Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.
All cases of respiratory illness (characterized by fever and cough or shortness of breath) of unknown etiology are assumed to be COVID-19 cases until test results confirm otherwise.
Outbreak Definition: Ten or more confirmed COVID-19 cases in participants who attend the adult day program for in-person activities within a 14-day period. These cases must be part of a group* where members do not share a household and are not a close contact of each other outside of the facility. Epidemiological links require cases to be present in the same setting during the same time period while infectious.
*Groups include persons that share a common membership, e.g., adult day care centers, same classroom, school event, school-based extracurricular activity, academic cohort, athletic teams, clubs.
For adult day programs where activities are conducted virtually and staff do not have any contact with participants, general guidance for quarantine, isolation, cleaning, mask wearing, distancing, and hand hygiene should be given for preventing further spread of infection to other staff, but no outbreak investigation needs to be done.
Investigation can be conducted over the phone.
The frequency of follow-up with the facility for outbreak updates will be at least weekly, but more frequently as needed and determined by the Outbreak Investigation Branch (OMB).
Public Health is encouraging targeted testing to prevent spread of COVID-19 in adult day care centers. This strategy is aimed to supplement infection control, universal source control, and physical distancing measures. With the targeted testing strategy, when there is a known COVID-19 case, all confirmed cases and contacts are tested whether the contacts have symptoms or not.
Refer suspected cases and contacts of confirmed cases to their primary care provider to discuss testing options. If the facility is able to provide or facilitate testing, cases and contacts of confirmed cases may take advantage of that service.
For facilities that are providing or facilitating testing, refer to the LA County COVID-19 Testing Strategy. They can also be referred to the LA County Department of Public Health Targeted Testing Guidance for Congregate Residential Facilities. Even though adult day care centers are not residential, they provide care for those that may live in congregate residential facilities.
Facilities with 10% or more of participant cases will be closed down until isolation periods for the cases are over. The facility can be reopened after all positive cases have completed their isolation periods and changes have been instituted in the facility that follow Public Health guidelines for infection prevention.
A confirmed case of COVID-19 is a person with a laboratory test positive for SARS- CoV-2.
All cases of respiratory illness (characterized by fever and cough or shortness of breath) of unknown etiology are suspected cases of COVID-19 at this time.
A contact is a person with exposure to a confirmed or suspected case of COVID-19 during the period from 48 hours before symptom onset until the case meets criteria for discontinuing home isolation (See Home Isolation Instructions). For asymptomatic cases, the date of collection of the specimen that was positive for SARS-CoV-2 can be used in place of symptom onset.
Vendors and Visitors: Contact any vendors and visitors that may have been exposed to a suspected or confirmed case, especially those who are at higher risk for severe infection. Instruct them to self-quarantine (see above Quarantine Instructions for Contacts). Clients, vendors, and visitors should call their primary care provider to discuss testing options.
Document contacts in a line list see reporting procedures above.
Do not require a healthcare provider’s note for staff to return to work. Do not require a healthcare provider’s note for participants to return to the adult day care center.
Some participants at the adult day care center require assistance with activities of daily living.
These include: bathing, toileting, dressing, feeding themselves, walking, and transferring from one position or place to another (bed to chair, lying down to sitting up, etc.). Staff that help participants with any of these activities can easily be exposed if not wearing the correct PPE.
Outbreak can be closed once closure criteria is met:
At least 10 days have passed since last confirmed case in a participant.