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 CDC: Act as if Coronavirus is Already in the Community

The Centers for Disease Control and Prevention (CDC) is recommending that all nursing centers, assisted living communities, and residential care centers take extra precaution to protect residents and staff by acting as if COVID-19 is already detected in their community. The recommendation translates to what the agency says is more aggressive action on infection control and prevention in the form of guidance recently announced by CDC and Centers for Medicare & Medicaid Services (CMS).

“To protect vulnerable residents, nursing homes, assisted living, and other residential care communities should assume that COVID-19 is already in their community and take aggressive effort to keep residents, visitors, and other health care personnel healthy,” said Kara Jacobs Slifka, MD, medical officer, CDC COVID-19 Infection Prevention and Control Response Team, during a webinar for long term and post-acute care providers hosted by the CDC Center for Preparedness and Response on March 17.

In the webinar, the agency highlighted strategies to prevent COVID-19 from entering facilities and infecting residents and staff, including those already announced in guidance from CDC and CMS.
The actions include restricting visitors and nonessential health personnel, practicing social distancing of residents, communicating with residents and families, educating health care personnel on the signs and symptoms of COVID-19, notifying the local health department, and assessing inventory of supplies and personal protective equipment (PPE).
“Our understanding of the clinical nature of COVID-19 is still evolving, especially in the long term care population,” said Brendan Jackson, MD, medical epidemiologist from the COVID-19 response clinical team from CDC.
What is known is that older people and those with chronic medical conditions are at higher risk of death. While many cases are going undiagnosed, not everyone with COVID-19 will have a fever, said Jackson. “Older adults and those with serious medical conditions don’t always display typical responses to infection,” he said.
“Educate staff on what the signs and symptoms are. Consider checking on residents more frequently than you otherwise would. Ask residents if they feel feverish or have symptoms of respiratory infection upon admission and at least daily. Assisted living facilities should also increase their vigilance for monitoring for symptoms.”
Restricting all visitors and non-essential health personnel is essential, CDC recommends.
“We’ve discovered clusters of symptomatic residents at not just one facility but at multiple facilities in the same geographic areas, and we have identified ill health personnel as the earliest cases of COVID-19 in facilities,” says Slifka. “We’ve also seen visitors of long term care facilities develop COVID-19.”
To assist in the restrictions, Slifka recommended creating a list of staff and anyone else that enters the facility and engaging each of those different services and providers to create a plan for how the facility may limit or stop visits. “Make a list of services that absolutely must continue, those that could be delayed, and those that could be stopped, even temporarily,” said Slifka.
For communication assistance, CDC has created a template letter to share with residents of nursing centers and assisted living communities that explains restrictions with visitation, how health care personnel and residents will be monitored for symptoms of respiratory illness, the infection prevention and control practices that they can expect to see in a facility, and the actions that residents can take, such as residents practicing social distancing and cleaning their hands.
CDC also recommends incorporating alternative methods of communication into a facility’s routine in order to help with the anxiety that residents and their families may be experiencing due to COVID-19 and visitation restrictions. This may include phone calls or videoconferencing. Maintaining and sharing contact information for residents and family members and continuing to post signage outside the facility about restrictions is also important.
As CDC recommends that all group activities are cancelled and communal dining halted, providers should find creative ways to keep residents active and engaged.
In the area of PPE, CDC recommended providers focus on talking and educating staff on ways to preserve PPE supply. One recommendation is to prioritze gowns only for certain procedures, such as high-contact resident care activities, which also present the highest risk of transferring an infection pathogen. These activities include bathing, assisting with toileting, and wound care.
“PPE supply is very low in the U.S.,” says Slifka. “Assess your inventory. If you can’t get more or if you’re part of a corporate group and you can’t get more through that group, reach out to health departments and health coalitions for next steps.”

Watch the webinar at: https://emergency.cdc.gov/coca/calls/2020/callinfo_031720.asp​

For more information, visit CDC’s Coronavirus website here.
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