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Correctional & Detention Facilities

B73 COVID-19 - Procedural Guidance for DPH Staff



OUTBREAK OVERVIEW AND REPORTING

Outbreak Definition:

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

Definition of Outbreak:

At least three or more epidemiologic linked laboratory confirmed cases (symptomatic or asymptomatic) of COVID-19 among incarcerated/detained individuals within a 14-day period.

  • Cases among incarcerated/detained individuals identified at intake to the correctional facility do not meet outbreak case criteria. Infections identified at intake were acquired prior to entering the facility, and therefore are not attributed to the correctional facility outbreak.
  • Cases among staff only at the correctional facility do not meet criteria to open an outbreak; however, staff cases that occur during an open outbreak and meet the following criteria are attributed to the outbreak:
    • Staff case confirmed to have been onsite during their infectious period.
    • Infectious period defined as 2 days prior to date onset (earliest of either symptom onset or specimen collection date) through 10 days following date onset.
  • For city jail facilities: If three or more epidemiologically linked cases among detained persons OR staff are identified at a city jail facility, then a corrections outbreak will be opened. Ascertainment of positive cases among detained persons in city jail facilities is limited due to due to short durations of stay, high turnover of detainees, and infrequent testing. Therefore, cases among detainees OR staff at a city jail facility qualify as an outbreak.

 

Presumed case criteria

LAC DPH requires 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 in the absence of an alternative diagnosis:

  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)

Other COVID-19 terms defined for the purpose of this document:

Definition of up to date with COVID-19 vaccines:

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.
  3. Determine the onset date of the outbreak. The onset date of the outbreak is the date of symptom onset or the specimen collection date for the first case or PUI, whichever comes first. Given the incubation period of SARS CoV2 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 Outbreak Line List for Correctional Facilities template.
  6. Maintain surveillance for new cases until no new cases among incarcerated/detained persons 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 CASES AND CONTACTS

Cases

Refer to LAC DPH Guidance for Correctional and Detention Facilities

See guidance below for control of disease transmission among single cases and multiple cases in incarcerated/detained persons, as well as cases among correctional facility staff.

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

CONTACTS

A close contact (staff and/or incarcerated persons) is defined as someone sharing the same indoor airspace for a cumulative total of 15 minutes or more over a 24-hour period while the case was infectious.

An example of "a total of 15 minutes or more" is being in the same airspace with the person for 5 minutes at least 3 different times in 24 hours.

*This is regardless of use of face masks by the case or contact. Exception: Cal/OSHA states that employees are not a close contact if they wore a respirator required by the employer and used in compliance with section 5144, whenever they were sharing the same airspace of the COVID-19 case while they were infectious.

Note: In large indoor spaces, correctional facilities may determine close contacts by using a smaller shared airspace area within the larger airspace (such as an individual room, break or eating area, or waiting area) or by using a distinct cohort of employees (such as departments or shifts). When a larger indoor space cannot be easily divided into smaller discrete spaces or distinct cohorts of individuals, then close contacts may be determined based on proximity to the case. Those persons closer to the infected person or in a more enclosed shared airspace are at the greatest risk of exposure.

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

Facility should document the contacts on the “Close Contacts” tab of the COVID-19 Outbreak Line List for Correctional Facilities and provide to DPH upon request.

Visitors:

Refer to LAC DPH Guidance for Visitation

Facility 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 10 days after last exposure.

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

Facilities are encouraged to maintain daily visitor log with date and time of visit as a regular practice.

GUIDELINES FOR PREVENTING AND MANAGING COVID-19 IN CORRECTIONAL/DETENTION FACILITIES

These guidelines outline actions that correctional/detention facilities should take to help prevent and manage COVID-19, based on the status of and trends in community transmission in LA County.

Refer to LAC DPH Guidance for Correctional and Detention Facilities

Key recommendations include:

  1. The facility must conduct COVID-19 diagnostic testing for incarcerated/detained persons, who may persons 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.

COVID-19 prevention and management for incarcerated/detained persons

Refer to LAC DPH Guidance for Correctional and Detention Facilities

Key recommendations include:

  1. The facility should conduct COVID-19 diagnostic viral testing for incarcerated/detained persons, who 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 up to date on COVID-19 vaccines, testing can be combined with a 10-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.
      • Asymptomatic individuals who are up to date on COVID-19 vaccines OR have tested positive for COVID-19 within the last 90 days do not need to quarantine at intake or after transfer to the facility.
  2. If incarcerated/detained person has symptoms of COVID-19, regardless of vaccination status:
    • Place the individual under medical isolation, 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 incarcerated/detained person is an asymptomatic close contact of someone with COVID-19:
    • If individual is not up to date on COVID-19 primary series vaccine plus booster (if booster eligible), then quarantine the individual and monitor for symptoms at least once per day for 10 days.
    • Asymptomatic individuals who are up to date on COVID-19 primary series vaccine plus booster (if booster eligible) OR have tested positive for COVID-19 within the last 90 days do not need to quarantine following exposure to a person with suspected or confirmed COVID-19.
    • Recommend testing 3-5 days after exposure, regardless of vaccination status.
  4. The facility will comply with state and local guidelines for interfacility transfer of incarcerated/detained persons.
  5. Asymptomatic individuals who are up to date on COVID-19 primary series vaccine plus booster (if booster eligible) OR have tested positive for COVID-19 within the last 90 days  do not need to quarantine or transfer.

