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Community Settings

Including education, community care facilities, sites servicing people experiencing homeless, correctional/detention facilities, and worksites

B73 COVID-19 - Procedural Guidance for DPH Staff


SETTING TYPES

  • Education settings:
    1. Early Care and Education (ECE) Facilities
    2. TK-12 Schools
    3. Institutes of Higher Education (IHE), including colleges, universities, and trade and technical schools
    4. Programs serving school-aged children, including day care, camps, and youth sports programs
  • Community congregate settings:
    • Community care facilities (CCF):
      • Adult Residential Care Facilities, all license types
      • Continuing Care Retirement Communities
      • Psychiatric Health Facilities, not including Acute Psychiatric Hospitals
      • Residential Care Facilities for the Elderly
      • Residential Facilities for the Chronically Ill
      • Social Rehabilitation Facilities
      • Long-Term Care Facilities
      • Residential Substance Use Treatment Facilities
      • Mental Health Treatment Facilities
    • Sites that provide housing for people experiencing homelessness (PEH):
      • Shelters
      • Recuperative care centers
      • Single room occupancy hotels (SRO)
    • Correctional/detention facilities
  • Workplace settings

OUTBREAK DEFINITIONS

Outbreak Case Definition

An individual is defined as an outbreak case if they are epidemiologically linked (epi-linked) and meet at least one of the following criteria (except in workplace settings*):

  1. Diagnostic criteria:
    1. The individual has a positive viral test for COVID-19 (ie, a PCR or antigen test, including self-administered and self-read tests).
    2. The individual has been diagnosed by a provider with COVID-19.
  2. Symptom-only criteria*:
    1. The individual exhibits the new onset of two or more symptoms related to acute respiratory illness (ARI), which include: fever or chills, cough, sore throat, runny or stuffy nose, difficulty breathing, and body aches; AND
    2. The individual does not have an alternative lab-confirmed diagnosis that explains these symptoms.

* In workplace settings, symptom-based criteria does not apply.

Excludes:

  • Individuals that are not epidemiologically linked to the outbreak cluster.
  • Individuals that are epidemiologically linked to an outbreak case(s) but whose exposure was more likely to have occurred off site should not be linked to the outbreak. This includes cases who share a household or carpool in private vehicles with outbreak cases, where transmission was more likely to have occurred outside of the facility.

OUTBREAK OPENING THRESHOLDS

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

  • In an epidemiologically linked group:
    • A minimum of 5* outbreak cases (at least 20% of the group) within a 7 day period, OR
  • Facility-wide:
    • At least 10% of the average daily population are reporting new onset of symptoms of acute respiratory illness, with a minimum of 5* ill, within a 3-day period.

* In settings with groups smaller than 15 people, the minimum is reduced to 3 cases.

Epidemiologic Data for Outbreaks & Reporting Procedures

Reporting Forms and Documentation

 

Education

Worksites

Community Congregate

Line List:

All outbreak cases should be included

The outbreak line list is managed in CalCONNECT. Site liaisons should add cases using SPOT, following the steps in SPOT Quick Guide for Community Settings (not including Workplaces)

The outbreak line list is managed in CalCONNECT. Site liaisons should add cases using SPOT, following the steps in SPOT Quick Guide for Worksites: Adding Cases to Existing Reports

An initial line list will usually be provided and attached to the IRIS filing cabinet. Download a blank template here.

Other Documentation

Complete required documentation in IRIS and CalCONNECT as outlined in protocols from Nursing Administration and Community Field Services.

Other Epidemiologic Data

  • Site Floor Plan: Obtain site floor plan if it aids in the investigation. (Optional)
  • Epi-Curve: Create an epi-curve based on the earliest date of symptom onset date or the first positive specimen collection date for outbreak cases. (Optional)

GENERAL OUTBREAK INVESTIGATION GUIDELINES

  • Investigation Process & follow up: Conduct investigations via phone, with the possibility of in-person visits if necessary. Weekly updates with the facility are standard, increasing in frequency based on the outbreak’s severity and the investigation team’s assessment.
  • Ongoing case reporting: Advise the facility to submit any new cases arising during the surveillance period.
  • Consultation and Site Visits: Environmental Health may be consulted for additional prevention and mitigation advice, especially for ventilation issues or non-compliance. Joint site visits may occur if required.
  • Public Notification: Notify facilities that they will be listed on LAC DPH’s public outbreak notification list until they fulfill outbreak closure criteria.
  • Notify ACD of unusual circumstances: This includes non-compliance; a significant rise in cases; or deaths related to the outbreak.

CONTROL RECOMMENDATIONS FOR OUTBREAKS

Cases

Cases should be instructed to follow all Instructions for COVID-19 Cases and Close Contacts. This includes:

  • Isolation: Outbreak cases should be instructed to follow all applicable Instructions for COVID-19 Cases and Close Contacts.
    1. In Community Congregate Settings: Isolation instructions are more protective than for the general public. Ensure facility is following isolation requirements as outlined in COVID-19 and Common Respiratory Viruses Guidance for Community Congregate Settings.
  • Testing: Recommend prompt COVID-19 testing for anyone exhibiting ARI symptoms. If initial rapid tests are negative, advise retesting 2 days later and continuing isolation.
  • Masking: Require masking of all outbreak cases for 10 days from becoming sick, including after they have met criteria to return to the facility / exit isolation.
  • Referral to Treatment: Refer outbreak cases meeting diagnostic criteria who cannot access therapeutics through a provider to a Test to Treat program or the DPH Public Health Call Center (833-540-0473).
  • Exposure Notification: Individuals who have been exposed to a confirmed case should be notified. This can include displaying clear exposure notifications in common areas.

