed or suspected COVID-19 (ideally individually; cohorted if necessary). The plan should include contingencies for multiple locations if numerous infected individuals and/or close contacts are identified and require medical isolation or quarantine simultaneously.
    2. The COVID-19 area is for persons who have suspected or confirmed COVID-19. The area must be physically separated from the area for those who do not have COVID-19.
    3. All staff, equipment and common areas should be kept separate as much as possible.
    4. Designate HCP who will be responsible for caring for suspected or known COVID-19 incarcerated/detained persons. Ensure they are trained on the infection prevention and control recommendations for COVID-19 and the proper use of PPE.
    5. All staff should follow physical distancing and perform frequent hand hygiene.
  13. If staffing scarcity requires staff to work with COVID-19 positive and negative incarcerated/detained persons, staff should be careful to change required PPE between patients, though N95 and face shields may be worn throughout the day consistent with CDC PPE conservation contingency strategies, have employees work at only one facility in order to reduce interfacility spread of COVID-19.
  14. Offer COVID-19 vaccination and routine immunizations: Continue to encourage COVID-19 vaccination for those who have not yet received it, as well as routine immunizations as needed.

WHAT TO DO IF YOU IDENTIFY ONE OR MORE COVID-19 CASES IN A CORRECTIONAL FACILITY

  1. Immediately initiate standard, contact, and droplet precautions, plus eye protection for all suspect or confirmed persons with fever and/or respiratory symptoms.
  2. Immediately transfer COVID-19 positive incarcerated/detained person to medical isolation.
  3. Identify any close contacts or exposures to the COVID positive person and place them in the quarantine for 14 days, regardless of vaccination status.
  4. The facility should start response testing for incarcerated/detained person and staff regardless of vaccination status for at least 2 weeks until no further cases are identified.
    1. Testing people with signs and symptoms consistent with COVID-19, regardless of vaccination status
      • Incarcerated/detained persons with symptoms, regardless of COVID-19 vaccination status, should be given a mask (if not already wearing one and if it can be worn safely), moved to medical isolation in a separate environment from other individuals, medically evaluated, and tested. Facility staff should carefully evaluate and support the mental health needs of individuals before and during medical isolation. If incarcerated/detained persons receive a positive test result for SARS-CoV-2, they should remain in medical isolation until they meet the criteria for discontinuing isolation, but may be moved to a cohort with other people who have confirmed COVID-19, if needed. If a case is identified in an open dorm-style housing unit, all persons living in the same unit should be considered exposed. 
      • Staff with symptoms, regardless of COVID-19 vaccination status, should be excluded from work and tested. If the test result is positive, staff should isolate at home and follow CDC guidance for caring for oneself.
    2. Testing asymptomatic persons with recent known or suspected exposure to SARS-CoV-2
      • Close contacts should be tested regardless of their COVID-19 vaccine status. As contact tracing to identify each individual close contact can be difficult, person considered to be close contacts should include all persons defined by a particular setting (such as all incarcerated/detained persons and staff assigned to a dormitory or unit).
      • Use Broad-based testing when contact tracing is challenging. In settings where contact tracing is difficult, facilities should conduct broad-based testing which involves testing everyone in the affected area(s) of the facility, regardless of COVID-19 vaccination status.
  5. Isolation and Quarantine Requirements
    1. Isolation requirements:
      • Cases: Persons with symptomatic COVID-19 can be released from isolation after at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms have improved. Asymptomatic persons with COVID-19 who never developed any symptoms may be released from isolation 10 days after the date of collection of their initial positive viral test.
    2. Quarantine Requirements - Individuals:
      • Incarcerated/detained persons who are close contacts of someone with confirmed or suspected COVID-19 (whether the infected individual is another incarcerated/detained person, staff member, or visitor) should be placed under quarantine for 14 days.
        1. Fully vaccinated asymptomatic incarcerated /detained persons do not need to quarantine following close contact with a person with laboratory-confirmed COVID-19. Post-exposure testing should be considered for fully vaccinated asymptomatic residents of high-risk residential congregate settings. Contacts should be instructed to self-monitor for symptoms twice a day for 14 days regardless of vaccination status.
      • Asymptomatic staff contacts who are not fully vaccinated should be instructed to stay home in quarantine for 14 days starting after last exposure to a suspected or confirmed case.
      • If contacts test positive or develop symptoms of respiratory illness (fever and cough or shortness of breath), then they should immediately be transferred to medical isolation and the timing of isolation resets based on symptoms or tests dates.
    3. Cohort Quarantine for Multiple Close Contacts
      • All cohorted individuals should be monitored closely for symptoms of COVID-19, and those with symptoms should be placed under medical isolation immediately:
      • If an individual who is part of a quarantined cohort becomes symptomatic:
        1. If the individual is tested for SARS-CoV-2 and receives a positive result: the 14 day quarantine clock for this individual and the remainder of the cohort must be reset to 0.
        2. If the individual is tested for SARS-CoV-2 and receives a negative result: the 14-day quarantine clock for this individual and the remainder of the cohort does not need to be reset. This individual can return from medical isolation to the quarantine cohort for the remainder of the quarantine period as their symptoms and diagnosis allow.
        3.  If the individual is not tested for SARS-CoV-2: the 14-day quarantine clock for the remainder of the cohort must be reset to 0.
      • Do not add more individuals to an existing quarantine cohort after the 14-day quarantine clock has started.
  6. Ensure all facility staff (i.e. food service workers, receptionist, housekeeping) and HCP wear face masks at all times. For conservation of Personal Protective Equipment (PPE), refer to the CDC guidance on conservation of PPE.
    1. Correctional and detention staff who are fully vaccinated (i.e., ≥2 weeks after receiving the second dose in a two-dose series [Pfizer-BioNTech or Moderna], or ≥2 weeks after receiving a single-dose vaccine [Johnson and Johnson/Janssen]) and do not have symptoms consistent with COVID-19 do not need to quarantine or be excluded from work following exposure to suspected or confirmed COVID-19. However, testing and symptom monitoring following an exposure are still recommended. Staff with symptoms of COVID-19, regardless of COVID-19 vaccination status, should be excluded from work, immediately self-isolate, and be tested for SAR-CoV-2.
  7. Increase environmental cleaning throughout the facility with emphasis on high touch  surfaces particularly in the unit where the resident was located. If you have not already done so, ensure that you are using an approved cleaning agent: List N: Disinfectants for Use Against SARS-CoV-2
  8. Continue to restrict visitors.
  9. Continue to monitor all exposed incarcerated/detained persons for fever and respiratory symptoms (i.e. cough, sore throat, shortness of breath) until 14-days after the last COVID-19 case has recovered.
  10. Designate an area in your facility for the placement of suspect incarcerated/detained persons and cohort staff caring for suspect cases to minimize transmission.

CLOSURE CRITERIA

Outbreak can be closed once closure criteria is met:
14 days have passed since last confirmed or symptomatic case (includes staff and incarcerated/detained persons).

DEATH REPORTING

ACD COVID Corrections team must be notified of a death and the facilities will need to complete and submit a death report form to ACDC.


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  • Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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