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Seattle-King, Pierce and Snohomish, Washington Community Mitigation
CDC’s Recommendations for the next 30 days of Mitigation Strategies for Seattle-King, Pierce and Snohomish based on current situation with widespread COVID-19 transmission and affected health care facilities
Seattle-King and Pierce County has recently implemented many interventions consistent with CDC’s recently posted guidance (https://www.cdc.gov/coronavirus/2019-ncov/community/index.html).
Seattle-King County’s own interventions are detailed at: https://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/novel-coronavirus/protection.aspxexternal icon
The following describes CDC recommendations for evidence-base community interventions for the situation in King and Pierce Counties and will be the roadmap for other counties as needed.
Bottom Line Up Front:
Due to widespread transmission in Seattle, Washington, CDC recommends extensive community mitigation activities to support slowing the spread of respiratory virus infections. These approaches are used to minimize morbidity and mortality caused by COVID-19 and minimize social and economic impacts of COVID-19. Individuals, communities, businesses, and healthcare organizations are all part of a community mitigation strategy. Given the widespread community transmission in Seattle, WA, and the extensive involvement of health care facilities, especially nursing facilities at the epicenter, substantial interventions for both community (Table) and health care settings (appendix A) should be implemented at this time, based on the urgency of protecting the health care system with expected rise in cases by slowing the spread within the community.
Goals
The goals for using mitigation strategies for Seattle-King and Pierce Counties at this time are to protect:
- Individuals at risk for severe illness, including persons of any age with underlying health conditions including immune suppression and especially seniors with underlying health conditions (See Appendix B).
- The healthcare workforce and critical infrastructure workforces
These approaches are used to minimize morbidity and mortality caused by COVID-19 and minimize social and economic impacts of COVID-19. Individuals, communities, businesses, and healthcare organizations are all part of a community mitigation strategy.
Implementation emphasizes:
- Emphasizing individual responsibility for implementation of recommended personal-level actions,
- Empowering businesses, schools, and community organizations to implement recommended actions, particularly in ways that protect persons at risk of severe illness such as older adults and persons with serious underlying health conditions (e.g., people requiring dialysis , or those with congestive heart failure or emphysema)
- Focusing on settings that provide critical services to implement recommended actions to protect critical infrastructure and individuals at risk of severe disease
- Minimizing disruptions to daily life to the extent possible
Table. Community mitigation strategies for Seattle-King and Pierce County
For Every Individual and Family at Home |
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For Every School/Childcare Facility |
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For Every Assisted Living Facility, Senior Living Facility, and Adult Day Programs |
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Every Workplace |
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Every Community and Faith-Based Organization |
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Healthcare settings and healthcare provider (includes outpatient, nursing homes/long-term care facilities, inpatient, telehealth)** |
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Appendix A: CDC Recommendations for Seattle-King and Pierce County, WA Strategy for Long-term Care Facilities
Background:
Given their congregate nature and resident population served (e.g., older adults with multiple co-morbidities), all long-term care facilities are at the highest risk of being affected by COVID-19. If infected, residents are at highest risk for morbidity and mortality and, based on early experience, have the potential to decompensate quickly.
Ill healthcare personnel (HCP) or visitors are the most likely sources of introduction of COVID-19 into the facility. To protect this fragile population, aggressive efforts toward visitor restrictions and screening of HCP for fever and respiratory symptoms when they report to work are recommended, even before COVID-19 is identified in a community or facility.
Objectives:
- Protect healthcare personnel (HCP) to maintain a functioning healthcare system
- Minimize morbidity and mortality
- Minimize transmission
Plan:
- Testing: Establish central location and process for referring ill HCP for COVID-19 testing
- Training: Perform remote regional infection prevention and control trainings for long-term care personnel. Emphasis on:
- HCP monitoring
- Selection and use of recommended PPE
- Use of Standard, Contact, and Droplet Precautions with eye protection for any undiagnosed respiratory infection for which airborne precautions is not otherwise recommended (e.g., tuberculosis)
- Visitor restrictions
- Active checks for fever and respiratory symptom for patients, residents, and HCP
- Restrictions on resident movement and activities
- Visitor Restrictions: Restrict all visitation to long-term care facilities and other congregate healthcare settings
- Exceptions might be allowed for end-of-life situations. In this situation, the visitor should wear a facemask and eye protection and be restricted to the resident’s room.
- HCP Monitoring and Restrictions:
- Restrict non-essential personnel including volunteers and non-essential consultant personnel (e.g., barbers) from entering the building
- Screen all HCP at the beginning of their shift for fever and respiratory symptoms
- Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and self-isolate at home
- Ill HCP should be prioritized for testing
- HCP who work in multiple locations may pose higher risk and should be monitored for exposure to facilities with recognized COVID-19 cases
- Implement universal facemask use for HCP while in the facility
- Consider having HCP wear all recommended PPE (gown, gloves, eye protection, facemask) for the care of all residents, regardless of presence of symptoms
- Resident Monitoring and Restrictions:
- Actively monitor all residents (at least daily) for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat).
- If positive for fever or symptoms, implement recommended IPC practices
- Restrict residents to their room (except for medically necessary purposes)
- If they leave their room they should wear a facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others)
- Cancel group field trips and activities, including communal dining
- Have a low threshold to transfer residents with fever or acute respiratory illness to a higher level of care
- Actively monitor all residents (at least daily) for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat).
- Managing PPE Shortages: When PPE supplies are limited, rapidly transition to extended use of eye and face protection (i.e., respirators or facemasks) – e.g., changing facemask every 2 hours while at work unless wet or soiled.
- Reporting to the Health Department: Notify the health department about anyone with COVID-19 or if facility identifies 2 or more residents or HCP with respiratory infection within 72 hours.
Appendix B: Underlying medical conditions that may increase the risk of serious COVID-19 for individuals of any age.
- Blood disorders (e.g., sickle cell disease or on blood thinners)
- Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because kidney disease, or is under treatment for kidney disease, including receiving dialysis
- Chronic liver disease as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease.
- Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as chemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HIV or AIDS)
- Current or recent pregnancy in the last two weeks
- Endocrine disorders (e.g., diabetes mellitus)
- Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
- Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
- Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic conditions associated with impaired lung function or that require home oxygen
- Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].