Close Contacts

Close contacts can continue to participate in normal activities as long as they remain asymptomatic and follow all Instructions for COVID-19 Cases and Close Contacts. This includes:

  • Symptom Monitoring: Anyone developing symptoms of acute respiratory illness must stay away home and away from others until 24 hours have passed after resolution of fever (without the use of fever reducing medications) and other symptoms are improving.
  • Symptom-based outbreak cases: Except in worksite settings, a close contact developing symptoms during the surveillance period should be immediately treated as an outbreak case, per the symptom-based criteria.
  • Testing: Recommend COVID-19 testing 3-5 days after last exposure.
  • Masking: Close contacts should mask through day 10 after exposure. Consider requiring masking, particularly in higher risk settings.

General Measures

  • Adherence to Guidelines: Reinforce COVID-19 Instructions for Cases and Close Contacts and work to ensure compliance. Emphasize importance of early detection of cases and removing them from contact with others.
  • Improve Ventilation: Enhancing indoor air quality is essential for reducing the spread of respiratory illnesses. Set HVAC systems to "On" rather than "Auto" to maintain continuous air filtration and circulation. Utilize portable HEPA filters in areas lacking adequate ventilation. Encourage upgrades to HVAC systems and increase air exchange rates to further reduce the concentration of airborne virus particles. These measures collectively decrease the risk of transmission by diluting and removing infectious particles in indoor environments.
  • Vaccination Promotion: Encourage vaccination and provide information on vaccination sites or the possibility of hosing a mobile vaccine clinic in partnership with LAC DPH.
  • Transmission Prevention & Planning: Implement transmission prevention measures as appropriate, such as remote work / learning, physical distancing, staggered shifts, outdoor activities, and improved indoor ventilation. Plan for absences with a backup system and restrict staff to working at one facility whenever possible.
  • Hygiene and Sanitation: Promote personal and environmental hygiene. Ensure there is ready access to well-stocked handwashing stations, touchless sanitizers, tissues, and regular cleaning of high-contact surfaces using EPA registered disinfectant appropriate for SARS-CoV-2. Encourage hand hygiene, respiratory etiquette and physical distancing. Masks should be available upon request.
  • Communication and Signage: Display clear signage on hygiene practices, COVID-19 symptoms, and exposure notifications. Communicate any potential exposure risks promptly. See LAC DPH COVID-19 Print Materials.
  • Education: Provide COVID-19 education and training covering symptoms, transmission, infection control practices, and PPE use.
  • Additional Protection for High-Risk Individuals: Implement additional protective strategies for high-risk individuals (such as the elderly, very young, medically compromised). This may include enforcing stricter requirements at the discretion of the outbreak investigation team. Consult with the Community Outbreak Team as appropriate.
  • Regulatory Compliance: Note that some sites may be subject to additional regulations including Cal/OSHA’s COVID-19 Non-Emergency Regulations or the Aerosol Transmissible Diseases (ATD) standard.

Considerations for Community Congregate Settings

Community congregate settings often serve higher risk populations and thus should consider the following additional control measures during outbreaks to mitigate the increased risk of transmission in congregate spaces:

  • Isolation Facilities: Isolate symptomatic residents onsite in private rooms and/or with a designated bathroom when possible. Review recommendations found in COVID-19 and Common Respiratory Viruses Guidance for Community Congregate Settings.
  • Visitor Restrictions: Consider limiting volunteers and non-essential personnel during an outbreak. Recommend visitation under strict conditions, such as requiring health screenings, mask usage, and restricting visits to designated areas.
  • Indoor masking for non-residents: Consider implementing required masking for staff and/or visitors.
  • Resident masking: Encourage residents to mask outside their rooms if appropriate. Ensure masks are readily available.
  • Healthcare facilities and personnel: Healthcare settings within these facilities must also follow local requirements or guidelines highlighted in Infection Prevention Guidance for Healthcare Personnel.
  • Daily Health Checks: Perform symptom checks daily for staff and non-staff, including at facility entry.
  • Heightened emphasis on testing, treatment, and vaccination: Consider offering catch-up vaccination for everyone at the facility, as appropriate. Emphasize the importance of treatment among higher risk populations. In some settings, it may be appropriate to recommend testing for influenza or other common respiratory pathogens.
  • Separate High-Risk Individuals: Designate separate areas for non-symptomatic, high-risk individuals (over 50, with chronic medical conditions, or pregnant), placing them in less crowded areas.
  • Service Continuation: Prepare to maintain essential services with reduced on-site operations. Restrict group activities and communal dining as deemed necessary.
  • New Admissions: New resident admission should continue unless there are serious concerns that the facility is unable to continue meeting safety standards.

OUTBREAK CLOSURE CRITERIA

The outbreak may be considered resolved based on the following conditions:

  1. Maintain surveillance until no new outbreak cases for a minimum of 7 days.
  2. The location appears to have effectively implemented all necessary COVID-19 control and preventive measures and observed violations have been abated.
  3. Certain outbreaks with different transmission dynamics or compliance issues may require more restrictive criteria, upon discretion of the outbreak investigation team and AMD.


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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