COVID-19 prevention and management for staff:

Refer to LAC DPH Guidance for Correctional and Detention Facilities

  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 are up to date on COVID-19 vaccines. They can be referred to their primary care provider or 2-1-1 to access county or city testing resources.

  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 the date when the employee was first symptomatic and when they were tested.

  5. Determine which days or shifts the case was on site at the facility and the last date worked by the case on the facility.

  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 COVID-19 Outbreak Line List for Correctional Facilities.

  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

Correctional/detention facility is advised to:

  1. Identify a mechanism to obtain SARS CoV-2 samples and to send these specimens from the 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).
  3. Develop a surge plan for emerging infectious diseases, particularly suspected or confirmed COVID-19 patients.
  4. Plan for how to continue essential services if on-site operations are reduced temporarily.
  5. Plan for employee absences and create a back-up/on-call system.
  6. 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.
  7. Immediately implement symptom screening and temperature checks for all staff, incarcerated/detained persons, and visitors. 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.
    1. Every individual entering the correctional facility, regardless of reason, should be asked about COVID-19 symptoms and they must also have their temperature checked.
      1. This includes, but is not limited to, incarcerated/detained persons, staff, visitors, outside healthcare workers, and vendors.
      2. Exception: Emergency Medical Services (EMS) workers responding to an urgent medical need are not required to be screened separately.
    2. 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.
    3. Facilities are advised to maintain a record of temperature checks for staff and incarcerated/detained persons.
    4. Facilities should limit access points and ensure that all accessible entrances have a screening station.
  8. Prohibit most visitors from entering the facility unless for compassionate care situations, such as end-of-life.
  9. Visitors that are permitted must follow DPH visitation guidance.
    1. Visitors at the facility for compassionate case situations must pass symptom screening and temperature check upon arrival to the facility.
    2. Post signs explaining visitor restrictions.
    3. Set-up alternative methods of visitation such as through videoconferencing through Skype or FaceTime
  10. Limit volunteers and staff on-site to those that perform essential functions at the facility.
  11. 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 up to date on COVID-19 vaccines) or a surgical mask (if up to date on COVID-19 vaccines) when in patient care areas, and when moving through common spaces where they may interact with other staff or incarcerated/detained persons.
    2. Masks and respirators are not required for staff working alone in closed areas.
    3. All staff should follow physical distancing and hand hygiene guidance.
  12. All incarcerated/detained persons must wear a face mask when outside their room. This includes incarcerated/detained persons who must leave the facility for any reason.
    1. Surgical masks are required for any resident that is COVID-19-positive or assumed to be COVID-19-positive.
    2. The facility is required to provide each resident with a clean non-medical face covering and replace them if damaged.
  13. Provide education and job-specific training to staff about 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
    5. How and to whom COVID-19 cases should be reported
  14. Establish a COVID-19 area within the facility:
    1. Identify separate physical locations (dedicated housing areas and bathrooms) 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).
    2. 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.
    3. 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.
    4. All staff, equipment and common areas should be kept separate as much as possible.
    5. Designate health care provider(s) (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.
    6. All staff should follow physical distancing and perform frequent hand hygiene.
  15. If staffing scarcity requires staff to work with COVID-19 positive and negative incarcerated/detained persons, staff must change required PPE between patients. N95 and face shields may be worn throughout the day consistent with CDC PPE conservation contingency strategies. Recommend employees work at only one facility in order to reduce interfacility spread of COVID-19.
  16. 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.

OUTBREAK CLOSURE CRITERIA

The outbreak can be closed once closure criteria is met:
  • At least 14 days have passed since the last confirmed COVID-19 case in an incarcerated/detained person. Date of last case defined as date onset (earlier of the specimen collection date or first date of symptom onset).
  • For city jail facilities, the outbreak can be closed when at least 14 days have passed since the last confirmed COVID-19 case in a detained person OR staff.

DEATH REPORTING

Facilities are to report all fatalities related to COVID-19, including out of hospital deaths of presumed cases. Facilities should notify LAC DPH immediately by email at covidcorrections@ph.lacounty.gov. In addition, facilities are to submit a death report form to ACDC.

Facilities are required to report deaths in any person:

  1. Who tested positive for COVID-19 within 90 days prior to death; OR
  2. Clinically suspected of having died from COVID-19 (either directly attributable to COVID-19 or a secondary complication of COVID-19) regardless of prior testing results; OR
  3. Who was a resident of a correctional facility with an ongoing COVID-19 outbreak, regardless of testing*

*Suspected cases are not counted towards a facility's COVID-19 death count until investigated and determined to be a COVID-19 associated death.

For additional information on reporting COVID-19 associated deaths, please visit the COVID-19 Death Reporting Page.


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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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